meta-analysis

Iran is a religiously conservative nation where premarital sexual activity is prohibited. Early sexual behaviors are recognized as risk factors for sexually transmitted infections (STIs), including HIV. The transmission of HIV through sexual contact has increased by 33% in Iran, and the age of incidence has decreased by 16 years. We conducted a systematic review and meta-analysis to assess the prevalence of premarital sexual relationships. An advanced search was performed using keywords related to sexual behavior and similar terms, encompassing publications from 2000 to December 2023. All selected studies focused on sexual behavior among Iranian youth. Following the evaluation of various articles and the exclusion of duplicate, irrelevant, and low-quality papers, 14 studies were ultimately included in the current research. Data were analyzed using the random effects model in Rev5.3 software. The total number of participants in the selected articles was 13,889 individuals. The prevalence of sexual relations among Iranian youth was estimated at 22.80% (CI 95%; 16.93 - 28.66). It was 18.69% (CI 95%; 11.03 – 26.34) in females and 30.46% (CI 95%; 22.44 - 38.48) in males. The results of the study indicated that at least one-quarter of individuals engage in premarital sexual activity in Iran, with these individuals experiencing sexual intercourse before the age of 20 years. Given the increasing age of marriage and the necessity for education to prevent high-risk sexual behavior in Iran, it is imperative to develop programs and policies promoting safe sexual health practices

Context:

 Toxoplasma gondii remains a global concern, especially in developing countries. This parasite is particularly important in women of childbearing age due to its increased risk of miscarriage and serious complications in the newborn.

This systematic review and meta-analysis was conducted to determinet the serum prevalence of acute and chronic T. gondii infection in women of reproductive age in Iran.

The systematic search process was carried out from January 2010 to July 2024 through four English databases (PubMed, Scopus, Web of Science, and Science Direct) and two Persian databases (Magiran and SID) as well as Google Scholar as a specialized search engine for the article. Meta-analysis analysis was performed using a random effects model. Prevalence estimates and 95% confidence intervals were calculated for each study. Heterogeneity was evaluated using the I2 statistic. Egger and Begg's test was also used to assess the publication bias.

A total of 869 records were retrieved, resulting in 28 studies including 13,177 individuals of reproductive age included in the meta-analysis for T. gondii -specific IgG and/or IgM antibodies. The seroprevalence of IgG and IgM antibody serum in women is 29% (95% CI: 23% - 34%) and 4% (95% CI:3% - 5%) respectively. Egger's test results (P = 0.001) showed publication bias.

The prevalence of chronic (IgG) and acute infection (IgM) T. gondii in women of reproductive age in Iran is relatively high. Therefore, there is an urgent need for education to increase women's awareness.

This study aimed to analyze the prevalence of osteopenia and osteoporosis in MEN1-related primary hyperparathyroidism (PHPT), examine the impact of parathyroidectomy (PTX) on bone metabolic outcomes, and compare bone density metrics between sporadic and MEN1-related PHPT.

A systematic review and meta-analysis were conducted in accordance with the guidelines for Meta-Analyses and Systematic Reviews of Observational Studies (MOOSE). We searched PubMed, Web of Science, and Scopus up to June 2024, subsequently screening the articles to identify relevant research. Studies focusing on bone mineral density (BMD), T and Z-scores in patients with MEN1-related conditions were included. Meta-analyses were conducted using random-effects models.

From the initial 2,563 articles, 15 studies were included in the meta-analysis. The pooled prevalence of osteoporosis and osteopenia in patients with MEN1-related PHPT was 45.2% (95% CI: 39.1-51.4%; I2: 16.7%) and 53.3% (95% CI: 44.4-62.0%; I2: 36.15%), respectively. PTX showed no significant impact on BMD in MEN1-related PHPT patients at the lumbar spine (mean difference: -0.054; P-value = 0.092; I2: 0.86%) or femoral neck (mean difference: -0.025; P-value = 0.219; I2: 0.47%). Comparisons of bone density metrics showed that MEN1-related PHPT patients had significantly lower Z-scores at the lumbar spine (mean difference: -0.676; P-value < 0.001; I2: 41.86%), total hip (mean difference: -0.629; P < 0.001; I2: 23.4%), and femoral neck (mean difference: -0.516; P < 0.001; I2 = 38.82%) compared to patients with sporadic PHPT.

Patients with MEN1-related PHPT exhibited a high prevalence of osteopenia and osteoporosis, along with lower BMD metrics compared to those with sporadic PHPT. PTX was not associated with significant changes in BMD among MEN1-related PHPT patients.        Level of evidence: V

Various pharmacological and non-pharmacological treatments are utilized to address sleep disorders. This meta-analysis aimed to evaluate the effects of acupuncture and acupressure on enhancing sleep quality in menopausal women.

A systematic search was conducted using multiple databases, including Scopus, MEDLINE/PubMed, Cochrane CENTRAL, ProQuest, Google Scholar, and Iranian databases (SID, Iranmedex, Magiran) with no date restrictions up to July 2024. Studies published in both Persian and English were included in this meta-analysis. The search utilized keywords such as acupuncture, acupressure, sleep quality, insomnia, menopause, and sleep disorders. A pairwise random-effects meta-analysis was performed to calculate the mean difference (MD) and 95% confidence intervals (95% CIs).

The analyses indicated that both acupuncture and acupressure effectively improved sleep quality in menopausal women. Eight trials with 499 participants demonstrated that acupressure significantly enhanced sleep quality (MD=-2.33, 95% CI=-3.27 to -1.38; I2=94%, P<0.001, n=8). Additionally, six trials with 344 participants showed that acupuncture enhanced sleep quality (MD=-3.47, 95% CI=-5.06 to -1.88; I2=97%, P<0.001, n=6).

The findings revealed that acupressure and acupuncture might improve sleep quality in menopausal women. However, there was a high heterogeneity between studies, and further research is required to confirm the findings of the present study.

This article explores the impact of managers' communication skills on the job satisfaction of health sector employees through a meta-analysis. The purpose is to determine how these communication skills influence job satisfaction and how strategic decisions can be improved for greater organizational efficiency.

Using the meta-analysis method, studies on the impact of managers' communication skills on the job satisfaction of health sector employees were collected. Searches in databases like the Iran Documentation Center, Magiran, Noormags, and others led to the retrieval of 20 relevant articles, theses, and treatises. Of these, 13 studies provided suitable data for effect size calculation. The data was analyzed using SPSS software to assess the relationship between communication skills and job satisfaction among health sector employees.

The analysis showed that managers' communication skills significantly impact job satisfaction. The Q-test indicated significant heterogeneity in the studies, suggesting the presence of moderating variables. The I-squared index confirmed that 99% of the variance is real. Additionally, Egger’s regression test confirmed the heterogeneity, and publication bias was assessed using funnel plots and regression methods. The effect size analysis emphasized that extreme values could affect the validity of the results.

Improving managers' communication skills directly enhances job satisfaction among health sector employees. The study confirms that the communication skills of managers have a significant and positive relationship with the job satisfaction of employees in the health sector

Positive surgical margins (PSM) following partial nephrectomy (PN) for renal cell carcinoma (RCC) are a concern due to potential implications for recurrence and survival. This systematic review and meta-analysis assess the impact of PSM on recurrence rates and progression-free survival in RCC patients.

We conducted a systematic search of PubMed, Embase, Scopus, Cochrane, and Web of Science databases from inception through July 2024. Studies examining recurrence and survival outcomes in RCC patients with and without PSM post-PN were included. A random-effects model was applied to calculate pooled hazard ratios (HR) and 95% confidence intervals (CI) for recurrence and survival.

Thirty studies met the inclusion criteria. Our analysis showed that PSM was significantly associated with a higher risk of local recurrence (HR = 2.13, 95% CI: 1.67–2.72) and a lower recurrence/progression-free survival (HR = 1.70, 95% CI: 1.40–2.07) compared to negative surgical margins. Subgroup analyses indicated consistent results across study designs and RCC histologic subtypes.

The presence of PSM following PN for RCC is associated with a 2.13-fold increase in local recurrence and a 1.7-fold reduction in progression-free survival, emphasizing the need for precise margin management during surgery. These findings highlight the importance of optimizing surgical techniques and considering adjuvant treatment strategies for patients with PSM to improve oncologic outcomes.

To study the clinical effect of postoperative nursing on patients undergoing transurethral resection of the prostate (TURP).

The relevant researches about nursing intervention effect evaluation after TURP during January 2000 to May 2024 were selected from databases. These were sorted into an intervention group (Int group) and a control group (Ctrl group) with different nursing methods. Theemotional status, length of hospital stays (LOHS), nursing satisfaction, the incidence, volume, and frequency of urinary incontinence (UI), and the incidences of urinary hemorrhage (UH), bladder spasm (BS), and catheter occlusion (CO) were compared after intervention.

Eleven articles and 1,020 cases were included. The LOHS in the Int group was much shorter (mean difference (MD)=-2.91, 95% confidence interval (CI): -4.47~-1.35, Z=3.66, P=0.0002). The nursing satisfaction was significantly improved (odds ratio (OR)=5.70, 95% CI: 3.65-8.90, Z=7.64, P<0.00001). For complications, incidence of UI (OR=0.41, 95% CI: 0.26-0.66, Z=3.72, P=0.0002), the volume of UI (MD=-66.17, 95% CI: -124.74~-11.60, Z=2.36, P=0.02), and the frequency of UI (MD=-1.18, 95% CI: -1.69~-0.67, Z=4.55, P<0.00001) greatly reduced. The incidences of UH (OR=0.43, 95% CI: 0.21-0.87, Z=2.35, P=0.02), BS (OR=0.24, 95% CI: 0.14-0.42, Z=4.97, P<0.00001), and CO (OR=0.20, 95% CI: 0.11-0.36, Z=5.21, P<0.00001) were also highly reduced.

Postoperative nursing intervention could effectively shorten LOHS after TURP in patients with benign prostatic hyperplasia (BPH), improving the nursing satisfaction and reducing the incidence of postoperative complications.

Depression is a prevalent mental health disorder with adverse effects on both physical and psychological health. Taekwondo is posited to exert a positive influence on depression, yet its efficacy warrants further verification.

This study employed meta-analysis to quantify the intervention effect of Taekwondo on depression. Concurrently, based on subgroup analysis results, an optimal intervention program was suggested. Multiple databases were searched, including English (Web of Science, PubMed), Chinese (CNKI, WANFANG DATA), and Korean (RISS, KISS, DBPIA), to retrieve randomized controlled trials (RCTs) studying Taekwondo's impact on depression, published up to Jan 2024. The Cochrane bias risk tool version 2 (RoB 2.0) was utilized for literature bias risk assessment. Comprehensive Meta-Analysis software facilitated the meta-analysis, subgroup analysis, and publication bias evaluation.

Fifteen articles, encompassing 1945 participants, were included in the study. The primary findings indicated a significant reduction in depression risk due to Taekwondo intervention (Effect Size [ES]=-0.635, P<0.001). Subgroup analysis revealed the most substantial intervention effects in elderly individuals (ES=-1.025, P=0.004) and women (ES=-1.114, P=0.009). Taekwondo exercises, when conducted over 12 wk (ES=-0.922, P<0.001), three times per week (ES=-0.729, P<0.001), for 60 min per session (ES=-0.980, P=0.003), and at low intensity (ES= -1.777, P=0.024), yielded the greatest depression mitigation effects.

Taekwondo is an effective means to alleviate depression, particularly in older women. The study recommends a low-intensity Taekwondo exercise regimen, consisting of 60-minute sessions, three times weekly for 12 wk, as an optimal exercise prescription for best outcomes.

Gestational diabetes mellitus (GDM) is a serious pregnancy complication that can affect various organs and organ systems of the mother and fetus. In diabetic mothers, increased blood glucose delivery to the fetus leads to fetal hyperglycemia and hyperinsulinemia, which promotes the growth of insulin-dependent organs such as the liver. Therefore, this systematic review and meta-analysis was conducted to more precisely estimate the association between GDM and fetal liver length (FLL).

Six electronic databases (PubMed, Scopus, Web of Science, ProQuest, Cochrane, and Wiley) were searched up to Aug 2023. Two reviewers independently extracted data and assessed the risk of bias using the Newcastle–Ottawa Scale. The pooled weighted and standardized mean differences in FLL were calculated using random-effects models. Heterogeneity, subgroup analysis, and publication bias were also assessed using funnel plots. All statistical analyses were performed using Stata Version 16.0.

Twelve articles were included in the final meta-analysis. GDM was associated with increased FLL, as assessed by ultrasound, in both the second (SMD=1.56; 95% CI: 1.04, 2.08; P<0.001) and third (SMD=0.84; 95% CI: 0.07, 1.61; P<0.001) trimesters of pregnancy. The pooled mean difference in FLL between the GDM and non-GDM groups was 4.85 mm (WMD=4.85; 95% CI: 3.26, 6.45), indicating larger liver size in fetuses from mothers with GDM.

GDM is a significant risk factor for increased FLL, as assessed by ultrasound, which may reflect fetal overgrowth and metabolic dysfunction.

Although various factors play a role in the development of systemic lupus erythematosus (SLE), infectious agents, such as Toxoplasma gondii, are suggested as a risk factor.

To further describe the relationship between T. gondii and SLE, we performed a systematic review and meta-analysis of case reports, cross-sectional studies, and case-control studies investigating the association between T. gondii and SLE.

Web of Science, Scopus, PubMed, and Google Scholar databases were searched for related articles published up to January 1, 2024. Moreover, a random effects meta-analysis model was utilized to determine the combined odds ratio (OR) and its corresponding 95% confidence interval (CI).

Nine case reports, six case-control studies (eight datasets), and four cross-sectional records were involved in the present meta-analysis. Considering the nine case reports, the cases were reported from seven countries (two cases in Malaysia, two cases in Japan, one case in Brazil, one case in Israel, one case in Denmark, one case in the USA, and one case in France). The prevalence of T. gondii in female SLE patients was higher (7/9, 77.8%) than in male SLE patients (2/9, 22.2%). However, all these cases were reported in adults. The reported cases were SLE patients who visited the doctor due to various disorders (i.e., visual loss, seizure, confused state, convulsive episode, transient unconsciousness, restlessness, general malaise, muscular pain, decreased appetite, weight loss, fever, dyspnea, psychosomatic reactions, and pulmonary hypertension). Considering cross-sectional studies (four studies) and case groups in case-control studies (six studies including eight datasets), the pooled seroprevalence of anti-Toxoplasma IgG antibody in SLE patients was calculated to be 31.7% (95% CI, 20.7–45.1%). The outcomes of the present (meta) analysis of case-control reports exhibited a pooled OR of 2.58 (95% CI, 1.52–4.39), signifying that either Toxoplasma infection/exposure could be linked with an increased risk of SLE or patients with SEL have an increased risk of T. gondii infection.

Hence, we suggest that additional experimental research utilizing mouse models, along with longitudinal cohort studies in humans, would be helpful in providing further evidence for a potential link between T. gondii infection and SLE. Furthermore, these studies could help determine whether T. gondii infection acts as a co-factor in the onset/development of SLE.

  Polycystic ovary syndrome (PCOS) casts a wide shadow over the reproductive health of millions of women worldwide, emerging as one of the most complex and multifaceted endocrine disorders. In addition, nitric oxide (NO) stands out as a pivotal signaling molecule, orchestrating a symphony of physiological processes.

This meta-analysis aims to elucidate the association between NO levels and PCOS, investigate the potential of NO as a biomarker for PCOS diagnosis, and evaluate its clinical significance.

A systematic review was conducted in several electronic databases, including PubMed, Web of Science, Cochrane Library, Scopus, EMBASE, and Google Scholar, to identify relevant studies published up to January 2024. Standardized mean difference and 95% CI were calculated using a random effects model to assess the overall effect size. Meta-regressions and subgroup analysis were performed to investigate sources of heterogeneity.

A meta-analysis of 14 studies with 1171 participants showed that NO levels were significantly lower in the PCOS group than in the control group. The pooled analysis yielded a standardized mean difference of -0.482; 95% CI: -0.908 to -0.056; p = 0.027. Subgroup analyses further demonstrated variations in NO levels between different PCOS phenotypes and in relation to metabolic parameters.

This meta-analysis provides evidence for an association between PCOS and dysregulated NO levels and suggests a potential role of NO as a biomarker in the diagnosis and pathogenesis of PCOS.

This systematic review and meta-analysis aimed to evaluate the prevalence and clinical implications of metabolic syndrome in individuals with diabetes mellitus. 

A comprehensive search was conducted across multiple databases using key terms related to metabolic syndrome and diabetes. Access to subscription-based journals was facilitated through the HINARI program. Study quality was assessed using the adapted Newcastle–Ottawa scale, with a minimum inclusion score of ≥5/10. Statistical analysis included a meta-analysis using the DerSimonian and Laird random-effects model to determine the pooled prevalence, with heterogeneity assessed using Cochran’s Q and I² statistics. Publication bias was evaluated via funnel plot symmetry. Analyses were conducted using Stata/MP 17.0.

The meta-analysis revealed a pooled effect size of 1.98 (95% CI: 1.85, 2.10), with significant heterogeneity (I² = 92.35%). Prevalence ranged from 19.88% to 88.13%, underscoring a substantial burden. Variations in HbA1c, HDL cholesterol, blood pressure, and BMI highlighted the heterogeneity in metabolic syndrome characteristics. Advanced statistical approaches enriched the understanding of metabolic profiles and their interplay with glycemic control and lipid metabolism.

This study underscores the critical interplay between glycemic control and lipid profiles in metabolic syndrome. The findings emphasize the need for tailored, region-specific interventions to address its substantial burden and implications for clinical practice and policy.

Prolonged consumption of vegetables containing pesticide residues can pose a risk to the health of individuals over time.

This study aimed to retrieve the studies on the concentration of pesticides such as acetamiprid, chlorpyrifos, and diazinon in cucumber through a systematic review, and then, a meta-analysis focusing on specific subgroups. Finally, the hazard quotient (HQ) was used to assess the non-carcinogenic risk posed to consumers.

The sequence of pesticides according to pooled (mean) concentration was acetamiprid (140.91 μg/kg) > diazinon (59.03 μg/kg) > chlorpyrifos (40.49 μg/kg). Also, the countries were sorted based on the pooled concentration of chlorpyrifos: Spain (180.00 μg/kg) > Egypt (124.90 μg/kg) > Kazakhstan (49.95 μg/kg) > Greece (20.50 μg/kg) > Saudi Arabia (20.00 μg/kg) > Jordan (3.54 μg/kg) > Iran (3.10 μg/kg). The order for diazinon and acetamiprid was Iran (43.20 μg/kg) > Saudi Arabia (33.00 μg/kg) > China (4.60 μg/kg) and Turkey (231.70 μg/kg) > Egypt (220 μg/kg) > Pakistan (100.00 μg/kg) > Kazakhstan (99.34 μg/kg), respectively.

The HQ of acetamiprid, chlorpyrifos, and diazinon was less than 1 for all countries; hence, the consumption of cucumbers containing these pesticides does not pose a non-carcinogenic risk.

Research on foot reflexology (FR) for lactation and its impact on increasing breast milk volume is scarce. This study aimed to evaluate the effect of FR on lactation and breast milk volume in postpartum women.

This systematic review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). 2023. The search strategy was directed to databases of PubMed, Embase, Cochrane Library, Scopus, and Web of Science as well as the search engine of Google Scholar from inception to February 30, 2023. The quality of the included trials evaluated by the Cochrane Risk of Bias tool. The main results were analyzed by RevMan 5.1.

Out of 525 initially searched studies, six studies involving 364 women were included in the final analysis. Findings indicated that the use of FR significantly improved LATCH (Latch, Audible swallowing, Type of nipple, Comfort and Hold) scores (MD = 0.98; 95% CI: 0.57 – 1.38, P < 0.001). However, no significant differences were observed between groups regarding breast milk volume (MD: 2.52; 95% CI: 0.04-5.01; P = 0.05) or lactation onset symptoms (breast tension, heat, and pain) in the first day post-intervention. But, two groups were significantly different in terms of symptoms of the onset of lactation on the second day after intervention.

This study showed that FR significantly increase the LATCH score and symptoms of onset of lactation on the second day after intervention and did not display any significant increase in volume of breast milk.

The most frequent dementia is senile dementia or Alzheimer disease. Meanwhile, anticholinergic drugs can potentially modify the risk factors. As different studies have achieved dissimilar results and the clinical findings of these interventions have not been conclusive, the objective of this research will be to evaluate the effect of anticholinergic drugs on the risk of dementia. 

This systematic review and meta-analysis with no language limitation will search WoS, EMBASE, and MEDLINE via PubMed, Scopus, ProQuest electronic databases, and Grey Literature between December 15, 1988, and December 15, 2021. Our search strategy with suitability criteria covers cohort, case-control, nested case-control, randomized, and non-randomized clinical trial studies evaluating the effect of anticholinergic drugs on the risk of dementia. Two authors will independently implement the selection phase, data extraction, and quality assessment. The reviewers will evaluate the risk of bias using the Newcastle-Ottawa, Cochrane risk of bias tool and ROBINS-I (risk of bias in non-randomized studies - of interventions)  quality assessment scale. We will conduct a meta-analysis with a random or fixed effect model according to the severity of methodological heterogeneity. The results will be presented via the forest plot for the final studies’ data composition, demonstrating the separated and combined frequency and their corresponding 95% CIs, summary tables, and narrative summaries. 

The results of different studies in this field are various. This study’s findings and other studies will help physicians and other health professionals before prescribing these drugs. Older people, especially those with polypharmacy, should be carefully assessed for the risk of dementia, Alzheimer or a variety of cognitive disorders.

Today, because of the increasing level of people's need to improve wellbeing in social and individual life, air pollutants have been released that have Pollution harms both human health and the environment. This research examined Benzene, Toluene, Ethylbenzene, and Xylenes (BTEX) levels in indoor air across different global locations from 1963 to 2023. The investigation employed both; a systematic review and meta-analysis method. The health risks associated with long and short-terms exposure to benzene, toluene, ethylbenzene, and xylene were assessed. That average concentration benzene was 23.07 μg⁄m3, toluene was 131.60, ethylbenzene was 28.91, and xylene was 63.87. Also, the health risk assessment based on a 95% confidence level showed that the pollutants in question play a role in causing diseases such as lung neoplasm, stomach neoplasm, colon neoplasm, liver neoplasm, headache, dizziness, nausea, insomnia, etc. Consequently, it is crucial to implement stringent measures aimed at lowering the levels of these contaminants in indoor spaces.