Performance of blood pressure-to-height ratio as a screening tool for elevated blood pressure in pediatric population: a systematic meta-analysis.

Yin X, Liu Q, Bovet P, Ma C, Xi B.

J Hum Hypertens. 2016 Mar 3.doi: 10.1038/jhh.2016.12. [Epub ahead of print]

The aim of this study was to assess the performance of the blood pressure-to-height ratio (BPHR) for screening elevated blood pressure (BP) in children and adolescents using a meta-analysis of eligible published studies. We retrieved studies that investigated the performance of the BPHR for identifying elevated BP from Pubmed and other databases. We performed meta-analyses by subgroups of sex, age and ethnicity using a fixed or random effect model based on whether there was between-study heterogeneity. A total of 13 publications including 262 830 children and adolescents aged 6-18 years on BPHR and a total of three publications including 95 343 children on the modified BPHR were included in this meta-analysis. The summary results suggested that BPHR performed well to  identify pre-high BP and high BP for children aged 6-11 years and adolescents aged 12-18 years. The performance of BPHR was perfect for identifying severe high BP in adolescents aged 12-18 years. However, the modified BPHR did not improve accuracy for screening high BP in children aged 6-12 years. In summary, BPHR performed well for identifying elevated BP in children and adolescents, independently of sex, age and ethnicity group. In addition, the modified BPHR performed similarly with BPHR for screening high BP in childhood.Journal of Human

Hypertension advance online publication, 3 March 2016; doi:10.1038/jhh.2016.12.

Brief alcohol interventions for adolescents and young adults: a systematic review and meta-analysis.

J Subst Abuse Treat. 2015 Apr;51:1-18. doi: 10.1016/j.jsat.2014.09.001. Epub 2014

Sep 16.

Tanner-Smith EE, Lipsey MW.

This study reports findings from a meta-analysis summarizing the effectiveness of brief alcohol interventions for adolescents (age 11-18) and young adults (age 19-30). We identified 185 eligible study samples using a comprehensive literature search and synthesized findings using random-effects meta-analyses with robust standard errors. Overall, brief alcohol interventions led to significant reductions in alcohol consumption and alcohol-related problems among adolescents (g = 0.27 and g = 0.19) and young adults (g = 0.17 and g = 0.11). These effects persisted for up to 1 year after intervention and did not vary across participant demographics, intervention length, or intervention format. However, certain intervention modalities (e.g., motivational interviewing) and components (e.g., decisional balance, goal-setting exercises) were associated with larger effects. We conclude that brief alcohol interventions yield beneficial effects on alcohol-related outcomes for adolescents and young adults that are modest but potentially worthwhile given their brevity and low cost.

A GRADE Working Group approach for rating the quality of treatment effect estimates from network meta-analysis.

Puhan MA, Schünemann HJ, Murad MH, Li T, Brignardello-Petersen R, Singh JA, Kessels AG, Guyatt GH; GRADE Working Group.

BMJ. 2014 Sep 24;349:g5630. doi: 10.1136/bmj.g5630.

Network meta-analysis (NMA), combining direct and indirect comparisons, is increasingly being used to examine the comparative effectiveness of medical interventions. Minimal guidance exists on how to rate the quality of evidence supporting treatment effect estimates obtained from NMA.

We present a four-step approach to rate the quality of evidence in each of the direct, indirect, and NMA estimates based on methods developed by the GRADE working group. Using an example of a published NMA, we show that the quality of evidence supporting NMA estimates varies from high to very low across comparisons, and that quality ratings given to a whole network are uninformative and likely to mislead.

http://www.bmj.com/content/bmj/349/bmj.g5630.full.pdf

Meta-analysis of parental protection of children from tobacco smoke exposure.

Rosen LJ, Myers V, Hovell M, et al. Meta-analysis of parental protection of children from tobacco smoke exposure. Pediatrics. 2014 Apr;133(4):698-714. doi: 10.1542/peds.2013-0958. Epub 2014 Mar 24. (Review) PMID: 24664094

BACKGROUND AND OBJECTIVE: Worldwide, roughly 40% of children are exposed to the damaging and sometimes deadly effects of tobacco smoke. Interventions aimed at reducing child tobacco smoke exposure (TSE) have shown mixed results. The objective of this study was to perform a systematic review and meta-analysis to quantify effects of interventions aimed at decreasing child TSE.

METHODS: Data sources included Medline, PubMed, Web of Science, PsycNet, and Embase. Controlled trials that included parents of young children were selected. Two reviewers extracted TSE data, as assessed by parentally-reported exposure or protection (PREP) and biomarkers. Risk ratios and differences were calculated by using the DerSimonian and Laird random-effects model. Exploratory subgroup analyses were performed.

RESULTS: Thirty studies were included. Improvements were observed from baseline to follow-up for parentally-reported and biomarker data in most intervention and control groups. Interventions demonstrated evidence of small benefit to intervention participants at follow-up (PREP: 17 studies, n = 6820, relative risk 1.12, confidence interval [CI] 1.07 to 1.18], P < .0001). Seven percent more children were protected in intervention groups relative to control groups. Intervention parents smoked fewer cigarettes around children at follow-up than did control parents (P = .03). Biomarkers (13 studies, n = 2601) at follow-up suggested lower child exposure among intervention participants (RD -0.05, CI -0.13 to 0.03, P = .20).

CONCLUSIONS: Interventions to prevent child TSE are moderately beneficial at the individual level. Widespread child TSE suggests potential for significant population impact. More research is needed to improve intervention effectiveness and child TSE measurement.

Meta-analysis of Parental Protection of Children From Tobacco Smoke Exposure.

Pediatrics. 2014 Mar 24. [Epub ahead of print]  

Rosen LJ(1), Myers V, Hovell M, Zucker D, Ben Noach M. 

BACKGROUND AND OBJECTIVE: Worldwide, roughly 40% of children are exposed to the damaging and sometimes deadly effects of tobacco smoke. Interventions aimed at reducing child tobacco smoke exposure (TSE) have shown mixed results. The objective of this study was to perform a systematic review and meta-analysis to quantify effects of interventions aimed at decreasing child TSE. 

METHODS: Data sources included Medline, PubMed, Web of Science, PsycNet, and Embase. Controlled trials that included parents of young children were selected. Two reviewers extracted TSE data, as assessed by parentally-reported exposure or protection (PREP) and biomarkers. Risk ratios and differences were calculated by using the DerSimonian and Laird random-effects model. Exploratory subgroup analyses were performed. 

RESULTS: Thirty studies were included. Improvements were observed from baseline to follow-up for parentally-reported and biomarker data in most intervention and control groups. Interventions demonstrated evidence of small benefit to intervention participants at follow-up (PREP: 17 studies, n = 6820, relative risk 1.12, confidence interval [CI] 1.07 to 1.18], P < .0001). Seven percent more children were protected in intervention groups relative to control groups. Intervention parents smoked fewer cigarettes around children at follow-up than did control parents (P = .03). Biomarkers (13 studies, n = 2601) at follow-up suggested lower child exposure among intervention participants (RD -0.05, CI -0.13 to 0.03, P = .20). 

CONCLUSIONS: Interventions to prevent child TSE are moderately beneficial at the individual level. Widespread child TSE suggests potential for significant population impact. More research is needed to improve intervention effectiveness and child TSE measurement.

Which type of sedentary behaviour intervention is more effective at reducing body mass index in children? A meta-analytic review.

Liao Y, Liao J, Durand CP, Dunton GF.

Obes Rev. 2014 Mar;15(3):159-68. doi:10.1111/obr.12112

Sedentary behaviour is emerging as an independent risk factor for paediatric obesity. Some evidence suggests that limiting sedentary behaviour alone could be effective in reducing body mass index (BMI) in children. However, whether adding physical activity and diet-focused components to sedentary behaviour reduction interventions could lead to an additive effect is unclear. This meta-analysis aims to assess the overall effect size of sedentary behaviour interventions on BMI reduction and to compare whether interventions that have multiple components (sedentary behaviour, physical activity and diet) have a higher mean effect size than interventions with single (sedentary behaviour) component. Included studies (n = 25) were randomized controlled trials of children (<18 years) with intervention components aimed to reduce sedentary behaviour and measured BMI at pre- and post-intervention. Effect size was calculated as the mean difference in  BMI change between children in an intervention group and a control group. Results indicated that sedentary behaviour interventions had a significant effect on BMI reduction. The pooled effect sizes of multi-component interventions (g = -0.060∼-0.089) did not differ from the single-component interventions (g = -0.154), and neither of them had a significant effect size on its own.

Future paediatric obesity interventions may consider focusing on developing strategies to decrease multiple screen-related sedentary behaviours.

School-based obesity prevention programs: a meta-analysis of randomized controlled trials

Sobol-Goldberg S, Rabinowitz J, Gross R. Obesity (Silver Spring). 2013 Dec;21(12):2422-8. doi: 10.1002/oby.20515. Epub 2013 Aug 13. (Review) PMID: 23794226

OBJECTIVE: Attempts have been made to reduce childhood obesity through school-based programs. Systematic reviews of studies until 2006 reported a lack of consistency about effectiveness of such programs. Presented is an updated systematic review and meta-analysis. 

DESIGN AND METHODS: Replication of methodology used in previous comprehensive systematic review and meta-analysis of randomized controlled trials of school-based obesity prevention programs covering studies until 2006 to review studies thru January 2012.

RESULTS: Based on 32 studies (n = 52,109), programs were mildly effective in reducing BMI relative to controls not receiving intervention. Studies of children had significant intervention effects, those of teenagers did not, though the difference between the two groups was not statistically significant. Meta-regression showed a significant linear hierarchy of studies with the largest effects for comprehensive programs more than 1 year long that aimed to provide information on nutrition and physical activity, change attitudes, monitor behavior, modify environment, involve parents, increase physical activity and improve diet, particularly among children.

CONCLUSIONS: Unlike earlier studies, more recent studies showed convincing evidence that school-based prevention interventions are at least mildly effective in reducing BMI in children, possibly because these newer studies tended to be longer, more comprehensive and included parental support.http://www.ncbi.nlm.nih.gov/pubmed/23794226?dopt=Abstract

Effects of daily iron supplementation in primary-school-aged children: systematic review and meta-analysis of randomized controlled trials.

Low M, Farrell A, Biggs BA, et al. 
CMAJ. 2013 Nov 19;185(17):E791-802. doi: 10.1503/cmaj.130628. Epub 2013 Oct 15. (Review) PMID: 24130243

BACKGROUND: Anemia is an important public health and clinical problem. Observational studies have linked iron deficiency and anemia in children with many poor outcomes, including impaired cognitive development; however, iron supplementation, a widely used preventive and therapeutic strategy, is associated with adverse effects. Primary-school-aged children are at a critical stage in intellectual development, and optimization of their cognitive performance could have long-lasting individual and population benefits. In this study, we summarize the evidence for the benefits and safety of daily iron supplementation in primary-school-aged children.
METHODS: We searched electronic databases (including MEDLINE and Embase) and other sources (July 2013) for randomized and quasi-randomized controlled trials involving daily iron supplementation in children aged 5-12 years. We combined the data using random effects meta-analysis.
RESULTS: We identified 16 501 studies; of these, we evaluated 76 full-text papers and included 32 studies including 7089 children. Of the included studies, 31 were conducted in low- or middle-income settings. Iron supplementation improved global cognitive scores (standardized mean difference 0.50, 95% confidence interval [CI] 0.11 to 0.90, p = 0.01), intelligence quotient among anemic children (mean difference 4.55, 95% CI 0.16 to 8.94, p = 0.04) and measures of attention and concentration. Iron supplementation also improved age-adjusted height among all children and age-adjusted weight among anemic children. Iron supplementation reduced the risk of anemia by 50% and the risk of iron deficiency by 79%. Adherence in the trial settings was generally high. Safety data were limited.
INTERPRETATION: Our analysis suggests that iron supplementation safely improves hematologic and nonhematologic outcomes among primary-school-aged children in low- or middle-income settings and is well-tolerated.

Comment in

• Iron supplementation for children: Safety in all settings is not clear. [CMAJ. 2013]

Anaemia, prenatal iron use, and risk of adverse pregnancy outcomes: systematic review and meta-analysis.

BMJ. 2013 Jun 21;346:f3443. doi: 10.1136/bmj.f3443.
Haider BA, Olofin I, Wang M, Spiegelman D, Ezzati M, Fawzi WW; Nutrition Impact
Model Study Group (anaemia).

Comment in
    BMJ. 2013;347:f4399.

OBJECTIVES: To summarise evidence on the associations of maternal anaemia and
prenatal iron use with maternal haematological and adverse pregnancy outcomes;
and to evaluate potential exposure-response relations of dose of iron, duration
of use, and haemoglobin concentration in prenatal period with pregnancy outcomes.
DESIGN: Systematic review and meta-analysis
DATA SOURCES: Searches of PubMed and Embase for studies published up to May 2012 
and references of review articles.
STUDY SELECTION CRITERIA: Randomised trials of prenatal iron use and prospective 
cohort studies of prenatal anaemia; cross sectional and case-control studies were
excluded.
RESULTS: 48 randomised trials (17 793 women) and 44 cohort studies (1 851 682
women) were included. Iron use increased maternal mean haemoglobin concentration 
by 4.59 (95% confidence interval 3.72 to 5.46) g/L compared with controls and
significantly reduced the risk of anaemia (relative risk 0.50, 0.42 to 0.59),
iron deficiency (0.59, 0.46 to 0.79), iron deficiency anaemia (0.40, 0.26 to
0.60), and low birth weight (0.81, 0.71 to 0.93). The effect of iron on preterm
birth was not significant (relative risk 0.84, 0.68 to 1.03). Analysis of cohort 
studies showed a significantly higher risk of low birth weight (adjusted odds
ratio 1.29, 1.09 to 1.53) and preterm birth (1.21, 1.13 to 1.30) with anaemia in 
the first or second trimester. Exposure-response analysis indicated that for
every 10 mg increase in iron dose/day, up to 66 mg/day, the relative risk of
maternal anaemia was 0.88 (0.84 to 0.92) (P for linear trend<0.001). Birth weight
increased by 15.1 (6.0 to 24.2) g (P for linear trend=0.005) and risk of low
birth weight decreased by 3% (relative risk 0.97, 0.95 to 0.98) for every 10 mg
increase in dose/day (P for linear trend<0.001). Duration of use was not
significantly associated with the outcomes after adjustment for dose.
Furthermore, for each 1 g/L increase in mean haemoglobin, birth weight increased 
by 14.0 (6.8 to 21.8) g (P for linear trend=0.002); however, mean haemoglobin was
not associated with the risk of low birth weight and preterm birth. No evidence
of a significant effect on duration of gestation, small for gestational age
births, and birth length was noted.
CONCLUSIONS: Daily prenatal use of iron substantially improved birth weight in a 
linear dose-response fashion, probably leading to a reduction in risk of low
birth weight. An improvement in prenatal mean haemoglobin concentration linearly 
increased birth weight.

PMCID: PMC3689887
PMID: 23794316  [PubMed - indexed for MEDLINE]

Associations between problems with crying, sleeping and/or feeding in infancy and long-term behavioural outcomes in childhood: a meta-analysis.

Associations between problems with crying, sleeping and/or feeding in infancy and long-term behavioural outcomes in childhood: a meta-analysis. Hemmi MH, Wolke D, Schneider S.  Arch Dis Child. 2011 Jul;96(7):622-9. Epub 2011 Apr 20. (Review) PMID: 21508059

BACKGROUND: Excessive crying, sleeping or feeding problems are found in approximately 20% of infants and may predict behavioural problems in childhood.

METHODS: A quantitative meta-analysis of 22 longitudinal studies from 1987 to 2006 that statistically tested the association between infant regulatory problems and childhood internalising, externalising and attention-deficit/hyperactivity disorder (ADHD) problems was carried out; 1935 children with regulatory problems were tested. Cohen`s d was used to express the association between regulatory problems and behavioural problems. Heterogeneity of the effect sizes was assessed using the I(2) statistic and meta-analysis of variance and meta-regressions were conducted to assess the influence of moderators. Rosenthal`s classic fail-safe N and correlation of sample sizes to effect sizes were used to assess publication bias.

RESULTS: The weighted mean effect size for the main regulatory problems-behavioural problems association was 0.41 (95% CI 0.28 to 0.54), indicating that children with previous regulatory problems have more behavioural problems than controls. Externalising and ADHD problems were the strongest outcome of any regulatory problem, indicated by the highest fail-safe N and lowest correlation of sample size to effect size. Meta-analyses of variance revealed no significant moderating influences of regulatory problem comorbidity (I(2)=44.0, p>0.05), type (I(2)=41.8, p>0.05) or duration (I(2)=44.0, p>0.05). However, cumulative problems and clinical referral increased the risk of behavioural problems.

CONCLUSIONS: The meta-analyses suggest that children with previous regulatory problems have more behavioural problems than controls, particularly in multi-problem families. Further studies are required to assess the behavioural outcomes of previously sleep, feeding or multiply disturbed children. 

Interventions to reduce sexual risk for human immunodeficiency virus in adolescents: a meta-analysis of trials, 1985-2008.

OBJECTIVE: To provide an updated review of the efficacy of behavioral interventions to reduce sexual risk of human immunodeficiency virus (HIV) among adolescents.
DESIGN: We searched electronic databases, leading public health journals, and the document depository held by the Synthesis of HIV/AIDS Risk Reduction Project. Studies that fulfilled the selection criteria and were available as of December 31, 2008, were included.
SETTING: Studies that investigated any behavioral intervention advocating sexual risk reduction for HIV prevention, sampled adolescents (age range, 11-19 years), measured a behavioral outcome relevant to sexual risk, and provided sufficient information to calculate effect sizes.
PARTICIPANTS: Data from 98 interventions (51,240 participants) were derived from 67 studies, dividing for qualitatively different interventions and gender when reports permitted it.
MAIN OUTCOME MEASURES: Condom use, sexual frequency, condom use skills, interpersonal communication skills, condom acquisition, and incident sexually transmitted infections (STIs).
RESULTS: Relative to controls, interventions succeeded at reducing incident STIs, increasing condom use, reducing or delaying penetrative sex, and increasing skills to negotiate safer sex and to acquire prophylactic protection. Initial risk reduction varied depending on sample and intervention characteristics but did not decay over time.
CONCLUSIONS: Comprehensive behavioral interventions reduce risky sexual behavior and prevent transmission of STIs. Interventions are most successful to the extent that they deliver intensive content.

Birth weight, early weight gain, and subsequent risk of type 1 diabetes: systematic review and meta-analysis.

Harder T, Roepke K, Diller N, et al. Am J Epidemiol. 2009 Jun 15;169(12):1428-36. Epub 2009 Apr 10.(Review) PMID: 19363100.
Revisión sistemática y meta-análisis sobre la asociación entre el peso al nacimiento y el aumento de peso durante el primer año de vida y la posterior aparación de diabetes tipo 1.
El peso al nacimiento > 4,000 g se asoció con mayor riesgo de diabetes tipo 1 y en todos los estudios los pacientes con diabetes tipo 1 mostraron una mayor ganancia de peso durante el primer año de vida, en comparación con los controles.

Risk of contralateral testicular cancer among men with unilaterally undescended testis: A meta analysis

Akre O., Pettersson A., Richiardi L.
Int J Cancer. 2008 Oct 30. [Epub ahead of print]
The association between undescended testis (cryptorchidism) and testicular cancer is established, but it is not known whether the risk of testicular cancer among men with unilateral maldescent is increased in both testes, or only on the undescended side. This is a meta-analysis of 11 case-control studies and 1 cohort study that all assessed the risk of testicular cancer separately for the undescended and descended testis. We used fixed-effects meta-analysis to calculate pooled estimates and 95% confidence intervals (CIs) for the relative risk. Of 199 tumors in men with unilateral cryptorchidism, 158 (79%) were on the ipsilateral side and 41 (21%) on the contralateral side. The pooled relative risks for testicular cancer in the ipsilateral and contralateral testis were 6.33 (95% CI, 4.30 to 9.31) and 1.74 (95% CI, 1.01 to 2.98), respectively. We conclude that in 1-sided undescended testis, the risk of testicular cancer may be increased in both testes, although to a much greater extent on the ipsilateral side.

Child-parent screening for familial hypercholesterolaemia: screening strategy based on a meta-analysis.

BMJ. 2007 Sep 22;335(7620):599. Epub 2007 Sep 13.
Comment in: BMJ. 2007 Oct 6;335(7622):683.
BMJ. 2007 Oct 6;335(7622):683.
BMJ. 2007 Sep 22;335(7620):573-4.
Wald DS, Bestwick JP, Wald NJ.
OBJECTIVE: To develop a population screening strategy for familial hypercholesterolaemia.
DESIGN: Meta-analysis of published data on total and low density lipoprotein (LDL) cholesterol in people with and without familial hypercholesterolaemia according to age. Thirteen studies reporting on 1907 cases and 16 221 controls were used in the analysis. Included studies had at least 10 cases and controls with data on the distribution of cholesterol in affected and unaffected individuals.
MAIN OUTCOME MEASURES: Detection rates (sensitivity) for specified false positive rates (0.1%, 0.5%, and 1%) in newborns and in age groups1-9, 10-19, 20-39, 40-59, and > or =60 years.
RESULTS: Serum cholesterol concentration discriminated best between people with and without familial hypercholesterolaemia at ages 1-9, when the detection rates with total cholesterol were 88%, 94%, and 96% for false positive rates of 0.1%, 0.5%, and1%. The results were similar with LDL cholesterol. Screening newborns was muchless effective. Once an affected child is identified, measurement of cholesterol would detect about 96% of parents with the disorder, using the simple rule thatthe parent with the higher serum cholesterol concentration is the affected parent.
CONCLUSIONS: The proposed strategy of screening children and parents for familial hypercholesterolaemia could have considerable impact in preventing the medical consequences of this disorder in two generations simultaneously.