Therapist-guided remote versus in-person cognitive behavioural therapy: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Cognitive behavioural therapy (CBT) has been shown to be effective for several psychiatric and somatic conditions; however, most randomized controlled trials (RCTs) have administered treatment in person and whether remote delivery is similarly effective remains uncertain. We sought to compare the effectiveness of therapist-guided remote CBT and in-person CBT. METHODS: We systematically searched MEDLINE, Embase, PsycINFO, CINAHL, and the Cochrane Central Register of Controlled Trials from inception to July 4, 2023, for RCTs that enrolled adults (aged ≥ 18 yr) presenting with any clinical condition and that randomized participants to either therapist-guided remote CBT (e.g., teleconference, videoconference) or in-person CBT. Paired reviewers assessed risk of bias and extracted data independently and in duplicate. We performed random-effects model meta-analyses to pool patient-important primary outcomes across eligible RCTs as standardized mean differences (SMDs). We used Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidance to assess the certainty of evidence and used the Instrument to Assess the Credibility of Effect Modification Analyses (ICEMAN) to rate the credibility of subgroup effects. RESULTS: We included 54 RCTs that enrolled a total of 5463 patients. Seventeen studies focused on treatment of anxiety and related disorders, 14 on depressive symptoms, 7 on insomnia, 6 on chronic pain or fatigue syndromes, 5 on body image or eating disorders, 3 on tinnitus, 1 on alcohol use disorder, and 1 on mood and anxiety disorders. Moderate-certainty evidence showed little to no difference in the effectiveness of therapist-guided remote and in-person CBT on primary outcomes (SMD -0.02, 95% confidence interval -0.12 to 0.07). INTERPRETATION: Moderate-certainty evidence showed little to no difference in the effectiveness of in-person and therapist-guided remote CBT across a range of mental health and somatic disorders, suggesting potential for the use of therapist-guided remote CBT to facilitate greater access to evidence-based care. Systematic review registration: Open Science Framework (https://osf.io/7asrc).

Duplicate portion sampling gives the most accurate iron intake estimate: Implications for iron status of female students.

Iron deficiency (ID) is one of the most common nutritional problems in the developing world, affecting primarily women of childbearing age. Poor dietary iron intake is a major reason of ID. Accurate measurement of iron intake is of crucial importance to combat the problem. The daily dietary iron intake of 67 female students aged between 20-30 years (a mean BMI of 21.8±3.4 kg/m2) was evaluated using three assessment methods: atomic absorption spectrometry of 3-day food duplicate samples, and food composition tables (FCTs) in combination with either food frequency questionnaire (FFQ) or dietary records. Iron status was examined using hematological and biochemical tests. The dietary iron intake determined by duplicate portion sampling (DPS; 4.12±1.84 mg/day) was significantly lower than the FCT-based estimates (P<0.001), and it was less than » of the recommended dietary allowance of 18 mg/day. No significant correlation was found between DPS technique and FCT-based assessment methods. Fifty percent of the participants had small or depleted iron stores (serum ferritin< 30 ng/mL), but only 4.5% had ID anemia (serum ferritin< 12 ng/mL and hemoglobin<12 g/dL). Dietary iron intakes and FFQ-based intakes of vitamin C were not significantly correlated with all the investigated hematological parameters. In order to take some steps toward more practical approaches to combat this health problem, development of an accurate iron intake assessment seems to be the first priority. In this regard, improvement and validation of national FCTs would be a promising solution.

The efficacy of probiotic supplementation in rheumatoid arthritis: a meta-analysis of randomized, controlled trials.

Probiotics are considered as -immunomodulatory agents; their efficacy as an adjunct therapy option for rheumatoid arthritis (RA), however, remains controversial. The main aim of the present meta-analysis, therefore, was to compare available data from the published randomized, controlled trials (RCTs) recruiting adults with RA which compared probiotics with placebo. The English literature search was performed using Ovid version of Medline, EmBase, Web of Science, and the Central Cochrane library through October 2016 and supplemented by hand searching reference lists. Among 240 citations identified, 4 RCTs (153 participants; 89% female) were included. All data were pooled using a standardized mean difference (SMD) with a 95% CI. Compared to the placebo, probiotics did not change the inflammatory parameters (erythrocyte sedimentation rate, tumor necrosis factor [TNF]-α, interleukin [IL]-1ß, IL-6, IL-10, and IL-12) and oxidative stress indices (total antioxidant capacity and malondialdehyde) significantly. The borderline significant reduction as a result of probiotic administration was only determined in C-reactive protein [SDM - 0.32 (95% CI - 0.65 to 0.00)]. Among disease activity indices (disease activity score [DAS], tender joint count, and swollen joint count), DAS showed a significant improvement following probiotic treatment with a SMD (95% CI) of - 0.58 (- 0.97 to - 0.19). The number of trials was too small to determine if a strain-, dose-, or duration-response effect was present. Probiotics seem to be less effective in RA; however, to reach a firm conclusion, we need further evidence.

Heavy metals (Pb, Cd, Cu, Zn, Ni, Co) in leafy vegetables collected from production sites: their potential health risk to the general population in Shiraz, Iran.

Heavy metal contamination of vegetables is a great public health concern. One hundred samples of spinach, dill, cilantro, and cress from the production sites of Shiraz, Iran, and its outskirts were, therefore, examined for lead (Pb), cadmium (Cd), copper (Cu), zinc (Zn), nickel (Ni), and cobalt (Co) content. The potential health risks of these metals to local residents via the consumption of leafy vegetables were also estimated. The mean concentrations of Pb, Cd, Cu, Zn, Ni, and Co were 3.21, 0.28, 4.55, 40.44, 3.11, and 1.86 mg/kg dry weight, respectively. The Pb level exceeded the permissible limit of 0.3 mg/kg in 44.7% of vegetable samples. The other elements were, however, within FAO/WHO standards. The estimated daily intake (EDI) of Pb, Cd, Cu, Zn, Ni, and Co from leafy vegetables was 0.10, 0.01, 0.14, 1.26, 0.10, and 0.06 µg/kg body weight/day, respectively. At the mean and 97.5 percentile levels, all health risk index (HRI) values were less than the safe limit (< 1). Thus, within the area this study was focused on, leafy vegetables did not make a major contribution to the dietary intake of the elements which could be mainly attributed to the low vegetable consumption by the study population (20 g/day). Nevertheless, the lead content of the vegetables should be viewed with some concern. Regular monitoring of heavy metal contamination of foodstuff is recommended to control the sources of contaminants in the food chain.

Daily dietary intakes of zinc, copper, lead, and cadmium as determined by duplicate portion sampling combined with either instrumental analysis or the use of food composition tables, Shiraz, Iran.

Estimation of essential and toxic element intakes is crucial to evaluate the risks of deficiency or toxicity. The purpose of this study was to investigate and also to compare the dietary intakes of zinc (Zn) and copper (Cu) by adults living in Shiraz, Iran, determined by two procedures: duplicate portion sampling of 21 hospital meals combined with either instrumental analysis (voltammetric measurement) or the use of food composition tables (FCTs). The level of exposure to lead (Pb) and cadmium (Cd) was evaluated as well. The daily Zn intakes of both methods were not significantly different and were higher than the RDA values except the value measured by the instrumental analysis which was lower than the RDA established for a male adult. Daily intake of Cu determined by instrumental analysis was significantly lower and closer to RDA for adults compared with the value estimated by FCTs. The dietary intakes of Pb and Cd were 313 and 61% of the respective provisional tolerable weekly intakes (PTWIs), respectively. The accuracy of two methods used for estimation of Zn intake was similar. In the case of Cu, the use of FCTs, in which the influence of environmental conditions and dietary habits of meal preparation is not taken into account, overestimated dietary intake. The risk of zinc deficiency was found in adult males. Moreover, the estimated intake of Pb, but not Cd, could be a cause of concern for Shiraz population. Thus, conducting regular periodic studies to assess the dietary intake of mentioned elements are recommended.

Acute or Short-term Effects of Whey Protein Alone or Along with Carbohydrate on Inflammation: A Systematic Review of Clinical Trials:.

BACKGROUND: Excessive inflammatory response is associated with several diseases. Recently, there has been an increasing trend for investigation of the acute or short-term effects of whey protein alone or in combination with carbohydrates on inflammatory status, especially in athletes. This systematic review aimed to clarify these effects. MATERIALS AND METHODS: PubMed, Scopus, and Web of Science databases were searched from January 1990 to September 2021, without language restriction. Adult studies examining the effects of whey protein alone or together with carbohydrates on interleukin-6, tumor necrosis factor-α, and C-reactive protein levels with a maximum duration of 15 days and with at least one comparison group were included. The quality of studies was analyzed using the Cochrane risk of bias tool. RESULTS: Twenty-five studies met the inclusion criteria. Significant reductions in inflammatory markers was observed in seven out of 25 studies (28%). However, one out of 25 studies (4%) reported a significant increase in inflammatory status. Among those studies comparing the effects of whey protein alone with non-protein or protein-containing groups, 18.18% (two out of 11) and 10% (one out of ten) of the trials revealed a significant decrease in the markers, respectively. Moreover, of those studies comparing whey protein plus carbohydrate with non-protein or protein-containing groups, 33.33% (two out of six) and 40% (two out of five) of them showed a significant reduction in the inflammatory response, respectively. The quality of the majority of studies (84%) was poor. CONCLUSION: It seems that whey protein alone or the combination of it with carbohydrates may not affect the inflammatory markers in the short run (PROSPERO registration number: CRD42021273915).[GMJ.2023;12:e2441].

Carbulin: A Comprehensive Mobile Application for Advanced Carbohydrate Counting and Diet- and Insulin-Regimen Planning for Type 1 Diabetic Patients.

Nowadays, the introduction of the so-called 'diabetes technology', either hardware/device or software, to different aspects of day-to-day living in patients with diabetes aims to improve blood glucose control and various lifestyle features. The coordination of vast context of diabetes education/training, particularly in the area of medical nutrition therapy, is considered as a great concern. On the other hand, Iranian food culture consists of a set of traditional dietary patterns and food consumption habit. The study was aimed to develop "the Comprehensive Mobile Application of Advanced Carbohydrate Counting and Diet- and Insulin-Regimen Planning" to help type 1 diabetic patients, improving their health status. The programming language of Kotlin, JavaScript, Node JS, and HTML5 was used for the mobile app development. The app was developed with the following abilities: 1) educating users on different aspects of disease control including, updated general treatment guidelines on physical activity, medical nutrition and insulin therapy, stress management, and the patient's specific goals and dietary needs, 2) performing advanced carbohydrate counting using both picture-represented and kitchen-scale of carbohydrate foods as well as traditional Iranian foods, 3) recommending the patient's specific insulin dose, either short- or rapid-acting, based on the carbohydrate content of the selected meal or the selected amount of Iranian foods, 4) recommending the personalized insulin dose needed for decreasing the high blood glucose levels, and 5) performing 3 and 4 simultaneously. Developing Carbulin was an effort to increase type 1 diabetes self-management using the traditional Iranian dietary pattern and menu.