Age-related hearing loss and mild cognitive impairment: a meta-analysis and systematic review of population-based studies.

BACKGROUND: The aim of this study was to identify any relationship between hearing loss and mild cognitive impairment. METHOD: This was a systematic review and meta-analysis of randomised controlled trials conducted using Medline and the Cochrane Library up to 24 June 2020. Prospective, cohort and cross-sectional, and observational studies that reported on the relationship between mild cognitive impairment and hearing loss were included. RESULTS: A total of 34 studies reporting data on 48 017 participants were included. Twenty-three studies observed a significant association between hearing loss and mild cognitive impairment. The pooled risk ratio across all studies of prevalence of mild cognitive impairment in people with hearing loss was 1.44 (random-effects; 95 per cent CI = 1.27-1.64; p < 0.00001; I2 = 0 per cent). Significantly more people with mild cognitive impairment had peripheral hearing loss compared with those without (risk ratio, 1.40 random-effects; 95 per cent CI = 1.10-1.77; p = 0.005; I2 = 0 per cent). When the incidence was studied, significantly more people with peripheral hearing loss had mild cognitive impairment compared with those without (risk ratio = 2.06 random-effects; 95 per cent CI = 1.35-3.15; p = 0.0008; I2 = 97 per cent); however; a high level of statistical heterogeneity was evident. CONCLUSION: Most of the studies included in this systematic review observed a significant association between hearing loss and mild cognitive impairment.

Evidence-based guidelines for interpreting change scores for the European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30.

AIM: To use published literature and experts' opinion to investigate the clinical meaning and magnitude of changes in the Quality of Life (QOL) of groups of patients measured with the European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). METHODS: An innovative method combining systematic review of published studies, expert opinions and meta-analysis was used to estimate large, medium, and small mean changes over time for QLQ-C30 scores. RESULTS: Nine hundred and eleven papers were identified, leading to 118 relevant papers. One thousand two hundred and thirty two mean changes in QOL over time were combined in the meta-analysis, with timescales ranging from four days to five years. Guidelines were produced for trivial, small, and medium size classes, for each subscale and for improving and declining scores separately. Estimates for improvements were smaller than respective estimates for declines. CONCLUSIONS: These guidelines can be used to aid sample size calculations and interpretation of mean changes over time from groups of patients. Observed mean changes in the QLQ-C30 scores are generally small in most clinical situations, possibly due to response shift. Careful consideration is needed when planning studies where QOL changes over time are of primary interest; the timing of follow up, sample attrition, direction of QOL changes, and subscales of primary interest are key considerations.

A meta-analysis of impact exercise on postmenopausal bone loss: the case for mixed loading exercise programmes.

OBJECTIVES: To assess the effects of differing impact exercise protocols on postmenopausal bone loss at the hip and spine. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Electronic bibliographic databases, key journals and reference lists of reviews and articles. REVIEW METHODS: Two independent reviewers assessed controlled trials evaluating effects of impact exercise on lumbar spine, femoral neck and total hip bone mineral density (BMD) in postmenopausal women for inclusion. Heterogeneity amongst trials and publication bias were assessed. Trial quality assessment was also performed. RESULTS: Impact protocols that included jogging mixed with walking and stair climbing, and protocols that incorporated impact exercise with high-magnitude loading (resistance exercises), were effective at lumbar spine (weighted mean difference (random effects) 0.025 g/cm(2) 95% CI (0.004 to 0.046) and 0.016 g/cm(2) 95% CI (0.005 to 0.027); p = 0.02 and p = 0.005 respectively), although heterogeneity was evident (I(2) = 88% and I(2) = 73%, where I(2) measures the extent of inconsistency among the trials). Effects on femoral neck BMD following these types of protocols were significant (weighted mean difference (fixed effect) 0.022 g/cm(2) 95% CI (0.014 to 0.030); p<0.001 and 0.005 g/cm(2) 95% CI (0.001 to 0.010); p = 0.03 respectively). High-impact only and odd-impact only protocols were ineffective in increasing BMD at any site. CONCLUSION: Mixed loading exercise programmes combining jogging with other low-impact loading activity and programmes mixing impact activity with high-magnitude exercise as resistance training appear effective in reducing postmenopausal bone loss at the hip and spine. Other forms of impact exercise appear less effective at preserving BMD in this population. However, diverse methodological and reporting discrepancies are evident in current published trials.

High-intensity resistance training and postmenopausal bone loss: a meta-analysis.

INTRODUCTION: Conflicting evidence exists regarding the optimum exercise for postmenopausal bone loss. A systematic review and meta-analysis was undertaken to evaluate the effects of randomised controlled trials (RCTs) of progressive, high-intensity resistance training on bone mineral density (BMD) amongst postmenopausal women. METHODS: Structured electronic searching of multiple databases and hand-searching of key journals and reference lists was undertaken to locate relevant studies up to December 2004. Study quality and possible publication bias were assessed using recognised methods. Primary outcomes were absolute changes in BMD at the lumbar spine (LS), femoral neck (FN) and total hip (TH). A priori defined subgroup analyses included concurrent hormonal or antiresorptive therapy or calcium supplementation during the intervention. The weighted mean difference method (WMD) was used for combining study group estimates. Random or fixed effect models were applied according to study heterogeneity observed from the I (2) statistic. RESULTS: At the LS, 14 RCT study groups were homogenous (I (2)=25.2%) in demonstrating a significant increase (P=0.006) in BMD of 0.006 g/cm(2) (fixed effect; 95% CI 0.002-0.011) following high-intensity resistance training. In contrast, marked heterogeneity (I (2)=88.2%) was apparent within 11 RCT study groups evaluating FN. For this comparison, a random effects model showed a positive change in FN BMD of 0.010 g/cm(2) (95% CI -0.002 to 0.021; P = 0.11). Subgroup analyses showed more anatomical variability of BMD responses to resistance training according to participants' hormone therapy use. Treatment effects for study groups increasing all participants' calcium intake showed significant positive BMD changes at TH (P=0.007). Methodological quality of all included studies was low, and a reporting bias towards studies with positive BMD outcomes was evident. CONCLUSIONS: These findings are relevant to the nonpharmacological treatment of postmenopausal bone loss.