Neurocognitive Suicide and Homicide Markers in Patients with Schizophrenia Spectrum Disorders: A Systematic Review.

Suicide and homicide are considered important problems in public health. This study aims to identify the cognitive performance of suicidal and homicidal behaviors in people with schizophrenia spectrum disorders, as well as examining whether there are shared neuropsychological mechanisms. A systematic review of the recent literature was carried out from September 2012 to June 2022 using the Medline (via PubMed), Scopus, Embase, and Cochrane databases. Among the 870 studies initially identified, 23 were finally selected (15 related to suicidal behaviors and 8 to homicidal behaviors). The results evidenced a relationship between impairment of cognitive performance and homicidal behavior; meanwhile, for suicidal behaviors, no consistent results were found. High neuropsychological performance seems to act as a protective factor against violent behavior in people with schizophrenia spectrum disorders, but not against suicidal behavior; indeed, it can even act as a risk factor for suicidal behavior. To date, there is insufficient evidence that shared neurocognitive mechanisms exist. However, processing speed and visual memory seem to be affected in the presence of both behaviors.

Effectiveness of nontechnical skills educational interventions in the context of emergencies: A systematic review and meta-analysis.

INTRODUCTION: In recent years, the importance of training healthcare professionals in nontechnical skills using effective methodologies has been increasingly recognised as a means of preventing clinical errors in the practice of health care. The aim of this study was to evaluate the effectiveness of educational interventions on nontechnical skills in the emergency medical services and/or critical care unit settings. METHODS: A systematic search was carried out in the PubMed, SCOPUS, CINAHL, and Web of Science databases according to predetermined inclusion and exclusion criteria. After the initial search, 7952 records were selected after duplicates removed. Finally, a selection of 38 studies was included for quantitative analysis. Separate meta-analyses of standardised mean changes were carried out for each outcome measure assuming a random-effects model. Cochran's Q-statistic and I2 index were applied to verify study heterogeneity. Weighted analyses of variance and meta-regressions were conducted to test the influence of potential moderators and funnel plots using Duval and Tweedie's trim-and-fill method, and Egger's regression test were used to examine publication bias. RESULTS: All the variables analysed had a significant effect size, with the exception of situational awareness (d+ = -0.448; 95% confidence interval [CI] = -1.034, 0.139). The highest mean effect size was found for knowledge (d+ = -0.925; 95% CI = -1.177, -0.673), followed by the mean effect sizes for global nontechnical skills (d+ = -0.642; 95% CI = -0.849, -0.434), team nontechnical skills (d+ = -0.606; 95% CI = -0.949, -0.262), and leadership nontechnical skills (d+ = -0.571; 95% CI = -0.877, -0.264). Similar mean effect sizes were found for attitude (d+ = -0.406; 95% CI = -0.769, -0.044), self-efficacy (d+ = -0.469; 95% CI = -0.874, -0.064), and communication nontechnical skills (d+ = -0.458; 95% CI = -0.818, -0.099). Large heterogeneity among the standardised mean changes was found in the meta-analyses (I2 > 75% and p < .001), except for self-efficacy where I2 = 58.17%, and there was a nonstatistical result for Cochran's Q. This great variability is also reflected in the forest plots. DISCUSSION: The use of simulation interventions to train emergency and critical care healthcare professionals in nontechnical skills significantly improves levels of knowledge, attitude, self-efficacy, and nontechnical skills performance.

Cognitive-Behavioral Therapy and Anxiety and Depression Level in Pediatric Obsessive-Compulsive Disorder: A Systematic Review and Meta-Analysis.

BACKGROUND: Although some meta-analyses have identified potential moderators associated with treatment outcomes for pediatric obsessive-compulsive disorder (OCD), there is as yet no consensus regarding the influence of anxiety and depression symptoms on the recovery from pediatric OCD. A meta-analysis was conducted to investigate the effects of depression and anxiety symptoms and their comorbidities on the efficacy of CBT in pediatric OCD, as well as other potential moderators that may be associated with outcomes. METHOD: An exhaustive literature search from 1983 to March 2021 located 22 published articles that applied cognitive-behavioral therapy (CBT) to pediatric OCD, producing a total of 26 treatment groups. Some of the moderator variables analyzed included age, gender, comorbidity baseline in anxiety, depression and obsession, and methodological quality. RESULTS: Results showed that the psychological treatment of OCD achieves clinically significant effectiveness, both for measures of obsessions and compulsions ( d + = 2.030), and for anxiety ( d + = 0.613) and depression ( d + = 0.451). An explanatory model for the CY-BOCS effect sizes showed that three moderator variables were statistically related: the mean of the CY-BOCS (Children´s Yale Brown Obsessive Compulsive Scale) in pretest, the effect size for anxiety, and the mean age of the sample. CONCLUSIONS: CBT reduced obsessive-compulsive symptoms and, to a lesser extent, anxiety and depression symptoms. Since anxiety symptoms are reduced with the same therapy, resources would be saved compared to other treatments.

Overviews of Reviews: Concept and Development.

BACKGROUND: In the last years, overviews of systematic reviews, or umbrella reviews, have seen a dramatic increase in their use. An overview aims to provide a summary of the included reviews and will often examine research questions beyond those addressed in the systematic reviews being synthesised. The purpose of this article is to provide some recommendations on how overviews should be conducted and reported. METHOD: A literature review was performed to identify relevant papers on both methodological and applied overviews. RESULTS: The current literature recommends carrying out overviews by following similar steps to those of systematic reviews: (a) Defining the overview research question; (b) inclusion and exclusion criteria; (c) literature search; (d) data extraction; (e) assessment of risk of bias and reporting quality; (f) overview results; and (g) reporting the overview. Of special interest is how to address dependencies between the systematic reviews. CONCLUSIONS: Overviews allow evidence to be efficiently combined from multiple systematic reviews. This offers the possibility of translating and summarizing large amounts of information. As in primary studies and systematic reviews, conducting and reporting of overviews must meet appropriate quality standards.

A Reliability Generalization Meta-analysis of the Padua Inventory-Revised (PI-R).

Background/Objective: The Padua Inventory-Revised (PI-R) is a widely applied instrument to measure obsessive-compulsive symptoms in clinical and nonclinical samples. We conducted a reliability generalization meta-analysis on the PI-R. Method: An exhaustive literature search yielded 118 empirical studies that had applied the PI-R, from which 30 studies (33 samples) reported an original reliability estimate. Results: Assuming a random-effects model, the average internal consistency reliability (Cronbach's alpha) was .92 (95% CI [.91, .93]) for the total scores, and ranged from .74 to .89 for the subscales. Assuming mixed-effects models, moderator analyses showed a positive statistically significant association between the standard deviation of the total scores and the reliability coefficients (p = .002; R2  = .38). Conclusions: In terms of reliability, the PI-R scale was found to be adequate for both research and clinical purposes, although exhibiting large heterogeneity across studies. Future empirical studies using the PI-R should be required to provide at least one reliability estimate based on their own data.

Antecedentes/Objetivo: El Padua Inventory-Revised (PI-R) es un instrumento ampliamente utilizado para medir los síntomas obsesivo-compulsivos en muestras clínicas y no clínicas. Llevamos a cabo un meta-análisis de generalización de la fiabilidad del PI-R. Método: Una búsqueda exhaustiva de la literatura arrojó 118 estudios empíricos que habían aplicado el PI-R, de los cuales 30 estudios (33 muestras) reportaron una estimación propia de la fiabilidad. Resultados: Asumiendo un modelo de efectos aleatorios, la fiabilidad en términos de consistencia interna promedio (alfa de Cronbach) fue de 0,92 (IC del 95% [0,91, 0,93]) para las puntuaciones totales, y osciló entre 0,74 y 0,89 para las subescalas. Asumiendo modelos de efectos mixtos, los análisis de moderadores mostraron una relación positiva estadísticamente significativa entre la desviación típica de las puntuaciones totales y los coeficientes de fiabilidad (p = 0,002; R2  = 0,38). Conclusiones: En términos de fiabilidad, se encontró que el PI-R es adecuado tanto para fines clínicos como de investigación, aunque con una alta heterogeneidad entre los estudios. Es necesario que los estudios empíricos futuros que apliquen el PI-R proporcionen al menos una estimación de la fiabilidad basada en sus propios datos.

A Meta-analysis of Gut Microbiota in Children with Autism.

Previous studies have reported dysbiosis in the gut microbiota (GM) of children with autism spectrum disorders (ASD), which may be a determining factor on child development through the microbiota-gut-brain axis. However, it is not clear if there is a specific group of dysbiotic bacteria in ASD. The aim of this study was to carry out a meta-analysis on the studies that analyze GM in children with ASD. 18 studies fulfilled our selection criteria. Our results showed a lower relative abundance of Streptococcus (SMD+ = - 0.999; 95% CI - 1.549, - 0.449) and Bifidobacterium genera (SMD+ = - 0.513; 95% CI - 0.953, - 0.073) in children with ASD. Overall, the Bifidobacterium genera is involved. However, differences found between studies are attributed to factors such as reporting bias.

A meta-review of transparency and reproducibility-related reporting practices in published meta-analyses on clinical psychological interventions (2000-2020).

Meta-analysis is a powerful and important tool to synthesize the literature about a research topic. Like other kinds of research, meta-analyses must be reproducible to be compliant with the principles of the scientific method. Furthermore, reproducible meta-analyses can be easily updated with new data and reanalysed applying new and more refined analysis techniques. We attempted to empirically assess the prevalence of transparency and reproducibility-related reporting practices in published meta-analyses from clinical psychology by examining a random sample of 100 meta-analyses. Our purpose was to identify the key points that could be improved, with the aim of providing some recommendations for carrying out reproducible meta-analyses. We conducted a meta-review of meta-analyses of psychological interventions published between 2000 and 2020. We searched PubMed, PsycInfo and Web of Science databases. A structured coding form to assess transparency indicators was created based on previous studies and existing meta-analysis guidelines. We found major issues concerning: completely reproducible search procedures report, specification of the exact method to compute effect sizes, choice of weighting factors and estimators, lack of availability of the raw statistics used to compute the effect size and of interoperability of available data, and practically total absence of analysis script code sharing. Based on our findings, we conclude with recommendations intended to improve the transparency, openness, and reproducibility-related reporting practices of meta-analyses in clinical psychology and related areas.

Cognitive-Behavioral Therapy and Anxiety and Depression Level in Pediatric Obsessive-Compulsive Disorder: A Systematic Review and Meta-Analysis / Terapia Cognitivo-Conductual y Niveles de Ansiedad y Depresión en el Trastorno Obsesivo-Compulsivo Pediátrico: una Revisión Sistemática y Meta-Análisis

Background: Although some meta-analyses have identified potential moderators associated with treatment outcomes for pediatric obsessive-compulsive disorder (OCD), there is as yet no consensus regarding the influence of anxiety and depression symptoms on the recovery from pediatric OCD. A meta-analysis was conducted to investigate the effects of depression and anxiety symptoms and their comorbidities on the efficacy of CBT in pediatric OCD, as well as other potential moderators that may be associated with outcomes. Method: An exhaustive literature search from 1983 to March 2021 located 22 published articles that applied cognitive-behavioral therapy (CBT) to pediatric OCD, producing a total of 26 treatment groups. Some of the moderator variables analyzed included age, gender, comorbidity baseline in anxiety, depression and obsession, and methodological quality. Results: Results showed that the psychological treatment of OCD achieves clinically significant effectiveness, both for measures of obsessions and compulsions (d+ = 2.030), and for anxiety (d+ = 0.613) and depression (d+ = 0.451). An explanatory model for the CY-BOCS effect sizes showed that three moderator variables were statistically related: the mean of the CY-BOCS (Children’s Yale Brown Obsessive Compulsive Scale) in pretest, the effect size for anxiety, and the mean age of the sample. Conclusions: CBT reduced obsessive-compulsive symptoms and, to a lesser extent, anxiety and depression symptoms. Since anxiety symptoms are reduced with the same therapy, resources would be saved compared to other treatments.(AU)

Antecedentes: Aunque algunos metanálisis han identificado posibles moderadores asociados con los resultados del tratamiento en el trastorno obsesivo compulsivo (TOC) pediátrico, todavía no existe consenso sobre la influencia de los síntomas de ansiedad y depresión en la recuperación de éste. Se realizó un metanálisis para investigar los efectos de los síntomas ansioso-depresivos y sus comorbilidades sobre la eficacia de la TCC en el TOC pediátrico, así como otras posibles variables moderadoras que pudieran estar asociados con el resultado. Método: Realizamos una búsqueda exhaustiva de la literatura desde 1983 hasta marzo de 2021 que nos permitió localizar 22 artículos publicados que aplicaban la terapia cognitivo-conductual (TCC) en el TOC pediátrico, produciendo un total de 26 grupos de tratamiento. Algunas variables moderadoras analizadas fueron: edad, sexo, comorbilidad, linea base en ansiedad, depresión y obsesion-compulsión, calidad metodológica. Resultados: Los resultados mostraron que el tratamiento psicológico del TOC consigue una eficacia clínicamente relevante, tanto para las medidas de obsesiones y compulsiones (d+= 2.030), como para la ansiedad (d+= 0,613) y la depresión (d+= 0,451). Un modelo explicativo para los tamaños del efecto CY-BOCS (Escala obsesiva compulsiva de Yale-Brown para niños) reveló que tres variables moderadoras estaban relacionadas estadísticamente: la media del CY-BOCS en el pretest, el tamaño del efecto para la ansiedad y la media de edad de la muestra. Conclusiones: La TCC redujo los síntomas obsesivo-compulsivos y, en menor medida, los síntomas de ansiedad y depresión. Dado que los síntomas de ansiedad se reducen con la misma terapia, se ahorrarían recursos con respecto a la implementación y adición de otros tratamientos.(AU)

Overviews of Reviews: Concept and Development / Meta-Revisiones: Concepto y Desarrollo

Background: In the last years, overviews of systematic reviews, orumbrella reviews, have seen a dramatic increase in their use. An overviewaims to provide a summary of the included reviews and will often examineresearch questions beyond those addressed in the systematic reviews beingsynthesised. The purpose of this article is to provide some recommendationson how overviews should be conducted and reported. Method: A literaturereview was performed to identify relevant papers on both methodologicaland applied overviews. Results: The current literature recommendscarrying out overviews by following similar steps to those of systematicreviews: (a) Defining the overview research question; (b) inclusion andexclusion criteria; (c) literature search; (d) data extraction; (e) assessmentof risk of bias and reporting quality; (f) overview results; and (g) reportingthe overview. Of special interest is how to address dependencies betweenthe systematic reviews. Conclusions: Overviews allow evidence to beefficiently combined from multiple systematic reviews. This offers thepossibility of translating and summarizing large amounts of information.As in primary studies and systematic reviews, conducting and reporting ofoverviews must meet appropriate quality standards.

Antecedentes: en los últimosaños, las meta-revisiones, o revisiones paraguas, han incrementadoexponencialmente su uso. Una meta-revisión proporciona un resumende las revisiones incluidas y, a menudo, aborda preguntas más allá de lasplanteadas en las revisiones sistemáticas sintetizadas. El propósito de esteartículo fue proporcionar recomendaciones sobre cómo deben hacerse yreportarse las meta-revisiones. Método: se llevó a cabo una revisión dela literatura para identificar artículos relevantes sobre meta-revisiones,tanto metodológicos como aplicados. Resultados: a día de hoy la literaturasobre meta-revisiones recomienda seguir los mismos pasos que en lasrevisiones sistemáticas: (a) definición de la pregunta de investigación;(b) criterios de inclusión y exclusión; (c) búsqueda de la literatura; (d)extracción de datos; (e) valoración del riesgo de sesgo y de la calidad delreporte; (f) presentación de resultados; y (g) reporte de la meta-revisión.De especial interés es cómo abordar los problemas de dependencia entrelas revisiones sistemáticas sintetizadas. Conclusiones: las meta-revisionespermiten combinar evidencia de múltiples revisiones sistemáticas de unaforma eficiente. Esto permite transformar y resumir grandes cantidadesde información. Al igual que en los estudios primarios y las revisionessistemáticas, las meta-revisiones deben realizarse y reportarse cumpliendocon estándares mínimos de calidad.

A Reliability Generalization Meta-analysis of the Dimensional Obsessive-Compulsive Scale.

BACKGROUND: The Dimensional Obsessive-Compulsive Scale (DOCS) is a well-established tool for assessing obsessive-compulsive symptomatology. A reliability generalization meta-analysis was conducted to estimate the average reliability of DOCS scores and how reliability estimates vary according to the composition and variability of samples, to identify study characteristics that can explain its variability, and to estimate the reliability induction rate. METHOD: A literature search produced 86 studies that met the inclusion criteria. RESULTS: For the DOCS total scores, an average alpha coefficient of .925 was found (95% CI [.920,.931]), as well as mean alphas of .881, .905, .913, and .914 for Contamination, Responsibility, Unacceptable Thoughts, and Symmetry subscales, respectively. Moderator analysis showed that internal consistency fell significantly the more clinical and subclinical participants there were in the sample, and the larger the mean score in the sample for the total scores. The most important moderator variables for the subscales were the standard deviation and the mean of the scores. CONCLUSIONS: The DOCS scores exhibited excellent internal consistency reliability for both total score and subscale scores and DOCS is suitable both for research and clinical purposes.

Concentrations of bisphenol-A in adults from the general population: A systematic review and meta-analysis.

BACKGROUND: Human bisphenol-A (BPA) exposure has been linked to adverse health effects even at low doses, which may be of potential public health concern. OBJECTIVE: To summarize BPA concentrations in general human population and their variability according to sex, geographic area, and analytical method. METHODS: Systematic review and meta-analysis of studies reporting BPA concentrations in adult human populations. Separate meta-analyses of median values were carried out for BPA in serum, creatinine-adjusted urinary BPA, and unadjusted urinary BPA concentrations using a random-effects model. Cochran's Q-statistic, I2 index, 95% prediction intervals (PIs), between-studies standard deviation (τ), and forest plots were applied to verify study heterogeneity. Sensitivity and subgroup analyses and weighted ANOVAs and meta-regressions were conducted. Funnel plots and Egger's tests were used to examine publication bias. RESULTS: Fifteen studies were included in the meta-analysis, totaling 28,353 participants. BPA was detected in over 90% of participants. The pooled creatinine-adjusted urinary BPA concentration was 1.76 µg/g (95% PI: 0.79-2.73), with individual estimates ranging between 1.20 and 2.41. The pooled estimate for unadjusted urinary BPA was 1.91 µg/l (95% PI: 0-3.97), ranging between 0.81 and 3.50, while the pooled estimate for serum BPA was 1.75 µg/l (95% PI: 0-10.58), ranging between 0.34 and 3.76. No differences were found by sex, geographic area or analytical technique. Larger sample sizes were associated with lower BPA concentrations. There was large heterogeneity across studies, whereas data for urinary BPA levels suggested a publication bias affecting research in low exposed populations. CONCLUSION: This first meta-analysis of human BPA concentrations highlights a widespread population exposure to BPA. Although there was high heterogeneity across studies, the expected range of estimated human BPA concentrations suggests that potential health risks are unlikely. Further studies are warranted to better characterize the epidemiology of human BPA exposure, accounting for ethnic, geographic, individual and environmental variability.

Improving the reporting quality of reliability generalization meta-analyses: The REGEMA checklist.

Reliability generalization (RG) is a meta-analytic approach that aims to characterize how reliability estimates from the same test vary across different applications of the instrument. With this purpose RG meta-analyses typically focus on a particular test and intend to obtain an overall reliability of test scores and to investigate how the composition and variability of the samples affect reliability. Although several guidelines have been proposed in the meta-analytic literature to help authors improve the reporting quality of meta-analyses, none of them were devised for RG meta-analyses. The purpose of this investigation was to develop REGEMA (REliability GEneralization Meta-Analysis), a 30-item checklist (plus a flow chart) adapted to the specific issues that the reporting of an RG meta-analysis must take into account. Based on previous checklists and guidelines proposed in the meta-analytic arena, a first version was elaborated by applying the nominal group methodology. The resulting instrument was submitted to a list of independent meta-analysis experts and, after discussion, the final version of the REGEMA checklist was reached. In a pilot study, four pairs of coders applied REGEMA to a random sample of 40 RG meta-analyses in Psychology, and results showed satisfactory inter-coder reliability. REGEMA can be used by: (a) meta-analysts conducting or reporting an RG meta-analysis and aiming to improve its reporting quality; (b) consumers of RG meta-analyses who want to make informed critical appraisals of their reporting quality, and (c) reviewers and editors of journals who are considering submissions where an RG meta-analysis was reported for potential publication.

The heritability of insomnia: Systematic review and meta-analysis of twin studies.

Twin studies have consistently found that genetic factors explain a substantial proportion of the variance for insomnia. However, studies vary widely in their heritability estimates. Therefore, this meta-analysis aimed to: 1) Estimate the mean heritability of insomnia; 2) Assess heterogeneity among twin studies of insomnia; and 3) Search and analyse characteristics of the studies (moderator variables) that may explain heterogeneity among estimates. For this purpose, separate meta-analyses were carried out for MZ and DZ correlations and for heritability estimates by assuming random-effects models. Thirteen independent samples were included in this meta-analysis. The heterogeneity index for heritability estimates was significant in both best fitting models (I2 = 98.77, P < .0001) and full models (I2 = 97.80, P < .0001). MZ correlations were higher (0.37; 95%CI: 0.31,.43) than DZ correlations (0.15; 95%CI: 0.12,.18). A mean heritability of 0.39 (95%CI: 0.32,.44) was found for insomnia. These results highlight the role of genetic factors in explaining differences among the population on insomnia and Emphasize heterogeneity among studies. Further research is needed to identify variables that could explain this heterogeneity.

Sleep Quality, Mental and Physical Health: A Differential Relationship.

This study aimed to explore the association between sleep quality and its components and both dimensions of health-related quality of life (HRQoL) in a sample of young adults. The sample comprised 337 participants with a mean age of 19.6 y (SD = 2.22). Sleep quality and HRQoL were measured through the Pittsburgh Sleep Quality Index and the SF-12, respectively. Regression analyses were used to investigate the association between sleep quality and HRQoL. Our results confirm the significant association between sleep quality and both physical (p = 0.015; ß = -0.138; R2 = 0.07) and mental (p < 0.001; ß = -0.348; R2 = 0.22) HRQoL in the adjusted models. However, our results also highlight the differential association between sleep quality and mental and physical HRQoL. Whereas all the sleep quality components (except sleep latency; p = 0.349) were significantly associated with mental HRQoL (p < 0.05), just two subscales (subjective sleep quality; p = 0.021; ß = -0.143 and sleep disturbances p = 0.002; ß = -0.165) showed a significant association. This study showed that there is a stronger association between sleep quality and mental health than sleep quality and physical health in young adults.

The Association Between the Number of Neuropsychological Measures and the Base Rate of Low Scores.

Obtaining one or more low scores, or scores indicative of impairment, is common in neuropsychological batteries that include several measures even among cognitively normal individuals. However, the expected number of low scores in batteries with differing number of tests is unknown. Using 10 neuropsychological measures from the National Alzheimer's Coordinating Center database, 1,023 permutations were calculated from a sample of 5,046 cognitively normal individuals. The number of low scores (i.e., z score ≤-1.5) varied for the same number of measures and among different number of measures and did not increase linearly as the number of measures increased. According to the number of low scores shown by fewer than 10% of the sample, cognitive impairment should be suspected for 1 or more, 2 or more, and 3 or more in batteries with up to 2 measures, 3 to 9 measures, and 10 measures, respectively. These results may increase the identification of mild cognitive impairment.

The association of telomere length with substance use disorders: a systematic review and meta-analysis of observational studies.

BACKGROUND AND AIMS: Several recent studies have investigated the relationship between telomere length and substance use disorders with inconsistent results. We aimed to assess this association and to identify moderators of the relationship. METHODS: Systematic review and meta-analysis. Selection criteria were observational studies reporting telomere length in people with a substance use disorder compared with a control group. Studies focused solely on nicotine addiction, employing other study designs, and non-human studies were excluded. Study selection and data extraction were independently conducted by two researchers following a standardized protocol and included studies until December 2019. Standardized mean differences were used as the effect size index [d; 95% confidence interval (CI)] and random-effects models were used for the meta-analysis. Cochran's Q-statistic, I2 index, visual inspection of the forest plot and a 95% prediction interval were applied to verify study heterogeneity. Subgroup analyses and meta-regressions were conducted to explore heterogeneity. Small study effects were examined using the 'funnel plot', the Egger test, Duval & Tweedie's trim-and-fill method and the precision-effect test-precision-effect estimate with standard error (PET-PEESE) method. The risk of bias and the quality of evidence were assessed. RESULTS: Ten studies (12 analysis units with 2671 cases and 4532 controls) met the selection criteria. An overall effect size of moderate magnitude was found (d+  = -0.63; 95% CI = -1.00 and -0.26; P = 0.0008). A potential small study effect was detected, as well as large heterogeneity between studies (Q-statistic P < 0.001, I2  = 97.3%). Selection of controls, reporting laboratory quality control procedures and total sample size significantly affected the effect size. The quality of the evidence was very low, based on risk of bias analysis and the grading of recommendations assessment, development and evaluation (GRADE) system. CONCLUSIONS: People with substance use disorders appear to have shorter telomere length than controls; however, this finding should be interpreted with caution due to the poor quality of the evidence.

Neurocognitive Functioning and Suicidal Behavior in Violent Offenders with Schizophrenia Spectrum Disorders.

Suicide is one of the main premature causes of death in patients with schizophrenia. However, little is known about the relationship between neurocognitive functioning and suicidality in violent offenders with schizophrenia who have been sentenced to psychiatric treatment after committing violent crimes. We examined the neurocognitive functioning of a sample of 61 violent offenders, most of them murderers with schizophrenia who were classified as suicide attempters (n = 26) and non-attempters (n = 35). We compared the neurocognitive functioning of both groups using a neuropsychological battery. Suicide attempters showed similar performance to non-attempters in a neuropsychological test across all domains of cognitive functioning, memory, attention, verbal fluency, and executive functioning. However, after controlling for demographic and clinical variables, suicide attempters performed better than non-attempters in two planning-related tasks: the Tower of London (p < 0.01) and the Zoo Map (p < 0.01). Suicide attempters were also characterized as having more family histories of suicidality and as displaying more depressive symptoms and negative symptoms of psychopathology on the Positive and Negative Syndrome Scale (PANSS) scale. These results suggest that suicide attempters have a greater ability to formulate plans and initiate goals directed at making a suicide attempt.

Suicidio y demencia: revisión sistemática y metaanálisis / Suicide and dementia: systematic review and meta-analysis

INTRODUCCIÓN: Analizar la posible relación entre demencia en el anciano y el posterior desarrollo de ideas, intentos y/o suicidios consumados. MÉTODOS: Revisión sistemática y metaanálisis. Criterios de selección: estudios que analizaran la relación entre demencia y suicidio. Estrategia de búsqueda: i) en PubMed, EMBASE, CINAHL, IME y LILACS hasta diciembre de 2018; ii) búsqueda manual de la bibliografía de artículos seleccionados; iii) contacto con principales autores. Revisión independiente por pares para la selección de artículos y extracción de datos según protocolo de registro, incluyendo la evaluación del riesgo de sesgos. Cálculo del índice del tamaño del efecto mediante razón de ventajas (RV) y su intervalo de confianza del 95% (IC 95%) (modelo de efectos aleatorios). La heterogeneidad se evaluó con forest plots, Q de Cochran e índice I2. Valoración del sesgo de publicación mediante funnel plots (método «trim-and-fill») y el test de Egger. El análisis de variables moderadoras se realizó mediante un modelo de metarregresión múltiple de efectos mixtos. RESULTADOS: Se identificaron 37 estudios y 47 unidades básicas de estudio. Tamaño del efecto de la asociación de demencia con: ideación suicida RV=1,37 (IC 95%: 0,78-2,39); intento de suicidio: RV=2,24 (IC 95%: 1,01-4,97); y suicidio consumado: RV=1,28 (IC 95%: 0,77-2,14). Se descartó un posible sesgo de publicación. CONCLUSIONES: Se identifica una tendencia hacia la aparición de eventos suicidas, especialmente intento de suicidio en personas con demencia. Sería recomendable una mayor atención y cuidado tras un diagnóstico reciente de demencia, especialmente con adecuada valoración de comorbilidades, que pudieran influir en aparición y desenlace de eventos suicidas

INTRODUCTION: To analyse the possible relationship between dementia in the elderly and the subsequent development of suicide ideation, attempts and / or completed suicides. METHODS: Systematic review and meta-analysis. Selection criteria: studies that analysed the relationship between dementia and suicide. Search strategy: i) in PubMed, EMBASE, CINAHL, IME and Lilacs until December 2018; ii) manual search of the bibliography of selected articles; iii) contact with leading authors. Article selection and data extraction according to a predefined protocol, including bias risk assessment, were performed by independent peer reviewers. The effect size index was calculated using Odds Ratio (OR) and its 95% confidence interval (random-effects model). Heterogeneity was evaluated with forest plots, Cochran's Q and I2 index. Assessment of publication bias using funnel plots ("trim-and-fill" method) and the Egger test. The analysis of moderating variables was performed using a multiple meta-regression under a mixed-effects model. RESULTS: 37 studies and 47 basic units of study were identified. Effect size of the association of dementia with: Suicidal Ideation OR = 1.37 (95% CI: .78-2.39); Suicide Attempt: OR = 2.24 (95% CI: 1.01-4.97); and Completed Suicide: OR = 1.28 (95% CI: .77-2.14). Possible publication bias was ruled out. CONCLUSIONS: A trend towards suicidal events is identified, especially suicide attempts in people with dementia. Greater attention and care are recommended after a recent diagnosis of dementia, especially with adequate assessment of comorbidities, which could influence the occurrence and outcome of suicidal events

The Medical Outcome Study-HIV Health Survey: A systematic review and reliability generalization meta-analysis.

The Medical Outcome Study-HIV Health Survey (MOS-HIV) is one of the most used questionnaires for the evaluation of the health-related quality of life (HRQoL) in people living with HIV (PLWHIV) in both medical settings and research studies. This study aimed to estimate the average reliability of the MOS-HIV scores and to evaluate the characteristics of the studies that could explain the variability between reliability estimates. Furthermore, the study aimed to estimate the induction rate of the reliability of the MOS-HIV. A systematic review of the previous literature, including studies that reported α and/or test-retest coefficients with the data at hand for the total score of the MOS-HIV and the subscales, was conducted. Fifty studies (52 samples; N = 14,132) were included in the reliability generalization meta-analysis. The average α coefficient for the total score of MOS-HIV was .91 and above .80 for all of the subscales, except for role functioning, which had an average coefficient of .76. Different study dimensions were related to the heterogeneity of reliability between studies. Reliability induction was found to be 76.1%. The results obtained in the present study indicate that the MOS-HIV is a reliable instrument for HRQoL evaluation in PLWHIV, for clinical and research purposes. In the clinical practice of health services, nurses could employ this gold standard for reliable evaluations of HRQoL in PLWHIV.

Suicide and dementia: Systematic review and meta-analysis. / Suicidio y demencia: revisión sistemática y metaanálisis.

INTRODUCTION: To analyse the possible relationship between dementia in the elderly and the subsequent development of suicide ideation, attempts and / or completed suicides. METHODS: Systematic review and meta-analysis. SELECTION CRITERIA: studies that analysed the relationship between dementia and suicide. SEARCH STRATEGY: i) in PubMed, EMBASE, CINAHL, IME and Lilacs until December 2018; ii) manual search of the bibliography of selected articles; iii) contact with leading authors. Article selection and data extraction according to a predefined protocol, including bias risk assessment, were performed by independent peer reviewers. The effect size index was calculated using Odds Ratio (OR) and its 95% confidence interval (random-effects model). Heterogeneity was evaluated with forest plots, Cochran's Q and I2 index. Assessment of publication bias using funnel plots ("trim-and-fill" method) and the Egger test. The analysis of moderating variables was performed using a multiple meta-regression under a mixed-effects model. RESULTS: 37 studies and 47 basic units of study were identified. Effect size of the association of dementia with: Suicidal Ideation OR = 1.37 (95% CI: .78-2.39); Suicide Attempt: OR = 2.24 (95% CI: 1.01-4.97); and Completed Suicide: OR = 1.28 (95% CI: .77-2.14). Possible publication bias was ruled out. CONCLUSIONS: A trend towards suicidal events is identified, especially suicide attempts in people with dementia. Greater attention and care are recommended after a recent diagnosis of dementia, especially with adequate assessment of comorbidities, which could influence the occurrence and outcome of suicidal events.