Environmental pollutants as risk factors for autism spectrum disorders: a systematic review and meta-analysis of cohort studies.

BACKGROUND: Autism Spectrum Disorder (ASD) is a lifelong neurodevelopmental condition affecting communication, social interaction, and behavior. Evidence suggests that environmental pollutants are associated with ASD incidence. This review aimed to analyze the effect of environmental pollutants on ASD. METHODS: Systematic review and meta-analysis of cohort studies evaluated the association between exposure to environmental pollutants and ASD. We searched COCHRANE CENTRAL, MEDLINE, CINAHL, LILACS, EMBASE, PsycINFO, Web of Science, SciELO, and gray literature from inception to January 2023. The model used for meta-analysis was inverse variance heterogeneity (IVhet). The effect measures were the beta coefficient (ß) and the relative risk (RR) with their 95% confidence intervals (95% CI). Sensitivity analyses were carried out using an instrument to screen or diagnose autism. RESULTS: A total of 5,780 studies were identified; 27 were included in the systematic review, and 22 were included in the meta-analysis. These studies included 1,289,183 participants and 129 environmental pollutants. Individual meta-analyses found a significant association between nitrogen dioxide RR = 1.20 (95% CI: 1.03 to 1.38; I2: 91%), copper RR = 1.08 (95% CI: 1.03 to 1.13; I2: 0%), mono-3-carboxy propyl phthalate ß = 0.45 (95% CI: 0.20 to 0.70; I2: 0%), monobutyl phthalate ß = 0.43 (95% CI: 0.13 to 0.73; I2: 0%) and polychlorinated biphenyl (PCB) 138 RR = 1.84 (95% CI: 1.14 to 2.96; I2:0%) with ASD. Subgroup meta-analyses found a significant association with carbon monoxide RR = 1.57 (95% CI: 1.25 to 1.97; I2: 0%), nitrogen oxides RR = 1.09 (95% CI: 1.04 to 1.15; I2: 34%) and metals RR = 1.13 (95% CI: 1.01 to 1.27; I2:24%). CONCLUSION: This study found positive associations nitrogen dioxide, copper, mono-3-carboxypropyl phthalate, monobutyl phthalate, and PCB 138, and the development of ASD, likewise, with subgroups of pollutants carbon monoxide, nitrogen oxides, and metals. Therefore, it is important to identify these risk factors in children and adolescents to contribute to ASD and identify prevention strategies effectively.

Efficacy of Remote Psychological Interventions for Patients with Anxiety and Depression Symptoms: Systematic Review and Meta-Analysis.

Background: Anxiety and depression are common mental disorders that are highly prevalent worldwide. Clinical trials have found that telehealth interventions result in increased accessibility and improved mental treatment effectiveness. However, a few comprehensive syntheses of evidence from randomized clinical trials that have been conducted to evaluate remote psychological vs face-to-face interventions for anxiety and depression are not conclusive. The objective of this work was to evaluate the efficacy of remote psychological interventions for patients with anxiety and depression symptoms. Methods: Randomized clinical trials with the following criteria were included: participants aged ≥5 years, of both sexes, and who underwent psychological therapy to treat anxiety and or depression symptoms. They were randomized to receive the same psychological treatment remotely or face-to-face. Review studies, animal studies, pilot studies, and studies with patients diagnosed with chronic diseases were excluded. Searches were performed on March 2024 in the following databases: MEDLINE, EMBASE, LILACS, CENTRAL, CINAHL, Web of Science, SciELO, APA PsycINFO, and Scopus. The meta-analysis was conducted using the random-effects model, and the standardized mean difference with the 95% confidence interval (CI) was used to estimate the effect. Results: Six studies were included in this systematic review. The meta-analysis showed no statistically significant difference when comparing remote or face-to-face treatment for depression (SMD of -0.10 [95% CI: -0.57 to 0.37; I2: 77%]) and anxiety (SMD of -0.06 [95% CI: -0.34 to 0.21; I2: 0%]) symptoms. Conclusion: Our meta-analysis indicates that remote psychotherapy demonstrates comparable efficacy to face-to-face care in mitigating symptoms of depression and anxiety. It allows patients to select the best modality for their daily routines, promoting greater engagement and adherence to treatment.

The role of environmental pollutants in body composition: Systematic review and meta-analysis.

The effects of environmental pollution are associated with higher rates of mortality, morbidity, and years of life lost. It is known that these produce alterations in the human body, including changes in body composition. Research has focused on the association between contaminants and BMI through cross-sectional studies. The objective of this study was to synthesize the evidence for the association of pollutants on different measures of body composition. The PECOS strategy was defined, in which "P": participants of any age, sex, or ethnicity, "E": a higher level of environmental pollution, "C": a lower level of environmental pollution, "O": body composition measurements and "S": longitudinal studies. Studies from the following databases were included: MEDLINE, EMBASE, SciELO, LILACS, Scopus, Web of Science, SPORTDiscus, and gray literature from inception to January 2023.3069 studies were identified, 18 were included in the systematic review, and 13 in the meta-analysis. These studies included 8.563 people, 47 environmental contaminants, and 16 measures of body composition. The meta-analysis by subgroup found that the association between dioxins, furans, PCBs, and waist circumference was ß = 1.0 (95% CI: 0.85 to 1.16; I2: 95%), and the sum of four skinfolds ß = 1.02 (95% CI: 0.88 to 1.16; I2: 24%). The association between pesticides and waist circumference was ß = 1.00 (95% CI: 0.68 to 1.32; I2: 98%), and the fat mass was ß = 0.99 (95% CI: 0.17 to 1.81; I2: 94%). Pollutants, especially endocrine-disrupting chemicals, among which dioxins, furans, PCBs, and pesticides, are associated with changes in body composition, mainly with waist circumference and the sum of four skinfolds.

Effect of Educational Interventions to Reduce Readmissions due to Heart Failure Decompensation in Adults: a Systematic Review and Meta-analysis.

OBJECTIVES: To estimate the combined effect of educational interventions (EI) on decreased readmissions and time of hospital stay in adults with heart failure, compared with usual care. METHODS: Systematic review (SR) and meta-analysis (MA) of randomized controlled trials that followed the recommendations of the PRISMA statement. The protocol was registered on PROSPERO (CRD42019139321). Searches were made from inception until July 2019 in the databases of PubMed/Medline, Embase, Cochrane CENTRAL, Lilacs, Web of Science, and Scopus. The MA was conducted through the random effects model. The effect measure used for the dichotomous outcomes was relative risk (RR) and for continuous outcomes the mean difference (MD) was used, with 95% confidence intervals (CI). Heterogeneity was evaluated through the inconsistency statistic (I2). RESULTS: Of 2369 studies identified, 45 were included in the SR and 43 in the MA. The MA of studies with follow-up at six months showed a decrease in readmissions of 30% (RR: 0.70; 95% CI: 0.58 to 0.84; I2: 0%) and the 12-month follow-up evidenced a reduction of 33% (RR: 0.67; 95% CI: 0.58 to 0.76; I2: 52%); both analyses in favor of the EI group. Regarding the time of hospital stay, a reduction was found of approximately two days in patients who received the EI (MD: -1.98; 95% CI: -3.27 to -0.69; I2: 7%). CONCLUSIONS: The findings support the benefits of EI to reduce readmissions and days of hospital stay in adult patients with heart failure.

Intervenciones educativas para reducir mortalidad y aumento de calidad de vida en adultos con insuficienciacardiaca: revisión sistemática y metaanálisis / Educational interventions to reduce the mortality and increase the quality of life in adults with heart failure

Objetivo: estimar el efecto de estudios de intervenciones educativas (IE) en la reducción de la mortalidad y el aumento en la calidad de vida (CV) en adultos con insuficiencia cardiaca, comparado con el cuidado estándar. Método: revisión sistemática (RS) y metaanálisis (MA) de ensayos clínicos aleatorizados que siguió las recomendaciones de la declaración PRISMA. El protocolo fue registrado en PROSPERO (CRD42019139321). Las búsquedas se realizaron en PubMed/Medline, Embase, Cochrane CENTRAL, Lilacs, Web of Science y Scopus, desde el inicio hasta julio de 2019. El MA fue realizado mediante modelo de efectos aleatorios. La medida de efecto utilizada para el desenlace de mortalidad fue el riesgo relativo (RR) y para el desenlace de CV se usó la diferencia de medias (DM), con intervalos de confianza (IC) del 95%. La heterogeneidad fue evaluada mediante el estadístico de inconsistencia (I2). Resultados: de 2.369 estudios identificados se incluyeron 58 trabajos. Para el resultado de mortalidad, el MA con seguimiento ≥ 12 meses evidenció una reducción de la mortalidad del 26% (RR: 0,74; IC 95%: 0,66-0,83; I2: 0%) a favor del grupo IE. Para el desenlace de CV (cuestionario Minnesota Living with Heart Failure Questionnaire), el MA con seguimiento ≤ 3 meses mostró un aumento en la CV a favor del grupo IE, con una diferencia relevante en la puntuación de casi 7 puntos (DM: -6,77; IC 95%: -9,85, -3,69; I2: 23%). Conclusiones: los hallazgos demuestran el efecto protector que tienen las IE para reducir la mortalidad y aumentar la CV de pacientes adultos con insuficiencia cardiaca.(AU)

Objective: to estimate the effect of educational intervention (EI) studies on the reduction of mortality and the increase in quality of life (QoL) in adults with heart failure, compared with standard care. Method: a systematic review (SR) and meta-analysis (MA) of randomized clinical trials, following the recommendations of the PRISMA declaration. The protocol was registered in PROSPERO (CRD42019139321). Searches were conducted in PubMed/Medline, Embase, Cochrane CENTRAL, Lilacs, Web of Science and Scopus since the start of the year and until July 2019. The MA was conducted through random effects model. The measure of effect used for the mortality outcome was Relative Risk (RR), and the mean difference (MD) was used for the QoL outcome, with 95% confidence interval (CI). Heterogeneity was assessed through inconsistency statistics (I2). Results: fifty-eight (58) studies were included out of the 2.369 studies identified. For the mortality outcome, the MA with follow-up at ≥ 12 months, there was a 26% reduction in mortality (RR: 0.74; CI 95%: 0.66-0.83; I2: 0%) in favour of the EI group. For the QoL outcome (Minnesota Living with Heart Failure Questionnaire), the MA with follow-up at ≤ 3 months showed an increase in QoL in favour of the EI group, with a relevant difference in score by almost 7 points (MD: -6.77; CI 95%: -9.85, -3.69; I2: 23%). Conclusions: the findings demonstrated the protective effect of EIs for reducing mortality and increasing the QoL of adult patients with heart failure.(AU)

Effect of Educational Interventions to Reduce Readmissions due to Heart Failure Decompensation in Adults: a Systematic Review and Meta-analysis / Efecto de intervenciones educativas para reducir readmisiones debido a descompensación de falla cardiaca en adultos: una revisión sistemática y meta-análisis / Efecto de intervenciones educativas para reducir readmisiones debido a descompensación de falla cardiaca en adultos: una revisión sistemática y meta-análisis

Objective. To estimate the combined effect of educational interventions (EI) on decreased readmissions and time of hospital stay in adults with heart failure, compared with usual care. Methods. Systematic review (SR) and meta-analysis (MA) of randomized controlled trials that followed the recommendations of the PRISMA statement. The protocol was registered on PROSPERO (CRD42019139321). Searches were made from inception until July 2019 in the databases of PubMed/Medline, Embase, Cochrane CENTRAL, Lilacs, Web of Science, and Scopus. The MA was conducted through the random effects model. The effect measure used for the dichotomous outcomes was relative risk (RR) and for continuous outcomes the mean difference (MD) was used, with 95% confidence intervals (CI). Heterogeneity was evaluated through the inconsistency statistic (I2). Results. Of 2369 studies identified, 45 were included in the SR and 43 in the MA. The MA of studies with follow-up at six months showed a decrease in readmissions of 30% (RR: 0.70; 95% CI: 0.58 to 0.84; I2: 0%) and the 12-month follow-up evidenced a reduction of 33% (RR: 0.67; 95% CI: 0.58 to 0.76; I2: 52%); both analyses in favor of the EI group. Regarding the time of hospital stay, a reduction was found of approximately two days in patients who received the EI (MD: -1.98; 95% CI: -3.27 to -0.69; I2: 7%). Conclusion. The findings support the benefits of EI to reduce readmissions and days of hospital stay in adult patients with heart failure.

Objetivo. Estimar el efecto combinado de las intervenciones educativas (IE) en la disminución de readmisiones y tiempo de estancia hospitalaria en adultos con falla cardiaca comparado con el cuidado usual. Métodos. Revisión Sistemática (RS) y meta-análisis (MA) de ensayos clínicos aleatorizados que siguieron las recomendaciones de la declaración PRISMA. El protocolo se registró en PROSPERO (CRD42019139321). Se realizaron búsquedas desde el inicio hasta julio de 2019, en las bases de datos PubMed/Medline, Embase, Cochrane CENTRAL, Lilacs, Web of Science y Scopus. El MA se realizó mediante modelo de efectos aleatorios. La medida de efecto utilizada para los desenlaces dicotómicos fue el riesgo relativo (RR) y para desenlaces continuos se usó la diferencia de medias (DM), con sus intervalos de confianza (IC) del 95%. La heterogeneidad se evaluó mediante el estadístico de inconsistencia (I2). Resultados. De 2369 estudios identificados, 45 se incluyeron en la RS y 43 en el MA. El MA de estudios con seguimiento a seis meses mostró una disminución en las readmisiones de 30% (RR: 0.70; IC 95%: 0.58 a 0.84; I2: 0%) y el seguimiento a doce meses evidenció una reducción de 33% (RR: 0.67; IC 95%: 0.58 a 0.76; I2: 52%), ambos análisis a favor del grupo de IE. Referente al tiempo de estancia hospitalaria, se encontró una reducción de aproximadamente dos días en los pacientes que recibieron las IE (DM: -1.98; IC 95%: -3.27 a -0.69; I2: 7%). Conclusión. Los hallazgos soportan los beneficios de las IE para la disminución de readmisiones y días de estancia hospitalaria en pacientes adultos con falla cardiaca.

Objetivo. Estimar o efeito combinado de intervenções educacionais (IE) na redução de readmissões e tempo de internação em adultos com insuficiência cardíaca, em comparação com o cuidado usual. Métodos. Revisão sistemática (RS) e meta-análise (MA) de ensaios clínicos randomizados que seguiu as recomendações da declaração PRISMA. O protocolo foi registrado no PROSPERO (CRD42019139321). Foram realizadas buscas desde o início até julho de 2019, nas bases de dados PubMed/Medline, Embase, Cochrane CENTRAL, Lilacs, Web of Science e Scopus. A MA foi realizada usando um modelo de efeitos aleatórios. A medida de efeito utilizada para desfechos dicotômicos foi o risco relativo (RR) e para desfechos contínuos foi usada a diferença de médias (DM), com seus intervalos de confiança (IC) de 95%. A heterogeneidade foi avaliada por meio da estatística de inconsistência (I2). Resultados. De 2369 estudos identificados, 45 foram incluídos na RS e 43 na MA. A MA dos estudos com seguimento de seis meses mostrou uma diminuição nas readmissões de 30% (RR: 0.70; IC 95%: 0.58 a 0.84; I2: 0%) e o seguimento de doze meses mostrou uma redução de 33 % (RR: 0.67; IC 95%: 0.58 a 0.76; I2: 52%), ambas as análises em favor do grupo de IE. Em relação ao tempo de internação, foi observada uma redução de aproximadamente dois dias nos pacientes que receberam as IE (DM: -1.98; IC 95%: -3.27 a -0.69; I2: 7%). Conclusão. Os achados evidenciam os benefícios das IE para a redução de readmissões e dias de internação em pacientes adultos com insuficiência cardíaca.