Objective to systematically review randomized trials that compared methotrexate (MTX) monotherapy to MTX in combination with other non-biologic disease-modifying anti-rheumatic Drugs (DMARD) and to compare the performances of PubMed versus MEDLINE (Ovid®) and EMBASE. Methods We performed a systematic review of randomized trials comparing MTX alone and MTX in combination with other non-biologic DMARDs. Heterogeneity was investigated and explored. The performances of Pubmed and MEDLINE were evaluated. The EMBASE unique trials were identified and investigated. Results A total of 19 trials were included and grouped by the type of patients randomized. Trials in DMARD naive patients showed no significant advantage of the MTX combination versus monotherapy. The recall was 85% vs. 90% for Ovid and PubMed, respectively, while the precision and number-needed-to read of Ovid and Pubmed were comparable. Only 23% of trials were EMBASE unique trials Conclusions In DMARD naive patients, the balance of efficacy/toxicity favours MTX monotherapy.

BACKGROUND: MRI is increasingly being used for rectal cancer staging. The purpose of this study was to summarize published evidence to determine the accuracy of MRI for T-category, lymph node (LN) metastases, and circumferential resection margin (CRM) involvement in rectal cancer. METHODS: Sensitivity, specificity, and diagnostic odds ratios (DOR) were estimated using hierarchical summary receiver operating characteristics modeling and bivariate random effects modeling. RESULTS: MRI was more specific for CRM (94%, 95%CI 88-97) than for T-category (75%, 95%CI 68-80) and LN’s (71%, 95%CI 59-81) but was more sensitive for T-category (87%, 95%CI 81-92) than for CRM (77%, 95%CI 57-90) and LN’s (77%, 95%CI 69-84). DOR was higher for CRM (56.1, 95%CI 15.3-205.8) than for LN’s (8.3, 95%CI 4.6-14.7) and T-category (20.4, 95%CI 11.1-37.3). CONCLUSIONS: MRI has good accuracy for both CRM and T-category and should be considered for preoperative rectal cancer staging. In contrast, LN assessment is poor on MRI.

BACKGROUND: MRI is increasingly being used for rectal cancer staging. The purpose of this study was to summarize published evidence to determine the accuracy of MRI for T-category, lymph node (LN) metastases, and circumferential resection margin (CRM) involvement in rectal cancer. METHODS: Sensitivity, specificity, and diagnostic odds ratios (DOR) were estimated using hierarchical summary receiver operating characteristics modeling and bivariate random effects modeling. RESULTS: MRI was more specific for CRM (94%, 95%CI 88-97) than for T-category (75%, 95%CI 68-80) and LN’s (71%, 95%CI 59-81) but was more sensitive for T-category (87%, 95%CI 81-92) than for CRM (77%, 95%CI 57-90) and LN’s (77%, 95%CI 69-84). DOR was higher for CRM (56.1, 95%CI 15.3-205.8) than for LN’s (8.3, 95%CI 4.6-14.7) and T-category (20.4, 95%CI 11.1-37.3). CONCLUSIONS: MRI has good accuracy for both CRM and T-category and should be considered for preoperative rectal cancer staging. In contrast, LN assessment is poor on MRI.

Children’s risk for overweight and obesity is particularly high in rural areas of the United States. Many health, psychosocial, and economic consequences are associated with childhood overweight and obesity, which concerns health researchers and professionals. But how and why might rural children be more at risk for being overweight and obese? This dissertation investigates childhood overweight and obesity in rural settings through three separate studies. First, a systematic literature review was conducted to identify determinants and mechanisms of childhood obesity-related behaviors that are specific to rural locations. The findings from the review show that lack of health resources and poverty within the rural environment may impact children’s social environment and individual factors. However, results are inconclusive and there continues to be a lack of studies focusing on linking environmental influence with individual factors. Second, a meta-analysis of current research evidence was conducted to assess the efficacy of rural interventions designed to reduce childhood overweight and obesity. Results showed that interventions have been efficacious yet modest, with a mean effect size of 0.18. Moderating variables were also examined. Mean intervention effect size was moderated by children’s age and intervention duration. Last, secondary data were used to examine the association between rural food stores and availability and affordability of fresh fruits and vegetables. A multilevel analytical approach was used to determine if rural location was associated with availability and affordability of fresh fruits and vegetables. After controlling for other variables, results showed that rural location was not associated with fruit and vegetable availability and affordability. The findings from this dissertation suggest that the area of rural childhood overweight and obesity remains understudied. More research is needed in order to understand the mechanisms of social ecological influences on diet, physical activity, and childhood overweight and obesity. This area of research, however, is rife with opportunities for public health education and promotion. Public health educators can help promote and advocate for environmental conditions that support healthy lifestyles.

A variety of statistical models have been developed to examine longitudinal stability and change of individual differences. Kenny and Zautra’s (1995) trait-state-error (TSE) model models stability as a function of stable variance that does not change (trait), moderately stable variance that changes over time (state), and error variance. Applications of this model have been limited to panel studies with repeated observations of the same individual. The present study developed a non-linear regression model to apply the TSE model to retest correlations from different samples. This model was used to compare the stability of measures of personality traits, affective well-being (AWB), cognitive well-being (CWB), and self-esteem. After correcting for differences in reliability, age, gender, and scale length, the amount of trait (vs. state) variance was similar across constructs. Stability of the state component was highest for AWB and CWB, suggesting that situational influences have most enduring effects on these two constructs.

Objective to systematically review randomized trials that compared methotrexate (MTX) monotherapy to MTX in combination with other non-biologic disease-modifying anti-rheumatic Drugs (DMARD) and to compare the performances of PubMed versus MEDLINE (Ovid®) and EMBASE. Methods We performed a systematic review of randomized trials comparing MTX alone and MTX in combination with other non-biologic DMARDs. Heterogeneity was investigated and explored. The performances of Pubmed and MEDLINE were evaluated. The EMBASE unique trials were identified and investigated. Results A total of 19 trials were included and grouped by the type of patients randomized. Trials in DMARD naive patients showed no significant advantage of the MTX combination versus monotherapy. The recall was 85% vs. 90% for Ovid and PubMed, respectively, while the precision and number-needed-to read of Ovid and Pubmed were comparable. Only 23% of trials were EMBASE unique trials Conclusions In DMARD naive patients, the balance of efficacy/toxicity favours MTX monotherapy.

Semi-natural grasslands are species-rich and one of the most threatened habitats in Europe, since land-use changes have led to reduced area of grassland. Appropriate management practices like grazing or mowing is needed to maintain the conservation values and species-richness of semi-natural grasslands. However, few studies have investigated which of grazing or mowing is most appropriate. Furthermore, almost no studies have investigated which mowing technique is best for the conservation value of grassland flora. The aim of this study was to determine which management practice of grazing and mowing, and which mowing technique, has the most positive effect on grassland flora. Data from two long-term trials were evaluated: one compared the effect of grazing and mowing in eleven sites in southern Sweden during at least twelve years; the other compared the effect of the knife mower and grass trimmer at different cutting heights in one site during twelve years. Meta-analysis was used, based on the odds for a plant record being an indicator species, using eight different indicator systems of classification of grassland plants. Over time, results show increasing odds of finding indicators of good management and no change in odds of finding indicators of lack of management in mowed compared to grazed plots. There were no differences in the odds of finding any indicator species for any of the mowing techniques. Hence, to maintain the conservation values of semi-natural grasslands, mowing is the better management practice compared to grazing. Mowing using a knife mower or grass trimmer has similar effects, and can both be recommended.

De acuerdo con la literatura científica, la frecuencia del acortamiento de los isquiotibiales, está relacionado con factores genéticos, hábitos diarios y actividades deportivas. Sin embargo, con las numerosas metodologías de tratamiento propuestas en la literatura se hace difícil establecer cuál de ellas resulta ser la más efectiva. En este trabajo se llevó a cabo meta-análisis sobre la eficacia de los tratamientos para la ganancia de flexibilidad en los músculos isquiotibiales. La búsqueda de la literatura permitió identificar 41 estudios, 39 publicados y 2 no publicados, entre 1930 y 2007, que cumplieron con los criterios de inclusión, totalizando 85 comparaciones entre grupo tratado y control. El índice del tamaño del efecto utilizado fue la diferencia de medias estandarizada. Los tratamientos obtuvieron una efectividad estadísticamente significativa (d+ = 1,054). El estiramiento muscular, más la combinación de estiramiento más calentamiento resultaron ser los tratamientos más efectivos. La relación entre el tamaño del efecto con las demás variables de tratamiento, de sujeto, metodológicas y extrínsecas, también fueron examinadas. El sesgo de publicación no fue una amenaza contra la validez de los resultados. Los tratamientos son más eficaces cuando: son empleados en sujetos del género femenino; cuanto más jóvenes sean los sujetos; y cuando se utiliza un número mayor de semanas de tratamiento. / According to the scientific literature, the frequency of the shortened hamstring, is related to genetic factors, daily habits and sports activities. In spite of the found treatment methodologies diversity is difficult to establish which of them is more effective. In this paper we carried out a meta-analysis about the efficacy of the treatment for the increase the flexibility in the hamstring muscle. The searched of the literature enabled us identify 41 studies, 39 published and 2 no published, between 1930 and 2007, that fulfilled our the selection criteria, giving a total 85 comparisons between a treated an a control group. The effect size index was the standardized mean difference in the posttest. The treatments obtained a statistically significant effectiveness (d+ = 1,054). The stretching and stretching plus warming -up resulted to be the treatment more effective. The relationship of others treatment, subjects, methodological and extrinsic variables with the effect size were also examined. The publication bias was not a threat against the validity of the results. The treatments are more efficient when: they are applied in subjects of the feminine gender; the more young be the subjects and when a greater number of weeks of treatment are utilized

To understand the etiology of psychopathic personality traits and thus in the long run to be able to develop successful prevention, a first step is to find out what role genetic and environmental effects play. A meta-review of 15 twin studies (N=26, 981), was conducted to estimate the magnitude of genetic and environmental influences on psychopathic personality traits. The results show that additive genetic (heritable) factors and non-shared environmental factors each explain 50% of the variance in psychopathic personality traits, while shared environmental factors were of no importance. Measure, informant, age, and sex were investigated as potential moderators showing that informant had an impact on the findings. This meta-analysis provides a structured synthesis of the relative genetic and environmental contributions in psychopathic personality traits through various stages of development and across sex. / För att förstå etiologin av psykopatiska personlighetsdrag och därmed i det långa loppet kunna utveckla framgångsrik prevention, är ett första steg att klargöra vilken roll genetiska och miljömässiga effekter spelar. En meta-översikt på 15 tvillingstudier (N=26,981), genomfördes för att uppskatta i vilken grad genetiska och miljömässiga faktorer påverkar psykopatiska personlighetsdrag. Resultaten visade att additiva genetiska (ärftliga) och unika miljömässiga faktorer förklarar 50% var av variansen i psykopatiska personlighetsdrag, medan delade miljömässiga faktorer inte var av betydelse. Mått, informant, ålder och kön undersöktes som potentiella moderatorer och visade att informant påverkade resultaten. Denna meta-analys ger en strukturerad syntes av de relativa genetiska och miljömässiga bidrag som påverkar psykopatiska personlighetsdrag genom olika utvecklingsstadier och mellan könen.

Interactions between cyanobacteria and herbivorous grazers play an important role in mediating the responses of freshwater phytoplankton assemblages to nutrient enrichment and top-down manipulation. Negative consequences associated with these interactions include dangerous blooms of harmful blue-green algae that have been implicated in the sickness and death of fishes, livestock, and, in extreme cases, humans. Frequently cited mechanisms influencing the interactions between grazers and cyanobacteria include cyanobacterial toxicity and morphology. To tease apart the importance of these mechanisms, I used meta-analysis to quantitatively synthesize the available literature on this topic. In addition, I conducted several experiments using novel techniques to determine the effect that cyanobacterial secondary metabolites from the bloom-forming cyanobacterium,