scholarly journals Detecting small-study effects and funnel plot asymmetry in meta-analysis of survival data: A comparison of new and existing tests

2017 ◽  
Vol 9 (1) ◽  
pp. 41-50 ◽  
Author(s):  
Thomas P. A. Debray ◽  
Karel G. M. Moons ◽  
Richard D. Riley
Keyword(s):  
Survival Data ◽  
Meta Analysis ◽  
Small Study ◽  
Funnel Plot ◽  
Funnel Plot Asymmetry

scholarly journals Does retirement trigger depressive symptoms? A systematic review and meta-analysis

2021 ◽  
Vol 30 ◽  
Author(s):  
A. Odone ◽  
V. Gianfredi ◽  
G. P. Vigezzi ◽  
A. Amerio ◽  
C. Ardito ◽  
...  
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Depressive Symptoms ◽  
Protective Effect ◽  
Meta Analysis ◽  
Assessment Tools ◽  
Cochrane Library ◽  
High Quality ◽  
Funnel Plot ◽  
Funnel Plot Asymmetry

Abstract Aims Retirement is a major life transition that may improve or worsen mental health, including depression. Existing studies provide contradictory results. We conducted a systematic review with meta-analysis to quantitatively pool available evidence on the association of retirement and depressive symptoms. Methods We applied PRISMA guidelines to conduct a systematic review and meta-analysis to retrieve, quantitatively pool and critically evaluate the association between retirement and both incident and prevalent depression and to understand better the potential role of individual and contextual-level determinants. Relevant original studies were identified by searching PubMed, Embase, PsycINFO and the Cochrane Library, through 4 March 2021. Subgroup and sensitivity meta-analyses were conducted by gender, study design (longitudinal v. cross-sectional studies), study quality score (QS) and considering studies using validated scales to diagnose depression. Heterogeneity between studies was evaluated with I2 statistics. Results Forty-one original studies met our a priori defined inclusion criteria. Meta-analysis on more than half a million subjects (n = 557 111) from 60 datasets suggested a protective effect of retirement on the risk of depression [effect size (ES) = 0.83, 95% confidence interval (CI) = 0.74–0.93], although with high statistical heterogeneity between risk estimates (χ2 = 895.19, df = 59, I2 = 93.41%, p-value < 0.0001). Funnel plot asymmetry and trim and fill method suggested a minor potential publication bias. Results were consistent, confirm their robustness and suggest stronger protective effects when progressively restricting the included studies based on quality criteria: (i) studies with the highest QS [55 datasets, 407 086 subjects, ES = 0.81, 95% CI = 0.71–0.91], (ii) studies with a high QS and using validated assessment tools to diagnose depression (44 datasets, 239 453 subjects, ES = 0.76, 95% CI = 0.65–0.88) and (iii) studies of high quality, using a validated tool and with a longitudinal design (24 datasets, 162 004 subjects, ES = 0.76, 95% CI = 0.64–0.90). We observed a progressive reduction in funnel plot asymmetry. About gender, no statistically significant difference was found (females ES = 0.79, 95% CI = 0.61–1.02 v. men ES = 0.87, 95% CI = 0.68–1.11). Conclusions Pooled data suggested that retirement reduces by nearly 20% the risk of depression; such estimates got stronger when limiting the analysis to longitudinal and high-quality studies, even if results are affected by high heterogeneity. As retirement seems to have an independent and protective effect on mental health and depressive symptoms, greater flexibility in retirement timing should be granted to older workers to reduce their mental burden and avoid the development of severe depression. Retirement may also be identified as a target moment for preventive interventions, particularly primary and secondary prevention, to promote health and wellbeing in older ages, boosting the observed impact.

Power-Enhanced Funnel Plots for Meta-Analysis

2020 ◽  
Vol 228 (1) ◽  
pp. 43-49 ◽  
Author(s):  
Michael Kossmeier ◽  
Ulrich S. Tran ◽  
Martin Voracek
Keyword(s):  
Statistical Power ◽  
Meta Analysis ◽  
Relevant Information ◽  
Selective Reporting ◽  
Graphical Display ◽  
Funnel Plot ◽  
Evidential Value ◽  
Graphical Displays ◽  
Funnel Plots ◽  
Meta Analyses

Abstract. Currently, dedicated graphical displays to depict study-level statistical power in the context of meta-analysis are unavailable. Here, we introduce the sunset (power-enhanced) funnel plot to visualize this relevant information for assessing the credibility, or evidential value, of a set of studies. The sunset funnel plot highlights the statistical power of primary studies to detect an underlying true effect of interest in the well-known funnel display with color-coded power regions and a second power axis. This graphical display allows meta-analysts to incorporate power considerations into classic funnel plot assessments of small-study effects. Nominally significant, but low-powered, studies might be seen as less credible and as more likely being affected by selective reporting. We exemplify the application of the sunset funnel plot with two published meta-analyses from medicine and psychology. Software to create this variation of the funnel plot is provided via a tailored R function. In conclusion, the sunset (power-enhanced) funnel plot is a novel and useful graphical display to critically examine and to present study-level power in the context of meta-analysis.

scholarly journals Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials

BMJ ◽  
2011 ◽  
Vol 343 (jul22 1) ◽  
pp. d4002-d4002 ◽  
Author(s):  
J. A. C. Sterne ◽  
A. J. Sutton ◽  
J. P. A. Ioannidis ◽  
N. Terrin ◽  
D. R. Jones ◽  
...  
Keyword(s):  
Randomised Controlled Trials ◽  
Controlled Trials ◽  
Funnel Plot ◽  
Funnel Plot Asymmetry ◽  
Randomised Controlled ◽  
Meta Analyses

The Impact of Subclinical Hypothyroidism on Patients with Polycystic Ovary Syndrome: A Meta-Analysis

2021 ◽  
Vol 53 (06) ◽  
pp. 382-390
Author(s):  
Yuling Xing ◽  
Jinhu Chen ◽  
Jing Liu ◽  
Huijuan Ma
Keyword(s):  
Polycystic Ovary Syndrome ◽  
Subclinical Hypothyroidism ◽  
Polycystic Ovary ◽  
Meta Analysis ◽  
Chinese Patients ◽  
Cochrane Library ◽  
Academic Journal ◽  
Ovary Syndrome ◽  
Funnel Plot ◽  
The Impact

AbstractThe association between subclinical hypothyroidism (SCH) and polycystic ovary syndrome (PCOS) has been shown in many studies. These findings are still controversial, however. It is unclear whether the co-incidence of subclinical hypothyroidism and polycystic ovary syndrome will affect the severity of metabolism. Therefore, we performed this meta-analysis to investigate the association. A comprehensive search strategy was developed to obtain all relevant studies published in PubMed, EMBASE, Cochrane Library, and Chinese Academic Journal Full-text Database (CNKI) up to 31 December 2020. We adopted the standardized mean difference (SMD) with 95% confidence intervals (CI) for evaluation, and sensitivity analysis was performed. Publication bias was analyzed and represented by a funnel plot, and funnel plot symmetry was assessed with Egger’s test. Twenty-seven studies with 4821 participants (1300 PCOS patients with SCH, 3521 PCOS patients without SCH) were included in the present meta-analysis,among which 71.31% chinese patients out of the total. The results showed that PCOS patients with SCH had higher levels of HOMA-IR, TG, TC, LDL, FBG, FCP, PRL and lower levels of HDL, LH and T. It also recognized the limitation of the lack of a consistent definition of hypothyroidism in the 27 studies included. The results of this study indicated that SCH may aggravate lipid and glucose metabolism in patients with PCOS.

scholarly journals Psychological distress among healthcare providers during COVID-19 in Asia: Systematic review and meta-analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0257983
Author(s):  
Siew Mooi Ching ◽  
Kar Yean Ng ◽  
Kai Wei Lee ◽  
Anne Yee ◽  
Poh Ying Lim ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Healthcare Providers ◽  
Random Effects Model ◽  
Depression And Anxiety ◽  
Cross Sectional ◽  
Funnel Plot ◽  
Health And Wellbeing ◽  
Pooled Prevalence ◽  
Increased Risk ◽  
Prevalence Of Depression

Introduction COVID-19 pandemic is having a devastating effect on the mental health and wellbeing of healthcare providers (HCPs) globally. This review is aimed at determining the prevalence of depression, anxiety, stress, fear, burnout and resilience and its associated factors among HCPs in Asia during the COVID-19 pandemic. Material and methods We performed literature search using 4 databases from Medline, Cinahl, PubMed and Scopus from inception up to March 15, 2021 and selected relevant cross-sectional studies. Publication bias was assessed using funnel plot. Random effects model was used to estimate the pooled prevalence while risk factors were reported in odds ratio (OR) with 95% CI. Results We included 148 studies with 159,194 HCPs and the pooled prevalence for depression was 37.5% (95%CI: 33.8–41.3), anxiety 39.7(95%CI: 34.3–45.1), stress 36.4% (95%CI: 23.2–49.7), fear 71.3% (95%CI: 54.6–88.0), burnout 68.3% (95%CI: 54.0–82.5), and low resilience was 16.1% (95%CI: 12.8–19.4), respectively. The heterogeneity was high (I2>99.4%). Meta-analysis reported that both females (OR = 1.48; 95% CI = 1.30–1.68) and nurses (OR = 1.21; 95%CI = 1.02–1.45) were at increased risk of having depression and anxiety [(Female: OR = 1.66; 95% CI = 1.49–1.85), (Nurse: OR = 1.36; 95%CI = 1.16–1.58)]. Females were at increased risk of getting stress (OR = 1.59; 95%CI = 1.28–1.97). Conclusion In conclusion, one third of HCPs suffered from depression, anxiety and stress and more than two third of HCPs suffered from fear and burnout during the COVID-19 pandemic in Asia.

scholarly journals Gastrointestinal Bleeding in COVID-19 Patients: A Systematic Review with Meta-Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Giovanni Marasco ◽  
Marcello Maida ◽  
Gaetano Cristian Morreale ◽  
Massimo Licata ◽  
Matteo Renzulli ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Meta Analysis ◽  
Small Study ◽  
The Novel ◽  
Bleeding Rate ◽  
Novel Coronavirus ◽  
The Impact ◽  
Different Sources ◽  
Upper Gastrointestinal ◽  
Egger Test

The novel coronavirus disease 2019 (COVID-19) has been reported to affect the gastrointestinal system with a variety of symptoms, including bleeding. The prevalence of bleeding in these patients remains unclear. The aim of this meta-analysis is to estimate the rate of gastrointestinal bleeding in COVID-19 patients and its association with mortality. MEDLINE and Embase were searched through December 20, 2020. Studies reporting COVID-19 patients with and without gastrointestinal bleeding were included. Estimated prevalence with 95% confidence intervals (CI) was pooled; heterogeneity was expressed as I2. Metaregression analysis was performed to assess the impact of confounding covariates. Ten studies met the inclusion criteria and were included in the analysis. A total of 91887 COVID-19 patients were considered, of whom 534 reported gastrointestinal bleeding (0.6%) [409 (76.6%) upper and 121 (22.7%) lower gastrointestinal bleeding (UGIB and LGIB, resp.)]. The overall pooled gastrointestinal bleeding rate was 5% [95% CI 2–8], with high heterogeneity (I2 99.2%); “small study effect” was observed using the Egger test ( p = 0.049 ). After removing two outlier studies, the pooled bleeding rate was 2% [95% CI 0–4], with high heterogeneity (I2 99.2%), and no “small study effect” ( p = 0.257 ). The pooled UGIB rate was 1% (95% CI 0–3, I2 98.6%, p = 0.214 ), whereas the pooled LGIB rate was 1% (95% CI 0–2, I2 64.7%, p = 0.919 ). Metaregression analysis showed that overall estimates on gastrointestinal bleeding were affected by studies reporting different sources of bleeding. No significant association between gastrointestinal bleeding and mortality was found. In this meta-analysis of published studies, individuals with COVID-19 were found to be at risk for gastrointestinal bleeding, especially upper gastrointestinal bleeding.

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