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This meta-analysis was conducted to systematically synthesize research findings on effects of gamification on cognitive, motivational, and behavioral learning outcomes. Results from random effects models showed significant small effects of gamification on cognitive ( g  = .49, 95% CI [0.30, 0.69], k  = 19, N  = 1686), motivational ( g  = .36, 95% CI [0.18, 0.54], k  = 16, N  = 2246), and behavioral learning outcomes ( g  = .25, 95% CI [0.04, 0.46], k  = 9, N  = 951). Whereas the effect of gamification on cognitive learning outcomes was stable in a subsplit analysis of studies employing high methodological rigor, effects on motivational and behavioral outcomes were less stable. Given the heterogeneity of effect sizes, moderator analyses were conducted to examine inclusion of game fiction , social interaction , learning arrangement of the comparison group , as well as situational, contextual, and methodological moderators, namely, period of time , research context , randomization , design , and instruments . Inclusion of game fiction and social interaction were significant moderators of the effect of gamification on behavioral learning outcomes. Inclusion of game fiction and combining competition with collaboration were particularly effective within gamification for fostering behavioral learning outcomes. Results of the subsplit analysis indicated that effects of competition augmented with collaboration might also be valid for motivational learning outcomes. The results suggest that gamification as it is currently operationalized in empirical studies is an effective method for instruction, even though factors contributing to successful gamification are still somewhat unresolved, especially for cognitive learning outcomes.

Radiomics in nuclear medicine is rapidly expanding. Reproducibility of radiomics studies in multicentre settings is an important criterion for clinical translation. We therefore performed a meta-analysis to investigate reproducibility of radiomics biomarkers in PET imaging and to obtain quantitative information regarding their sensitivity to variations in various imaging and radiomics-related factors as well as their inherent sensitivity. Additionally, we identify and describe data analysis pitfalls that affect the reproducibility and generalizability of radiomics studies. After a systematic literature search, 42 studies were included in the qualitative synthesis, and data from 21 were used for the quantitative meta-analysis. Data concerning measurement agreement and reliability were collected for 21 of 38 different factors associated with image acquisition, reconstruction, segmentation and radiomics-specific processing steps. Variations in voxel size, segmentation and several reconstruction parameters strongly affected reproducibility, but the level of evidence remained weak. Based on the meta-analysis, we also assessed inherent sensitivity to variations of 110 PET image biomarkers. SUVmean and SUVmax were found to be reliable, whereas image biomarkers based on the neighbourhood grey tone difference matrix and most biomarkers based on the size zone matrix were found to be highly sensitive to variations, and should be used with care in multicentre settings. Lastly, we identify 11 data analysis pitfalls. These pitfalls concern model validation and information leakage during model development, but also relate to reporting and the software used for data analysis. Avoiding such pitfalls is essential for minimizing bias in the results and to enable reproduction and validation of radiomics studies.

To examine whether patients' trust in the health care professional is associated with health outcomes. We searched 4 major electronic databases for studies that reported quantitative data on the association between trust in the health care professional and health outcome. We screened the full-texts of 400 publications and included 47 studies in our meta-analysis. We conducted random effects meta-analyses and meta-regressions and calculated correlation coefficients with corresponding 95% confidence intervals. Two interdependent researchers assessed the quality of the included studies using the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Overall, we found a small to moderate correlation between trust and health outcomes (r = 0.24, 95% CI: 0.19-0.29). Subgroup analyses revealed a moderate correlation between trust and self-rated subjective health outcomes (r = 0.30, 0.24-0.35). Correlations between trust and objective (r = -0.02, -0.08-0.03) as well as observer-rated outcomes (r = 0.10, -0.16-0.36) were non-significant. Exploratory analyses showed a large correlation between trust and patient satisfaction and somewhat smaller correlations with health behaviours, quality of life and symptom severity. Heterogeneity was small to moderate across the analyses. From a clinical perspective, patients reported more beneficial health behaviours, less symptoms and higher quality of life and to be more satisfied with treatment when they had higher trust in their health care professional. There was evidence for upward bias in the summarized results. Prospective studies are required to deepen our understanding of the complex interplay between trust and health outcomes.

Self-control is positively associated with a host of beneficial outcomes. Therefore, psychological interventions that reliably improve self-control are of great societal value. A prominent idea suggests that training self-control by repeatedly overriding dominant responses should lead to broad improvements in self-control over time. Here, we conducted a random-effects meta-analysis based on robust variance estimation of the published and unpublished literature on self-control training effects. Results based on 33 studies and 158 effect sizes revealed a small-to-medium effect of g = 0.30, confidence interval (CI 95) [0.17, 0.42]. Moderator analyses found that training effects tended to be larger for (a) self-control stamina rather than strength, (b) studies with inactive compared to active control groups, (c) males than females, and (d) when proponents of the strength model of self-control were (co) authors of a study. Bias-correction techniques suggested the presence of small-study effects and/or publication bias and arrived at smaller effect size estimates (range: gcorrected =. 13 to. 24). The mechanisms underlying the effect are poorly understood. There is not enough evidence to conclude that the repeated control of dominant responses is the critical element driving training effects.

Mental disorders create high individual and societal costs and burden, partly because help-seeking is often delayed or completely avoided. Stigma related to mental disorders or mental health services is regarded as a main reason for insufficient help-seeking. To estimate the impact of four stigma types (help-seeking attitudes and personal, self and perceived public stigma) on active help-seeking in the general population. A systematic review of three electronic databases was followed by random effect meta-analyses according to the stigma types. Twenty-seven studies fulfilled eligibility criteria. Participants' own negative attitudes towards mental health help-seeking (OR = 0.80, 95% CI 0.73-0.88) and their stigmatising attitudes towards people with a mental illness (OR = 0.82, 95% CI 0.69-0.98) were associated with less active help-seeking. Self-stigma showed insignificant association (OR = 0.88, 95% CI 0.76-1.03), whereas perceived public stigma was not associated. Personal attitudes towards mental illness or help-seeking are associated with active help-seeking for mental problems. Campaigns promoting help-seeking by means of fighting mental illness-related stigma should target these personal attitudes rather than broad public opinions.

Personality disorder is a severe health issue. However, the epidemiology of personality disorders is insufficiently described and surveys report very heterogeneous rates.AimsWe aimed to conduct a meta-analysis on the prevalence of personality disorders in adult populations and examine potential moderators that affect heterogeneity. We searched PsycINFO, PSYNDEX and Medline for studies that used standardised diagnostics (DSM-IV/-5, ICD-10) to report prevalence rates of personality disorders in community populations in Western countries. Prevalence rates were extracted and aggregated by random-effects models. Meta-regression and sensitivity analyses were performed and publication bias was assessed. The final sample comprised ten studies, with a total of 113 998 individuals. Prevalence rates were fairly high for any personality disorder (12.16%; 95% CI, 8.01-17.02%) and similarly high for DSM Clusters A, B and C, between 5.53 (95% CI, 3.20-8.43%) and 7.23% (95% CI, 2.37-14.42%). Prevalence was highest for obsessive-compulsive personality disorder (4.32%; 95% CI, 2.16-7.16%) and lowest for dependent personality disorder (0.78%; 95% CI, 0.37-1.32%). A low prevalence was significantly associated with expert-rated assessment (versus self-rated) and reporting of descriptive statistics for antisocial personality disorder. Epidemiological studies on personality disorders in community samples are rare, whereas prevalence rates are fairly high and vary substantially depending on samples and methods. Future studies investigating the epidemiology of personality disorders based on the DSM-5 and ICD-11 and models of personality functioning and traits are needed, and efficient treatment should be a priority for healthcare systems to reduce disease burden.Declaration of interestNone.

Aging has been assumed to go along with deficient inhibitory processes in cognitive performance. According to this inhibition deficit hypothesis, older adults are less able to suppress or ignore irrelevant thoughts and actions than young adults are. This hypothesis has been investigated in a large number of studies. We conducted a meta-analysis to determine whether there is an inhibition deficit in older age and whether this deficit is general or task-specific. We selected 176 studies in which young and older adults were tested on tasks commonly assumed to measure inhibition (i.e., the color Stroop, flanker, Simon, stop-signal, go/no-go, global–local, positive and negative compatibility tasks, as well as the paradigm assessing n-2 repetition costs in task switching). For most tasks (i.e., the color Stroop, flanker, and local tasks, as well as the n-2 repetition costs), the results speak against an inhibition deficit in older age. Only in a few tasks (i.e., the go/no-go and stop-signal tasks), older adults showed impaired inhibition. Moreover, for four tasks (i.e., the Simon, global, positive and negative compatibility tasks), the results suggest that more studies are necessary to draw a firm conclusion. Together, the present findings call into question the hypothesis of a general inhibition deficit in older age.

To what extent has the learning progress of school-aged children slowed down during the COVID-19 pandemic? A growing number of studies address this question, but findings vary depending on context. Here we conduct a pre-registered systematic review, quality appraisal and meta-analysis of 42 studies across 15 countries to assess the magnitude of learning deficits during the pandemic. We find a substantial overall learning deficit (Cohen's d = -0.14, 95% confidence interval -0.17 to -0.10), which arose early in the pandemic and persists over time. Learning deficits are particularly large among children from low socio-economic backgrounds. They are also larger in maths than in reading and in middle-income countries relative to high-income countries. There is a lack of evidence on learning progress during the pandemic in low-income countries. Future research should address this evidence gap and avoid the common risks of bias that we identify. (DIPF/Orig.).

Working memory subsumes the capability to memorize, retrieve and utilize information for a limited period of time which is essential to many human behaviours. Moreover, impairments of working memory functions may be found in nearly all neurological and psychiatric diseases. To examine what brain regions are commonly and differently active during various working memory tasks, we performed a coordinate-based meta-analysis over 189 fMRI experiments on healthy subjects. The main effect yielded a widespread bilateral fronto-parietal network. Further meta-analyses revealed that several regions were sensitive to specific task components, e.g. Broca's region was selectively active during verbal tasks or ventral and dorsal premotor cortex were preferentially involved in memory for object identity and location, respectively. Moreover, the lateral prefrontal cortex showed a division in a rostral and a caudal part based on differential involvement in task set and load effects. Nevertheless, a consistent but more restricted “core” network emerged from conjunctions across analyses of specific task designs and contrasts. This “core” network appears to comprise the quintessence of regions, which are necessary during working memory tasks. It may be argued that the core regions form a distributed executive network with potentially generalized functions for focussing on competing representations in the brain. The present study demonstrates that meta-analyses are a powerful tool to integrate the data of functional imaging studies on a (broader) psychological construct, probing the consistency across various paradigms as well as the differential effects of different experimental implementations.

To provide a systematic review of studies that investigated the effects of Active Break (AB) school-based interventions on Physical Activity (PA) levels, classroom behavior, cognitive functions, and academic performance in primary school children. Systematic review and meta-analysis. Searches of electronic databases and grey literature, with no time restriction and up to April 2019, resulted in 22 intervention studies meeting the inclusion criteria. Quality assessment of the studies was performed in accordance with the Cochrane Tool for Quality Assessment for RCTs and the STROBE tool for observational studies. Four AB related outcomes were analyzed: (i) AB interventions had a significant effect in increasing PA levels in primary school children, both in terms of increased moderate to vigorous PA and step count. The meta-analysis seems to confirm this trend, showing a statistically significant result for the step count (p<0.00001, CI95% −0.71,1.21) (random model I²=0%). (ii) Regarding classroom behavior, time spent on task (TOT) during lessons significantly increased in each of the included studies. On the other hand, the effects on (iii) cognitive functions (attention components, working memory, executive functions) and (iv) academic achievements (mathematics, reading) were not conclusive. Positive effects were found for PA levels and classroom behavior, while the conflicting results for cognitive functions and academic achievements suggest that the effect could be more evident with curriculum focused active breaks and active lessons that integrate ABs with key learning aspects and cognitive engagement.