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The beneficial association of the Mediterranean diet (MedDiet) with longevity has been consistently demonstrated, but the associations of MedDiet components have not been accordingly evaluated. We performed an updated meta-analysis of prospective cohort studies published up to 31 December 2017, to quantify the association of adherence to MedDiet, expressed as an index/score (MDS) and of its components with all-cause mortality. We estimated summary relative risks (SRR) and 95 % CI using random effects models. On the basis of thirty studies (225 600 deaths), SRR for the study-specific highest/lowest and per 1sd MDS increment were 0·79 (95 % CI 0·77, 0·81, Ι 2=42 %, P-heterogeneity 0·02) and 0·92 (95 % CI 0·90, 0·94, Ι 2 56 %, P-heterogeneity <0·01), respectively. Inversely, statistically significant associations were evident in stratified analyses by country, MDS range and publication year, with some evidence for heterogeneity across countries overall (P-heterogeneity 0·011), as well as across European countries (P=0·018). Regarding MDS components, relatively stronger and statistically significant inverse associations were highlighted for moderate/none-excessive alcohol consumption (0·86, 95 % CI 0·77, 0·97) and for above/below-the-median consumptions of fruit (0·88, 95 % CI 0·83, 0·94) and vegetables (0·94, 95 % CI 0·89, 0·98), whereas a positive association was apparent for above/below-the-median intake of meat (1·07, 95 % CI 1·01, 1·13). Our meta-analyses confirm the inverse association of MedDiet with mortality and highlight the dietary components that influence mostly this association. Our results are important for better understanding the role of MedDiet in health and proposing dietary changes to effectively increase adherence to this healthy dietary pattern.

A systematic review and meta-analysis of observational studies were performed to assess the dose–response associations between fruit or vegetable consumption and the chance of the metabolic syndrome (MetS). Studies on the association between fruit or vegetable consumption and the risk of the MetS published from January 1958 to 30 October 2018 were searched using the PubMed, MEDLINE and Embase databases, and the references of relevant articles were reviewed. Random-effects models were used to estimate the summary OR with 95 % CI for the MetS, and dose–response analysis was conducted to quantify the associations. Heterogeneity among studies was evaluated using Q and I2 statistics. A total of nine observational studies (seven cross-sectional studies and two cohort studies) were included in the meta-analysis. In a dose–response analysis of cohort studies and cross-sectional studies, the summary estimate of the MetS for an increase of 100 g/d in fruit consumption (nine studies) was 0·97 (95 % CI 0·95, 0·99; I2 = 26·7 %), whereas an increase of 100 g/d in vegetable consumption (nine studies) was not associated with a reduction in the MetS (OR 0·98; 95 % CI 0·96, 1·01; I2 = 54·6 %). In conclusion, an increased intake of fruit may reduce the risk of the MetS. For future research, prospective studies or randomised clinical trials are needed to identify the effects of fruits and vegetables by variety on the risk of the MetS.

The Mediterranean diet (MD) has been associated with prolonged survival in the general population, but no meta-analysis has apparently investigated the potential health benefits in relation to mortality in the elderly. We performed a longitudinal analysis on 5200 individuals aged ≥65 years identified within the general population recruited in the Moli-sani study cohort (2005–2010). Adherence to the MD was appraised by the a priori Mediterranean diet score (MDS; range 0–9). Survival estimates were derived using Cox regression and competing risk models. For the meta-analysis, PubMed and Scopus databases were searched from inception until April 2018 to identify prospective studies on the MD and death risk in the elderly. Over a median follow-up of 8·1 years, a total of 900 deaths were ascertained in the elderly sub-sample of the Moli-sani cohort. A one-point increase in the MDS was associated with lower risk of all-cause, coronary artery disease/cerebrovascular and non-cardiovascular/non-cancer mortality (multi-variable hazard ratio (HR)=0·94; 95 % CI 0·90, 0·98; HR=0·91; 95 % CI 0·83, 0·99 and HR=0·89; 95 % CI 0·81, 0·96, respectively). In a meta-analysis of seven prospective studies, including our results, for a total of 11 738 participants and 3874 deaths, one-point increment in MDS was associated with 5 % (4–7 %) lower risk of all-cause death. An inverse linear dose–response relationship was found from a meta-analysis including three studies. In conclusion, a prospective cohort study and a meta-analysis showed that closer adherence to the MD was associated with prolonged survival in elderly individuals, suggesting the appropriateness for older persons to adopt/preserve the MD to maximise their prospects for survival.

Background Attention-deficit/hyperactivity disorder (ADHD) is the most common neurodevelopmental disorders in childhood and adolescence, affecting 2.2 to 17.8% of all school-aged children and adolescents. ADHD in children has been associated with a wide range of developmental deficits including limitations of learning or control of executive functions as well as global impairments of social skills. However, no review has been conducted to report the consolidated magnitude of ADHD in children and adolescents in Africa. Therefore, this systematic review and meta-analysis aimed to estimate the prevalence of ADHD in Africa. Methods Following the PRISMA guideline, we systematically reviewed and meta-analyzed studies that investigated the prevalence of ADHD in Africa from three electronic databases (PubMed, Embase, and Scopus). We also looked at the reference lists of included studies to include other relevant studies. Subgroup and sensitivity analysis was carried out based on the study setting, tools used to measure ADHD, sex of participants, and the subtype of ADHD. Heterogeneity across the studies was evaluated using Cochran's Q - and the I 2 -test. We assessed potential publication bias using Egger's test and visual inspection of the symmetry in funnel plots. Results In the present meta-analysis, 7452 articles were initially identified and evaluated. Of these, 12 studies that met the inclusion criteria were included in the final analysis. The pooled prevalence of ADHD in children and adolescents in Africa was 7.47% (95% CI 60–9.26). The prevalence of ADHD was apparently greater in boys (10.60%) than in girls (5.28%) with a male:female ratio of 2.01:1. In our subgroup analysis, the predominantly inattentive type (ADHD-I) was found to be the most common subtype of ADHD, followed by hyperactive–impulsive type (ADHD-HI) and the combined type (ADHD-C) with the prevalence of 2.95%, 2.77%, and 2.44% respectively. The predominantly inattentive type (ADHD-I) was the most common type of ADHD in both boys (4.05%) and girls (2.21%). The funnel plot and Egger's regression tests provided no evidence of substantial publication bias in the prevalence of ADHD. Conclusion Our systematic review suggested a higher prevalence of ADHD (7.47%) in children and adolescents in Africa, indicating that ADHD is a serious public health problem in children and adolescents in Africa. The prevalence of ADHD was considerably greater in males than in females. The predominantly inattentive type (ADHD-I) was the most common type of ADHD in both males and females. Greater attention needs to be paid to the prevention and treatment of ADHD.

Background Depression is a leading cause of disability worldwide and is a major contributor to the overall global burden of disease. It is also one of the most common geriatric psychiatric disorders and a major risk factor for disability and mortality in elderly patients. Even though depression is a common mental health problem in the elderly population, it is undiagnosed in half of the cases. Several studies showed different and inconsistent prevalence rates in the world. Hence, this study aimed to fill the above gap by producing an average prevalence of depression and associated factors in old age. Objective This study aims to conduct a systematic review and meta-analysis to provide a precise estimate of the prevalence of depression and its determinants among old age. Method A comprehensive search of PubMed, Scopus, Web of sciences, Google Scholar, and Psych-info from database inception to January 2020. Moreover, the reference list of selected articles was looked at manually to have further eligible articles. The random-effects model was employed during the analysis. Stata-11 was used to determine the average prevalence of depression among old age. A sub-group analysis and sensitivity analysis were also run. A graphical inspection of the funnel plots and Egger’s publication bias plot test were checked for the occurrence of publication bias. Result A search of the electronic and manual system resulted in 1263 articles. Nevertheless, after the huge screening, 42 relevant studies were identified, including, for this meta-analysis, n  = 57,486 elderly populations. The average expected prevalence of depression among old age was 31.74% (95% CI 27.90, 35.59). In the sub-group analysis, the pooled prevalence was higher among developing countries; 40.78% than developed countries; 17.05%), studies utilized Geriatrics Depression Scale-30(GDS-30); 40.60% than studies that used GMS; 18.85%, study instrument, and studies having a lower sample size (40.12%) than studies with the higher sample; 20.19%. Conclusion A high prevalence rate of depression among the old population in the world was unraveled. This study can be considered as an early warning and advised health professionals, health policymakers, and other pertinent stakeholders to take effective control measures and periodic care for the elderly population.

Hypertension is a major public health issue worldwide. The imbalance of gut microbiota is thought to play an important role in the pathogenesis of hypertension. The authors conducted the systematic review and meta‐analysis to clarify the relationship between gut microbiota and hypertension through conducting an electronic search in six databases. Our meta‐analysis included 19 studies and the results showed that compared with healthy controls, Shannon significantly decreased in hypertension [SMD = −0.13, 95%CI (−0.22, −0.04), p = .007]; however, Simpson [SMD = −0.01, 95%CI (−0.14, 0.12), p = .87], ACE [SMD = 0.18, 95%CI (−0.06, 0.43), p = .14], and Chao1 [SMD = 0.11, 95%CI (−0.01, 0.23), p = .08] did not differ significantly between hypertension and healthy controls. The F/B ratio significantly increased in hypertension [SMD = 0.84, 95%CI (0.10, 1.58), p = .03]. In addition, Shannon index was negatively correlated with hypertension [r = −0.12, 95%CI (−0.19, −0.05)], but had no significant correlation with SBP [r = 0.10, 95%CI (−0.19, 0.37)] and DBP [r = −0.39, 95%CI (−0.73, 0.12)]. At the phylum level, the relative abundance of Firmicutes [SMD = −0.01, 95%CI (−0.37, 0.34), p = .94], Bacteroidetes [SMD = −0.15, 95%CI (−0.44, 0.14), p = .30], Proteobacteria [SMD = 0.25, 95%CI (−0.01, 0.51), p = .06], and Actinobacteria [SMD = 0.21, 95%CI (−0.11, 0.53), p = .21] did not differ significantly between hypertension and healthy controls. At the genus level, compared with healthy controls, the relative abundance of Faecalibacterium decreased significantly [SMD = −0.16, 95%CI (−0.28, −0.04), p = .01], while the Streptococcus [SMD = 0.20, 95%CI (0.08, 0.32), p = .001] and Enterococcus [SMD = 0.20, 95%CI (0.08, 0.33), p = .002] significantly increased in hypertension. Available evidence suggests that hypertensive patients may have an imbalance of gut microbiota. However, it still needs further validation by large sample size studies of high quality.

Far transfer rarely occurs, and a recent meta-analysis suggests that music is no exception. The overall effect of musical training on cognition was claimed to be null when considering studies with active control groups or implemented randomization procedures (Sala & Gobet, Memory & Cognition , 48: 1429–1441, 2020). Using the authors’ data file and program ( https://osf.io/rquye ), we did not confirm the effect of randomization, and we demonstrated that their conclusion is based in part on the failure to differentiate near and far transfer, with near transfer effect sizes being selectively excluded for the musical training group studies, but not for the active control group studies. Reanalyzing their data file resulted in a significant effect size ( g = .234), and also provided new evidence that far-transfer effects of musical training can challenge near-transfer effects of linguistic training. Music is a recreational activity that may be special in allowing for small but statistically significant far-transfer effects.

We aimed to systematically review available data on the association between vitamin C intake and bone mineral density (BMD), as well as risk of fractures and osteoporosis, and to summarise this information through a meta-analysis. Previous studies on vitamin C intake in relation to BMD and risk of fracture and osteoporosis were selected through searching PubMed, Scopus, ISI Web of Science and Google Scholar databases before February 2017, using MeSH and text words. To pool data, either a fixed-effects model or a random-effects model was used, and for assessing heterogeneity, Cochran’s Q and I 2 tests were used. Subgroup analysis was applied to define possible sources of heterogeneity. Greater dietary vitamin C intake was positively associated with BMD at femoral neck (pooled r 0·18; 0·06, 0·30) and lumbar spine (pooled r 0·14; 95 % CI 0·06, 0·22); however, significant between-study heterogeneity was found at femoral neck: I 2=87·6 %, P heterogeneity<0·001. In addition, we found a non-significant association between dietary vitamin C intake and the risk of hip fracture (overall relative risk=0·74; 95 % CI 0·51, 1·08). Significant between-study heterogeneity was found (I 2=79·1 %, P heterogeneity<0·001), and subgroup analysis indicated that study design, sex and age were the main sources of heterogeneity. Greater dietary vitamin C intake was associated with a 33 % lower risk of osteoporosis (overall relative risk=0·67; 95 % CI 0·47, 0·94). Greater dietary vitamin C intake was associated with a lower risk of hip fracture and osteoporosis, as well as higher BMD, at femoral neck and lumbar spine.

Purpose During COVID‐19, stigmatization and violence against and between professional healthcare workers worldwide are increasing. Understanding the prevalence of such stigmatization and violence is needed for gaining a complete picture of this issue. Therefore, the purpose of this review was to update estimates of the prevalence of stigmatization and violence against healthcare workers during the pandemic. Design A systematic review and meta‐analysis was conducted. Methods This review followed PRISMA guidelines and encompassed these databases: PubMed, Academic Search Complete, CINAHL, Web of Science, MEDLINE Complete, OVID (UpToDate), and Embase (from databases inception to September 15, 2021). We included observational studies and evaluated the quality of the study using the Joanna Briggs Institute methodology. Further, a random effects model was used to synthesis the pooled prevalence of stigmatization and violence in this study. Findings We identified 14 studies involving 3452 doctors, 5738 nurses, and 2744 allied health workers that reported stigmatization and violence during the pandemic. The pooled prevalence was, for stigmatization, 43% (95% confidence interval [CI]: 21% to 65%) and, for violence, 42% (95% CI: 30% to 54%). Conclusions Stigmatization and violence during the COVID‐19 pandemic were found to have affected almost half the studied healthcare workers. Healthcare professionals are more prone to be stigmatized by the community and to face workplace violence. Clinical Relevance Health administrators and policymakers should anticipate and promptly address stigmatization and violence against and between healthcare workers, while controlling the spread of COVID‐19. Health care systems should give serious attention to the mental health of all health providers.

Abstract Context Nonalcoholic fatty liver disease (NAFLD) prevalence is high, especially in patients with obesity and type 2 diabetes, and is expected to rise steeply in the coming decades. Objective We estimated NAFLD prevalence in patients with type 1 diabetes and explored associated characteristics and outcomes. Data Sources We reviewed PubMed and Embase for studies on NAFLD and type 1 diabetes to March 2020. We screened references of included articles. Study Selection Two authors independently screened titles/abstracts. One author screened full text articles. NAFLD was defined as described in the individual studies: steatosis and/or fibrosis. Studies not reporting alternative causes of hepatic steatosis or defining NAFLD only as elevated liver enzymes, were excluded. Initially, 919 articles met the selection criteria. Data Extraction One researcher performed data extraction and risk of bias assessment using standardized tables. Data Synthesis We assessed pooled prevalence rates by meta-analysis using a random-effects model, subsequently exploring heterogeneity by subgroup-, meta-regression-, and sensitivity analysis. Twenty studies between 2009 and 2019 were included (n = 3901). Pooled NAFLD prevalence was 19.3% (95% CI, 12.3%-27.5%), increasing to 22.0% (95% CI, 13.9%-31.2%) in adults only. Pooled prevalence of ultrasound studies was high (27.1%, 95% CI, 18.7%-36.3%) compared to studies using magnetic resonance imaging (8.6%, 95% CI, 2.1%-18.6%), liver biopsy (19.3%, 95% CI, 10.0%-30.7%), or transient elastography (2.3%, 95% CI, 0.6%-4.8%). Conclusion NAFLD prevalence in patients with type 1 diabetes is considerable and is highly dependent on the specific diagnostic modality and NAFLD definition used. These data are helpful in directing actions to standardize NAFLD diagnosis, which will help defining contributing mechanisms and outcomes.