Abstract This study reports findings from a meta-analysis summarizing the effectiveness of brief alcohol interventions for adolescents (age 11–18) and young adults (age 19–30). We identified 185 ...eligible study samples using a comprehensive literature search and synthesized findings using random-effects meta-analyses with robust standard errors. Overall, brief alcohol interventions led to significant reductions in alcohol consumption and alcohol-related problems among adolescents ( g ¯ = 0.27 and g ¯ = 0.19) and young adults ( g ¯ = 0.17 and g ¯ = 0.11). These effects persisted for up to 1 year after intervention and did not vary across participant demographics, intervention length, or intervention format. However, certain intervention modalities (e.g., motivational interviewing) and components (e.g., decisional balance, goal-setting exercises) were associated with larger effects. We conclude that brief alcohol interventions yield beneficial effects on alcohol-related outcomes for adolescents and young adults that are modest but potentially worthwhile given their brevity and low cost.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
In this meta-analysis, we systematically reviewed research on digital games and learning for K–16 students. We synthesized comparisons of game versus nongame conditions (i.e., media comparisons) and ...comparisons of augmented games versus standard game designs (i.e., value-added comparisons). We used random-effects meta-regression models with robust variance estimates to summarize overall effects and explore potential moderator effects. Results from media comparisons indicated that digital games significantly enhanced student learning relative to nongame conditions (ḡ = 0.33, 95% confidence interval 0.19, 0.48, k = 57, n = 209). Results from value-added comparisons indicated significant learning benefits associated with augmented game designs (ḡ = 0.34, 95% confidence interval 0.17, 0.51, k = 20, n = 40). Moderator analyses demonstrated that effects varied across various game mechanics characteristics, visual and narrative characteristics, and research quality characteristics. Taken together, the results highlight the affordances of games for learning as well as the key role of design beyond medium.
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BFBNIB, NMLJ, NUK, OILJ, PNG, SAZU, UKNU, UL, UM, UPUK
Aims
To estimate effects of brief substance use interventions delivered in general medical settings.
Methods
A systematic review and meta‐analysis of randomized trials conducted since 1990 of brief ...substance use interventions in patients of any age or severity level recruited in general medical settings. Primary outcomes were any measure of substance use or substance‐related consequences (indexed with Hedges’ g and risk ratios). Mixed‐effects meta‐regressions were used to estimate overall effects and predictors of effect variability. Analyses were conducted separately by brief intervention (BI) target substance: alcohol only or drugs.
Findings
A total of 116 trials (64 439 participants) were identified; 111 (62 263 participants) provided effect size data and were included in the meta‐analysis. Drug‐targeted BIs yielded significant small improvements in multiple drug/mixed substance use (Hedges' g
(g¯) = 0.08; 95% CI = 0.002, 0.15), but after adjusting for multiple comparisons, they did not produce significant effects on cannabis use (
g¯ = 0.06; 95% CI = 0.001, 0.12), alcohol use (
g¯ = 0.08; 95% CI = −0.0003, 0.17), or consequences (
g¯ = 0.05; 95% CI = 0.01, 0.10). Drug‐targeted BIs yielded larger improvements in multiple drug/mixed substance use when delivered by a general practitioner (
g¯ = 0.19; 95% CI = 0.187, 0.193). Alcohol‐targeted BIs yielded small beneficial effects on alcohol use (
g¯ = 0.12; 95% CI 0.08, 0.16), but no evidence of an effect on consequences (
g¯ = 0.05; 95% CI = −0.04, 0.13). However, alcohol‐targeted BIs only had beneficial effects on alcohol use when delivered in general medical settings
(g¯ = 0.17; 95% CI = 0.10, 0.24); the findings were inconclusive for those delivered in emergency department/trauma centers (
g¯ = 0.05; 95% CI = 0.00, 0.10).
Conclusions
When delivered in general medical settings, alcohol‐targeted brief interventions may produce small beneficial reductions in drinking (equivalent to a reduction in 1 drinking day per month). There is limited evidence regarding the effects of drug‐targeted brief interventions on drug use.
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BFBNIB, DOBA, FSPLJ, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Objective: This study describes the mental and behavioral health histories and treatment utilization among students enrolled in Collegiate Recovery Programs (CRPs), college-based supports for ...students who are in recovery from substance use or other comorbid disorders. Participants: Participants were 861 college students enrolled in five CRPs across the United States (44% female, 89% white, 91% undergraduate). Methods: De-identified student data, collected from 2019-2020, were harmonized and descriptively analyzed. Results: A majority of CRP students reported mental health and substance use treatment histories. Approximately one-third reported a history of eating disorders or other compulsive behaviors (46%) and 69% reported histories of mental health concerns. Results indicated a complex history of mental health and substance use recovery needs among students. Conclusions: Students attending CRPs reported a wide range of mental and behavioral health concerns in addition to substance use disorders, highlighting the need for continued support for these students' recovery and well-being at higher education institutions.
Practitioners and policymakers rely on meta-analyses to inform decision making around the allocation of resources to individuals and organizations. It is therefore paramount to consider the validity ...of these results. A well-documented threat to the validity of research synthesis results is the presence of publication bias, a phenomenon where studies with large and/or statistically significant effects, relative to studies with small or null effects, are more likely to be published. We investigated this phenomenon empirically by reviewing meta-analyses published in top-tier journals between 1986 and 2013 that quantified the difference between effect sizes from published and unpublished research. We reviewed 383 meta-analyses of which 81 had sufficient information to calculate an effect size. Results indicated that published studies yielded larger effect sizes than those from unpublished studies (d; = 0.18, 95% confidence interval 0.10, 0.25). Moderator analyses revealed that the difference was larger in meta-analyses that included a wide range of unpublished literature. We conclude that intervention researchers require continued support to publish null findings and that meta-analyses should include unpublished studies to mitigate the potential bias from publication status.
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BFBNIB, NMLJ, NUK, OILJ, PNG, SAZU, UKNU, UL, UM, UPUK
Meta-analysis is a prominent method for estimating the effects of public health interventions, yet these interventions are often complex in ways that pose challenges to using conventional ...meta-analytic methods. This article discusses meta-analytic techniques that can be used in research syntheses on the effects of complex public health interventions. We first introduce the use of complexity frameworks to conceptualize public health interventions. We then present a menu of meta-analytic procedures for addressing various sources of complexity when answering questions about the effects of public health interventions in research syntheses. We conclude with a review of important practices and key resources for conducting meta-analyses on complex interventions, as well as future directions for research synthesis more generally. Overall, we argue that it is possible to conduct meaningful quantitative syntheses of research on the effects of public health interventions, though these meta-analyses may require the use of advanced techniques to properly consider and attend to issues of complexity.
Background
Inflammatory bowel disease (IBD) is a chronic, relapsing disease of the gastrointestinal tract that is thought to be associated with a complex interplay between microbes and the immune ...system, leading to an abnormal inflammatory response in genetically susceptible individuals. Dysbiosis, characterized by the alteration of the composition of the resident commensal bacteria in a host compared to healthy individuals, is thought to play a major role in the pathogenesis of ulcerative colitis (UC) and Crohn's disease (CD), two subtypes of IBD. There is growing interest to correct the underlying dysbiosis through the use of fecal microbiota transplantation (FMT) for the treatment of IBD.
Objectives
The objective of this systematic review was to assess the efficacy and safety of FMT for the treatment of IBD.
Search methods
We searched the MEDLINE, Embase, Cochrane Library, and Cochrane IBD Group Specialized Register databases from inception to 19 March 2018. We also searched ClinicalTrials.gov, ISRCTN metaRegister of Controlled Trials, and the Conference Proceedings Citation Index.
Selection criteria
Only randomized trials or non‐randomized studies with a control arm were considered for inclusion. Adults or pediatric participants with UC or CD were eligible for inclusion. Eligible interventions were FMT defined as the administration of fecal material containing distal gut microbiota from a healthy donor to the gastrointestinal tract of a someone with UC or CD. The comparison group included participants who did not receive FMT and were given placebo, autologous FMT, or no intervention.
Data collection and analysis
Two authors independently screened the titles and extracted data from the included studies. We used the Cochrane risk of bias tool to assess study bias. The primary outcomes were induction of clinical remission, clinical relapse, and serious adverse events. Secondary outcomes included clinical response, endoscopic remission and endoscopic response, quality of life scores, laboratory measures of inflammation, withdrawals, and microbiome outcomes. We calculated the risk ratio (RR) and corresponding 95% confidence interval (95% CI) for dichotomous outcomes and the mean difference and 95% CI for continuous outcomes. Random‐effects meta‐analysis models were used to synthesize effect sizes across trials. The overall certainty of the evidence supporting the primary and selected secondary outcomes was rated using the GRADE criteria.
Main results
Four studies with a total of 277 participants were included. These studies assessed the efficacy of FMT for treatment of UC in adults; no eligible trials were found for the treatment of CD. Most participants had mild to moderate UC. Two studies were conducted in Australia, one study was conducted in Canada, and another in the Netherlands. Three of the included studies administered FMT via the rectal route and one study administered FMT via the nasoduodenal route. Three studies were rated as low risk of bias. One study ( publication) was rated as unclear risk of bias. Combined results from four studies (277 participants) suggest that FMT increases rates of clinical remission by two‐fold in patients with UC compared to controls. At 8 weeks, 37% (52/140) of FMT participants achieved remission compared to 18% (24/137) of control participants (RR 2.03, 95 % CI, 1.07 to 3.86; I² = 50%; low certainty evidence). One study reported data on relapse at 12 weeks among participants who achieved remission. None of the FMT participants (0/7) relapsed at 12 weeks compared to 20% of control participants (RR 0.28, 95% CI 0.02 to 4.98, 17 participants, very low certainty evidence). It is unclear whether there is a difference in serious adverse event rates between the intervention and control groups. Seven per cent (10/140) of FMT participants had a serious adverse event compared to 5% (7/137) of control participants (RR 1.40, 95% CI 0.55 to 3.58; 4 studies; I² = 0%; low certainty evidence). Serious adverse events included worsening of UC necessitating intravenous steroids or surgery; infection such as Clostridium difficile and cytomegalovirus, small bowel perforation and pneumonia. Adverse events were reported by two studies and the pooled data did not show any difference between the study groups. Seventy‐eight per cent (50/64) of FMT participants had an adverse event compared to 75% (49/65) of control participants (RR 1.03, 95% CI 0.81 to 1.31; I² = 31%; moderate certainty evidence). Common adverse events included abdominal pain, nausea, flatulence, bloating, upper respiratory tract infection, headaches, dizziness, and fever. Four studies reported on clinical response at 8 weeks. Forty‐nine per cent (68/140) of FMT participants had a clinical response compared to 28% (38/137) of control participants (RR 1.70, 95% CI 0.98 to 2.95, I² = 50%, low certainty evidence). Endoscopic remission at 8 weeks was reported by three studies and the combined results favored FMT over the control group. Thirty per cent (35/117) of FMT participants achieved endoscopic remission compared to 10% (11/112) of control participants (RR 2.96, 95 % CI 1.60 to 5.48, I² = 0%; low certainty evidence).
Authors' conclusions
Fecal microbiota transplantation may increase the proportion of participants achieving clinical remission in UC. However, the number of identified studies was small and the quality of evidence was low. There is uncertainty about the rate of serious adverse events. As a result, no solid conclusions can be drawn at this time. Additional high‐quality studies are needed to further define the optimal parameters of FMT in terms of route, frequency, volume, preparation, type of donor and the type and disease severity. No studies assessed efficacy of FMT for induction of remission in CD or in pediatric participants. In addition, no studies assessed long‐term maintenance of remission in UC or CD. Future studies are needed to address the therapeutic benefit of FMT in CD and the long‐term FMT‐mediated maintenance of remission in UC or CD.
Abstract Prior research has identified traumatic experiences and substance use as risk factors for adolescent engagement in sexual risk‐taking; however, these studies have relied upon subthreshold or ...non–dually diagnosed samples. The present study examined differences in sexual risk behaviors between adolescents with a substance use disorder (SUD) and co‐occurring posttraumatic stress disorder (PTSD) versus those with an SUD and another co‐occurring psychiatric disorder. Participants were 269 adolescents who met the clinical screening criteria for an SUD and at least one psychiatric disorder. Bivariate comparisons and generalized linear models were used to compare sexual risk behaviors in participants with co‐occurring PTSD (30.0%) and those with a different psychiatric disorder (70.0%). Participants with co‐occurring PTSD were twice as likely to have multiple sex partners during the same period compared to those without PTSD, odds ratio ( OR ) = 2.35, p = .012. They also reported, on average, over twice the incidence rate of unprotected sexual encounters, incidence rate ratio ( IRR ) = 2.06, p = .034, and a 51.0% higher incidence of sexual risk behaviors, IRR = 1.51, p = .008, than participants without co‐occurring PTSD. The results suggest dually diagnosed adolescents with co‐occurring PTSD are more likely to engage in sexual risk behaviors than those with a different co‐occurring disorder, placing them at higher risk for adverse health effects, such as sexually transmitted infections and unplanned pregnancies. As such, this population is likely to benefit from targeted trauma‐informed sexual health education programs focused on sexual risk reduction.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
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