Anticoagulation in chronic nonvalvular atrial fibrillation: a critical appraisal and meta-analysis

OBJECTIVE: To assess the outcomes associated with warfarin treatment of patients with chronic nonvalvular atrial fibrillation (CNVAF) for prevention of primary stroke. DATA SOURCES: MEDLINE was searched for literature published from 1987 to August 1996. Search terms used were 'atrial fibrillation' and 'anticoagulants'. STUDY SELECTION: Five published randomized controlled trials concerning primary stroke prevention. DATA EXTRACTION: Data were pooled across trials to estimate the magnitude of the effect for each of nine reported end-points. The annual probability of occurrence of each outcome was calculated, including standard errors and Mantel-Haenszel significance tests with 95% CIs. DATA SYNTHESIS: In view of the lack of blinded assessment and documented low inter-rater reliability of soft neurological end-points, the analysis was limited to the relatively objective end-points of major strokes, fatal strokes, major bleeding and fatal bleeding. Warfarin did not reduce the incidence of fatal strokes to a statistically significant extent, nor was incidence of fatal bleeding increased significantly. Warfarin reduced the absolute annual incidence of major strokes in patients with CNVAF by 0.89%, while at the same time it increased the absolute annual risk of major bleeding incidents by 1.8%. Though small, these differences were statistically significant. CONCLUSIONS: On balance, the margin between expected benefit and harm for warfarin prophylaxis in patients with CNVAF is uncomfortably thin. These results and conclusions differ from those of a previously published meta-analysis of these same studies.     

Everyday memory failure: Age differences in appraisal and attribution.

A person perception paradigm was used to test 86 young and 84 older Ss for evidence of a double standard in appraising everyday memory failures of young and older targets. Vignettes were judged on separate Likert scales for possible attributions for the failure (ability, effort, task difficulty, chance, and 2 measures of attention), signs of mental difficulty, need for memory training, and indications of need for professional evaluation. Results confirmed a double standard used by young and old: The failures of older targets were judged as signifying greater mental difficulty and greater need for memory training than were the identical failures of young targets. Older Ss were more lenient overall than young Ss in their appraisals. Young Ss judged target persons' memory failures as signifying more mental difficulty, and they more readily recommended professional evaluation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Age differences and the identity negative priming effect: An updated meta-analysis.

A recent meta-analysis (P. Verbaeghen & L. De Meersman, 1998a) revealed that older adults show a reliable but significantly reduced negative priming effect compared with young adults. The present study provides an updated quantitative review on the effect of aging on the magnitude of the negative priming effect in identity tasks. This analysis demonstrated that the negative priming effect was not significantly different between young and old adults. This result differs from P. Verhaeghen and L. De Meersman's study. The implications of this finding for inhibitory-based theories of cognitive aging are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Religiosity and mental health: A critical reevaluation and meta-analysis.

A meta-analysis of 24 studies on the relationship between religiosity and personality revealed no support for the preconception that religiousness is necessarily correlated with psychopathology; but it also showed only slightly positive correlates of religion. Better specification of concepts and methods of measuring religiosity are alleviating the problem of ambiguity in research results and suggest that religion reflects a multidimensional phenomenon that has positive and negative aspects. Clinical education, practice, and research need revision so that professionals will be better informed of the evidence, more open to the study of such variables, and more efficacious in their work with individuals who approach life from a religious perspective. (73 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Differences between caregivers and noncaregivers in psychological health and physical health: A meta-analysis.

Providing care for a frail older adult has been described as a stressful experience that may erode psychological well-being and physical health of caregivers. In this meta-analysis, the authors integrated findings from 84 articles on differences between caregivers and noncaregivers in perceived stress, depression, general subjective well-being, physical health, and self-efficacy. The largest differences were found with regard to depression (g = .58), stress (g = .55), self-efficacy (g = .54), and general subjective well-being (g = -.40). Differences in the levels of physical health in favor of noncaregivers were statistically significant, but small (g = .18). However, larger differences were found between dementia caregivers and noncaregivers than between heterogeneous samples of caregivers, and noncaregivers. Differences were also influenced by the quality of the study, relationship of caregiver to the care recipient, gender, and mean age of caregivers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Age, gender, and individual differences in memory failure appraisal.

Young adults (22 men and 24 women) and older adults (24 men and 24 women) rated 12 gender-neutral vignettes describing short-term, long-term, and very-long-term memory failures. Vignette target persons were young (aged 21–32 yrs) or older (aged 65–75 yrs) men or women. Ss of both age and gender groups used a double standard: Failures of older targets of both genders were rated as signifying greater mental difficulty than failures of young targets; failures of young targets were attributed to lack of effort and attention. Young Ss judged very-long-term failures more harshly than did older Ss. Ss' objective memory performance, self-rated memory failure frequency, memory failure discomfort, and depression made little difference in their target person ratings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Task complexity as a moderator of goal effects: A meta-analysis.

Much evidence exists that supports the use of goal setting as a motivational technique for enhancing task performance; however, little attention has been given to the role of task characteristics as potential moderating conditions of goal effects. Meta-analysis procedures were used to assess the moderator effects of task complexity for goal-setting studies conducted from 1966 to 1985 (n?=?125). The reliability of the task complexity ratings was .92. Three sets of analyses were conducted: for goal-difficulty results (hard vs. easy), for goal specificity–difficulty (specific difficult goals vs. do-best or no goal), and for all studies collapsed across goal difficulty and goal specificity–difficulty. It was generally found that goal-setting effects were strongest for easy tasks (reaction time, brainstorming), d?=?.76, and weakest for more complex tasks (business game simulations, scientific and engineering work, faculty research productivity), d?=?.42. Implications for future research on goal setting and the validity of generalizing results are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interpreting contradictory communications: Age and context effects.

This study examined how contradictory verbal–facial communications are understood and resolved at different ages. Preschoolers, grade school children, and adults were asked to interpret videotapes in which an actor conveyed contradictory verbal and facial expressions with and without a story context that provided a reason for the contradiction. Results showed both age and context effects: Whereas younger children were more likely to focus on the literal contents of the verbal or facial components, older subjects were more likely to relate each of the two components to an overall communicative intent. In addition, messages presented within a meaningful context were resolved in a more sophisticated manner than those presented in isolation, although younger children were limited in the extent to which they were helped by the context cues. The results are discussed in terms of the development of understanding message-referent relations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adverse effects associated with selective serotonin reuptake inhibitors and tricyclic antidepressants: a meta-analysis

BACKGROUND: The use of antidepressant medications and the resulting costs have increased dramatically in recent years, partly because of the introduction of selective serotonin reuptake inhibitors (SSRIs). An assessment of the clinical and economic aspects of SSRIs compared with the older tricyclic antidepressants (TCAs) was initiated to generate information for purchasers of these drugs as well as clinicians. One component of this study was an examination of the adverse effects associated with the use of these drugs. METHODS: Searches of bibliographic databases (for January 1980 through May 1996) and manual scanning of both peer-reviewed publications and other documents were used to identify double-blind, randomized controlled trials involving at least one SSRI and one TCA. For the study of adverse effects, only trials that had at least 20 patients in each trial arm and that reported rates of adverse effects in both arms were retained. In total 84 trials reporting on 18 adverse effects were available. Meta-analyses were undertaken to calculate pooled differences in rates of adverse effects. The question of whether the method of eliciting information from patients about adverse effects made a difference in the findings was also examined. Finally, differences in drop-out rates due to adverse effects were calculated. RESULTS: The crude rates of occurrence of adverse effects ranged from 4% (palpitations) to 26% (nausea) for SSRIs and from 4% (diarrhea) to 27% (dry mouth) for TCAs. The differences in the rates of adverse effects between the 2 types of drugs ranged from 14% more with SSRIs (for nausea) to 11% more with TCAs (for constipation). The results did not depend on the method of eliciting information from patients. There were no statistically significant differences between drug classes in terms of drop-outs due to adverse effects. INTERPRETATION: SSRIs and TCAs are both associated with adverse effects, although the key effects differ between the drug classes. Further explanation of the adverse effects and their relation to discontinuation of medication will require better studies involving prospective collection of quality-of-life data.     

Work strain, health, and absenteeism: A meta-analysis.

Work strain has been argued to be a significant cause of absenteeism in the popular and academic press. However, definitive evidence for associations between absenteeism and strain is currently lacking. A theory focused meta-analysis of 275 effects from 153 studies revealed positive but small associations between absenteeism and work strain, psychological illness, and physical illness. Structural equation modeling results suggested that the strain-absence connection may be mediated by psychological and physical symptoms. Little support was received for the purported volitional distinction between absence frequency and time lost absence measures on the basis of illness. Among the moderators examined, common measurement, midterm and stable sources of variance, and publication year received support. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Age effects on social cognition: Faces tell a different story.

The authors administered social cognition tasks to younger and older adults to investigate age-related differences in social and emotional processing. Although slower, older adults were as accurate as younger adults in identifying the emotional valence (i.e., positive, negative, or neutral) of facial expressions. However, the age difference in reaction time was largest for negative faces. Older adults were significantly less accurate at identifying specific facial expressions of fear and sadness. No age differences specific to social function were found on tasks of self-reference, identifying emotional words, or theory of mind. Performance on the social tasks in older adults was independent of performance on general cognitive tasks (e.g., working memory) but was related to personality traits and emotional awareness. Older adults also showed more intercorrelations among the social tasks than did the younger adults. These findings suggest that age differences in social cognition are limited to the processing of facial emotion. Nevertheless, with age there appears to be increasing reliance on a common resource to perform social tasks, but one that is not shared with other cognitive domains. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Participation effects in appraisal interviews conducted in a training situation.

Participation, order, and interviewee personality effects were studied in appraisal interviews conducted as a part of a training program. 3 groups of Ss were used: 16 undergraduate education majors, 25 graduate students, and 12 high school students. Nonparticipative appraisal interviews brought about greater behavior change and interviewee satisfaction than participative interviews. Order of presentation did not affect interview outcome, and personality variables were not found to moderate the effectiveness of type of interview. The importance of the training situation is discussed in relation to the results of the study. (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Age effects on block design: Qualitative performance features and extended-time effects.

Qualitative performance features and extended-time effects on the Block Design subtest of the Wechsler Adult Intelligence Scale—Revised (WAIS—R) were examined in 145 healthy Ss (aged 50–95 yrs). Raw scores were calculated at standard and extended time limits; error types and starting points were recorded for a subgroup of Ss. In Ss age 60 yrs and older, there was a consistent decline with age in overall scores at both time limits. Extra time allotments resulted in modest but significant increases in scores. Older and younger Ss benefited equally from the extra time, indicating that the age-related decline on this task cannot be accounted for by general age-related psychomotor slowing. Single- and multiblock rotation errors were relatively common, whereas stimulus boundedness and broken configurations were rare. Despite some potential limitations in generalizability, the results suggest that the incorporation of qualitative scoring procedures in the assessment of visuoconstructional skills may enhance understanding of normal and abnormal brain–behavior relationships. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Incorporation of sequential trials into a fixed effects meta-analysis

The technique of meta-analysis provides a systematic and quantitative approach to the summary of results from a collection of similar randomized studies. Comprehensive methodology exists for analysis when all trials are of a fixed sample size design, but this is based on assumptions which are no longer valid when incorporating sequentially designed studies. In this paper the effect of incorporating one or more sequential trials into a meta-analysis otherwise consisting of fixed sample size trials is investigated. The results from simulation studies of a variety of plausible scenarios are presented. The aim is to quantify the extent to which bias is introduced. It was found that when incorporating two alternative sequential designs, the triangular test and the O'Brien and Fleming procedure, the results of a conventional meta-analysis remain accurate.     

Validation of a meta-analysis: the effects of fish oil in rheumatoid arthritis

The purpose of this study was to validate the results of a meta-analysis showing the efficacy of fish oil in rheumatoid arthritis with the results of a re-analysis of the complete primary data set. A Medline search yielded seven published papers. Three additional trials were found by contacting authorities in the field. Inclusion criteria included (1) a double-blind, placebo-controlled study, (2) use of at least one of seven predetermined outcome measures, (3) results reported for both placebo and treatment groups at baseline and follow-up, (4) randomization, and (5) parallel or cross-over design. Papers were scored for quality. Demographic and outcomes variables were collected. For the re-analysis of the primary data, the same variables were abstracted for the 395 individual patients randomized. The meta-analysis demonstrated that dietary fish oil supplementation for 3 months significantly reduced tender joint count (rate difference [RD] [95% CI] = -2.9 [-3.8 to -2.1] [p = 0.001]) and morning stiffness (RD [95% CI] = -25.9 [-44.3 to -7.5] [p < 0.01]) as compared with heterogeneous dietary control oils. The re-analysis of the primary data confirmed a significant reduction in tender joint count (p = 0.001) and in morning stiffness (p < 0.02) in the parallel analysis that ignored interaction terms. The analyses that included an interaction term between site and treatment again confirmed a significant reduction in tender joint count. The results for morning stiffness were similar to the meta-analysis, but did not quite reach statistical significance (p = 0.052-0.083). The relative improvements in the other outcome variables did not reach statistical significance. Use of fish oil improved the number of tender joints and duration of morning stiffness at 3 months as analyzed by both meta- and mega-analysis. The fuller mega-analysis confirmed the results of the meta-analysis. The advantages of mega-analysis were as follows: (1) the ability to analyze the homogeneity of the patient populations, (2) the ability to make clinically sensible adjustments in the form of the comparison, and (3) the ability to examine subsets of the data.     

Moderators of gender effects on parents'' talk to their children: a meta-analysis

We present a longitudinal study of children in the first 2 years of learning to read. A battery of tests of phonological skills administered when the children were prereaders identified two distinct and relatively independent factors, Rhyming (defined by measures of rhyme detection and rhyme production) and Segmentation (defined by measures of phoneme identification and phoneme deletion). Segmentation was strongly correlated with attainment in reading and spelling at the end of the first year at school, while Rhyming was not. In addition, letter name knowledge predicted both reading and spelling skill and showed an interactive effect with children's segmentation skills. By the end of the second year of school, however, rhyming had started to exert a predictive effect on spelling, but not on reading. The results are discussed in the context of current theories of the role of phonological skills in learning to read.     

Context effects in performance appraisal: A methodological critique and empirical study.

The standard design used in research on assimilation and contrast effects in performance appraisal suffers from methodological flaws that preclude unambiguous interpretation of experimental results. This standard design is compared with two other designs that provide more appropriate tests of context effects (D. A. Kravitz and W. K. Balzer, 1990). 123 undergraduates rated a videotaped lecture of average quality after rating (1) 2 videotapes depicting good lectures, (2) 2 videotapes depicting poor lectures, or (3) no other videotapes. Half the Ss had rated the target videotape 1 wk earlier. Analyses of the standard design implied contrast effects. Analyses of the alternative designs revealed problems with the positive context manipulation, assimilation effects in the positive context, contrast effects in the negative context, and pretest effects. It is recommended that the standard design not be used. (PsycINFO Database Record (c) 2010 APA, all rights reserved)