A systematic review (SR) is a research methodology that involves a comprehensive search for and analysis of relevant studies on a specific topic. A strict and objective research process is conducted that comprises a systematic and comprehensive literature search in accordance with predetermined inclusion/exclusion criteria, and an assessment of the risk of bias of the selected literature. SRs require a multidisciplinary approach that necessitates cooperation with clinical experts, methodologists, other experts, and statisticians. A meta-analysis (MA) is a statistical method of quantitatively synthesizing data, where possible, from the primary literature selected for the SR. Review articles differ from SRs in that they lack a systematic methodology such as a literature search, selection of studies according to strict criteria, assessment of risk bias, and synthesis of the study results. The importance of evidence-based medicine (EBM) in the decision-making for public policy has recently been increasing thanks to the realization that it should be based on scientific research data. SRs and MAs are essential for EBM strategy and evidence-based clinical practice guidelines. This review addresses the current trends in SRs and MAs in the field of hepatology via a search of recently published articles in the Cochrane Library and Ovid-MEDLINE.
Databases, Factual ; Fatty Liver/pathology ; Gastroenterology/*trends ; Hepatitis B/pathology ; Hepatitis C/pathology ; Humans ; Liver Cirrhosis/pathology ; Liver Neoplasms/pathology ; Peer Review, Research/*trends

BACKGROUND/AIMS: We identified reports in the literature regarding the diagnostic accuracy of hepatic vein arrival time (HVAT) measured by contrast-enhanced ultrasonography (CEUS) to assess hepatic fibrosis in cirrhosis. METHODS: The Ovid MEDLINE, Embase, and Cochrane databases were searched for all studies published up to 23 July 2015 that evaluated liver status using CEUS and liver biopsy (LB). The QUADAS-II (quality assessment of diagnostic accuracy studies-II) was applied to assess the internal validity of the diagnostic studies. Selected studies were subjected to a meta-analysis with MetaDisc 1.4 and RevMan 5.3. RESULTS: A total of 12 studies including 844 patients with chronic liver disease met our inclusion criteria. The overall summary sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of the HVAT measured by CEUS for the detection of cirrhosis compared to LB were 0.83 (95% confidence interval [CI], 0.77 to 0.89), 0.75 (95% CI, 0.69 to 0.79), 3.45 (95% CI, 1.60 to 7.43), and 0.28 (95% CI, 0.10 to 0.74), respectively. The summary diagnostic odds ratio (random effects model) was 15.23 (95% CI, 3.07 to 75.47), the summary receiver operator characteristics area under the curve was 0.74 (standard error [SE]=0.14), and the index Q was 0.69 (SE=0.11). CONCLUSIONS: Based on a systematic review, the measurement of HVAT by CEUS exhibited an increased accuracy and correlation for the detection of cirrhosis.
Biopsy ; Fibrosis* ; Hepatic Veins* ; Humans ; Liver ; Liver Diseases ; Odds Ratio ; Sensitivity and Specificity ; Ultrasonography*

A systematic review (SR) provides the best and most objective analysis of the existing evidence in a particular field. SRs and derived conclusions are essential for evidence-based strategies in medicine and evidence-based guidelines in clinical practice. The popularity of SRs has also increased markedly in the field of hepatology. However, although SRs are considered to provide a higher level of evidence with greater confidence than original articles, there have been no reports on the quality of SRs and meta-analyses (MAs) in the field of hepatology. Therefore, we performed a quality assessment of 225 SRs and MAs that were recently published in the field of hepatology (January 2011 to September 2014) using A MeaSurement Tool to Assess systematic Reviews (AMSTAR). Using AMSTAR, we revealed both a shortage of assessments of the scientific quality of individual studies and a publication bias in many SRs and MAs. This review addresses the concern that SRs and MAs need to be conducted in a stricter and more objective manner to minimize bias and random errors. Thus, SRs and MAs should be supported by a multi-disciplinary approach that includes clinical experts, methodologists, and statisticians.
*Gastroenterology ; Humans ; *Meta-Analysis as Topic ; *Publication Bias ; *Review Literature as Topic

PURPOSE: In this study factors affecting quality of life in mothers who have children with precocious puberty were identified. METHODS: The participants were 102 mothers of children with precocious puberty. From September 12 to September 30, 2016, data were collected using a structured questionnaire and analyzed using SPSS/WIN 22.0. RESULTS: Regression analysis showed that the model's explanatory power was 45%(F=28.71, p<.001). Role stress (t=-4.83, p<.001), objective burden (t=-2.71, p<.001), and average monthly income (t=4.12, p<.001) were factors affecting quality of life among these mothers. The most influential factor was role stress (β=-.41), which showed a negative correlation. CONCLUSION: Role stress and objective burden were major factors that decreased the quality of life in these. The findings indicate that effective strategy programs for reducing role stress and objective burden are necessary to improve the quality of life in mothers of children with precocious puberty.
Child* ; Humans ; Mothers* ; Puberty, Precocious* ; Quality of Life*

PURPOSE: This study aimed to identify the effects of utilizing Smartphone Application Peer Support (SAPS) on health behavior and body mass index (BMI) among overweight or obese breast cancer survivors (BCS). METHODS: A nonequivalent control group with a non-synchronized design was utilized and 36 participants (experimental group 14, control group 22) were recruited from August 2017 to September 2018. Participants were 40~65 years old, overweight or obese, had completed primary cancer treatment within the 12 months prior to the study, and had not done regular exercise during the last 6 months. The 3-month SAPS consisted of exercise and diet education (once p/2 weeks), peer support (once p/week), and self-monitoring using smartphone applications (5 times p/week). All participants underwent assessments at baseline, right after SAPS, and at 3 months after SAPS. Data were analyzed using repeated measures ANOVA. RESULTS: At the completion of SAPS significant differences were found between groups in motivation for exercise (t=−3.24, p=.005), physical activity (t=−4.15, p<.001), total calorie intake (t=3.42, p=.002), calories from fat (t=−3.01, p=.005), intake of vegetables (t=−2.83, p=.008), and BMI (t=5.21, p<.001). Significant differences in BMI (t=4.13, p<.001) remained up to 3 months after SAPS completion. No significant differences was shown between groups in self-efficacy for exercise, either immediately after or 3 months after SAPS. CONCLUSION: The SAPS has the potential to improve motivation for exercise, health behavior, and BMI of BCS. However, special efforts are required to encourage participants to complete the intervention and maintain long-term effects for future trials.
Body Mass Index ; Breast Neoplasms ; Breast ; Diet ; Education ; Health Behavior ; Humans ; Motivation ; Motor Activity ; Overweight ; Peer Group ; Smartphone ; Survivors ; Vegetables

PURPOSE: This study aimed to evaluate the effects of an empowerment program on maternal stress, anxiety, depression and parenting confidence. METHODS: A total of 44 mothers of preterm infants were assigned into an experimental or a control group (n=22 each). The experimental group received the usual nursing care and 7 sessions of an empowerment program. The control group only received the usual care. The program was implemented from June to December, 2016 in the neonatal intensive care unit of K university-affiliated hospital in Daegu, Korea. The outcome variables measured were parental stress (PSS: NICU), anxiety (STAI), depression (CES-D) and parenting confidence. Data were analyzed using t-test or repeated measures ANOVA. RESULTS: Scores for both parental stress (t=3.07 p=.004) and depression (F=3.76, p=.26) were significantly lower in the experimental group than in the control group. However, there were no significant differences in anxiety between the groups (F=0.79, p=.505). Parenting confidence scores (F=9.05, p=.001) were significantly higher in the experimental group than in the control group. CONCLUSION: A maternal empowerment program can be an effective means of reducing parental stress and depression as well as enhancing parenting confidence, for mothers of preterm infants.
Anxiety* ; Daegu ; Depression* ; Humans ; Infant, Newborn ; Infant, Premature* ; Intensive Care Units ; Intensive Care, Neonatal* ; Korea ; Mothers* ; Nursing Care ; Parenting* ; Parents* ; Power (Psychology)* ; Stress, Psychological

PURPOSE: This study aimed to identify the effects of utilizing Smartphone Application Peer Support (SAPS) on health behavior and body mass index (BMI) among overweight or obese breast cancer survivors (BCS). METHODS: A nonequivalent control group with a non-synchronized design was utilized and 36 participants (experimental group 14, control group 22) were recruited from August 2017 to September 2018. Participants were 40~65 years old, overweight or obese, had completed primary cancer treatment within the 12 months prior to the study, and had not done regular exercise during the last 6 months. The 3-month SAPS consisted of exercise and diet education (once p/2 weeks), peer support (once p/week), and self-monitoring using smartphone applications (5 times p/week). All participants underwent assessments at baseline, right after SAPS, and at 3 months after SAPS. Data were analyzed using repeated measures ANOVA. RESULTS: At the completion of SAPS significant differences were found between groups in motivation for exercise (t=−3.24, p=.005), physical activity (t=−4.15, p<.001), total calorie intake (t=3.42, p=.002), calories from fat (t=−3.01, p=.005), intake of vegetables (t=−2.83, p=.008), and BMI (t=5.21, p<.001). Significant differences in BMI (t=4.13, p<.001) remained up to 3 months after SAPS completion. No significant differences was shown between groups in self-efficacy for exercise, either immediately after or 3 months after SAPS. CONCLUSION The SAPS has the potential to improve motivation for exercise, health behavior, and BMI of BCS. However, special efforts are required to encourage participants to complete the intervention and maintain long-term effects for future trials.

PURPOSE: This study was conducted to analyze physical symptom-related and life-style factors affecting suicidal ideation of senior grade students in elementary school. METHODS: Physical symptom-related and life-style factors were used to investigate suicidal ideation among 663 elementary school students. From February 11 to 15, 2018, data were collected using a structured questionnaire and analyzed using the χ² test, Pearson correlation analysis, and logistic regression analysis in SPSS for Windows version 22.0. RESULTS: The factors affecting suicidal ideation were gender, family structure, economic status, academic performance, exposure to school violence during the past year, physical symptoms, drinking experience, smoking experience, sleeping time, and ramen noodle consumption. The regression analysis showed that exposure to school violence during the past year (odds ratio [OR]: 102.99, 95% confidence interval [CI]: 51.19~207.19, p=.001), number of physical symptoms (OR: 1.25, 95% CI: 1.12~1.41, p=.001), drinking experience (OR: 3.17, 95% CI: 1.66~6.06, p=.001), and game and internet usage time (OR: 2.08, 95% CI: 1.08~4.01, p=.029) affected suicidal ideation. CONCLUSION: This study revealed that physical symptoms and life-style significantly influenced suicidal ideation. Therefore, interventions to reduce suicidal ideation in children must focus on improving children's physical symptoms and life-style.
Child ; Drinking ; Humans ; Internet ; Life Style ; Logistic Models ; Smoke ; Smoking ; Suicidal Ideation ; Symptom Assessment ; Violence

Purpose: This study aimed to evaluate the effects of health interventions using virtual reality (VR) on improving knowledge, attitudes, and skills; and inducing behavioral change among adolescents. Methods: This study is a systematic review and meta-analysis following PRISMA guidelines. We searched Cochrane, MEDLINE, Embase, CINAHL, Scopus, Web of Science, and Korean databases between database inception and April 10, 2021. Based on heterogeneity, a random- or fixed-effects model was used, as appropriate, to calculate effect sizes in terms of the standardized mean difference (SMD) and odds ratio (OR). Studies were selected if they verified the effects of health education using VR on adolescents; there was an appropriate control group; and if the effects of education were reported in terms of changes in knowledge, attitudes, skills, or behaviors. Results: This analysis included six studies (n = 1,086). The intervention groups showed greater responses in knowledge and attitudes (SMD = 0.57, 95% confidence interval (CI) [0.12 to 1.02]), skills related to health behavior (SMD = -0.45, 95% CI [-0.71 to -0.19]), and behavioral change after 12 months (OR = 2.36, 95% CI [1.03 to 5.41]). Conclusion The results confirm the effectiveness of health interventions using virtual reality (VR). Although the analysis include a small number of studies, a case can be made for health interventions using VR to be utilized as educational methods and strategies to prevent risky behaviors among adolescents.