{"title":"Effect of cross-sex hormones on the quality of life, depression and anxiety of transgender individuals: a quantitative systematic review.","authors":"Stefan Rowniak, Lindsay Bolt, Claire Sharifi","doi":"10.11124/JBISRIR-2017-003869","DOIUrl":"https://doi.org/10.11124/JBISRIR-2017-003869","url":null,"abstract":"<p><strong>Objective: </strong>The objective of the review was to evaluate the effectiveness of cross-sex hormone use in improving quality of life and the related measures of depression and anxiety in transgender individuals.</p><p><strong>Introduction: </strong>Transgender medicine as a specialty is still in its infancy and is beginning to attract more primary care providers. The use of hormones to aid in gender transition is expected to provide benefit with regard to quality of life, but there have been few high-quality studies. Two previous systematic reviews were found. One review included studies where participants had gender-affirming surgery, and the other review considered only prospective studies. Both reviews found a benefit with the use of hormones, despite the lack of high-quality studies. To describe outcomes specifically associated with hormone therapy, this review focused on patients who had not yet had surgical interventions, with an aim to inform primary care providers who are considering providing gender transition related-care in their office or clinic.</p><p><strong>Inclusion criteria: </strong>Eligible studies included participants who were transgender (trans) women, trans men or who did not identify with the gender binary and were using cross-sex hormones. This review only considered studies where hormone use was under medical supervision. Studies that included participants who already had any form of gender-affirming surgery were excluded, as were studies that did not use a validated tool to measure quality of life, depression or anxiety.</p><p><strong>Methods: </strong>A comprehensive database search of PubMed, CINAHL, Embase and PsycINFO was conducted in August and September of 2017. The search for unpublished studies and gray literature included Google, the New York Academy of Medicine and the World Professional Association for Transgender Health (WPATH) Conference Proceedings. No date limits were used in any part of the search. Study selection, critical appraisal and data extraction were conducted by two independent reviewers using the JBI protocols, standardized critical appraisal and data extraction tools.</p><p><strong>Results: </strong>Seven observational studies met the inclusion criteria for this review. The total number of transgender participants in all the included studies was 552. Population sizes in the studies ranged from 14 to 163. In general, the certainty of the findings was low to very low due to issues with imprecision and indirectness. The use of cross-sex hormones was associated with improved quality of life, depression and anxiety scores, although no causation can be inferred.</p><p><strong>Conclusions: </strong>Transgender participants who were prescribed cross-sex hormones had statistically significant scores demonstrating improvement on the validated scales that measured quality of life, anxiety and depression when compared to transgender people who had enrolled in a sex-reassignment clinic but ha","PeriodicalId":73539,"journal":{"name":"JBI database of systematic reviews and implementation reports","volume":" ","pages":"1826-1854"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.11124/JBISRIR-2017-003869","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40448445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Easing the transition to parenthood: the importance of perinatal and postnatal mental health for mothers and fathers.","authors":"A. Holopainen, T. Hakulinen","doi":"10.11124/JBISRIR-D-19-00244","DOIUrl":"https://doi.org/10.11124/JBISRIR-D-19-00244","url":null,"abstract":"","PeriodicalId":73539,"journal":{"name":"JBI database of systematic reviews and implementation reports","volume":"46 1","pages":"1727-1728"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80445013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Marcia Pestana-Santos, Margarida Reis Santos, Daniela Cardoso, Lurdes Lomba
{"title":"Non-pharmacological interventions used during the perioperative period to prevent anxiety in adolescents: a scoping review protocol.","authors":"Marcia Pestana-Santos, Margarida Reis Santos, Daniela Cardoso, Lurdes Lomba","doi":"10.11124/JBISRIR-2017-003925","DOIUrl":"10.11124/JBISRIR-2017-003925","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this review is to map the range of non-pharmacological interventions used during the perioperative period to prevent anxiety in adolescents.</p><p><strong>Introduction: </strong>Evidence shows that 80% of adolescents report having experienced significant anxiety in the perioperative period. Non-pharmacological interventions implemented in the perioperative period are recommended as a resource to help to control anticipatory, separation and perioperative anxiety and fear related to surgical procedures in adolescents.</p><p><strong>Inclusion criteria: </strong>This review will consider studies that focus on adolescents aged 10 to 19 who have undergone a surgical procedure, regardless of the type of surgery, and participated in non-pharmacological interventions aimed to prevent anxiety in the perioperative period. The intervention may be provided by any healthcare professional. Studies related to non-pharmacological interventions associated with hospitalization in a non-surgical context will be excluded.</p><p><strong>Methods: </strong>The methodology will follow the JBI recommendations for scoping reviews. Any published and unpublished sources of information will be considered. Studies published in English, Spanish and Portuguese will be included, with no geographical or cultural limitations. Duplicates will be removed and two independent reviewers will screen the abstracts and assess the full text of selected studies, based on the inclusion criteria. The results of study selection will be presented in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram for scoping reviews. Data synthesis will be presented in a narrative summary to provide a description of the existing evidence.</p>","PeriodicalId":73539,"journal":{"name":"JBI database of systematic reviews and implementation reports","volume":"17 9","pages":"1883-1893"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37410396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Hopper, Sherrie L Murray, Lucille R. Ferrara, J. Singleton
{"title":"Effectiveness of diaphragmatic breathing for reducing physiological and psychological stress in adults: a quantitative systematic review.","authors":"S. Hopper, Sherrie L Murray, Lucille R. Ferrara, J. Singleton","doi":"10.11124/JBISRIR-2017-003848","DOIUrl":"https://doi.org/10.11124/JBISRIR-2017-003848","url":null,"abstract":"OBJECTIVE\u0000The objective of this review was to evaluate the effectiveness of diaphragmatic breathing for reducing physiological and psychological stress in adults 18 years and over.\u0000\u0000\u0000INTRODUCTION\u0000Stress has reached epidemic proportions globally. Unidentified sequela of physiological and psychological stress can result in anxiety, depression, heart disease, cancer, immunologic conditions and death. There is a high cost associated with the treatment of stress related health conditions in the United States and worldwide. Many treatments are pharmacologic and cannot be self-initiated. Therefore, it is critical to identify evidence-based, low-cost, non-pharmacologic, self-administered interventions that can mitigate physiological and psychological stress.\u0000\u0000\u0000INCLUSION CRITERIA\u0000This review considered adults 18 years and over engaged in diaphragmatic breathing as an isolated intervention to reduce physiological and psychological stress. There were no exclusions based on physical or psychological conditions. The comparator was no treatment or usual treatment, which may constitute ordinary breathing.\u0000\u0000\u0000METHODS\u0000The comprehensive literature search included published and unpublished studies in English from the beginning of the databases through January 2018. The databases searched included: PubMed, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, PsycINFO, ProQuest Nursing and Allied Health and Health Source: Nursing/Academic Edition. The recommended JBI approach to critical appraisal, study selection, data extraction and data synthesis was used.\u0000\u0000\u0000RESULTS\u0000Three studies met the criteria for review: one randomized controlled trial and two quasi-experimental studies. Statistical pooling was not possible due to clinical and methodological heterogeneity of interventions and outcome measures of the included studies. All three studies demonstrated the effectiveness of diaphragmatic breathing on reducing stress. One study showed improvement in the biomarkers of respiratory rate and salivary cortisol levels, one showed improvement in systolic and diastolic blood pressure, and one study showed an improvement in the stress subscale of the Depression Anxiety Stress Scales-21 (DASS-21) after implementation of a diaphragmatic breathing intervention. Although there were limitations across the studies, such as sample size, and length and duration of the intervention over time, ranging from one 20-minute intervention to nine months, the studies demonstrated that diaphragmatic breathing had a positive effect on lowering physiological and psychological stress.\u0000\u0000\u0000CONCLUSIONS\u0000The evidence suggests that diaphragmatic breathing may decrease stress as measured by physiologic biomarkers, as well psychological self-report tools. Given the benefits of diaphragmatic breathing on stress reduction, ongoing research is needed to continue to establish the evidence-base for this self-administered, low-cost, non-pharmacologic intervention.","PeriodicalId":73539,"journal":{"name":"JBI database of systematic reviews and implementation reports","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86576242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Prioritizing impact to improve health services and reduce inequities in rural, remote and very remote locations.","authors":"T. Carey","doi":"10.11124/JBISRIR-D-19-00274","DOIUrl":"https://doi.org/10.11124/JBISRIR-D-19-00274","url":null,"abstract":"","PeriodicalId":73539,"journal":{"name":"JBI database of systematic reviews and implementation reports","volume":"172 1","pages":"1729-1730"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78912560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Quirke, G. Donohue, G. Prizeman, Patricia White, E. McCann
{"title":"Experiences and perceptions of emergency department nurses regarding people who present with mental health issues: a systematic review protocol.","authors":"M. Quirke, G. Donohue, G. Prizeman, Patricia White, E. McCann","doi":"10.11124/JBISRIR-D-18-00004","DOIUrl":"https://doi.org/10.11124/JBISRIR-D-18-00004","url":null,"abstract":"OBJECTIVE\u0000The objective of this review is to identify, appraise and synthesize available evidence related to the experiences and perceptions of emergency department (ED) nurses regarding people with any mental health issue who present at the ED.\u0000\u0000\u0000INTRODUCTION\u0000The ED is often the first point of contact for patients with a mental health issue, due to a shortage of available mental health services. Nursing staff in the ED are involved in key clinical decision making and hands-on care for these patients, despite a lack of mental health specialist training. In order to improve patient outcomes in the ED setting, it is necessary to have a thorough understanding of how ED nurses' experiences with this population affect their clinical decision making.\u0000\u0000\u0000INCLUSION CRITERIA\u0000This review will consider studies that include ED nurses, with or without specialist mental health training, working in urban and rural EDs in healthcare settings worldwide. Qualitative studies that explore the experiences and perceptions of ED nurses regarding people who present with mental health issues in the ED setting will be considered. Studies published in English will be considered, with no date limitations.\u0000\u0000\u0000METHODS\u0000CINAHL complete, MEDLINE, PsycINFO, Embase, Scopus, Web of Science and Google Scholar will be searched, along with several sources of gray literature. Retrieval of full-text studies, assessment of methodological quality and data extraction will be performed independently by two reviewers. Findings will be pooled using meta-aggregation, and a ConQual Summary of Findings will be presented.","PeriodicalId":73539,"journal":{"name":"JBI database of systematic reviews and implementation reports","volume":"581 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76256508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ziwa Yu, Audrey Steenbeek, Marilyn Macdonald, Cathy MacDonald, Shelley McKibbon
{"title":"Characteristics of Indigenous healing strategies in Canada: a scoping review protocol.","authors":"Ziwa Yu, Audrey Steenbeek, Marilyn Macdonald, Cathy MacDonald, Shelley McKibbon","doi":"10.11124/JBISRIR-2017-003942","DOIUrl":"10.11124/JBISRIR-2017-003942","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this review is to identify the characteristics of Indigenous healing strategies in Canada and approaches to improving cultural relevance to local Indigenous contexts.</p><p><strong>Introduction: </strong>In the previous 150 years, Indigenous peoples of Canada have experienced colonization, forced assimilation, cultural oppression and violence, and these are associated with high rates of social distress and health disparities. Today, legacies of colonization continue to marginalize Indigenous peoples, creating healthcare institutions devoid of Indigenous worldviews. Despite the growing number of Indigenous healing strategies currently in existence, literature describing these strategies has not been systematically scoped. To address this gap, this scoping review will identify characteristics of Indigenous healing strategies in Canada, and explore culturally relevant approaches used in research process.</p><p><strong>Inclusion criteria: </strong>This review will consider literature that describes Indigenous healing strategies in Canada and will include First Nations, Inuit and Métis as the population of interest. Strategies may include, but are not limited to, health services and programs, policies and guidelines, models and frameworks, and Indigenous narratives and expert opinions. Healing strategies delivered in all service settings are eligible for inclusion.</p><p><strong>Methods: </strong>The databases/sources to be searched will include: CINAHL, Sociological Abstracts, PsycINFO, MEDLINE and Academic Search Premier. Searches for gray literature will be conducted in iPortal, Canadian Electronic Library, and a list of Canadian government and Indigenous organization websites. Retrieval of full-text studies and data extraction will be performed independently by two reviewers. Findings will be summarized in tabular forms accompanied by narrative text.</p>","PeriodicalId":73539,"journal":{"name":"JBI database of systematic reviews and implementation reports","volume":"17 9","pages":"1933-1940"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37287356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kaylee Allan, Kati Hayes, Matt Thomas, Katie Barnard
{"title":"Coenzyme Q10 supplementation in traumatic brain injury: a scoping review protocol.","authors":"Kaylee Allan, Kati Hayes, Matt Thomas, Katie Barnard","doi":"10.11124/JBISRIR-2017-003984","DOIUrl":"10.11124/JBISRIR-2017-003984","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this review is to map evidence on coenzyme Q10 (CoQ10) use in traumatic brain injury (TBI).</p><p><strong>Introduction: </strong>Traumatic brain injury is an insult to the brain structure caused by external force and resulting in physiological disruption to brain function. Globally, 60% of all TBIs occur from road traffic accidents. In 2016, the World Health Organization reported that road traffic accidents were among the top 10 leading causes of death. Following the initial brain injury, a secondary injury can occur due primarily to a significant increase in production of free radicals causing oxidative stress, which can dictate the patient's ability to survive. Coenzyme Q10 is known to protect neuronal cells from oxidative stress; the mechanism for this has been examined in studies using rats. This review will examine what is known about CoQ10 in TBI and identify gaps in the literature, which may guide future research.</p><p><strong>Inclusion criteria: </strong>The review will include both human and animal subjects who have experienced a TBI in the acute/laboratory-controlled setting and where CoQ10 is supplemented. Animal studies will be included. The review will consider experimental and quasi-experimental study designs including randomized controlled trials, non-randomized controlled trials, before and after studies, and interrupted time-series studies. Studies published in English will be considered, with no date restriction.</p><p><strong>Methods: </strong>Searches will be conducted in the Cochrane Library, MEDLINE, Embase, CINAHL and trial registries. Data will be extracted and presented on details about the population, concept, context, study methods and key findings.</p>","PeriodicalId":73539,"journal":{"name":"JBI database of systematic reviews and implementation reports","volume":"17 9","pages":"1901-1908"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37287357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chee Keong See, Deborah Turnbull, Felix Ritson, Sean Martin, Phillip Tully, Gary Wittert
{"title":"Association of endogenous testosterone concentration with depression in men: a systematic review protocol.","authors":"Chee Keong See, Deborah Turnbull, Felix Ritson, Sean Martin, Phillip Tully, Gary Wittert","doi":"10.11124/JBISRIR-2017-004035","DOIUrl":"https://doi.org/10.11124/JBISRIR-2017-004035","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this review is to examine the association between serum testosterone concentration and the presence and severity of depression in men.</p><p><strong>Introduction: </strong>Cross-sectional and longitudinal cohort studies examining the relationship between serum testosterone concentration and depression in men have produced mixed results. There has not, however, been any prior attempt to systematically interrogate the data. Clarification of the relationship has clinical importance because depression may be under-diagnosed in men.</p><p><strong>Inclusion criteria: </strong>This review will consider studies involving community-dwelling men who are not receiving testosterone replacement therapy. The exposure of interest reviewed will include endogenous testosterone concentration measured through validated assays. Studies measuring total and testosterone fraction concentration will be included. This review will include studies with depression or incident depression outcomes as defined by either clinical diagnosis of depression or validated self-administered questionnaire assessing depression symptomatology.</p><p><strong>Methods: </strong>This review will follow the JBI approach for systematic reviews of etiology and risk. The following sources will be searched: PubMed, PsycINFO, Embase, the Cochrane Central Register of Controlled Trials, Australian New Zealand Clinical Trials Registry and the ISRCTN Registry. Analytical observational studies including prospective and retrospective cohort studies, case control studies and analytical cross-sectional studies published in English or other languages with English translation will be considered. Retrieval of full-text studies, assessment of methodological quality and data extraction will be performed independently by two reviewers. Data will be pooled in statistical meta-analysis, where possible.</p><p><strong>Systematic review registration number: </strong>PROSPERO CRD42018108273.</p>","PeriodicalId":73539,"journal":{"name":"JBI database of systematic reviews and implementation reports","volume":"17 9","pages":"1894-1900"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.11124/JBISRIR-2017-004035","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37277519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Doreen Mucheru, Mary-Claire Hanlon, Mark McEvoy, Ammarin Thakkinstian, Lesley MacDonald-Wicks
{"title":"Comparative efficacy of lifestyle intervention strategies targeting weight outcomes in people with psychosis: a systematic review and network meta-analysis.","authors":"Doreen Mucheru, Mary-Claire Hanlon, Mark McEvoy, Ammarin Thakkinstian, Lesley MacDonald-Wicks","doi":"10.11124/JBISRIR-2017-003943","DOIUrl":"10.11124/JBISRIR-2017-003943","url":null,"abstract":"<p><strong>Objectives: </strong>The objective of this review was to pool and rank the efficacy of lifestyle intervention strategies targeting weight, body mass index, waist circumference and waist-to-hip ratio in people with psychosis by comparing the effect size of these weight outcomes. Secondary to this, the objective was to stratify the lifestyle interventions according to their inclusion of dietary information that adheres to Australian Dietary Guidelines.</p><p><strong>Introduction: </strong>People living with psychosis have a significantly increased risk of all-cause mortality, with cardiovascular disease a considerable contributor to this risk. Controlling lifestyle risk factors, which include smoking, poor diet and inadequate physical activity, leads to significant weight reduction and decreases cardiovascular disease risk. Previous reviews on this topic have not clearly identified essential components of lifestyle interventions in people with psychosis, mainly due to statistical limitations of analyses. This review employed a network meta-analysis, which compares more than two groups of interventions and ranks them according to efficacy, thus providing a global estimate of effect. Additionally, available reviews have not assessed compliance of dietary information offered in lifestyle interventions to established guidelines.</p><p><strong>Inclusion criteria: </strong>This review considered randomized controlled trials that delivered lifestyle interventions to community-dwelling adults with psychotic disorders. Outcomes of interest included weight, body mass index, waist circumference and waist-to-hip ratio.</p><p><strong>Methods: </strong>The Cochrane Library, MEDLINE/PreMEDLINE, Embase, CINAHL, Scopus and PsycINFO were searched for studies published in English from 1985 to June 2018. Data were qualitatively summarized, during which lifestyle intervention subgroups were created (based on key similarities) and then compared in direct meta-analyses and network meta-analyses. Assessment of study adherence to Australian Dietary Guidelines was conducted in a narrative format.</p><p><strong>Results: </strong>Thirty-two randomized controlled trials were included, and the overall quality of these studies ranged from what appeared to be low to moderate. Lifestyle intervention studies contained both a dietary and physical activity component, with the exception of two studies that focused solely on physical activity. Delivery of dietary and physical activity information was mainly through education; however, some studies provided additional structure to the intervention by offering tailored advice or helping participants to set goals, and providing regular review of progress for diet, physical activity or both. Results from network-meta-analyses showed that only studies with a structured approach for both diet and physical activity demonstrated significant decreases in weight (effect size = -4.12, 95% confidence interval = -7.772 to -2.760, P = 0.0","PeriodicalId":73539,"journal":{"name":"JBI database of systematic reviews and implementation reports","volume":"56 1","pages":"1770-1825"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73998117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}