Abstract—Home blood pressure (HBP) monitoring is recommended for assessing the effects of antihypertensive treatment, but it is not clear how the treatment-induced changes in HBP compare,with the changes in clinic blood pressure (CBP). We searched PubMed using the terms “home or self-measured blood pressure,” and selected articles in which the changes in CBP and HBP (using the upper arm oscillometric method) induced by antihypertensive drugs were presented. We performed,a systematic review of 30 articles published before March 2008 that included a total of 6794 subjects.

Evidence during the nineties about the response of real wages to shocks highlights that this response is substantially lower in European countries than in the United States and that there are important differences among European countries. Which are the reasons that explain these different reactions? In this paper, we apply meta-analytical techniques in order to provide a quantitative summary of the available evidence regarding the influence of labour market institutions on real wage flexibility. We find that the design of the study affects the obtained results, and that in more deregulated labour markets with a lower presence of trade unions, this response is particularly larger.

1.00 (referent) 0.95 (0.76 to 1.19) 0.87 (0.68 to 1.12) 0.98 (0.72 to 1.33) .9 — Calcium (density) 1.00 (referent) 1.15 (0.93 to 1.42) 1.05 (0.84 to 1.30) 1.02 (0.82 to 1.27) .9 — Dairy product 1.00 (referent) 0.99 (0.80 to 1.23) 1.16 (0.93 to 1.44) 0.99 (0.78 to 1.26) .8 — Butter 1.00 (referent) 1.00 (0.80 to 1.24) 0.90 (0.72 to 1.13) 1.11 (0.85 to 1.46) .6 — Margarine 1.00 (referent) 1.28 (1.02 to 1.60) 1.10 (0.87 to 1.41) 1.25 (0.99 to 1.58) .2 — Nonaggressive cases ( N = 563) Calcium 1.00 (referent) 1.11 (0.87 to 1.41) 0.94 (0.72 to 1.23) 1.06 (0.77 to 1.47) .9 — Calcium (density) 1.00 (referent) 1.18 (0.93 to 1.49) 1.13 (0.89 to 1.43) 1.11 (0.87 to 1.41) .6 — Dairy product 1.00 (referent) 1.07 (0.84 to 1.37) 1.26 (0.99 to 1.60) 1.07 (0.82 to 1.39) .4 — Butter 1.00 (referent) 1.03 (0.81 to 1.31) 0.95 (0.75 to 1.21) 1.14 (0.85 to 1.54) .5 — Margarine 1.00 (referent) 1.30 (1.02 to 1.66) 1.11 (0.85 to 1.45) 1.25 (0.97 to 1.61) .3 — Aggressive cases ( N = 107) || Calcium 1.00 (referent) 0.43 (0.24 to 0.78) 0.65 (0.38 to 1.10) 0.74 (0.43 to 1.27) .6 .5 Calcium (density) 1.00 (referent) 1.03 (0.63 to 1.70) 0.70 (0.40 to 1.21) 0.72 (0.42 to 1.24) .1 .1 Dairy product 1.00 (referent) 0.71 (0.42 to 1.21) 0.81 (0.48 to 1.36) 0.77 (0.45 to 1.31) .4 .3 Butter 1.00 (referent) 0.88 (0.50 to 1.56) 0.62 (0.32 to 1.17) 1.03 (0.53 to 2.00) .8 .6 Margarine 1.00 (referent) 1.20 (0.68 to 2.12) 1.15 (0.64 to 2.06) 1.25 (0.73 to 2.15) .5 .9 * Hazard ratios from Cox proportional hazards models with age as time metric, left censored at the age at baseline, and adjusted for country of birth and total energy intake (except for the model for calcium energy density). Further adjustment for other potential confounders including education level, body mass index (derived from measured height and weight), fat and fat-free mass (measured from resistance and reactance to an electric current ( 3 ) ), smoking status and history, and alcohol consumption did not materially change the estimated rate ratios (relative change <5%). Cox regression models fi tted using competing risks methods ( 7 ) were used to obtain separate estimates for aggressive and nonaggressive tumors. Models were fi tted using Stata software (version 8.2; Stata Corporation, College Station, TX). — = not applicable. † The 25th, 50th, and 75th percentiles correspond to 617, 804, and 1033 mg/day, respectively, for calcium intake (the median values for increasing quartiles were 507, 710, 909, and 1238 mg/day); 70, 82, and 95 μ g/kJ, respectively, for calcium intake as nutrient density (the median values for increasing quartiles were 62, 76, 88, and 106 μ g/kJ); 17, 31, and 47 times/week, respectively, for dairy product (the median values for increasing quartiles were 10, 24, 39, and 56 times/week); and 0.5, 7, and 17.5 times/week, respectively, for margarine (the median values for increasing quartiles were 0, 3, 7, and 17.5 times/week). Approximately 59% of the participants did not consume butter and so they were included in the referent category for butter intake whereas the participants who did consume butter were categorized by tertiles: the 33rd and 67th percentiles correspond to 1 and 7 times/week, respectively (the median values for increasing tertiles were 0.5, 5.5, and 7.5 times/week). ‡ The hypothesis of a linear trend in the hazard ratio was tested by including in the model a pseudo-continuous variable computed assigning the median intake for each quartile.

Purpose: Meta-analysis involves the integration of several studies with small sample sizes, enabling the investigator to summarize research results into useful clinical information. Tai Chi exercise has recently gained the attention of Western researchers as a potential form of aerobic exercise. A goal of this meta-analysis was to estimate the effect of Tai Chi exercise on aerobic capacity. Methods: A computerized search of 7 databases was done using key words and all languages. Sixteen study elements were critically appraised to determine study quality. D-STAT software was used to calculate the standardized mean differences (ESsm) and the 95% confidence intervals (CI), using means and standard deviations (SD) reported on aerobic capacity expressed as peak oxygen uptake (V · O2peak) (mL · kg -1 · min-1). Results: Of 441 citations obtained, only 7 focused on aerobic capacity in response to Tai Chi exercise (4 experimental and 3 cross-sectional). Older adults including those with heart disease participated (n = 344 subjects); on average men were aged 55.7 years (SD = 12.7) and women 60.7 years (SD = 6.2). Study quality scores ranged from 22 to 28 (mean = 25.1, SD = 2.0). Average effect size for the cross-sectional studies was large and statistically significant (ESsm = 1.01; CI = +0.37, +1.66), while in the experimental studies the average effect size was small and not significant (ESsm = 0.33; CI = -0.41, +1.07). Effect sizes of aerobic capacity in women (ESsm = 0.83; CI = -0.43, +2.09) were greater than those for men (ESsm = 0.65; CI = -0.04, +1.34), though not statistically significant. Aerobic capacity was higher in subjects performing classical Yang style (108 postures) Tai Chi (ESsm = 1.10; CI = +0.82, +1.38), a 52-week Tai Chi exercise intervention (ESsm = 0.94; C = +0.06, +1.81), compared with sedentary subjects (ESsm = 0.80; CI = +0.19, +1.41). Conclusions: This meta-analysis suggests that Tai Chi may be an additional form of aerobic exercise. The greatest benefit was seen from the classical Yang style of Tai Chi exercise when performed for 1-year by sedentary adults with an initial low level of physical activity habits. Recommendations for future research are provided and the effect sizes generated provide information needed for sample size calculations. Randomized clinical trials in diverse populations, including those with chronic diseases, would expand the current knowledge about the effect of Tai Chi on aerobic capacity.

Context Falls among elderly individuals occur frequently, increase with age, and lead to substantial morbidity and mortality. The role of vitamin D in preventing falls among elderly people has not been well established. Objective To assess the effectiveness of vitamin D in preventing an older person from falling. Data Sources MEDLINE and the Cochrane Controlled Trials Register from January 1960 to February 2004, EMBASE from January 1991 to February 2004, clinical ex- perts, bibliographies, and abstracts. Search terms included trial terms: randomized- controlled trialorcontrolled-clinical trialorrandom-allocationordouble-blind method, or single-blind method or uncontrolled-trials with vitamin D terms: cholecalciferol or hydroxycholecalciferols or calcifediol or dihydroxycholecalciferols or calcitriol or vi- tamin D/aa(analogs & derivates) or ergocalciferol or vitamin D/bl(blood); and with accidental falls or falls, and humans. Study Selection We included only double-blind randomized, controlled trials (RCTs) of vitamin D in elderly populations (mean age, 60 years) that examined falls resulting from low trauma for which the method of fall ascertainment and definition of falls were defined explicitly. Studies including patients in unstable health states were ex- cluded. Five of 38 identified studies were included in the primary analysis and 5 other studies were included in a sensitivity analysis. Data Extraction Independent extraction by 3 authors using predefined data fields including study quality indicators. Data Synthesis Based on 5 RCTs involving 1237 participants, vitamin D reduced the corrected odds ratio (OR) of falling by 22% (corrected OR, 0.78; 95% confidence interval (CI), 0.64-0.92) compared with patients receiving calcium or placebo. From the pooled risk difference, the number needed to treat (NNT) was 15 (95% CI, 8-53), or equivalently 15 patients would need to be treated with vitamin D to prevent 1 per- son from falling. The inclusion of 5 additional studies, involving 10001 participants, in a sensitivity analysis resulted in a smaller but still significant effect size (corrected RR, 0.87; 95% CI, 0.80-0.96). Subgroup analyses suggested that the effect size was in- dependent of calcium supplementation, type of vitamin D, duration of therapy, and sex, but reduced sample sizes made the results statistically nonsignificant for calcium supplementation, cholecalciferol, and among men. Conclusions Vitamin D supplementation appears to reduce the risk of falls among ambulatory or institutionalized older individuals with stable health by more than 20%. Further studies examining the effect of alternative types of vitamin D and their doses, the role of calcium supplementation, and effects in men should be considered.

This article presents the results of a meta-analysis of 58 studies of mathematics interventions for elementary students with special needs. Interventions in three different domains were selected: preparatory mathematics, basic skills, and problem- solving strategies. The majority of the included studies described interventions in the domain of basic skills. In general, these inter- ventions were also the most effective. Furthermore, a few spe- cific characteristics were found to influence the outcomes of the studies. In addition to the duration of the intervention, the particu- lar method of intervention proved important: Direct instruction and self-instruction were found to be more effective than medi- ated instruction. Interventions involving the use of computer- assisted instruction and peer tutoring showed smaller effects than interventions not including these supports.

Outcome studies support the effectiveness of cognitive-behavioral approaches for treating various emotional and behavioral problems. The effectiveness of group cog- nitive-behavioral therapy (GCBT) has received less empirical attention. The current investigation employed meta-analytic procedures to examine various effects from a total of 22 published studies and 8 doctoral dissertations that used GCBT as a thera- peutic intervention to reduce general symptomatology. A total of 134 effect sizes yielded an overall pre- to posttreatment weighted mean effect size of .77 for a wide range of symptomatology treated with GCBT. Twelve of the 30 studies included a no- treatment control group, and these studies yielded a weighted mean effect size of .13 when comparing pre- and posttreatment levels of symptomatology. Implications for group work practice and research are discussed.

Background and Purpose—Greater availability and improvement of neuroradiological techniques have resulted in more frequent detection of unruptured aneurysms. Because prognosis of subarachnoid hemorrhage is still poor, preventive surgery is increasingly considered as a therapeutic option. Elective surgery requires reliable data on its risks. Therefore, we performed a meta-analysis on the mortality and morbidity of surgery for unruptured intracranial aneurysms. Methods—Through Medline and additional searches by hand, we retrieved studies on clipping of unruptured (additional, symptomatic, or incidental) aneurysms published from 1966 through June 1996. Two authors independently extracted data. We used weighted linear regression for data analysis. Results—We included 61 studies that involved 2460 patients (57% female; mean age, 50 years) and at least 2568 unruptured aneurysms (27% .25 mm, 30% located in the posterior circulation). Mortality was 2.6% (95% confidence interval (CI), 2.0% to 3.3%). Permanent morbidity occurred in 10.9% (95% CI, 9.6% to 12.2%) of patients. Postoperative mortality was significantly lower in more recent years for nongiant aneurysms and aneurysms with an anterior location; the last 2 characteristics were also associated with a significantly lower morbidity. Conclusions—In studies published between 1966 and 1996 on clipping of unruptured aneurysms, mortality was 2.6% and morbidity was 10.9%. In calculating the pros and cons of preventive surgery, these proportions should be taken into account. (Stroke. 1998;29:1531-1538.)

Background and Purpose —Acute myocardial infarction and sudden death display a circadian rhythm, with a higher risk between 6 am and noon. Some reports suggest that stroke does not follow such a circadian variation and that hemorrhagic stroke occurs more often during the evening. Methods —A meta-analysis of 31 publications reporting the circadian timing of 11 816 strokes was performed, subdividing (when possible) by the type of stroke, according to the time of onset of symptoms. When precise timing was not given, strokes were distributed evenly (that is, biasing toward the null hypothesis of lack of circadian variation). Results —All subtypes of strokes displayed a significant ( P <0.001) circadian variation in time of onset, whether divided into 3-, 4-, or 6-hour time periods. There was a 49% increase (95% confidence interval, 44% to 55%) in stroke of all types between 6 am and noon (compared with expectations if no circadian variation was present), which is a 79% (95% confidence interval, 72% to 87%) increase over the normalized risk of the other 18 hours of the day. There were 29% fewer strokes between midnight and 6 am , a 35% decrease compared with the other 18 hours of the day. All three subtypes of stroke had a significantly higher risk between 6 am and noon (55% for 8250 ischemic strokes; 34% for 1801 hemorrhagic strokes, and 50% for 405 transient ischemic attacks). Conclusions —These data support the presence of a circadian pattern in the onset of stroke, with a significantly higher risk in the morning.