Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement

Silicosis and tuberculosis: A systematic review and meta-analysis

INTRODUCTION

Silicosis mostly happens in workers with high silica exposure and may accompany the development of various diseases like tuberculosis, cancer, or autoimmune diseases. The term silico-tuberculosis describes a condition in which an individual is affected by both silicosis and tuberculosis at the same time. This systematic review and meta-analysis study was conducted to evaluate the risk of tuberculosis in silicosis patients and individuals exposed to silica dust.

METHODS

We performed a systematic search for relevant studies up to 6 September 2022 using PubMed/ Medline, and Embase with the following keywords in titles or abstracts: "silicosis" OR "silicoses" OR "pneumoconiosis" OR "pneumoconioses" AND "tuberculosis". Cohort and case-control studies containing relevant and original information about tuberculosis infection in silicosis patients were included for further analysis. Pooled estimates and 95% confidence intervals (CI) for the relative risk of tuberculosis in individuals with silicosis compared to those without; these were evaluated using the random effects model due to the estimated heterogeneity of the true effect sizes.

RESULTS

Out of 5352 potentially relevant articles, 7 studies were eligible for systematic review, of which 4 cohort studies were included for meta-analysis. The total population of all studies was 5884, and 90.63% were male. The mean age of participants was 47.7 years. Our meta-analysis revealed a pooled risk ratio of 1.35 (95%CI 1.18-1.53, I 2: 94.30%) which means an increased risk of silicosis patients and silica-exposed individuals to tuberculosis infection.

CONCLUSION

Silicosis and silica dust exposure increase the risk of tuberculosis. Therefore, we suggest that individuals with long-time silica exposure, like mine workers, be routinely considered for both silicosis and tuberculosis screening programs.

Chronic Wasting Disease Research in North America: A systematic review highlighting species-wise and interdisciplinary research trends

Chronic Wasting Disease (CWD) research has experienced significant growth, spanning diverse disciplines such as genetics, immunology, modelling, and behaviour. To gain a broad understanding of the changes in CWD research focusing cervids, we analysed temporal trends in study location, species, genus investigated, infection types, and population type since the discovery of CWD in 1980s. Our findings indicate that Colorado, USA, published the highest number of articles, followed by Wisconsin, and publication numbers correlated with reported CWD cases in states/provinces. Odocoileus emerged as the most studied genus. Wild populations are studied more commonly than captive populations. Keyword analysis of transmission types shows the discovery of novel transmission modes in the recent past. We also used a novel approach to categorize studies into five themes: field-based, lab-based, math/analytics/modelling-based, management-based, and human dimensions. Overall, most studies captured had a lab-based component. The interdisciplinary or transdisciplinary nature of major disciplines and evolving trends in keywords, particularly the increased reliance on genetics/genomics, accentuate the beginning of using genomics to under and tackle CWD at a fundamental scale. Encapsulated in our analysis, these dynamic changes offer valuable insights for navigating CWD through scientifically informed proactive management decisions in conjunction with existing surveillance efforts not only for the commonly studied species but also for potentially susceptible species.

Financial motivation models for community health workers in low- and middle-income countries: a scoping review

Community health workers (CHWs) are key players in providing primary healthcare in low- and middle-income countries. However, their absence from the formal health system in many of these countries often presents a challenge to their remuneration. The objective of this scoping review is to document programs implemented at both small and large scales in low- and middle-income countries, the remuneration strategies they have established, and the effects of these strategies on the work of CHWs. In total, we included 50 articles in this review. We have identified four types of compensation: fixed compensation, performance-based compensation, compensation based on income-generating activities (IGAs), and combined compensation. We identified the strengths and weaknesses of each type of compensation. A common strength for most models was improvement in motivation and performance. A common weakness for most models was irregular payments. The results of this review highlight the need to consider the economic, social, and cultural settings of the countries or environments at hand, and to include CHWs in discussions regarding the selection of a compensation model.

Assessing neurocognitive outcomes in PTSD: a multilevel meta-analytical approach

Background: Evidence supporting the association between posttraumatic stress disorder (PTSD) and cognitive impairment is accumulating. However, less is known about which factors influence this association.Objective: The aims of this meta-analysis were to (1) elucidate the association between PTSD and a broad spectrum of cognitive impairment, including the risk of developing neurocognitive disorder (NCD) later in life, using a multilevel meta-analytic approach, and (2) identify potential moderating factors of this association by examining the effects of age (20-39, 40-59, 60+), study design (cross-sectional or longitudinal), study population (war-exposed populations/veterans or the general population), neurocognitive outcome assessed (i.e. a diagnosis of NCD or type of cognitive domain as classified according to A Compendium of Neuropsychological tests), gender (≥50% women or <50% women), study quality (high vs low), type of PTSD measure (self-report or clinical diagnosis), as well as the presence of comorbidities such as traumatic brain injury (TBI), depression, and substance use (all coded as either present or absent).Method: Peer-reviewed studies on this topic were extracted from PubMed and Web of Science with predetermined keywords and criteria. In total, 53 articles met the criteria. Hedge's g effect sizes were calculated for each study and a three-level random effect meta-analysis conducted.Results: After accounting for publication bias, the results suggested a significant association between PTSD and cognitive impairment, g = 0.13 (95% CI: 0.10-0.17), indicating a small effect. This association was consistent across all examined moderators, including various neurocognitive outcomes, age, gender, study design, study population, study quality, type of PTSD measure, and comorbidities such as depression, substance use, and TBI.Conclusions: These findings collectively suggest that PTSD is associated with both cognitive impairment and NCD. This emphasizes the need for early intervention (including prevention strategies) of PTSD, alongside monitoring cognitive function in affected individuals.International Prospective Register of Systematic Reviews (PROSPERO) registration number: CRD42021219189, date of registration: 02.01.2021.

A scoping review of moral injury in refugees

Background and Objective: We review the empirical evidence about how moral injury, the experience of a transgression of one's moral framework, can be understood in refugee and asylum seekers.Method: Systematic search identified 12 studies that utilised a range of methodologies (8 quantitative, one qualitative, one mixed methods, and one case study). Study quality was assessed using critical appraisal tools: studies varied in quality from moderate to high (75-100%) with some having methodological issues or a risk of bias.Results: Moral injury is suggested to play a major role in psychological distress and mental health outcomes in these populations: refugees are exposed to a wide range of potentially morally injurious events (PMIEs) and suggest that it is the cognitive appraisal of the event that leads to negative psychological outcomes. Specifically, two distinct subtypes of moral injury appraisals appear pertinent to refugees: the appraisal of one's own actions as violating moral beliefs (MI-self) and the appraisal of others' actions as violating moral beliefs (MI-other).Conclusions: Moral injury may play a key role in understanding the psychological impact of traumatic events and stressful experiences that violate an individual's moral beliefs. Consequently, there is potential benefit in targeting moral injury appraisals in therapeutic interventions for refugee populations.

Incorporating machine learning and statistical methods to address maternal healthcare disparities in US: A systematic review

BACKGROUND

Maternal health disparities are recognized as a significant public health challenge, with pronounced disparities evident across racial, socioeconomic, and geographic dimensions. Although healthcare technologies have advanced, these disparities remain primarily unaddressed, indicating that enhanced analytical approaches are needed.

OBJECTIVES

This review aims to evaluate the impact of machine learning (ML) and statistical methods on identifying and addressing maternal health disparities and to outline future research directions for enhancing these methodologies.

METHODS

Following the PRISMA guidelines, the review of studies employing ML and statistical methods to analyze maternal health disparities within the United States was conducted. Publications between January 1, 2012, and February 2024 were systematically searched through PubMed, Web of Science, and ScienceDirect. Inclusion criteria targeted studies conducted within the U.S., peer-reviewed articles published during the period, research covering the postpartum period up to one year post-delivery, and studies incorporating both maternal and infant health data with a focus primarily on maternal outcomes.

RESULTS

A total of 147 studies met the inclusion criteria for this analysis. Among these, 129 (88 %) utilized statistical methods in health sciences to analyze correlations, treatment effects, and public health initiatives, thus providing vital, actionable insights for policy and clinical decisions. Meanwhile, 18 articles (12 %) applied ML techniques to explore complex, nonlinear relationships in data. The findings indicate that while ML and statistical methods offer valuable insights into the factors contributing to health disparities, there are limitations regarding dataset diversity and methodological precision. Most studies concentrate on racial and socioeconomic inequalities, with fewer addressing the geographical aspects of maternal health. This review emphasizes the necessity for broader dataset utilization and methodology improvements to enhance the findings' predictive accuracy and applicability.

CONCLUSIONS

ML and statistical methods show great potential to transform maternal healthcare by identifying and addressing disparities. Future research should focus on broadening dataset diversity, improving methodological precision, and enhancing interdisciplinary efforts.

Phytoremediation of pesticide-contaminated freshwaters by aquatic plants: a meta-analysis

In the last decade, water contamination by pesticides has become a global concern, and phytoremediation has gained increasing attention. This approach is cost-effective and ecologically beneficial, revealing the abilities of plants to remove, detoxify, or immobilize environmental contaminants. Despite the growing number of publications, some questions remain: (i) How effectively do aquatic plants reduce pesticides in water? (ii) How is the effectiveness of water phytoremediation influenced by plant characteristics, pesticide properties, and environmental/experimental conditions? To answer those questions, we conducted a meta-analysis with 405 extracted pairs of data points from 56 studies to systematically analyze and explore the efficiency of pesticide removal by aquatic plants. We found that, compared to the control without plants, aquatic vegetation increases pesticide removal from water by 38.86 % (95 % CI = 31.50-46.21 %). We conducted subgroup and meta-regression analyses to identify factors influencing the global effect size. The taxonomy (order) and the life form of the plants did not significantly influence the degree of pesticide removal. The removal efficiency was influenced by pesticides' type/mode of action, with insecticides being less efficiently removed than other pesticides. Additionally, we observed higher phytoremediation efficiency with increasing log KOW (lipophilicity), molecular mass, and in experiments conducted with contaminant mixtures. Environmental conditions also influenced removal efficiency, with higher temperatures and light intensity enhancing phytoremediation. Our results provide insights into the key factors determining the success of phytoremediation in aquatic environments contaminated by pesticides, thereby guiding decision-making on using this technology and directing new research toward developing strategies to enhance its effectiveness.

Plant-derived bioactive peptides and protein hydrolysates for managing MAFLD: A systematic review of in vivo effects

Metabolic dysfunction-associated fatty liver disease (MAFLD) represents a growing health concern worldwide. Among the pursuit of therapeutic interventions, interest in natural bioactive compounds has intensified because of their potential hepatoprotective effects. This systematic review aims to evaluate the impact of plant-derived hydrolysates and peptides on MAFLD through the current literatures, encompassing their mechanisms of action. Key outcomes evaluated included changes in liver enzymes, liver lipid content, inflammation markers, and histopathological improvements. Preliminary findings suggest a potential beneficial effect of plant-derived hydrolysates and peptides on the improvement of MAFLD-related parameters, with mechanisms implicating antioxidant, anti-inflammatory, and lipid-lowering properties. This review highlights emerging evidence supporting the potential therapeutic role of plant-derived hydrolysates and peptides in the management of MAFLD. However, more well-designed clinical trials with larger sample sizes and longer durations are warranted to elucidate their efficacy, optimal dose, and long-term safety.

The role of the human cerebellum in representing social behavior sequences: An SDM-PSI meta-analysis

Although the cerebellum has been widely considered to be a motor structure, recent studies have shown that it is also involved in constructing sequences of social events. However, little is known about (1) whether explicit sequencing processes elicit stronger cerebellar activation than non-sequencing processes, (2) whether the cerebellar sequence detection function is more applicable to social or non-social contexts, or (3) whether the cerebellum exhibits consistent or heterogeneous activation patterns in representing behavioral sequences across contexts. Thus, we conducted a meta-analysis of 13 neuroimaging studies by using a seed-based d mapping with permutation of subject images (SDM-PSI) approach. The results showed that the cerebellar Crus I and II were activated more strongly in social sequencing processes than in social non-sequencing, indicating that sequence detection is a basic function of the cerebellum. In sequencing processes, the cerebellar posterior Crus II responded more strongly to social than to non-social events, suggesting that the sequencing function of this cerebellar sub-region is more applicable to social contexts. The posterior cerebellum exhibited heterogeneous activation patterns, with distinct functional specializations in Crus I and Crus II. These findings provide a deeper understanding of the functions of the cerebellar regions in social cognition.

Systematic review of interventions for pre-frail and frail older adults: Evidence from clinical trials on frailty levels

INTRODUCTION

The increasing global longevity underscores the necessity of effective interventions for older adults. Pre-frailty and frailty affect 54.1 % and 26.3 % of the elderly population, respectively, leading to adverse physical and cognitive outcomes. This study systematically reviewed the effectiveness of interventions targeting robust, pre-frail, and frail older adults in randomized controlled trials, analyzing frailty levels both collectively and individually.

METHODS

Following the Joanna Briggs Institute (JBI) methodology and PRISMA guidelines, seven databases were searched for studies published between 2018 and 2023. Randomized controlled trials involving individuals aged ≥65 years were included. Methodological quality was assessed using the PEDro scale, with scores ranging from 7 to 10, indicating moderate to high quality.

RESULTS

A total of 3416 records were identified, and 40 studies were included, encompassing 17,822 participants (82.3 % women, mean age: 68-79 years). Physical exercise interventions accounted for 42.5 % of the studies, while multicomponent programs constituted 27.5 %. Improvements in frailty levels were reported in 32.5 % of the studies, with significant gains in quality of life (+15.2 %), gait speed (+0.22 m/s), and muscle strength (+18.7 %). Pre-frail individuals exhibited the greatest responsiveness to interventions, reflecting their remaining adaptability and potential for improvement.

DISCUSSION

Multifaceted interventions were found to be particularly effective for pre-frail individuals, emphasizing the need for standardized criteria for frailty assessment. Geographic variability and inconsistencies in assessment methods were noted. Physical activity emerged as a key component in improving outcomes, with most interventions led by physiotherapists and physical education professionals.

CONCLUSION

Integrated interventions significantly enhance health and functionality, particularly for pre-frail older adults, underscoring the importance of early and tailored approaches. This study highlights the need for standardized guidelines and multidisciplinary strategies to address the heterogeneity of the aging population effectively.

Effectiveness of interpreters and other strategies for mitigating language barriers: A systematic review

OBJECTIVE

To examine the effectiveness of different communication strategies for mitigating language barriers on patient-, provider- and context-related outcomes.

METHODS

A systematic search was conducted in nine databases for quantitative studies from 2013 comparing different strategies. The studies' quality was assessed with the Evidence Project Risk of Bias tool and the certainty of evidence with the GRADE approach.

RESULTS

Twenty-six articles were included, all about healthcare settings. Generally, having a shared language (e.g., a provider in the patient's native language) followed by using professional interpreters yielded the most positive outcomes, and in-person or video interpreters more than telephone interpreters. Compared to professional interpreters, the translation quality of informal interpreters was only similar when assessing patient outcomes after surgery, and the quality of digital translation tools was only sufficient with simple messages or when messages were pre-translated.

CONCLUSION

Having a provider in patients' native language and having professional interpreters outperform other strategies for mitigating language barriers in healthcare. However, other strategies may suffice in specific situations. Future research should explore the effectiveness of (combining) strategies, especially in social care.

PRACTICE IMPLICATIONS

This review can inform policy and help develop guidelines on mitigating language barriers to support providers in their daily practice.

Wet and dry cough classification using cough sound characteristics and machine learning: A systematic review

BACKGROUND

Distinguishing between productive (wet) and non-productive (dry) cough types is important for evaluating respiratory health, assisting in differential diagnosis, and monitoring disease progression. However, assessing cough type through the perception of cough sounds in clinical settings poses challenges due to its subjectivity. Employing objective cough sound analysis holds promise for aiding diagnostic assessments and guiding the management of respiratory conditions. This systematic review aims to assess and summarize the predictive capabilities of machine learning algorithms in analyzing cough sounds to determine cough type.

METHOD

A systematic search of the Scopus, Medline, and Embase databases conducted on March 8, 2025, yielded three studies that met the inclusion criteria. The quality assessment of these studies was conducted using the checklist for the assessment of medical artificial intelligence (ChAMAI).

RESULTS

The inter-rater agreement for annotating wet and dry coughs ranged from 0.22 to 0.81 across the three studies. Furthermore, these studies employed diverse inputs for their machine learning algorithms, including different cough sound features and time-frequency representations. The algorithms used ranged from conventional classifiers like logistic regression to neural networks. While the classification accuracy for identifying wet and dry coughs ranged from 78% to 87% across these studies, none of them assessed their algorithms through external validation.

CONCLUSION

The high variability in inter-rater agreement highlights the subjectivity in manually interpreting cough sounds and underscores the need for objective cough sound analysis methods. The predictive ability of cough-type classification algorithms shows promise in the small number of studies analyzed in this systematic review. However, more studies are needed, particularly those validating their models on independent and external datasets.

Ecotoxicological impact of the fungicide tebuconazole on fish: a historical review, global trends and challenges

Tebuconazole (TBZ) is a triazole fungicide broadly used to control fungal diseases in agricultural crops, fruit-bearing plants and forestry plantations. However, its increasing use and release into aquatic environments has raised concerns about its hazardous effects on the health of fish. Thus, the aim of the present study was to review the scientific literature on the ecotoxicological effects of TBZ and TBZ-based commercial formulations on fish. Historical review data (publication year and geographical distribution), TBZ type, experimental design, fish species, habitat, life stage, tissue/organ, lethal concentration (LC50), concentration and exposure time, biomarkers and effects were compiled and critically analyzed. Studies were mainly conducted with freshwater species at adult and larval stages, whereas no data were find for marine fish species. Zebrafish, (Danio rerio) was the most assessed species. Both TBZ and TBZ-based commercial formulations induced oxidative stress, endocrine disruption, neurotoxicity, genotoxicity, histopathologies, behavior impairments and mortality on fish. TBZ can induce synergistic and antagonistic effects on fish when it is combined to other pesticides. Overall, the current study has shown the potential hazardous effects of TBZ and TBZ-based commercial formulations on the health of fish.

Relationship Between Hepatic Iron Concentration and Glycemic Metabolism, Prediabetes, and Type 2 Diabetes: A Systematic Review

CONTEXT

Emerging research has suggested a potential link between high iron levels, indicated by serum ferritin levels, and the development of type 2 diabetes (T2D). However, the role of hepatic iron concentration (HIC) on T2D development and progression is not well understood.

OBJECTIVES

This study aims to systematically review the literature on HIC and/or the degree of hepatic iron overload (HIO) in individuals with prediabetes and/or diagnosed T2D, and to analyze associations between HIC and markers of glucose metabolism.

DATA SOURCES

The databases Medline, PubMed, Embase, CINAHL, and Web of Knowledge were searched for studies published in English from 1999 to March 2024. This review followed the Preferred Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist.

DATA EXTRACTION

Data were extracted following the established eligibility criteria. Study characteristics and biomarkers related to prediabetes, T2D, and HIO were extracted. The risk of bias was analyzed using the Newcastle-Ottawa Scale. Data were stratified by the exposure and analyzed in subgroups according to the outcome. Data regarding the HIC values in controls, individuals with prediabetes, and individuals with T2D and the association estimates between HIC or HIO and markers of glycemic metabolism, prediabetes, or T2D were extracted.

DATA ANALYSIS

A total of 12 studies were identified, and data from 4110 individuals were analyzed. HIO was not consistently observed in prediabetic/T2D populations; however, elevated HIC was frequently observed in prediabetic and T2D individuals, and was associated with the disruption of certain glycemic markers in some cases.

CONCLUSION

The extent of iron overload, as indicated by hepatic iron load, varied among the prediabetic and T2D populations studied. Further research is needed to understand the distribution and regulation of iron in T2D pathology.

Vitamin D as a Modifiable Risk Factor for Juvenile Idiopathic Arthritis: A Systematic Review and Meta-analysis of Observational Studies Comparing Baseline Vitamin D in Children with JIA to Individuals Without

CONTEXT

The varying interactions contributing to the development of juvenile idiopathic arthritis (JIA) drive the struggle to understand its etiology. Among the environmental risk factors, vitamin D has been posited to have a component in disease progression, acting as an inflammatory mediator.

OBJECTIVE

To investigate the correlation between serum 25-hydroxyvitamin D [25(OH)D] levels, indicative of vitamin D, among patients diagnosed with JIA compared with control participants. The aim was to elucidate potential therapeutic implications of vitamin D in the management of JIA.

DATA SOURCES

A systematic search of 6 electronic databases (MEDLINE, Embase, Scopus, CINAHL, Web of Science, and Cochrane Library) was performed until February 2023. Inclusion criteria required participants to be <16 years old (either clinically diagnosed with JIA or a matched control participant), with vitamin D levels measured through serum laboratory methods. Exclusion criteria omitted studies in which participants used vitamin D supplementation or medications affecting vitamin D levels without corresponding statistical analyses on their association with vitamin D levels.

DATA EXTRACTION

Each article was reviewed by at least 2 independent reviewers to assess eligibility for analysis.

DATA ANALYSIS

Data were qualitatively analyzed to compare means of serum 25(OH)D levels (ng/mL) between patients with JIA and control participants, followed by a meta-analysis to obtain effect size.

RESULTS

Ten eligible studies were included qualitatively, and eight were included in the meta-analysis. Seven studies found a statistically significant difference in vitamin D levels between control participants and patients with JIA, with five of these reporting a lower mean vitamin D level in patients with JIA. A random-effects model using standardized mean difference found a statistically significant difference in vitamin D levels between control participants and patients with JIA (-0.49; 95% CI, -0.92 to -0.06).

CONCLUSIONS

The findings from the analysis indicate vitamin D levels were lower in patients with JIA as compared with healthy control participants at baseline. It is recommended that research into vitamin D supplementation and JIA should be conducted.

A systematic review of behaviour change techniques employed in interventions aimed to change physical activity behaviour in autistic individuals

BACKGROUND

Autistic individuals experience disproportionately poor physical and mental health outcomes, many of which can be mitigated through lifestyle modification such as increasing levels of physical activity. While behaviour change interventions hold promise in promoting physical activity, their effectiveness in autistic populations remains underexplored, particularly in relation to theoretical foundations and intervention content.

OBJECTIVE

To systematically review behaviour change techniques applied to physical activity interventions for autistic individuals, evaluate application of psychological theory, and adaptations made for autism.

METHODS

A systematic search of five databases was conducted in accordance with PRISMA guidelines. Eligible studies were intervention-based, targeted physical activity behaviour as a primary outcome, and included autistic participants. Data were narratively synthesised, and intervention components were coded using the Behaviour Change Taxonomy (BCTTv1). Intervention efficacy was evaluated using a 'promise ratio' and statistical comparisons were conducted to assess associations between intervention promise, Behaviour Change Techniques, theory use, and autism-specific adaptations.

RESULTS

Thirty-three studies were included (n = 26 child-focused; n = 7 adult-focused). Eleven studies reported explicit use of behaviour change theory, with no significant association between theory use and intervention promise. A total of 266 BCTs were coded; most frequently used was instruction on how to perform the behaviour, though not associated with efficacy. In adults, promising techniques included goal setting and behavioural rehearsal; in children, demonstration and reinforcement were effective. Autism-specific adaptations were significantly associated with intervention promise and included sensory considerations and structured environments.

CONCLUSIONS

Theory-informed, autism-adapted interventions show potential for promoting physical activity in autistic populations. Future research should prioritise high-quality designs, meaningful involvement of autistic individuals, and rigorous application of behavioural theory.

PROSPERO REGISTRATION

CRD42021235140.

The nature-based solution implementation gap: A review of nature-based solution governance barriers and enablers

Nature-based solutions (NbS) represent a critical umbrella concept encompassing measures that employ nature's properties to systemically address societal challenges, potentially providing benefits for biodiversity, climate and people. NbS are accordingly emerging on an ever-expanding number of policy agendas, such as the Kunming-Montreal Global Biodiversity Framework and multiple European Union strategies. However, despite this increasing political traction, NbS implementation (that is, the design, planning, construction, monitoring and maintenance of NbS) remains fragmented and is often too context-specific for their wider upscaling and mainstreaming, creating an 'NbS implementation gap' between ambitions and on-the-ground operationalization. Based on a systematic review of grey- and peer-reviewed literature and workshop results (N = 34), we identify and discuss the institutional, legal, regulatory, social and economic enablers (N = 301) and barriers (N = 307) to NbS implementation. Our results highlight the governance factors that currently facilitate or limit NbS implementation and mainstreaming, which are often homologous. These include inclusive stakeholder engagement processes and true co-design; an evidence base on NbS performance and their co-benefits, including quantitative cost-benefit analyses; the existence of or lack of knowledge products and NbS-specific expertise; and available funds earmarked for NbS. We find that polycentric governance arrangements may act as a critical enabler for NbS implementation, yet path dependencies significantly limit NbS by still favouring grey alternatives. By providing an overview of NbS implementation enablers and barriers across literature and workshop findings, this analysis represents a first step towards understanding key pitfalls and leverage points for enhancing NbS implementation and mainstreaming.

Ocular-induced abnormal head postures: A systematic review and analysis

Abnormal head postures (AHPs) are frequently adopted as compensatory mechanisms by individuals affected by various ocular diseases to optimize the utilization of their visual field or alleviate symptoms such as diplopia. We review the causal relationship between ocular diseases and the resulting AHPs. An extensive literature search was conducted to identify and summarize relevant medical studies providing evidence of AHPs in patients diagnosed with conditions like Duane retraction syndrome, Brown syndrome, superior oblique palsy, and other ocular disorders. The analysis explores the proportion of AHP types (head tilt, turn, chin-up/down) and the frequency distribution of ocular conditions for each studied disease. In addition, the degrees of ocular misalignment (hypertropia, hypotropia, esotropia, exotropia) associated with specific AHP manifestations are quantified. Key properties of ocular misalignment and AHPs across different diseases are examined, and Cramer's V statistical measure is employed to assess the association between diseases, AHPs, and ocular misalignment. The findings highlight the need for comprehensive datasets encompassing diverse ocular diseases to support the development of robust artificial intelligence models capable of accurately diagnosing AHPs. This study contributes an in-depth understanding of the mechanisms underlying AHPs and provides a foundation for advancing diagnostic and rehabilitation strategies in vision sciences.

Effects of microplastics on black soil health: A global meta-analysis

Microplastics (MPs) have garnered widespread attention as an emerging global contaminant. However, the impacts of MPs on black soil health remain unclear. A meta-analysis of 337 cases from 33 studies was conducted to elucidate the effects of MPs on black soil health. The analysis incorporated 35 indicators, including soil properties, soil enzymes, plant growth, soil animal health, and soil microbial diversity. We investigated the effects of MPs properties, such as particle type, size, concentration, and exposure duration, on soil health. Results showed that MPs led to notable increases in SOM, DOC, available nitrogen by 31.84 %, 14.35 %, and 12.45 %, respectively, while decreasing nitrate nitrogen by 12.89 %. In addition, MPs exposure enhanced soil urease activity by 11.24 % but reduced phosphatase activity by 6.62 %. MPs also diminished microbial alpha-diversity, caused oxidative damage in earthworms, and suppressed plant germination rates. Notably, smaller MPs, higher concentrations, longer exposure periods, and conventional MPs have more detrimental effects on soil health. By applying the entropy weight method combined with the analytical hierarchy process, we quantified the overall impact of MPs on black soil health as a 12.09 % decrease. Our findings underscore the risks of persistent MPs pollution to black soil health.

Diagnostic Accuracy of Hepatic MRI-PDFF and R2* for the Evaluation of Liver Steatosis and Liver Iron Overload: A Meta-analysis

RATIONALE AND OBJECTIVES

To evaluate the diagnostic accuracy of hepatic magnetic resonance imaging-derived proton density fat fraction (MRI-PDFF) and R2* using the multi-echo Dixon technique for the evaluation of liver steatosis (LS) and liver iron overload (LIO). The study focuses on the determination of optimal cutoff values and the area under the summary receiver operating characteristic curve (AUROC) as primary measures of diagnostic performance.

MATERIALS AND METHODS

A systematic literature search was conducted by two independent researchers. The diagnostic accuracy of studies was assessed using the quality assessment of diagnostic accuracy studies-2. The AUROCs of MRI-PDFF (for LS grades: 0 versus 1-3, 0-1 versus 2-3, and 0-2 versus 3) and R2* (for LIO grades: 0 versus 1-4) were compared and analyzed. Meta-regression analyses were performed to explore sources of heterogeneity in MRI-PDFF. The review followed the preferred reporting items for systematic reviews and meta-analyses guidelines.

RESULT

29 studies with 4548 subjects (2565 males) were investigated. The summary AUROC values of MRI-PDFF for classifying LS grades 0 versus 1-3, 0-1 versus 2-3, and 0-2 versus 3 were 0.95 (95% confidence interval (CI): 0.93-0.97), 0.93 (95% CI: 0.91-0.95), and 0.93 (95% CI: 0.91-0.95), respectively. The summary AUROC values of R2* for classifying LIO grades 0 versus 1-4 was 0.81 (95% CI: 0.78-0.84). The optimal MRI-PDFF cutoffs for diagnosing LS were identified as 4.4% (LS ≥ G1), 13.34% (LS ≥ G2), and 16.9% (LS ≥ G3), while the optimal R2* cutoffs for LIO ≥ G1 were 60.5 s⁻¹ (3 T MRI).

CONCLUSION

MRI-PDFF and R2* demonstrate high diagnostic accuracy for evaluating LS and LIO, with established optimal cutoff values supporting their clinical utility as non-invasive diagnostic tools. These findings provide a standardized reference for MRI-based liver fat and iron quantification in clinical practice.

Global Prevalence of Human Demodex Mite: A Systematic Review and Meta-Analysis

Demodex mites are common ectoparasites in humans that typically reside as commensals in sebaceous glands, but under certain host conditions, they may become opportunistic pathogens. Despite numerous localized studies on the prevalence of human Demodex mites, the global prevalence and associated risk factors remain unclear. This study aims to systematically assess the global prevalence of human Demodex mites and the effects of age, gender, facial sampling region, humidity, World Health Organization (WHO) regions and countries, and population factors on this prevalence. A systematic literature search, following PRISMA guidelines, was conducted in multiple databases from January 2000 to January 2025. Meta-analysis using a random-effects model estimated the global prevalence of Demodex mites and examined associations with demographic, geographic, and climatic factors. Meta-regression, sensitivity analysis, and Egger's test were conducted to assess publication bias and the robustness of the findings. The global pooled prevalence of human Demodex mites was approximately 35% (based on available studies), with the highest prevalence observed in the South-East Asia Region (SEARO) at 44%. The highest prevalence among age groups was found in older adults (>60 years), reaching 59%, while the highest facial region-specific prevalence was observed in the eyelashes at 33%. Among different population groups, ophthalmology patients showed the highest prevalence (57%). Additionally, the prevalence was slightly higher in females compared to males. The analysis revealed significant heterogeneity and publication bias. The sensitivity analysis confirmed the stability of the prevalence estimate. Meta-regression identified significant differences in sample size but no associations with humidity or publication year. This meta-analysis highlights a global prevalence of human Demodex mites, especially among older adults and ophthalmology patients, emphasizing the need for clinical awareness and further studies.

Airborne pathogen monitoring and dispersion modelling on passenger ships: A review

The COVID-19 pandemic demonstrated a profound inability of pre-pandemic passenger ship policies implemented by both ship operators and governmental authorities to detect and address newly emerging diseases. The essentiality of maritime transport puts into focus the risk of approach to address known and new emerging airborne infectious diseases that, due to increasing capacity, are likely to occur on passenger ships. In order to enhance the passenger experience, prepare shipping for pandemics like COVID-19, and improve the resilience and safety of the industry, this review critically synthesises existing literature on (1) monitoring ventilation conditions and aerosol dispersion, linking them to airborne transmission risk using airborne aerosols and ventilation performance as input parameters for computational fluid dynamics (CFD) simulations, and (2) modelling airborne disease transmission risk in controlled passenger ship environments. This review analysed 39 studies on aerosol monitoring, thermal comfort, and infection risk modelling on passenger ships (2000-2023). Additionally, 55 papers on CFD modelling of airborne pathogen dispersion were reviewed: 22 included validation, with most focused on built environments and only four specifically addressing ship environments. Two major challenges relate to the complexity and poorly characterised ventilation boundary conditions on passenger ships, and the other is the lack of suitable validation data. For this reason, ship experimental studies are required for CFD model validation. Only a handful of studies were found that have measured aerosol concentrations on board passenger ships. To the best of our knowledge, there have been no studies conducted on aerosol mass or airborne transmission sampling on board passenger ships or other types of vessels. The results of this review have the potential to create synergistic connections between experimental and modelling studies to inform, characterise and improve the development of numerical models that can accurately estimate infection risk on ships for prevention, mitigation and management of outbreaks.

Opportunities, challenges, and requirements for Artificial Intelligence (AI) implementation in Primary Health Care (PHC): a systematic review

BACKGROUND

Artificial Intelligence (AI) has significantly reshaped Primary Health Care (PHC), offering various possibilities and complexities across all functional dimensions. The objective is to review and synthesize available evidence on the opportunities, challenges, and requirements of AI implementation in PHC based on the Primary Care Evaluation Tool (PCET).

METHODS

We conducted a systematic review, following the Cochrane Collaboration method, to identify the latest evidence regarding AI implementation in PHC. A comprehensive search across eight databases- PubMed, Web of Science, Scopus, Science Direct, Embase, CINAHL, IEEE, and Cochrane was conducted using MeSH terms alongside the SPIDER framework to pinpoint quantitative and qualitative literature published from 2000 to 2024. Two reviewers independently applied inclusion and exclusion criteria, guided by the SPIDER framework, to review full texts and extract data. We synthesized extracted data from the study characteristics, opportunities, challenges, and requirements, employing thematic-framework analysis, according to the PCET model. The quality of the studies was evaluated using the JBI critical appraisal tools.

RESULTS

In this review, we included a total of 109 articles, most of which were conducted in North America (n = 49, 44%), followed by Europe (n = 36, 33%). The included studies employed a diverse range of study designs. Using the PCET model, we categorized AI-related opportunities, challenges, and requirements across four key dimensions. The greatest opportunities for AI integration in PHC were centered on enhancing comprehensive service delivery, particularly by improving diagnostic accuracy, optimizing screening programs, and advancing early disease prediction. However, the most challenges emerged within the stewardship and resource generation functions, with key concerns related to data security and privacy, technical performance issues, and limitations in data accessibility. Ensuring successful AI integration requires a robust stewardship function, strategic investments in resource generation, and a collaborative approach that fosters co-development, scientific advancements, and continuous evaluation.

CONCLUSIONS

Successful AI integration in PHC requires a coordinated, multidimensional approach, with stewardship, resource generation, and financing playing key roles in enabling service delivery. Addressing existing knowledge gaps, examining interactions among these dimensions, and fostering a collaborative approach in developing AI solutions among stakeholders are essential steps toward achieving an equitable and efficient AI-driven PHC system.

PROTOCOL

Registered in Open Science Framework (OSF) ( https://doi.org/10.17605/OSF.IO/HG2DV ).

The effects of aerobic exercise in patients with cancer-related fatigue: A systematic review and meta-analysis

BACKGROUND

Cancer-related fatigue (CRF) is characterized by an unusual and persistent sensation of tiredness that can occur during or after treatment, potentially impacting both physical and mental capability, and which does not ameliorate with rest. Aerobic exercise (AE) has been identified as a potent modality to mitigate the severity of CRF in such patients.

OBJECTIVE

This study aims to investigate the efficacy of AE in alleviating CRF among patients.

METHODS

A comprehensive literature search was implemented on PubMed, Web of Science, EBSCO, Cochrane, and Embase until June 2024. Studies were selected based on the following PICOS criteria: Participants (P): cancer patients undergoing treatment or in recovery; Intervention (I): aerobic exercise, including activities such as walking, running, yoga, or tai chi; AE interventions conducted during both treatment and recovery were included. Comparison (C): usual care, no-treatment/wait-list, or attention/activity placebo controls; Outcome (O): cancer-related fatigue (CRF) measured by validated scales; Study design (S): randomized controlled trials (RCTs). The meta-analysis was performed using Review Manager 5.3.

RESULTS

The results indicate that AE exerts a significant impact on CRF, but the heterogeneity is high (SMD = -0.76, 95% CI: -1.30 to -0.22, P < 0.05, I² = 94%). Subgroup analysis revealed that AE interventions lasting at least 12 weeks (SMD = -1.12, 95% CI = -2.02 ~ -0.22, P < 0.05, I² = 96%), 3 times or less per week (SMD = -1.00, 95% CI = -1.83 ~ -0.16, P < 0.05, I2 = 96%), with each session exceeding 60 minutes (SMD = -1.48, 95% CI = -2.32 ~ -0.64, P < 0.01, I2 = 96%), compared to the control group, significantly improve CRF in patients.

CONCLUSION

The research findings confirm the effectiveness of AE in alleviating CRF. Subgroup analysis further elucidated that AE interventions lasting at least 12 weeks, 3 times or less per week, with 60 minutes or more per session, significantly alleviated CRF among patients. However, given the limited number of included studies, caution is warranted in interpreting these subgroup analysis outcomes. The protocol for this review was duly registered on PROSPERO under the registration number CRD42024559098.

Authenticity, Well-Being, and Minority Stress in LGB Individuals: A Scoping Review

In general (i.e. in heteronormative and cisgendered samples), authenticity appears protective against threats to well-being. Authenticity may also, in part, protect well-being against the minority stressors experienced by sexually minoritized (LGB; lesbian, gay, and bisexual) individuals. In this scoping review, we examined the relation between authenticity and well-being in LGB samples experiencing minority stress. We hypothesized that (i) LGB minority stress relates to decreased authenticity (i.e. inauthenticity), (ii) authenticity relates to increased well-being, and (iii) authenticity influences the relation between LGB minority stress and well-being. We identified 17 studies (N = 4,653) from systematic searches across Medline, ProQuest, PsycINFO, and Scopus using terms related to sexual identity, minority stress, authenticity, and well-being. In almost all studies, proximal (but not distal) stress was associated with inauthenticity, and inauthenticity with decreased well-being. In all but one study, the association between proximal stress and well-being was associated with inauthenticity. Although these results are consistent with our hypotheses, the included studies were limited in scope and heterogenous in their methods, instruments, and samples, restricting conclusions regarding mediation or moderation. The results require replication, well-powered direct comparisons between LGB and non-LGB samples, and consideration of the varied ways authenticity can be conceptualized and measured.

Effects of transcranial electrical stimulation on academic and cognitive skills in individuals with specific learning disabilities: A systematic review

There has been a rising interest in utilizing transcranial electrical stimulation (TES) techniques to induce neuroplasticity and modulate cognition in children and adults. Despite the escalating interest in non-pharmacological interventions in people with specific learning disabilities (SLD), there is a noticeable absence of a thorough and up-to-date review that consolidates studies of TES in individuals with SLD.A systematic literature search, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, was conducted across PubMed, Scopus, Web of Science, Google Scholar, and Embase databases, covering the period from 2000 to September 2024. Study eligibility criteria were pre-established using the Population, Intervention, Comparison, and Outcome (PICO) model. The grade of recommendation (GOR) for each learning disability was determined based on the level of evidence (LOE). Out of 1571 initial references, the screening resulted in inclusion of nineteen studies (17 dyslexia, 2 dyscalculia). The total number of participants in the included studies was 470, of which 249 were female (52.97 %) and 221 were male (47.03 %). The mean age of participants ranged from 9.5 to 33 years. Fifteen studies employed tDCS, one study used tACS and tRNS, and one utilized tRNS exclusively. TES interventions, especially tDCS, enhanced phonological awareness, improved reading accuracy, and reduced reading time in individuals with dyslexia. In those with dyscalculia, TES improved mathematical performance but did not demonstrate significant effects on cognitive skills. Findings suggest TES interventions, particularly tDCS, are beneficial for improving cognitive skills and reading performance in individuals with dyslexia.

Efficacy and safety of phytotherapy and anthroposophic medicine in bronchial asthma: A systematic review

BACKGROUND

Bronchial asthma is a highly prevalent health condition associated with low quality of life and high economic costs. Treatments from traditional, complementary and integrative medicine (TCIM) are commonly used by individuals with bronchial asthma. However, a synthesis of the evidence on plant-derived medications is lacking.

OBJECTIVE

This review aims to systematically summarize the evidence on the efficacy, effectiveness and safety of European/Western phytotherapy (PT) and medications from anthroposophic medicine (AM) in individuals with bronchial asthma.

METHODS

Four electronic databases and additional references were screened for clinical trials published between 1990 and 2023. The findings of the included studies were qualitatively synthesized and study quality was assessed.

RESULTS

Of 23 included studies, 19 examined European/Western PT and four investigated AM medications. Nine studies of sufficient quality reported beneficial effects of various plants (e.g., Nigella sativa) on asthma symptoms, pulmonary function and immunological parameters. The medications were considered safe in studies that reported on safety.

CONCLUSION

This systematic review suggests several medications from European/Western PT and AM that may be beneficial and appear to be safe in the treatment of bronchial asthma. However, further rigorous studies are needed to provide evidence-based guidance on add-on treatment options for individuals with bronchial asthma.

The use of telemedicine services for medical abortion

RATIONALE

Telemedicine models for medical abortion are service delivery models where care is provided by a health worker using telecommunications to support the abortion process. Existing evidence suggests that telemedicine for medical abortion is safe, effective, and acceptable to women compared to when care is provided in-clinic. However, the available data are often constrained by several factors. We sought to strengthen the evidence base by comparing telemedicine models for medical abortion with medical abortion provided in-clinic.

OBJECTIVES

To assess the safety, success rate, and acceptability of telemedicine models for medical abortion, according to which phase or phases (pre-abortion, abortion, and/or post-abortion) telecommunications were used as the primary means of service delivery, compared to in-clinic care for medical abortion in the corresponding phase/phases.

SEARCH METHODS

We searched CENTRAL (Ovid EBM Reviews), MEDLINE ALL (Ovid), Embase.com, CINAHL (EBSCOhost), LILACS, Global Health (Ovid), Scopus, Google Scholar, and grey literature sources from the inception of the database to 13 August 2024. We screened the references of included studies and contacted authors to identify additional data or enquire about ongoing studies.

ELIGIBILITY CRITERIA

We included randomised controlled trials (RCTs) and non-randomised studies (NRS) of telemedicine models compared with in-clinic care (standard care) for medical abortion. We only included studies that used an interactive type of telecommunication and studies where telemedicine services were provided by a health worker.

OUTCOMES

Critical: successful abortion (a terminated pregnancy without the need for surgical intervention to complete the abortion within 42 days of the abortion). Important: continuing pregnancy, blood transfusion, hospitalisation, emergency visits, satisfaction, adherence.

RISK OF BIAS

We used the RoB 2 and ROBINS-I tools to assess the risk of bias in the included RCTs and NRS, respectively.

SYNTHESIS METHODS

Two review authors (AC and ME) independently screened and extracted data in Covidence. We grouped interventions according to which abortion phase or phases (pre-abortion, abortion, post-abortion) telecommunications were used to deliver care. We graded the certainty of the evidence using the GRADE approach.

INCLUDED STUDIES

We included 22 studies: six RCTs and 16 NRS, comprising a total of 131,278 individuals undergoing medical abortion up to 12 weeks' gestation. Studies were conducted across five high-income and four middle-income countries. Due to the heterogeneity among included NRS, we performed meta-analyses only for comparisons where we had RCTs.

SYNTHESIS OF RESULTS

Main intervention: Pre- to post-abortion care telemedicine models for medical abortion versus in-clinic care In these telemedicine models, various forms of synchronous and asynchronous telecommunications were used to deliver care from the pre- to post-abortion phase, up to 12 weeks' gestation. Any in-clinic testing was done to complement, rather than to replace, service delivery in the pre-abortion phase. Five out of nine studies did not perform routine ultrasounds as part of the eligibility screening. Pre- to post-abortion telemedicine models probably result in little to no difference in successful abortion (RR 0.99, 95% CI 0.97 to 1.01; 2 RCTs, 837 participants; moderate-certainty evidence). This finding was supported by NRS results (Aiken 2021; 99% versus 98%; adjusted P value = 0.268; 7 NRS, 83,061 participants; moderate-certainty evidence). Further, pre- to post-abortion telemedicine models probably result in little to no difference in rates of continued pregnancy (Aiken 2021: 0.5% versus 1%; adjusted P value = 0.268; 5 NRS, 74,269 participants; moderate-certainty evidence) and may result in little to no difference in blood transfusions (Aiken 2021: 0.02% versus 0.03%, adjusted P value = 0.557; 5 NRS, 83,651 participants; low-certainty evidence). The effect of the intervention on hospitalisation is uncertain (RR 1.45, 95% CI 0.24 to 8.61; 2 RCTs, 846 participants; very low-certainty evidence). This intervention may result in little to no difference in emergency visits (RR 1.15, 95% CI 0.36 to 3.75; 2 RCTs, 847 participants; low-certainty evidence) and satisfaction (RR 1.01, 95% CI 1.00 to 1.02; 2 RCTs, 832 participants; low-certainty evidence), and probably results in little to no difference in adherence to the medical abortion regimen (RR 0.99, 95% CI 0.96 to 1.02; 1 RCT, 732 participants; moderate-certainty evidence). No deaths were reported in this review. Sub-interventions: Pre-abortion/abortion telemedicine models for medical abortion versus in-clinic; Post-abortion telemedicine models versus in-clinic Four NRS compared pre-abortion/abortion telemedicine models with in-clinic care; all outcomes had very low-certainty evidence. Four RCTs and five NRS compared post-abortion telemedicine models with in-clinic follow-up. Post-abortion telemedicine models likely result in little to no difference in successful abortion (RR 1.0, 95% CI 0.99 to 1.01; 4 RCTs, 5069 participants; moderate-certainty evidence). They may result in little to no difference in continuing pregnancy (RR 0.81, 95% CI 0.48 to 1.36; 4 NRS, 5069 participants; low-certainty evidence) and likely result in higher rates of adherence to follow-up procedures (RR 1.15, 95% CI 1.13 to 1.18; 4 RCTs, 5235 participants; moderate-certainty evidence). The effects of post-abortion telemedicine models on blood transfusion, hospitalisation, emergency visits, and satisfaction are uncertain.

AUTHORS' CONCLUSIONS

Pre- to post-abortion telemedicine models probably result in little to no difference in successful abortion, continuing pregnancy, and adherence to the medical abortion regimen, with moderate-certainty evidence. We found low-certainty evidence that this intervention may result in little to no difference in rates of blood transfusions, emergency visits, and satisfaction, but we are uncertain about the effect on hospitalisation. Post-abortion telemedicine models likely result in higher rates of adherence to follow-up procedures, with moderate-certainty evidence. We downgraded studies mainly due to serious risk of bias or imprecision, with some outcomes being rare events. Altogether, the findings indicate that telemedicine models for medical abortion in early pregnancy may result in similar outcomes in terms of safety, effectiveness, and acceptability when compared to in-clinic provision. Most studies were conducted in high-resource settings and data were limited to gestational ages above nine weeks. Future studies should investigate telemedicine models for medical abortion in lower-resourced settings and in gestational ages above nine weeks, compare different kinds of telecommunications, and assess models that omit testing (ultrasounds, physical exams, or blood tests).

FUNDING

None REGISTRATION: DOI: 10.1002/14651858.CD013764.

Molecularly directed therapy in cancers of unknown primary: A systematic review and meta-analysis

BACKGROUND

Cancers of unknown primary (CUP) are associated with a high mortality rate, with limited therapeutic options available and platinum-based chemotherapy recommended as standard of care. Over the past decade, molecularly guided approaches aiming to adapt treatment strategies in patients with CUP based on predicted site of origin (site-specific approach) or genomic characteristics (tissue-agnostic approach) have been explored in clinical studies, with heterogenous findings identified.

METHODS

PubMed/MEDLINE, Scopus, Web of Science, Embase, the Cochrane Library, and conference abstracts of American Society of Clinical Oncology (ASCO) and European Society of Medical Oncology (ESMO) meetings were searched from inception until October 2024, for clinical studies that assessed molecularly directed therapies (MDT) in the management of patients with CUP, as compared to empiric treatment. A meta-analysis using a random-effects model and the inverse variance method was conducted, with a subgroup analysis by study design (randomized versus non-randomized). The primary endpoint was overall survival (OS), and the secondary endpoint was progression-free survival (PFS).

RESULTS

Six studies encompassing 1644 patients were included, of which 4 randomized controlled trials. A significant improvement of OS in patients with CUP treated with MDT versus empiric therapy was identified (HR: 0.75, 95 %CI: 0.62-0.91), with consistent results seen across randomized (HR: 0.86, 95 %CI: 0.73-1.01) and non-randomized (HR: 0.50, 95 %CI: 0.26-0.96). Similarly, PFS was significantly improved with MDT, as compared to empiric treatment (HR: 0.79, 95 %CI: 0.67-0.94).

CONCLUSION

The use of MDT is associated with improved survival outcomes among patients with CUP. These findings provide evidence that support the role of MDT as a potential novel standard of care in CUP treatment.

Surgical ablation in patients with atrial fibrillation and left ventricular dysfunction: A systematic review and meta-analysis

Background

Atrial fibrillation (AF) and left ventricular dysfunction (LVD) are common conditions that often coexist, with about 25% of patients in NYHA classes I-II having AF. Efficacy and safety of surgical ablation (SA) in this population remains unclear.

Methods

We aimed to perform a single-arm meta-analysis to assess the outcomes of standalone and concomitant SA in adult patients with AF and LVD. We searched PubMed, Scopus and the Cochrane Library. Endpoints of interest were maintenance of sinus rhythm, freedom from anti-arrhythmic drug (AAD) use, change in LVEF, 30-day mortality, 1 year mortality and major procedural complications. We calculated pooled proportions or means for binary and continuous endpoints, respectively, with a 95 % confidence interval (CI).

Results

Ten observational studies comprising 863 patients (mean follow-up of 19 months) were included. At 1 year, SA resulted in a sinus rhythm rate of 83.9 % (95 % CI: 69.5-92.3); freedom from AAD use of 81.6 % (95 % CI: 64.7-91.7); and mortality of 5.77 (95 % CI:3.7-8.9). 30-day mortality was 2.16 % (95 % CI: 0.9-4.9); major complications 16.73 % (95 % CI: 12-23); and an improvement in LVEF of 12 % (95 % CI: 9-17).

Conclusion

This meta-analysis found that SA appears to be an effective strategy to achieve sinus rhythm in patients with AF and LVD, with a pooled 30-day mortality of 2.2%. Comparative studies are warranted to evaluate the relative safety and efficacy of SA compared with other rhythm control strategies in this population.

Defining human-centricity in Industry 5.0 and assessing the readiness of ergonomics/human factors communities in UK

There is a lack of a clear and consistent definition of human-centricity in Industry 5.0. This study identified the definition of human-centricity in Industry 5.0 through a systematic literature review and used it to assess the readiness of Ergonomics/Human Factors communities in the UK. The assessment of the communities readiness was conducted by reviewing UK accredited courses and events of three professional bodies; and interviewing practitioners (n = 8). Eleven themes were identified as elements of human-centricity from the thematic analysis of 30 publications. Gaps that had to be addressed to better equip UK practitioners to support the realisation of human-centricity in Industry 5.0 were also identified.

TNF-α polymorphism in oral cancer and oral potentially malignant disorders: meta-analysis and investigation as a potential tool to determine individual susceptibility and the prognosis

There is increasing evidence that tumour necrosis factor alpha (TNF-α) gene polymorphisms may promote development and spread of cancer through transitions at different loci that lead to its altered expression. However, data on TNF-α gene polymorphisms in oral cancer remain highly controversial. This meta-analysis was performed to determine the impact of TNF-α gene polymorphisms on oral squamous cell carcinoma (OSCC) and oral potentially malignant disorders (OPMD). An electronic search was conducted in the PubMed, Cochrane Library, Google Scholar, and Web of Science databases to identify original articles reporting TNF-α polymorphism in OSCC and OPMD. The articles were examined by two independent authors. Data from the included articles were compiled and tabulated. Risk of bias was analysed. Overall, 11 eligible articles that included 1070 cases of OSCC and 641 cases of OPMD in which TNF-α polymorphism was studied, were included for quantitative analysis. It was found that both TNF-α -308 and -238 polymorphisms were significantly associated with the development of oral cancer. TNF-α polymorphism was significantly associated with OSCC and OPMD. Moreover, in polymorphisms of TNF-α at both -308 and -238, the G allele, especially the homozygous form (GG), was found to be associated with oral cancer.

The influence of shifts in visual perspective on emotion in event memories: A meta-analytical review

Memories for events can be remembered from an own-eyes perspective, which mimics the original experience by visualizing the event through our own eyes, or from an observer-like perspective, such that we can visualize ourselves and our surroundings in the memory. Shifting across these two visual perspectives during retrieval influences how the emotional aspects of the events are recalled, although the effect differs based on the direction of shifting. While shifting from an own-eyes to an observer-like perspective reduces emotion, shifting from an observer-like to an own-eyes perspective does not. The current meta-analysis aimed to quantify this asymmetrical pattern of shifting perspectives on emotion in event memories. A multilevel model of 12 publications with 49 individual effects revealed a small effect (Hedges's g = -.255, 95% CI [-.359, -.151]), reflecting a reduction in emotion when shifting to a novel visual perspective compared with the initial viewpoint adopted. Moderator analyses revealed that this effect was significant when shifting from an own-eyes to an observer-like perspective but not when shifting in the reverse direction. This asymmetrical pattern was associated with differences in the subjective vividness between initial and shifted conditions. Together, these results reveal that shifting perspective is a powerful way to reduce the emotions elicited in event memories by reshaping event characteristics. However, there are also limits in the effectiveness of this strategy in regulating emotional experiences.

Effect of eHealth Interventions on Medication Adherence in Kidney Transplant Recipients: Meta-Analysis of Randomised Controlled Trials

BACKGROUND

Kidney transplant recipients must take immunosuppressive drugs for life, and medication non-adherence is a primary risk factor for graft loss and death. With the advancement of technology, electronic health applications are widely used in chronic disease management and offer the potential to improve medication adherence in kidney transplant recipients.

AIM

This meta-analysis aims to evaluate randomised controlled trials (RCTs) that assess the effectiveness of eHealth interventions in improving medication adherence among kidney transplant recipients.

METHODS

This study, which was designed as a systematic review and meta-analysis, followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocols in the planning and reporting phases. Electronic databases and manual literature searches were the two main data sources. Full-text RCTs in PubMed, Medline, Web of Science and Scopus databases were systematically searched. The searches covered studies from 2014 to March 2024.

RESULTS

The search yielded 524 articles. Eight RCTs with 779 participants were included in the analysis. The meta-analysis results indicated that, compared with the control group, adherence rates (RR: 1.19; 95% CI: 1.06-1.35; p = 0.01. Heterogeneity: Q = 8.69; p = 0.28; I2 = 19%) and adherence scores (SMD: 0.17; 95% CI: 0.05-0.29; p = 0.02. Heterogeneity: Q = 0.45; p = 0.93; I2 = 0%) significantly increased in the eHealth intervention group compared with the control group.

CONCLUSION

The findings of this report show that eHealth interventions to improve medication adherence in kidney transplant recipients show favourable outcomes compared with standard care. We recommend eHealth interventions to improve long-term survival and patient outcomes in kidney transplant recipients.

The Efficacy of Dual-layer Stent Compared to Single-layer Stent in Carotid Revascularization: A Systematic Review and Meta-analysis

BACKGROUND

Prior studies have demonstrated the dual-layer stent (DLS) was associated with encouraging results in carotid revascularization. This meta-analysis aimed to study the comparative efficacy between DLS and single-layer stent (SLS).

METHODS

The studies were retrieved from PubMed, Embase, and Scopus up to June 2023. The methodological evaluation was performed using the corresponding scale. Pooled analysis was conducted using R Studio to calculate the effects, including odds ratio (OR) and mean difference (MD). Heterogeneity among results was assessed using the I2 statistic. Sensitivity analysis and subanalysis were also performed.

RESULTS

In this meta-analysis, nine articles comprising 1,127 patients who underwent carotid stenting (606 with DLS) were studied. No significant difference between DLS and SLS was found in stroke (at 30 days DLS: 4/555 vs. SLS: 11/496; OR 0.38, 95% confidence interval [CI] 0.14-1.03; at 12 months DLS: 1/249 vs. SLS: 4/152; OR 0.21, 95% CI 0.03-1.36), death (at 30 days DLS: 3/526 vs. SLS: 0/467; OR 0.80, 95% CI 0.20-3.11; at 12 months DLS: 5/249 vs. SLS: 3/152; OR 1.12, 95% CI 0.25-5.03), stroke/death (at 30 days DLS: 6/526 vs. SLS: 11/467; OR 0.43, 95% CI 0.16-1.17; at 12 months DLS: 6/249 vs. SLS: 7/152; OR 0.52, 95% CI 0.17-1.61), new lesions (DLS: 56/202 vs. SLS: 96/254; OR 0.62, 95% CI 0.28-1.40), lesion count (MD = -0.24, 95% CI -0.82-0.34), lesion diameter (MD = -0.03, 95% CI -1.21-1.15), in-stent restenosis (ISR; DLS: 5/204 vs. SLS: 8/190; OR 0.61, 95% CI 0.21-0.74) and acute thrombosis (DLS: 4/146 vs. SLS: 1/122; OR 2.03, 95% CI 0.31-13.26). Subgroup analysis indicated that CGuard and Casper had shown similar efficacy in preventing stroke, death, and new brain lesions.

CONCLUSION

DLS has shown comparable prognoses to the first-generation stent concerning stroke, stroke/death, new magnetic resonance imaging lesion incidence, lesion count, lesion diameter, ISR and acute thrombosis. Further randomized trials are warranted to demonstrate whether patients with high-risk carotid plaques can benefit significantly from DLS.

Sex Hormones, Sex Hormone-Binding Globulin and Sleep Problems in Females With Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis

OBJECTIVE

Sleep problems like obstructive sleep apnea (OSA) are common in polycystic ovary syndrome (PCOS), although the underlying mechanisms are not well understood. We aimed to determine the prevalence of sleep problems, synthesise and appraise studies analysing the associations between serum sex hormones, sex hormone-binding globulin (SHBG) and sleep problems in females with PCOS.

DESIGN

Systematic review and meta-analysis.

METHODS

A systematic search using MEDLINE, Embase, PsycInfo, CINAHL, Scopus, and Google Scholar was performed till 3 August 2024. Studies that examined serum sex hormones, SHBG or hyperandrogenism with sleep disorders and/or sleep disturbances in PCOS were eligible. Random effects meta-analyses of sex hormones and SHBG among females with PCOS with compared to without OSA were conducted.

RESULTS

From 4487 screened studies, 24 were included, with nine suitable for meta-analyses. Among females with PCOS, 46.0% had OSA and 56.0% had other sleep disturbances. SHBG levels were significantly lower in women with PCOS and OSA compared to those without OSA (standardised mean difference = -0.62; 95% CI = -0.82 to -0.42; I2 = 0%; 179 participants; p < 0.00001), but no differences were seen in total and free testosterone, dehydroepiandrosterone sulfate, androstenedione, and oestradiol. No significant associations between serum sex hormones, SHBG or hyperandrogenism with sleep disturbances in PCOS were observed.

CONCLUSION

SHBG, rather than hyperandrogenism, may play a more important mechanistic role for OSA in PCOS, while other sleep disturbances exhibit a less severe SHBG profile. These findings enhance comprehension of underlying pathophysiology of sleep problems in PCOS. Further validation across PCOS populations is warranted.

Estimating the incidence of transfusion-associated circulatory overload using active surveillance: A systematic review and meta-analysis

BACKGROUND

Transfusion-associated circulatory overload (TACO) is an adverse event that is the leading cause of transfusion-related death. It is underrecognized, and the aim of this study was to synthesize the available evidence from active surveillance studies to estimate its incidence.

STUDY DESIGN AND METHODS

This study is a systematic review and meta-analysis of publications reporting TACO incidence using active surveillance. A research librarian searched Medline and Embase, identifying publications between January 1991 and June 2024. Studies reporting TACO either by patient, blood component (red blood cells [RBCs], platelets, or plasma) or transfusion episode were identified, and all patient settings were eligible. A random effects model estimated TACO incidence, and potential sources of heterogeneity were evaluated using meta-regression.

RESULTS

Twenty-two studies met eligibility criteria and were included for analysis. The rate per patient was 22.2/1000 (95% CI: 16.2-29.2) based on 21 studies. The rate estimate of TACO among total blood components (RBCs, plasma, and platelets combined) reported in 10 studies was 2.2/1000 units transfused (95% CI: 1.2-3.5/1000). There was substantial between-study variation in rates and more recent studies tended to report higher rates. Although the platelet point estimate was higher than the point estimates for RBCs and plasma, the confidence intervals overlapped. Only two studies reported TACO rates per transfusion episode and the pooled estimate was 6.3/1000 (95% CI: 1-16.3/1000), about three times greater than the overall per unit estimate.

DISCUSSION

Clinicians should consider quantitative risks of important transfusion-related harms, such as TACO, when making the decision to transfuse.

Gender differences in the associations of adverse childhood experiences with depression and anxiety: A systematic review and meta-analysis

BACKGROUND

Gender differences in the associations of adverse childhood experiences (ACEs) with depression and anxiety, remain underexplored. We aimed to quantify and directly compare gender-specific associations between ACEs and depression and anxiety.

METHODS

We systematically searched PubMed, Medline, and Embase for observational studies. Eligible articles should have reported effect sizes for depression or anxiety associated with varying number or specific types of ACEs. Using a random-effects model, we calculated the gender-specific pooled odds ratios (ORs) and derived the pooled women-to-men ratio of ORs (RORs) for the associations of ACEs with depression or anxiety, with corresponding 95 % confidence intervals (CIs).

RESULTS

In total, 42 articles met inclusion criteria. Regarding anxiety, gender differences were most pronounced for individuals exposed to 2 ACEs (compared to none), with women showing significantly higher odds of anxiety than men (ROR = 2.04, 95 % CI = 1.15-3.62), In addition, women exposed to emotional abuse (ROR = 0.66, 95 % CI = 0.52-0.83), sexual abuse (ROR = 0.58, 95 % CI = 0.37-0.91), and having a family member incarcerated (ROR = 0.83, 95 % CI = 0.71-0.98) showed lower odds of anxiety than men. For depression, women exposed to bullying showed lower odds of depression compared to men (ROR = 0.86, 95 % CI = 0.83-0.88).

CONCLUSIONS

Gender differences in the associations between ACEs and mental health outcomes vary by type and cumulative exposure to ACEs. This finding highlights the importance of incorporating gender-specific perspectives in research and interventions addressing the long-term mental health effects of ACEs.

Contact lenses for visual rehabilitation in post-keratoplasty eyes: A systematic review

PURPOSE

To evaluate the role of contact lenses (CLs) in visual rehabilitation following keratoplasty.

METHODS

Four databases, including PubMed, Scopus, Web of Science, and Embase were systematically searched for studies published between January 2010 and July 2023. Visual outcomes, daily wearing duration, subjective comfort, rate and etiology of CL discontinuation, corneal endothelial cell density, central corneal thickness, and complications were extracted.

RESULTS

This review included thirteen case series and two chart reviews, analyzing a total of 464 eyes, of which 97% underwent penetrating keratoplasty. Scleral CLs were the most frequently fitted lens (285 eyes, 61%). All studies reported a significant improvement in visual acuity with CL correction. Most post-keratoplasty patients could wear CLs comfortably for 8 to 12 h/day. The rate of CL dropout ranged from 0% to 39%, mainly due to CL intolerance, discomfort, and graft rejection. Corneal graft rejection (18 eyes), conjunctival hyperemia (8 eyes), corneal epithelial trauma (5 eyes), graft edema (4 eyes), and microbial keratitis (3 eyes) were the most frequently reported complications.

CONCLUSION

CLs are effective for improving visual acuity following keratoplasty, with minor complications depending on the type of CL.

Comprehensive appraisal of the association between sexually transmitted infections and prostate cancer: A scoping review of empirical studies, reviews, and meta-analyses

We performed a scoping review on the association of sexually transmitted infections (STIs) with prostate cancer and identified knowledge gaps. Searching four databases (Medline, Embase, Scopus, and Cochrane) identified 286 eligible records. Most empirical studies (n = 191) were cross-sectional (n = 66) and case-control (n = 52). The most studied STIs were human papillomavirus (HPV) (n = 82), human immunodeficiency virus (HIV) (n = 52), and herpes simplex virus (HSV) (n = 30). We included 68 narrative reviews, 10 systematic reviews, and 17 meta-analyses. Most effect estimates (odds ratios, hazard ratios, risk ratios and standardised incidence ratios) did not support an association between STIs and prostate cancer: 373 and 218 of 591 effect estimates were above and below the null, respectively, except for HIV where 74 of 108 estimates were below the null. Knowledge gaps included case-control studies, insights into HIV-related mechanisms for a lower risk for prostate cancer, studies on Mycoplasma and Ureaplasma, studies adjusting for co-infection with other STIs, and studies assessing whether STIs predispose men to a more aggressive form of prostate cancer. A key research priority identified is the need for more evidence on the biological mechanisms driving infection-mediated prostate carcinogenesis.

Effects of hypoxia-inducible factor prolyl hydroxylase inhibitors on hemoglobin, B-type natriuretic peptide, and renal function in anemic heart failure patients: A systematic review and meta-analysis

Background

Anemia is a common comorbidity in heart failure (HF) patients, often leading to worsened outcomes. Hypoxia-inducible factor prolyl hydroxylase (HIF-PH) inhibitors represent a novel approach for anemia management, yet their efficacy and safety in HF patients remain unclear. We aimed to conduct a systematic review and meta-analysis of studies on the effects of HIF-PH inhibitors on hemoglobin, N-terminal prohormone of brain natriuretic peptide (NT-proBNP), or estimated glomerular filtration rate (eGFR) in HF patients with chronic kidney disease (CKD).

Methods and Results

The search of electronic databases identified four studies including 98 patients. Among the included studies, two were conducted prospectively, while two were retrospective in design. No studies were identified that compared HIF-PH inhibitors with erythropoiesis-stimulating agents or placebo. In cases of significant heterogeneity (I2 > 50 %), data were pooled using a random-effects model; otherwise, a fixed-effects model was used. In pooled analyses, hemoglobin levels increased at one (weighted mean difference [WMD]: 0.697 [0.473, 0.920] g/dL; Pfix < 0.001; I2 = 24 %) and three months (WMD: 0.760 [0.443, 1.076] g/dL; Pfix < 0.001; I2 = 31 %) after the use of HIF-PH inhibitors. NT-proBNP levels showed a modest decrease at one month but no significant changes at three months. eGFR remained unchanged, and no severe adverse events were reported.

Conclusion

This meta-analysis suggests that HIF-PH inhibitors effectively improve anemia in HF patients with CKD without notable changes in renal or HF-related biomarkers. However, the small number of included studies and the absence of a comparator group underscore the need for cautious interpretation of the findings.

The Benefit of Short-Term Androgen Deprivation Therapy with Radiation Therapy for Intermediate-Risk Prostate Cancer

PURPOSE

A previous, individual patient-level meta-analysis of randomized controlled trials (RCTs) demonstrated the overall survival (OS) benefit of short-term androgen deprivation therapy (ST-ADT) when delivered with radiation therapy (RT) for the subset of patients with intermediate-risk prostate cancer (IR-PCa). However, because of inclusion criteria, several studies such as NRG/RTOG 0815, GETUG-14, and DFCI 95-096 were excluded. Thus, we conducted the present analysis, inclusive of all studies to define the current role of ST-ADT in IR-PCa.

METHODS AND MATERIALS

A systematic review was conducted of phase 3 RCTs published or presented between January 1980 and October 2024 which profiled the comparative efficacy of radiation therapy ± ST-ADT in patients with IR-PCa. A study-level, random-effects meta-analysis was performed. The primary endpoint of this meta-analysis was OS, with secondary endpoints of time-to-biochemical failure (BF) ± biochemical-progress-free survival (bPFS). Meta-regression was used to explore trial-level factors associated with treatment effects. Synthetic individual patient-level OS data were pooled for confirmation and used to estimate the relative and absolute survival benefit.

RESULTS

Seven RCTs (NRG/RTOG 9408, DFCI 95-096, TROG 96.01, PCS III, EORTC 22991, NRG/RTOG 0815, and GETUG-14) reporting outcomes of 6179 patients were identified. The pooled hazard ratios (HRs) for HROS, HRBF, and HRBF+bPFS were 0.88 (95% confidence interval [CI], 0.79-0.97; P = .01), 0.50 (95% CI, 0.37-0.68; P < .001), and 0.54 (95% CI, 0.46-0.65; P < .001), respectively. ST-ADT duration, RT dose, and Gleason score trial population composition were each associated with an increased benefit of ST-ADT for biochemical disease control (all P < .05) but not for OS (all P > .05). Pooling of simulated, patient-level data confirmed the presence of a survival benefit (HROS, 0.85 [95% CI, 0.76-0.96], log-rank P = .021), corresponding to an absolute survival benefit of 5% benefit at 10 years.

CONCLUSIONS

The present analysis confirms current knowledge that ST-ADT improves both OS and prostate-specific antigen-based outcomes for unselected patients with IR-PCa to a clinically significant degree.

Vitamin D and brain volumetric changes: An updated systematic review and meta-analysis

Background

In this systematic review and meta-analysis, we aimed to investigate the relationship between vitamin D levels and brain volumetric changes in human studies.

Method

We conducted a comprehensive search in PubMed, Scopus, and Google Scholar databases up to December 2024. A total of 450 studies were identified. Following title, abstract, and full-text screening, we included three studies for analysis. Data were extracted from these studies and analyzed using appropriate statistical methods.

Result

Our analysis revealed that the included case-control and cohort studies were conducted in the United States, Norway, and the Netherlands. The studies exhibited a range of characteristics, including sample size (number of patients: 183-240), demographic variables, and methods of assessing both vitamin D levels and brain volume. Brain volume assessments included gray matter, white matter, and total brain volume. The total follow-up duration across studies was 11 years. The age of participants ranged from 30 to 64 years in one study, while in another, they were aged 65 years or older. The meta-analysis indicated no significant association between vitamin D levels and brain volumetric changes across the included studies (effect size: 0.07, 95 % CI= [-0.01, 0.15], P = 0.07, I2=54.44 %).

Conclusion

This meta-analysis did not establish a significant association between vitamin D levels and brain volumetric changes. These findings highlighted the need for further large-scale studies to clarify the potential role of vitamin D in brain volume and to better understand the underlying mechanisms involved.

A systematic review of pre-registration in autism research journals

Pre-registration refers to the practice of researchers preparing a time-stamped document describing the plans for a study. This open research tool is used to improve transparency, so that readers can evaluate the extent to which the researcher adhered to their original plans and tested their theory appropriately. In the current study, we conducted an audit of pre-registration in autism research through a review of manuscripts published across six autism research journals between 2011 and 2022. We found that 192 publications were pre-registered, approximately 2.23% of publications in autism journals during this time frame. We also conducted a quality assessment of a sample of the pre-registrations, finding that specificity in the pre-registrations was low, particularly in the design and analysis components of the pre-registration. In addition, only 28% of sampled manuscripts adhered to their analysis plan or transparently disclosed all deviations. Autism researchers conducting confirmatory, quantitative research should consider pre-registering their work, reporting any changes in plans transparently in the published manuscript. We outline recommendations for researchers and journals to improve the transparency and robustness of the field.Lay abstractWhen researchers write down their plans for a study ahead of time and make this public, this is called pre-registration. Pre-registration allows others to see if the researchers stuck to their original plan or changed as they went along. Pre-registration is growing in popularity but we do not know how widely it is used in autism research. In this study, we looked at papers published in six major autism journals between 2011 and 2022. We found that only 2.23% of papers published in autism journals had been pre-registered. We also took a close look at a selection of the pre-registrations to check how good they were and if researchers stuck to their plans. We found that the pre-registrations generally lacked specifics, particularly about how the study was designed and the data would be analysed. We also found that only 28% of the papers closely followed the pre-registered plans or reported the changes.Based on these findings, we recommend that autism researchers consider pre-registering their work and transparently report any changes from their original plans. We have provided some recommendations for researchers and journals on how pre-registration could be better used in autism research.

The use of biomarkers as measures of PTSD treatment efficacy and predictors of treatment outcomes: A systematic review

The efficacy of posttraumatic stress disorder (PTSD) treatments might be hampered by individual differences. In order to maximize treatment efficacy in existing and newly developed interventions, controlling for individual variables is essential in treatment research. Given the marked physiological correlates of PTSD, biomarkers represent a promising solution. Throughout the PTSD literature, biomarkers have been used to assess treatment effects and predict treatment outcomes. However, the wide variety of biomarkers studied, along with several conflicting results, hinder researchers' abilities to comprehensively interpret the results reported. This systematic review of the literature aimed to identify and classify all biomarkers used to assess the efficacy of PTSD interventions and identify pre-treatment biomarkers able to predict treatment outcomes. Following PRISMA guidelines, we identified 70 studies that assessed biomarkers sensitivity to treatment effects and 25 that used biomarkers to predict treatment outcomes. Well-established treatments and newly developed protocols were included. The results were classified and interpreted by biomarker type. Indicators of neuroanatomical structures and functions were the most commonly studied biomarkers, followed by markers of cardiac activation and glucocorticoid analytes. Cardiac activation markers, and concretely heart rate reactivity to trauma cues, showed the most consistent findings, serving as a valuable method to assess treatment effects across different populations and treatment modalities. Other biomarkers showed promising trends both as predictors of treatment outcomes and measures of treatment efficacy, although essential methodological differences significantly impacted the comparison across studies.

Effective interventions to reduce sick leave in workers with mental illnesses: A systematic review of randomized controlled trials

OBJECTIVE

Effective interventions to reduce sick leave in people with mental illnesses remain unknown. This systematic review of randomized controlled trials (RCTs) assessed the impact of various interventions on reducing sick leave among individuals with mental illnesses.

METHODS

We conducted searches in PubMed, Cochrane Library, and PsycInfo until February 2024 and included RCTs with parallel designs. Two reviewers assessed the quality of trials using the Cochrane risk of bias tool (ROB-2).

RESULTS

Out of 5109 publications, 75 RCTs were included. Ten RCTs with no serious risk of bias demonstrated that certain interventions could reduce sick leave. Interventions based on cognitive behavioral therapy and problem-solving therapy reduced sick leave within a year, but the effect was not long-lasting. Enhanced care approaches, where physicians and care managers encouraged patients to start and maintain pharmacotherapy or psychotherapy, also decreased absenteeism. Online cognitive behavioral therapy yielded a modest decrease in absenteeism. An intervention involving both employees and supervisors to modify the workplace and address stress reduced long-term sick leave. Involving employees in stressor management initiatives decreased sick leave, and a combination of work-focused and online cognitive behavioral therapy reduced short-term sick leave but did not affect long-term (≥15 days) rates. Group therapy led by a clinical psychologist for stress management also showed benefits in the short term (3 months).

CONCLUSION

Multifaceted approaches that combine individual therapy and workplace adjustments are more effective in managing sick leave for individuals with mental illnesses than either approach alone.

Efficacy and Safety of Tirzepatide Compared with GLP-1 RAs in Patients with Type 2 Diabetes Treated with Basal Insulin: A Network Meta-analysis

INTRODUCTION

The relative efficacy and safety of tirzepatide was compared with glucagon-like peptide 1 receptor agonists (GLP-1 RAs) in patients with type 2 diabetes mellitus (T2DM) treated with basal insulin using a network meta-analysis (NMA).

METHODS

A systematic literature review was performed to identify randomized controlled trials of GLP-1 RAs in patients with T2DM treated with insulin and an antihyperglycaemic drug. For the NMA, studies included trials with 100% of patients treated with basal insulin background therapy with a titration scheme comparable to the SURPASS-5 trial. The following data were extracted for efficacy and safety assessment at the primary endpoint of each study: changes from baseline in glycated haemoglobin (HbA1c) and body weight and the incidence of nausea, vomiting or diarrhoea, hypoglycaemia, and patients discontinuing treatment because of adverse events. In this study, a comparative analysis of tirzepatide was performed with the GLP-1 RAs dulaglutide, exenatide, and lixisenatide in addition to placebo.

RESULTS

A total of six studies were included across the analyses. Tirzepatide 5, 10, and 15 mg showed statistically significant, greater reductions in HbA1c and body weight at the primary endpoint versus all GLP-1 RA comparators and placebo. Tirzepatide 5, 10, and 15 mg showed a statistically significant, higher likelihood of experiencing nausea compared with those who received placebo or exenatide 2 mg; no statistically significant differences were observed when compared with all other GLP-1 RA comparators. No statistically significant differences were observed in the proportions of patients who discontinued treatment because of adverse events when tirzepatide 5, 10, and 15 mg were compared with GLP-1 RA comparators, apart from tirzepatide 10 and 15 mg versus placebo.

CONCLUSION

Tirzepatide demonstrated statistically significantly greater reductions in HbA1c and body weight when compared with selected GLP-1 RAs and placebo in patients with T2DM treated with basal insulin. Overall, the safety profile of tirzepatide was similar to that of GLP-1RAs.

Effects of bariatric surgeries on Binge eating disorders, Food addiction, and eating behaviors: A comprehensive systematic review of RCTs

Different types of bariatric surgery have emerged as a major and most effective treatment for obesity. With the rapid growth of bariatric surgery in this decade, it is crucial to understand the postoperative outcomes, especially eating-related outcomes, such as non-preexisting eating disorders, food addiction, emotional eating, and eating behaviors. This systematic review of RCTs seeks to evaluate the impact of various bariatric surgery procedures on eating behaviors, eating disorders, and food addiction to better understand their post-operative effects and guide future clinical practice. Following the 2015 PRISMA guidelines, a systematic review was conducted using PubMed/Medline, Scopus, and WOS databases through May 2024. After assessing 1158 full-text articles, 14 studies were selected based on the established criteria. Based on the obtained results, bariatric surgery significantly improved eating behaviors and weight concerns among patients. Eating behavior was assessed by various questionnaires, such as TFEQ and PFS, across different types of bariatric surgeries, including RYGB, SG, LSG, DJBL, and LAGB. While some studies found varying degrees of improvements across different surgical procedures, the general trend suggests that bariatric surgery can lead to significant improvements in eating behaviors. In conclusion, bariatric surgery appears to influence eating behaviors, food addiction, and binge eating disorders by altering the gut microbiota, gut hormones, and brain regions associated with appetite. However, there is no significant difference in these outcomes among different types of surgery.

Do burn injury prevention interventions change what people know and how people think? A systematic review investigating the impact on psychological constructs

INTRODUCTION

Burns can result in life-long physical and psychological difficulties. Interventions aimed at preventing burns are therefore important. Behaviour change theories propose that psychological variables (e.g., knowledge, attitudes, beliefs, self-efficacy) are associated with injury prevention behaviour. However, whether or not burn prevention interventions impact psychological variables is uncertain. This systematic review aimed to address this gap in the literature.

METHODS

A systematic review was conducted according to PRISMA guidelines. Electronic databases (CINAHL, MEDLINE, PubMed and Scopus) were searched for randomized control trials (RCTs) of burn prevention interventions which measured at least one psychological construct. Studies were quality assessed using the Effective Public Health Practice Project (EPHPP) quality assessment tool.

RESULTS

Eight studies met inclusion criteria. A narrative synthesis was conducted. Seven RCTs detailed interventions aimed at reducing paediatric burns (five delivered to parents/caregivers and two delivered to children). One RCT was aimed at adults. All RCTs measured burns knowledge, but findings were mixed about whether knowledge changed following interventions. Four RCTs measured self-efficacy, with all finding an increased perceived ability to engage in burn prevention behaviour following interventions. Risk perceptions (e.g., around the perceived severity and susceptibility of burns) were rarely measured.

CONCLUSION

To date, burn prevention RCTs have mainly focused on paediatric burns and most often measured knowledge change. However, the impact of interventions on knowledge is variable. Future burn prevention interventions should measure a range of psychological constructs, as these are likely to be important in burn prevention behaviour.

A systematic review on test performance of the driver takeover process in automated driving

Much research has been conducted on takeover behavior in automated driving, and integrating these studies into a knowledge system can help to gain a deeper understanding of the current research status and guide critical future research. The takeover focused in this study refers to the takeover related to human intervention (i.e. the transfer of control between the human driver and the auto drive system), rather than the context of overtaking another vehicle (e.g., lane changes and acceleration). The takeover behavior is a multi-stage process consisting of situation awareness, decision & reaction, and takeover performance stages. An in-depth review of takeover behavior characteristics from the three takeover stages is helpful to describe the takeover process and analyze takeover behavior characteristics systematically. Therefore, this paper aims to review driver's takeover performance from the three levels of driver, automated vehicle, and road environment based on the takeover behavior mode. First, we identified 1329 articles through a systematic literature search. 122 articles were included in this review. Second, we use the knowledge graph method for bibliometric analysis. Third, we systematically review the characteristics of takeover behavior in three stages (situation awareness, decision & reaction, takeover performance) from three dimensions: driver, vehicle, and road environment. At the same time, this study develops scoring rules that quantify each factor's contribution to takeover behavior. Fourth, based on the reviewed literature and scores, 18 suggestions were proposed to improve takeover behavior from three levels: drivers, vehicles, road environment. Finally, we have outlined the future fundamental research of takeover behavior. This review summarizes the research content of takeover behavior testing and forms a knowledge system, which provides researchers with a window to understand the research status and development context. This review can guide future research on takeover behavior.