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.

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

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.

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.

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.

CRD42021235140.

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.

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.

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.

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.

Educational escape rooms within health sciences education are gaining traction as a unique and engaging game-based strategy for reviewing instructional content. Educational escape rooms cultivate valuable skills such as teamwork, communication, creativity, attention to detail, and the ability to apply knowledge under time pressures. While several studies have independently assessed learners' knowledge gains after educational escape room interventions, the present work meta-analyzes the efficacy of educational escape rooms across studies and student learners within health sciences education. A systematic search across seven databases was performed by a health sciences librarian from inception to March 24, 2023. Record screenings, full-text reviews, and data extractions were managed within Covidence. MERSQI criteria were used to assess study quality. Pooled effect sizes (Standardized Mean Differences = SMD) were estimated through meta-analysis to summarize learner performance outcomes after educational escape room interventions. Eleven studies followed a longitudinal pretest-posttest design, and five studies followed a control-treatment group design. Learners' posttest scores after participating in an educational escape room were statistically higher than their pretest scores as indicated by a large positive summary effect size (SMD ≥ 0.893; p <0.001). Educational escape rooms were also effective for treatment group participants (n = 508), who significantly outperformed (SMD = 0.616; p <0.001) control group participants (n = 555). Most escape rooms were employed as a mechanism for reviewing educational content. This meta-analytic review suggests escape rooms are effective educational interventions for increasing knowledge gains among health sciences learners and highlights common implementation practices to help guide educators interested in this game-based learning approach.

To address the following PICOS question: Can single-shade resin composites achieve a color match comparable to multi-shade composites in tooth restoration?

A comprehensive search was conducted across multiple electronic databases to identify in vitro and clinical studies evaluating the color match in tooth restoration, in terms of CIELAB (ΔE ab ) and/or CIEDE2000 (ΔE 00) color differences metrics, using single-shade and multi-shade composites. The risk of bias was assessed using the Quality Assessment Tool For In Vitro Studies (QUIN Tool), while the revised Cochrane Collaboration's tool (RoB 2) was employed for randomized controlled clinical trials (RCTs). Meta-analyses were performed using RevMan to compare ΔE ab and ΔE 00 values between single-shade and multi-shade composites (p < 0.05).

After initial screening, 15 in vitro studies and 4 RCTs met the inclusion criteria for qualitative synthesis, with 8 in vitro studies selected for quantitative analysis. The majority of in vitro studies were classified as medium risk of bias, while RCTs were ranked as low risk of bias. Meta-analyses performed on in vitro studies revealed that single-shade composites exhibited statistically significant higher color differences with the surrounding tooth structure compared to multi-shade composites, for both ΔE ab and ΔE 00 (p < 0.05). However, RCTs usually reported promising outcomes for single-shade materials.

This systematic review concluded that multi-shade composites provide a more accurate color match between tooth and direct restoration than single-shade materials when evaluated by instrumental analysis in laboratory settings.

Multi-shade composites exhibit superior color match properties in laboratory studies. However, single-shade composites are a promising alternative when observed visually in clinical settings.

In India, due to rapid urbanization, lifestyle changes, and the aging of the population, hypertension and diabetes have become the leading causes of morbidity and mortality over the past 20 years. The aim of this study is to evaluate the impact of mobile health (mHealth) technology interventions on hypertension and diabetes control in India.

A comprehensive search in PubMed, Cochrane Library, Dimensions, and Google Scholar was conducted for studies conducted in India and published from inception to October 15th, 2024. The retrieved studies assessed the impact of mHealth technology interventions on hypertension and diabetes control in India. The Population, Intervention, Comparator, Outcomes, & Study Design (PICOS) framework outlined the key elements of the review. This systematic review uses secondary data, so no ethical approval is needed.

Of 782 potential articles assessed, eight met the inclusion criteria. mHealth technology-enabled Interventions were associated with significantly improved blood pressure, glycated hemoglobin (HbA1c) and Fasting Blood Glucose (FBG) in the intervention group compared to the control group. Additionally, digital health interventions, such as SMS-based education and mHealth platforms, greatly improve treatment adherence and patient satisfaction.

Due to an increasing burden of chronic diseases, incorporating mHealth interventions in routine healthcare could be a game-changing strategy toward improved health outcomes, especially in areas with limited resources and access to traditional care. The study provides a basis on which future research can be done to develop further and implement digital health strategies for the management and control of diabetes and hypertension.

Exergaming has been frequently used in rehabilitation programs for people with multiple sclerosis (PwMS). However, its effects on the participation domain of the International Classification of Functioning, Disability, and Health (ICF) remain uncertain.

To examine the effects of exergaming on participation and the assessment tools used to evaluate participation in PwMS.

The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the protocol was registered on PROSPERO. Three databases (PubMed, Web of Science, and Scopus) were searched through February 2024. Selection of eligible studies was conducted by two independent reviewers and only randomized controlled trials were included. The methodologic quality of the included studies was determined using the PEDro scale. Data were categorized by two independent researchers as follows: demographic and clinical characteristics of the participants, content and duration of the treatment, outcome measures used, and the effects of exergaming on participation.

Seventeen randomized controlled trials with a total of 942 participants were included. The outcome measures used in the studies were not specific to the participation component of the ICF. It was observed that participation was most frequently evaluated through quality-of-life questionnaires, as well as mood, motivation/satisfaction, technology acceptance, or adherence assessments were used. Seven studies assessing quality of life reported statistically significant differences after exergaming.

Exergame interventions have been shown to improve participation-related factors including quality of life, mood, and treatment adherence in PwMS. However, future studies should prioritize increasing participation and assess improvements using targeted outcome measures.

Growing rates of overweight and obesity worldwide call for novel approaches to treatment, and plant-derived natural products present a promising therapeutic option. Evaluate the efficacy of plant-derived natural products as dietary interventions for overweight and obesity through a systematic review and network meta-analysis. We conduct a systematic review and network meta-analysis following PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. We searched from five databases and registries up to March 2024, selecting randomized controlled trials examining dietary interventions with plant-derived natural products for adults with obesity or overweight. The frequentist approach was used for the network meta-analysis, assessing 13 metabolic and obesity-related outcomes. Our review included 39 studies with 2513 participants with PROSPERO registration ID CRD42024520305. African Mango emerged as the most effective intervention, reducing body weight (MD: -10.00 kg, 95% CI: -16.74 to -3.26), waist circumference (MD: -11.70 cm, 95% CI: -17.15 to -6.25), total cholesterol (MD: -44.01 mg/dL, 95% CI: -58.95 to -29.08), triglycerides (MD: -42.65 mg/dL, 95% CI: -79.70 to -5.60), and random blood glucose (MD: -14.95 mg/dL, 95% CI: -18.60 to -11.30). Green coffee led to the largest reduction in body fat percentage (MD: -2.90%, 95% CI: -4.88 to -0.92) and BMI (MD: -3.08 kg/m2, 95% CI: -6.35 to 0.19). Ephedra was most effective in reducing fasting blood glucose (MD: -4.60 mg/dL, 95% CI: -5.49 to -3.71) and HOMA-IR (MD: -16.20, 95% CI: -18.66 to -13.74). There were too few direct comparisons between various metabolites; thus, most of the comparisons were indirect comparisons through placebo. Plant-derived natural products significantly impact obesity management, notably in body weight, waist circumference, and lipid profile reduction; however, further high-quality and rigorous studies were needed to establish the clinical efficacy of the plant-derived natural products.

We aimed to compare the acute and retention effects of motor training alone versus its combination with transcranial direct current stimulation (tDCS) on motor symptoms in Parkinson's disease (PD) patients.

Two independent reviewers searched for randomized controlled trials that applied motor training with active tDCS versus sham tDCS with motor function as an outcome measure for patients with PD. Random-effects meta-analyses were conducted to calculate standardized mean differences between the effects of motor training with active tDCS versus sham tDCS on motor function. A total of 16 randomized controlled trials (344 PD patients) were eligible for meta-analysis, resulting in 75 motor function comparisons for data synthesis.

Motor training with active tDCS showed positive acute effects on overall motor function compared to motor training with sham tDCS, particularly improving step length and gait speed. Moderator variable analyses indicated that these acute effects persisted regardless of the number of sessions or the targeted brain regions for tDCS. Meta-regression analysis showed that a higher proportion of female participants and shorter PD duration were associated with greater acute effects. However, no positive retention effects of motor training with active tDCS on overall motor function were observed.

Our results suggest that combining motor training with tDCS improves motor function, particularly in gait-related parameters, in PD patients. However, these effects were not sustained over time, highlighting the temporary nature of the benefits. Sex differences may influence the acute effects of combined motor training and tDCS interventions.

This systematic review and meta-analysis aimed to evaluate the effects of ketogenic diet (KD) and very-low-energy ketogenic therapy (VLEKT) protocols on various health outcomes in patients with polycystic ovary syndrome (PCOS) and increased body weight.

A systematic search was conducted across Scopus, PubMed, Cochrane, and Embase databases from their inception through January 2025, using a predefined search strategy. Studies were selected based on the PICOS criteria. Data extraction focused on anthropometric measures, glycometabolic and lipid profiles, and hormone levels. Controlled studies were analyzed to evaluate the effects of high-fat KDs and VLEKT compared to low calorie diets (LCDs). Additionally, uncontrolled studies were included, and the outcomes following high-fat KDs or VLEKT were compared to baseline values (before-after study design). A sub-analysis was also performed to compare VLEKT with high-fat KDs. We assessed the quality of the evidence, as well as heterogenity, sensitivity, and publication bias.

A total of 10 studies were included in the analyses, comprising three randomized controlle studies (RCTs), one non-randomized intervention study, four cohort studies, and two case series. Two RCTs comparing VLEKT and high-fat KDs with LCDs found no significant effect on body weight. However, both high-fat KDs and VLEKT were associated with reductions in body mass index (BMI) and fat mass percentage in patients with PCOS. Significant improvements in weight, BMI, fat mass, and lean mass were observed following high-fat KDs or VLEKT interventions compared to baseline values, with no substantial differences between the two diet types. Regarding glycometabolic outcomes, both high-fat KDs and VLEKT reduced serum glucose levels and the homeostatic model assessment index compared to LCDs, with VLEKT showing slightly more favorable effects. In terms of the lipid profile, both high-fat KDs and VLEKT lowered total cholesterol and triglyceride levels, and VLEKT showing greater efficacy in triglyceride reduction. Hormonal analyses from two RCTs showed that both high-fat KDs and VLEKT were associated with lower serum luteinizig hormone (LH) levels compared to LCDs. Additionally, both high-fat KDs and VLEKT led to reductions in LH and total testosterone levels relative to baseline, with VLEKT showing a slight advantage in lowering LH and follicle-stimulating hormone levels.

High-fat KDs and VLEKT show beneficial effects on weight, body composition, glycometabolic parameters, and hormone profile in women with PCOS. VLEKT may provide additional advantages, particularly in reducing fat mass and lowering triglyceride levels. Further studies with larger sample sizes and more robust study designs are needed to confirm these findings.

Due to the significant impact of Western diets on the environment, interventions are being trialled in supermarkets, restaurants, and other settings to encourage sustainable food consumption (SFC). The Behaviour Change Technique Taxonomy (BCTTv1) lists and categorises Behaviour Change Techniques (BCTs), which facilitates the development and understanding of behaviour change interventions. However, its applicability to pro-environmental behaviour change has not been extensively explored. This systematic review uses the BCTTv1 to identify the BCTs that have been previously used to encourage SFC behaviours. Studies were retrieved from Scopus, PSYCInfo, GreenFILE, and the Web of Science Core Collection. Twenty-six interventions across 19 articles were reviewed, enabling the identification of 13 BCTs which were coded using the BCTTv1 and categorised according to their target behaviour and effect size. The most frequently applied BCTs were 12.1 'restructuring the physical environment', which was used in the most effective interventions; 6.2 'social comparison', which was used in interventions with smaller and more unpredictable effects; 5.3 'information about social and environmental consequences'; 5.2 'salience of consequences'; and 7.1 'prompts/cues'. Despite challenges in assessing the BCTs' effectiveness due to multicomponent interventions and varying effects across different contexts, this review offers recommendations on changing SFC behaviour as well as the applicability of the BCTTv1 for SFC interventions.

Background: Modern dentistry strives to achieve increasingly less invasive procedures as the ultimate therapeutic goal. The careful selection of suitable candidates for immediate dental implants can offer an opportunity to reduce treatment time, lower the relative costs and improve overall patient satisfaction. Methods: A systematic search was conducted in March 2025, without any time restrictions, in Medline, Pubmed and Web of Science databases. To identify other related references, further research was performed. Articles related to current knowledge about the immediate loading of dental implants supporting fixed partial prosthesis in the posterior region were included. Articles not available in abstract form and articles not published in the English language were excluded. Results: A total of ten studies were eligible for inclusion in the current study. The search strategy resulted in a survival rate ranging from 86% to 100%, and a failure rate of less than 21.6%, with a mean follow-up of 55.6 months. Statistical analysis revealed no significant differences in survival rates between implants placed in the maxilla and mandible (χ2 = 0.42, p = 0.81, df = 2). Follow-up varied from one to ten years, reflecting variability both in study design and duration. Conclusions: The selected studies highlight the heterogeneity in immediate loading protocols for implant-supported fixed partial prosthesis in the posterior regions, emphasizing the variability in prosthetic materials and implant types, suggesting that immediate loading is a reliable, patient-centered therapeutic option with favorable long-term outcomes.

Enhancing physical performance and improving load tolerance through safe methods is a priority for most athletes. One potentially beneficial approach is listening to music, which exerts positive effects through various mechanisms. This study aims to investigate the influence of music on athletic performance and endurance, focusing specifically on its potential as an ergogenic aid in team sports-an area that has received less attention compared to individual sports.

To examine the effects of music on physical performance and load tolerance in team sports athletes, we conducted a systematic search for original English-language articles in PubMed, Mendeley, and the Cochrane Library from inception to June 2024, following PRISMA guidelines.

The search identified eight studies that met the inclusion criteria, involving 140 participants from football, volleyball, and basketball. All studies demonstrated a low risk of bias. None of the studies included elite adult international-level athletes. The analysed parameters included peak power, sprint and jump performance, maximal oxygen consumption, repeated sprint ability, change of direction, and load tolerance indicators such as heart rate, rating of perceived exertion (RPE), and fatigue index. Most studies demonstrated a significant positive effect of music on these parameters; however, the protocols for music accompaniment were not standardised.

The findings suggest that music can positively impact both physiological and psychological factors, though its application in team settings requires further investigation. Given its safety and accessibility, music may serve as a valuable tool for enhancing performance in various sporting contexts. Future studies should include more detailed information on music usage protocols and involve larger sample sizes, particularly including adult elite athletes.

Although a large number of trials have observed the anti-inflammatory properties of propolis, the currently available research remains controversial regarding its beneficial health effects. Hence, the purpose of this study was to examine the effect of propolis on inflammatory and oxidative stress markers in adults.

A comprehensive search was performed in Scopus, Web of Science, and PubMed/Medline to find relevant randomized controlled trials (RCTs) until January 2024. The overall effect sizes were calculated using the random-effects model and expressed as weighted mean differences (WMD) with a 95% confidence interval (CI). The possible heterogeneity between included trials was assessed by performing Cochran's Q test.

In total, 27 trials with 29 treatment arms were eligible for inclusion in this review. This meta-analysis revealed that propolis consumption led to a significant decrease in C-reactive protein (CRP) (WMD: -1.23; 95%CI: -1.76, -0.69; p < 0.001), Interleukin-6 (IL-6) (WMD: -1.52; 95%CI: -2.10, -0.93; p < 0.001), Tumor necrosis factor-α (WMD: -1.15; 95%CI: -1.75, -0.55; p < 0.001), and Monocyte chemoattractant protein-1 (MCP-1) (WMD: -35.33; 95%CI: -50.28, -20.37; p < 0.001), and a significant increase in total antioxidant capacity (TAC) (WMD: 0.32; 95%CI: 0.12, 0.51; p = 0.001), Glutathione (GSH) (WMD: 4.71; 95%CI: 3.17, 6.25; p < 0.001), and Glutathione peroxidase (GPx) (WMD: 44.75; 95%CI: 5.10, 84.40; p = 0.02). However, there were no significant effects on IL-10, IL-2, IL-8, pro-oxidant-antioxidant balance (PAB), malondialdehyde (MDA), and superoxide dismutase (SOD) in comparison to the control group.

Propolis supplementation appears effective in reducing inflammation and oxidative stress by enhancing antioxidant capacity and reducing specific inflammatory markers. However, variations in study designs, dosages, and participant characteristics contribute to the heterogeneity of results. Further well-designed RCTs are needed to confirm these findings and determine the optimal dosage and long-term effects. Given its potential anti-inflammatory and antioxidant properties, propolis may serve as a complementary approach in managing inflammation-related conditions, though its clinical application requires further validation.

https://clinicaltrials.gov/, identifier CRD42023474033.

The rapid development of COVID-19 vaccines highlighted the transformative potential of artificial intelligence (AI) in modern vaccinology, accelerating timelines from years to months. Nevertheless, the specific roles and effectiveness of AI in accelerating and enhancing vaccine research, development, distribution, and acceptance remain dispersed across various reviews, underscoring the need for a unified synthesis.

We conducted an umbrella review to consolidate evidence on AI's contributions to vaccine discovery, optimization, clinical testing, supply-chain logistics, and public acceptance. Five databases were systematically searched up to January 2025 for systematic, scoping, narrative, and rapid reviews, as well as meta-analyses explicitly focusing on AI in vaccine contexts. Quality assessments were performed using the ROBIS and AMSTAR 2 tools to evaluate risk of bias and methodological rigor.

Among the 27 reviews, traditional machine learning approaches-random forests, support vector machines, gradient boosting, and logistic regression-dominated tasks from antigen discovery and epitope prediction to supply‑chain optimization. Deep learning architectures, including convolutional and recurrent neural networks, generative adversarial networks, and variational autoencoders, proved instrumental in multiepitope vaccine design and adaptive clinical trial simulations. AI‑driven multi‑omic integration accelerated epitope mapping, shrinking discovery timelines by months, while predictive analytics optimized manufacturing workflows and supply‑chain operations (including temperature‑controlled, "cold‑chain" logistics). Sentiment analysis and conversational AI tools demonstrated promising capabilities for real‑time monitoring of public attitudes and tailored communication to address vaccine hesitancy. Nonetheless, persistent challenges emerged-data heterogeneity, algorithmic bias, limited regulatory frameworks, and ethical concerns over transparency and equity.

These findings illustrate AI's transformative potential across the vaccine lifecycle but underscore that translating promise into practice demands five targeted action areas: robust data governance and multi‑omics consortia to harmonize and share high‑quality datasets; comprehensive regulatory and ethical frameworks featuring transparent model explainability, standardized performance metrics, and interdisciplinary ethics committees for ongoing oversight; the adoption of adaptive trial designs and manufacturing simulations that enable real‑time safety monitoring and in silico process modeling; AI‑enhanced public engagement strategies-such as routinely audited chatbots, real‑time sentiment dashboards, and culturally tailored messaging-to mitigate vaccine hesitancy; and a concerted focus on global equity and pandemic preparedness through capacity building, digital infrastructure expansion, routine bias audits, and sustained funding in low‑resource settings.

This umbrella review confirms AI's pivotal role in accelerating vaccine development, enhancing efficacy and safety, and bolstering public acceptance. Realizing these benefits requires not only investments in infrastructure and stakeholder engagement but also transparent model documentation, interdisciplinary ethics oversight, and routine algorithmic bias audits. Moreover, bridging the gap from in silico promise to real‑world impact demands large‑scale validation studies and methods that can accommodate heterogeneous evidence, ensuring AI‑driven innovations deliver equitable global health outcomes and reinforce pandemic preparedness.

Open-skill and closed-skill agility attributes are pivotal for achieving success in basketball. However, systematic synthesis of evidence regarding the effectiveness of different basketball-specific training methods on agility performance is lacking among basketball players in the literature. Consequently, this systematic review with meta-analysis aimed to evaluate the effectiveness of prominent training methods in improving open-skill and closed-skill agility in basketball players.

Using keywords related to 'basketball', 'agility', and 'training', we searched for experimental studies in PubMed, Web of Science, and EBSCOhost databases that were published in the last decade (between January 2013 and September 2023). The included training methods were categorized into five groups, including reaction training (RT), speed training (SpT), strength and balance training (SBT), plyometric training (PT), and stretching training (StrT). The effects of training methods were summarized using standardized mean differences (SMD) with 95% confidence intervals in R software.

A total of 29 studies met the inclusion criteria, comprising 42 separate effects. Studies only assessed the effects of different training methods on closed-skill agility performance, with no open-skill agility assessments used. Improvements in closed-skill agility were apparent between pre-and post-training intervention with most training methods including a large effect for RT [SMD = 0.86, 95% CI (0.53, 1.19)], medium effects for PT [SMD = 0.62, 95%CI (0.38, 0.86)] and SBT [SMD = 0.59, 95%CI (0.13, 1.05)], and a small effect for SpT [SMD = 0.43, 95%CI (0.13, 0.74)]. While no effect for StrT [SMD = 0, 95%CI (-0.98, 0.98)] was apparent, only one study examined this training method.

RT appears to be the most effective method for developing closed-skill agility among basketball players, particularly when implemented in small-sided games. SBT and PT also appear impactful in developing closed-skill agility to similar extents. SpT appears to benefit closed-skill agility to a minor extent with limited research examining the effectiveness of StrT on agility among basketball players. Surprisingly, no studies have incorporated open-skill agility tests when assessing the effectiveness of training methods, which is essential to address in future research. Outcomes from this review provide guidance to basketball coaches and performance staff for selecting training methods that optimize closed-skill agility performance in their players.

Objective: To synthesize and analyze the prevalence, composition, longitudinal stability, and predictors of cancer symptom clusters in children and adolescents undergoing chemotherapy. Method: A systematic literature review was conducted in accordance with the PRISMA 2020 guidelines. Evidence was sourced from MEDLINE/PubMed, Cochrane Library, Embase, PsycINFO, and Web of Science, as well as clinical trial registries (Clinical Trials WHO-ICTRP) and gray literature. The search was performed in February 2025, with no restrictions on publication date or language. Two independent reviewers screened and selected the studies. The methodological quality of the included studies was assessed using design-specific tools, and the findings were synthesized narratively. Results: A total of 6221 records were identified, with 12 studies meeting the inclusion criteria. These studies were published between 2010 and 2024 in the United States, Brazil, China, and Turkey. Cancer symptom clusters in children and adolescents followed well-defined patterns, with the gastrointestinal, emotional, fatigue-related, somatic, and self-image clusters being the most prevalent. Conclusions: Early identification of these cancer symptom clusters is essential for guiding interprofessional teams in delivering personalized, evidence-based care to children and adolescents with cancer and their families.

Depression is one of the most common mental illnesses worldwide and is a major burden for those affected. As conventional therapies do not always work and are also associated with side effects, alternative treatment methods are urgently indicated. In the past, exercise has established itself as a seemingly good alternative treatment method. The aim of this work is to provide a state of the art review and to check whether there are new findings since the publication of the article by Wegner and colleagues 10 years ago.

A systematic literature search was conducted. This included searching for appropriate literature in databases such as PsycINFO, PsychARTICLES, PubMed, CINAHL Complete, SocINDEX, SPORTDiscus and Psyndex. Effect sizes calculation and evaluation of the methodological characteristics (AMSTAR 2) were carried out. Finally, the neurobiological explanations for the effect of exercise on depression are discussed.

Eleven meta-analyses met the inclusion criteria, with the total sample consisting of 16.255 participants and 229 individual studies. The most frequently implemented intervention was aerobic exercise, while the intervention in the control groups was usually no treatment, waiting list, or attention/activity placebo. The pooled results indicate a moderate clinical effect, suggesting the positive effect of exercise and physical activity in reducing depressive symptoms (SMD = -0.61, 95% CI [- 0.78; -0.43], p = <0.01).

The medium but consistently positive effects that were found in the present study place exercise/ physical activity as a promising and helpful alternative for adults with depression. The positive effect of exercise and physical activity could potentially be explained by neurological changes. However, the exact mechanisms underlying the antidepressant effects are still unclear.

This study aimed to describe overall survival (OS) of patients with APDS relative to the global population as well as among subsets of patients with concurrent lymphoma or hematopoietic stem cell transplant (HSCT) relative to the overall APDS population.

Patient-level data were extracted from a recent systematic literature review of 351 unique patients with APDS. OS was evaluated using the Kaplan-Meier method up to age 65 years. OS rate and corresponding 95% CI were reported at each decade of age. Global mortality estimates were obtained from World Health Organization life tables for 2019.

Of the 351 patients with APDS (APDS1, 267 [76.1%]; APDS2, 83 [23.6%]; unspecified, 1 [0.3%]), 41 (11.7%) died. The OS rate was 25.0% (95% CI, 1.6-62.7%) by the last death event at 64 years of age. Starting at 12 years of age, the OS rate was numerically lower in patients with APDS relative to the global population (median OS, 64 vs. 75 years, respectively). Relative to the overall APDS population, OS rates were numerically similar in those who underwent HSCT (median OS, 64 years for both; p = 0.569), whereas OS rates were numerically lower in patients with concurrent lymphoma (median OS, 41 vs. 64 years, respectively; p = 0.109). Publication bias in source data was a possible limitation.

Reduced survival in patients with APDS suggests a high disease burden, particularly in those with concurrent lymphoma. These results highlight the unmet need for disease-modifying treatments for APDS.

Given uncertain illness trajectories faced by older adults with frailty and risk of decline and poor outcomes, intervention development for readiness to engage with advance care planning may confer benefits. However, evidence in this area remains limited.

DESIGN: A mixed-methods systematic narrative review, underpinned by the COM-B system behaviour change model and employing thematic data synthesis.

Primary studies were included using experimental or observational designs, qualitative and quantitative. Eligible studies were identified through searches of four electronic databases from inception to January 19, 2025.

26 articles met the inclusion criteria. The data synthesis generated 14 themes across the three COM-B system components. The review identified the components of older adults' readiness, such as their limited physical and cognitive capacity for engaging in ACP (capability), influence and involvement of family (opportunity), and their desire to maintain the present and fear of change (motivation). It emphasised that readiness for advance care planning is a dynamic process influenced by family carers' and professionals' attitudes and behaviours, uncertainties inherent in older adults' conditions, as well as healthcare system, political, and social factors. The review also highlighted the uncertainties and ongoing changes involved in readiness, such as fluctuating physical and cognitive capabilities and changeable social situations. Based on these findings, a logic model was constructed to guide intervention development, outlining the components, intended outcomes, and influential factors.

Individual behaviour change models alone are insufficient to demonstrate older adults' readiness for advance care planning, as various external factors can influence their readiness. This emphasised the need for a comprehensive understanding of the contextual factors affecting readiness and the importance of flexibility in adapting interventions accordingly. Continuous assessment and enhancement of an individual's readiness for advance care planning, initiating conversations about what matters to them now, and improving family carers' readiness for advance care planning by assessing family dynamics and relationships are essential in practice. Further research is needed to elucidate the processes and causal pathways between intervention components and intended outcomes. This systematic review was registered on PROSPERO (CRD42023389337).

Atrial fibrillation (AF) is the most common cardiac arrhythmia, which significantly contributes to morbidity, mortality, and a diminished quality of life. Despite advancements in pharmacological treatments, many AF patients do not achieve adequate symptom control with oral medications. This network meta-analysis seeks to provide comprehensive evidence to guide clinical decision-making and optimize ablation strategies for patients with atrial fibrillation.

This network meta-analysis (NMA) was conducted in accordance to PRISMA NMA Checklist of Items (PROSPERO No. CRD42024577782). A comprehensive search was performed across major literature databases (PubMed, Scopus, CENTRAL, ProQuest, and Web of Science) up to July 10, 2024. Data analyses were performed using Rstudio v.4.4.1 employing Bayesian NMA with random-effects models. Sensitivity, subgroup, and network meta-regression analyses were also conducted. SUCRA values were estimated to present the ranking of each treatment in the network. Meta-proportions with GLMM (Generalized Linear Mixed Model) also performed to analyze the safety outcomes.

A total of 6332 AF patients from 46 randomized controlled trials (RCTs) were included. NMA demonstrate epicardial (surgical) approach, especially video-assisted thoracoscopic surgery (VATS) (OR 1.54; 95%CrI [1.03,2.38]; SUCRA 89.61) exhibited superiority to reduce the AF recurrence in AF patients. Hybrid epicardial-endocardial ablation (OR 1.51; 95% CrI [0.82,2.82]; SUCRA 85.7) had a similar freedom from AF rate to VATS. Subgroup and network meta-regression analysis revealed that AF type ((β -0.415; [-0.776;-0.042]) and AF duration (β 0.602; [0.066;1.079]) influence the freedom from AF rate. Meta-proportion indicated that surgical or hybrid ablation exhibited a higher risk of mortality (Prop = 5.07%), pericardial effusion (Prop = 4.35%), and phrenic nerve injury (Prop = 4.35%).

NMA demonstrated higher effectiveness of VATS and hybrid ablation in reducing the recurrence rate of AF. Despite complications associated with surgical and hybrid approaches have higher prevalence, type of complications encountered in this approaches are less diverse.

Bladder cancer (BCa) imposes a substantial economic burden on health care systems and patients. Understanding these financial implications is crucial for effective resource allocation and optimization of treatment cost effectiveness. Here, we aim to systematically review and analyze the financial burden of BCa from the health care and patient perspectives.

A Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA)-compliant systematic review was conducted, searching PubMed/Medline, Embase, and public sources for studies evaluating the financial impact of BCa, encompassing costs, cost effectiveness, and financial toxicity (FT).

Non-muscle-invasive BCa (NMIBC) incurs significant costs for surveillance and treatment, with costs exceeding $200 000 after 5 yr for high-risk NMIBC patients progressing after bacillus Calmette-Guerin (BCG) treatment (including inpatient, outpatient, and physician service expenses). Muscle-invasive BCa generates substantial costs from radical cystectomy (RC) and neoadjuvant chemotherapy, averaging $30 000-40 000 from surgical costs of RC, with additional expenses in case of complications. Trimodal therapy has higher costs (1-yr management cost >$200 000) than RC because of higher outpatient, radiology, and medication costs. Metastatic BCa incurs the highest financial burden, with systemic therapy costs ranging from $40 000 to over $100 000 per five-cycle course, increasing further with combination therapies (ie, enfortumab vedotin and pembrolizumab), treatment-related toxicity, and supportive care. FT is particularly prevalent among younger, less educated, and minority populations.

BCa treatment, particularly in advanced stages, imposes a substantial economic burden. Innovations in care, while improving oncologic outcomes, necessitate detailed cost-effectiveness assessments. Addressing these economic challenges is essential for optimizing BCa management, targeting patients at a higher risk of FT, and improving patient quality of life.

Dogs are an integral part of many households and important companion animals to humans. Their inquisitive and exploratory behaviour leads them to roam natural environments, making them susceptible to tick infestations that can also be transmitted to humans. To control these ticks, various plant extracts have been evaluated for their efficacy as acaricides and/or repellents against various species. This study was aimed at consolidating the data that has been published in terms of the plant species that have shown efficacy against ticks that parasitize dogs, it further evaluated the methods used in preparing these formulations. A keyword-Boolean strategy was created to extract a total of n = 103 articles that were included in the study. The leading countries in terms of the global distribution of acaricidal plant investigation outputs were Brazil at 23 %, India at 17 % and Turkey at 7 %. A total of n = 13 tick species were used in the evaluated studies. The dog tick Rhipicephalus sanguineus was the most widely used for efficacy testing at 43 % frequency. The Lamiaceae plant family had the highest frequency for reported use across the evaluated studies at 18 %, this was followed by the family Asteraceae at 11 %. Adult immersion test, larval packet test and larval immersion test were the most preferred assays for acaricidal efficacy studies. Leaves were the most preferred plant parts utilized for crude plant metabolites extraction (n = 43), while essential oils were the most highly reported extracts (n = 60). Lastly, extracts were primarily subjected to Gas chromatography for analysis of the plant compounds (n = 38). This paper gives the current global status of potential acaricidal plants utilized against ticks parasitizing dogs.

Criteria for assessment of the significance of scientific articles are presented. The focus is on research design and methodology, illustrated by the classical study on prehospital volume treatment of severely injured individuals with penetrating torso injuries by Bickell et al. (1994). A well-thought out research design is crucial for the success of a scientific study and is documented in a study protocol beforehand. A hypothesis is a provisional explanation or prediction and must be testable, falsifiable, precise, and relevant. There are various types of randomization methods, with the randomized controlled trial being the gold standard for clinical interventional studies. When reading a scientific article it is important to verify whether the research design and setting align with the research question and whether potential sources of error have been considered and controlled. Critical scrutiny should also be applied to references, the funding and expertise of the researchers.

Group-delivered programs for chronic pain are evidence-based and frequently used. The contribution of group factors to outcomes is unclear and there are no integrated findings on consumer perceptions of the group itself in programs for people with chronic pain. The aim of this systematic review was to search and synthesise qualitative data specifically related to the group itself in studies investigating group-delivered programs for people with chronic pain (PROSPERO, CRD42023382447). MEDLINE, EMBASE, EmCare, PsycINFO, Scopus, and CINAHL databases were searched, and qualitative studies that explored the experiences of consumers who had attended any style of group-delivered program for people with chronic pain were included. Methodological quality was assessed using the Critical Appraisal Skills Programme checklist and meta-synthesis was guided by a thematic synthesis approach. Ninety-three studies were included, with 1806 participants. Programs were predominantly multi-component, with diverse interventions and facilitators. Three analytical themes were generated: (1) Peer interaction: a program component in and of itself; (2) Comparison: frequently used and mostly helpful; and (3) Beyond the program: when the group itself contributes to change. Findings highlighted that most consumers valued the group itself, finding interaction, and comparing themselves with peers useful. Future research related to group factors in programs for people with chronic pain should include consumer participation and co-design. PERSPECTIVE: This review demonstrates that many consumers valued peer interaction and used comparison-based cognitive processing within group-delivered programs for chronic pain. Dialogue-based interactions with similar others promoted cognitive, affect, and behaviour changes. Group factors may have been underestimated and outcomes could be influenced if peer interactions within programs were optimised.

Controlling biofilm is a crucial strategy and an essential component of preventing dental caries. Considerable research has been conducted in recent years on the clinical application of hydroxyapatite (HAp) and hydroxyapatite nanoparticles (nHAp) in preventing dental caries. However, these studies have yet to investigate the effectiveness or mechanism of these substances as antibacterial and antibiofilm agents. This study aimed to provide a thorough analysis of the current evidence on the antibacterial and antibiofilm characteristics of HAp/nHAp in the prevention of dental caries. Searches were conducted across five databases: Cochrane Library, PubMed, Scopus, EBSCOhost, and ScienceDirect. Google Scholar was also searched. Titles, abstracts, and full text were evaluated following the guidelines set by the Preferred Reporting Item for Systematic Review and Meta-Analyses (PRISMA). A methodological quality assessment of the studies was conducted using the QUIN tool. The initial retrieval totaled 15,047 studies, from which 3,487 were excluded. A total of 11,560 studies were screened based on the title and abstract, resulting in 24 full-text studies considered potentially eligible for inclusion (κ = 0.9599). Finally, 19 studies met all the defined inclusion criteria and were included in this comprehensive systematic review (κ = 0.8837). HAp/nHAp demonstrates antimicrobial activities against gram-negative and gram-positive bacteria and fungi. However, nHAp's antibiofilm efficacy remains limited. Further investigation is required to improve the efficacy of antibacterial and antibiofilm agents.

Optimal thyroid function is particularly crucial during infancy. This systematic review and meta-analysis aimed to investigate the relationship between the mode of delivery and neonatal thyrotropin levels at birth.

We conducted a systematic search of MEDLINE/PubMed, Web of Science, Embase, Scopus, and the Cochrane Library for studies published up to 2023. Hedges' g with 95% confidence intervals was calculated to compare mean thyroid-stimulating hormone (TSH) levels based on the mode of delivery. Additionally, TSH levels were compared based on blood sampling methods, heel blood vs cord blood, using the same meta-analytic approach. A random effects model was employed due to the presence of heterogeneity. This study is registered with PROSPERO under the number CRD42024533649.

A total of 1438 studies were identified, of which 18 met the criteria for the systematic review. The meta-analysis of ten studies revealed significantly higher pooled TSH levels in neonates born via vaginal delivery compared to those delivered by cesarean section (Hedges' g = 0.390; P = .002). In the heel blood subgroup, no significant difference in TSH levels was found between vaginal and cesarean deliveries (Hedges' g = 0.167; P = .111). However, in the cord blood subgroup, neonates delivered vaginally exhibited significantly higher TSH levels than those delivered by cesarean section (Hedges' g = 0.493; P = .002).

The study found that the method of delivery has a significant impact on neonatal TSH levels, especially in umbilical cord blood samples, highlighting the need to consider delivery mode in evaluating neonatal health.

Borderline personality disorder (BPD) is a psychiatric condition characterised by pervasive patterns of thinking and feeling, which can lead to social dysfunction and poor mental health. BPD has a significant impact not just on individuals with the diagnosis but also on those around them. Currently, no medication is licenced for BPD. Despite this, it is common for people with BPD to be prescribed multiple psychotropics. All psychotropic medications are associated with adverse events. A systematic review was conducted to explore factors that influence prescribing in adult BPD patients. Searches were conducted of EMBASE, PsycINFO, PubMed, EThOS and Web of Science. One-hundred and two unique studies were identified, of which 13 suitable studies with diverse methodologies were included in the final synthesis. Of these, seven studies produced quantitative results, whereas the remaining six produced qualitative results. The synthesis identified several demographic factors statistically associated with prescribing. Most notably, prescribing was more likely in older patients and those with comorbid conditions. In addition to demographic factors identified, two key themes were generated from analysis of qualitative data from both healthcare professionals (HCPs) and patients discussing drivers: that the patient-HCP relationship and the care pathway are crucial to the prescribing process from both perspectives. Prescribing medications for BPD is common, but there is limited data on the factors that affect this prescribing choice. HCPs must be aware of their own roles and perceptions in their relationships with BPD patients so that patients receive the most suitable treatment.

When exercising to preferred music (PM), participants found more satisfaction and less typical exercise-related fatigue, which made it easier and more enjoyable to maintain the physical activity (PA) until the exercise goals were achieved. The purpose of this review and meta-analysis was to determine whether changes on internal training load in adult recreational athletes were modified by listening to PM and non-preferred music (NPM), during different PA.

A music-focused search was performed on the Google Scholar, PubMed, and Web of Science databases to identify relevant articles to this topic published after 2000 to investigate the effects of PM on psychophysiological responses to PA.

Twelve studies met the inclusion criteria and were included in the qualitative analysis. The research studies' sample sizes varied from ten to twenty-five participants. Heart rate (HR) and rate of perceived exertion (RPE) on internal training load were the selected indicators. The use of different kinds of music had mostly, non-significant effects on HR and RPE toward the ability of music to allow participants to dissociate from the intensity level they are experiencing.

The meta-analysis confirmed that preferred music had no significant effect on HRmean or RPE. The results of this review contradict the idea that listening to music improves exercise performance.

Elevated sperm DNA fragmentation has potential implications for semen quality and fertility. The commonly used sperm chromatin dispersion test offers an indirect estimation but has limitations in terms of bias and variability. This study aimed to assess the reliability of the sperm chromatin dispersion assay for predicting assisted reproductive technology outcomes.

This systematic review included studies published until December 2023 that adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed/MEDLINE, Scopus, and Google Scholar databases were searched. Various assisted reproductive technology outcomes in patients with high (≥ 30%) versus low (< 30%) sperm DNA fragmentation were compared using a sperm chromatin dispersion assay and including a sub-analysis of intracytoplasmic sperm injection versus in vitro fertilization. A comprehensive meta-analysis software facilitated quantitative analysis with statistical comparisons between cases and controls. Interstudy heterogeneity was assessed, and sensitivity and publication bias tests were performed.

Of the 199 abstracts assessed, 64 full-text articles were screened, and 44 articles were qualitatively synthesized. Fourteen articles representing 5346 participants were quantitatively analyzed. Using the sperm chromatin dispersion assay, elevated sperm DNA fragmentation was associated with lower fertilization and embryo cleavage rates. Notably, high sperm DNA fragmentation levels did not affect the clinical pregnancy, implantation, miscarriage, or live birth outcomes. Sub-analysis revealed lower fertilization, embryo cleavage, clinical pregnancy, live birth rates, and higher miscarriage rates in the intracytoplasmic sperm injection subgroup only.

The sperm chromatin dispersion assay did not show significant differences in pregnancy or live birth rates between the high- and low-sperm DNA fragmentation groups. Noteworthy, high sperm DNA fragmentation was associated with worse assisted reproductive technology outcomes in the intracytoplasmic sperm injection group. Given the current quality of the evidence, affected by the experimental design and the absence of correction for female factors of infertility, clinicians should be wary of the assay's limited predictive power for pregnancy and live birth outcomes.

Testicular tumor is the most common solid malignancy in males under 40 years of age. This malignancy is known to have a negative impact on male fertility. Therefore, several techniques for sperm retrieval have been proposed, including microdissection testicular sperm extraction (mTESE). The objective of this study was to review the literature on the outcomes of oncological (Onco)-mTESE at the time of radical orchiectomy. We conducted a comprehensive literature search through PubMed, Scopus, and Cochrane Central Controlled Register of Trials. Only studies reporting ex vivo mTESE in patients with testicular tumor were considered. Twelve papers met the inclusion criteria and were included in this review. Tumor size was identified as the sole preoperative factor influencing spermatogenesis. The considered studies demonstrated a satisfactory success rate for Onco-mTESE, associated with a similarly valid percentage of live healthy births through assisted reproductive technology. Currently, no comparison has been made between Onco-mTESE and conventional Onco-TESE, hence further assessment is required. In cases where the tumor completely replaces the cancer-bearing testicle, a contralateral micro-TESE may be a viable alternative. However, the surgeon should evaluate associated risks and benefits preoperatively. In conclusion, Onco-mTESE at the time of radical orchiectomy appears to be a promising therapeutic option for young patients with testicular tumors. Nevertheless, additional studies are necessary to achieve a definitive conclusion.

Robotic surgery represents a groundbreaking advancement in modern surgery, offering precision, enhanced visualization, and reduced invasiveness. Robotic single-site surgery (RSSS), utilizing a single incision for access, combines these benefits with improved cosmetic outcomes, making it particularly appealing for pediatric patients. This systematic review evaluates the feasibility, clinical outcomes, and procedural details of RSSS in children.A systematic review was conducted using PRISMA guidelines, with searches across PubMed, Web of Science, Scopus, Medline, and Cochrane Library up to June 2024. Studies reporting on RSSS in pediatric patients were included, focusing on demographics, surgical details and outcomes such as conversion rate, blood loss, complications, reoperations, and hospital stay. Data extraction and quality assessment were independently conducted by reviewers using the Newcastle-Ottawa Scale.Seventeen studies with 322 pediatric patients were included. Procedures performed included cholecystectomy (54.7%), pyeloplasty (23.6%), choledochal cyst resection (7.4%), ureteral reimplantation (7.8%), and inguinal hernia repair (6.5%). The overall complication rate was 6% (minor complications, Clavien-Madadi grade I), with a conversion rate of 0.3% and no reoperations reported. Mean operative times varied by procedure, with minimal blood loss and short hospital stays.RSSS is a feasible and safe technique in pediatric surgery, demonstrating low complication and conversion rates. While it offers significant benefits in precision and cosmetic outcomes, further research is essential to optimize its application in pediatric surgical practice.

Co-creation is recognised as a promising approach for addressing complex health issues by collaborating with end-users to develop tailored solutions that meet their needs. Planning a co-creation initiative-resulting in a co-creation protocol-requires balancing between providing clear project details and the need for flexibility in co-creation. However, existing structured guidance necessary for effective co-creation planning in the literature does not exist. This study aimed to develop a practical co-creation planning roadmap for public health researchers and practitioners.

Iterative development of an evidence-based co-creation planning roadmap based on case study reflections and expert input, and supported by existing co-creation literature.

The roadmap was developed based on the experience of applying the PRODUCES framework and principles of the planning phase by Leask and colleagues (2019) for planning a co-creation case study on reducing sedentary behaviour in Scottish companies. The roadmap underwent several rounds of iteration with the research team, incorporated feedback from researchers experienced with co-creation, and was further supported by the established evidence base of co-creation literature.

The resulting roadmap has a seven-step approach, divided into four sections, involving: whether and why co-creation is an appropriate approach, framing the co-creation initiative (Section 1: Identify), defining stakeholders and co-creator sampling, describing resources and outcomes (Section 2: Define), structuring co-creation sessions, selecting methods for the co-creation sessions (Section 3: Structure) and planning for evaluation (Section 4: Plan Evaluation).

The roadmap offers a structured and accessible process to guide the planning of co-creation initiatives. We suggest that the roadmap be applied to different contexts to further refine and validate its utility, with the ultimate goal of enhancing the systematic planning of co-creation in public health.

Although growing evidence suggests that aerobic exercise has beneficial effects on motor symptoms in patients with Parkinson's disease (PD), it remains unclear which specific aerobic exercise regimen optimizes improvement in these symptoms. This study aimed to investigate the difference in the effects of aerobic exercise on motor function in patients with PD according to exercise intervention protocols.

Through 28 qualified studies with randomized controlled trials, we assessed motor function using either the Unified PD Rating Scale (UPDRS) III or Movement Disorder Society-UPDRS III as an outcome measure. We employed random effects meta-analysis models to obtain standardized mean differences and 95 % confidence intervals (CIs). Moderator variable analyses were conducted based on exercise type (aerobic exercise vs. aerobic-based combined exercise), duration (<60 min vs. ≥60 min per session), frequency (

RESULTS

Aerobic exercise interventions demonstrated significant improvements in overall motor function. Although all categories were significantly effective in improving motor function, aerobic-based combined exercise had a greater effect size on motor symptoms compared to aerobic exercise alone. Additionally, ≥60 min per session showed a significantly increased effect size compared to <60 min per session. The impact of aerobic exercise did not differ based on exercise frequency, period, or intensity.

CONCLUSIONS

Our observations suggest that aerobic-based combined exercise and exercise sessions lasting 60 min or longer may be associated with greater improvements in motor symptoms in patients with PD.

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Childbirth related perineal trauma affects 80 % of women during vaginal birth in the UK. Childbirth related perineal trauma can create short and long term complications for women such as pain and incontinence.

The review aimed to explore women's, their birth partners' and health care professionals' views and experiences of childbirth related perineal trauma care provision in high income countries.

Search terms and eligibility criteria were developed and four databases (MEDLINE, Embase, PsychINFO and CINAHL) were searched in February 2024, yielding 5638 results. Studies were independently screened by two reviewers and disputes resolved by a third. Study quality was assessed using the critical appraisal skills programme, thematic synthesis analysed primary data, and confidence in findings were evaluated.

22 studies were included, containing 3473 women and 56 HCPs. No studies were identified for views of birth partners. Women reported they wanted more antenatal and postnatal information about childbirth related perineal trauma, that experiences of perineal repair were affected by health care professional behaviours, and that postnatal care was not always sufficient to meet their needs. Health care professionals highlighted a need for improved education for providing care to women after childbirth related perineal trauma.

Findings from the review can inform the development of care pathways to improve care and associated outcomes for women after childbirth related perineal trauma. Further research is needed to explore the views of birth partners and a wider range of health care professionals involved in caring for women after childbirth related perineal trauma.

This study aimed to conduct a comprehensive systematic review of wearable technologies used for monitoring cardiovascular diseases (CVD) in community settings.

An extensive search of international literature was performed across several electronic databases, including MEDLINE (3588 records), Web of Science (112), PUBMED (24), Scopus (2,393), Science Direct (805), and Google Scholar (176). The review followed the PRISMA-P guidelines, which are designed to enhance the quality of systematic reviews and meta-analyses. Studies were identified using relevant keywords, covering publications up to February 3, 2025. Initially, two authors independently screened the titles, abstracts, and full texts based on inclusion criteria. In cases of disagreement, all authors discussed the studies to reach a consensus. The data were analyzed and reported according to the PRISMA 2020 checklist. Out of the 7098 studies identified, 15 met the inclusion criteria and were critically evaluated.

Wearable devices have shown significant potential in monitoring patients with CVD, a condition associated with high mortality rates. These technologies offer an efficient follow-up approach, potentially reducing healthcare costs. Moreover, the confidence these devices instill in users may enhance their adherence to CVD monitoring and management.

Background: Despite positive perceptions of telemedicine, there's a recognized need for stronger evidence on its safety and effectiveness. This study aims to evaluate telemedicine's current status in diagnosing and treating peripheral vestibular symptoms. Methods: Systematic searches across multiple databases assessed methodological quality using Physiotherapy Evidence Database scale and Revised Cochrane Risk of Bias tool for randomized trials 2.0. Results: Findings reveal significant improvements in vertigo-related disability with virtual vestibular rehabilitation (mean difference [MD] = -12.6; 95% confidence interval [CI] = -23.61, -1.59; p < 0.01; I2 = 76%) albeit with high heterogeneity. However, pooled analysis on vertigo severity across three studies did not show a significant effect (MD = -0.41; 95% CI = -0.64, -0.17; p < 0.78; I2 = 0%). Conclusions: Evidence suggests telemedicine holds promise in diagnosing and managing peripheral vestibular disorders, potentially alleviating symptoms and improving disability. Nonetheless, caution is warranted due to review limitations, emphasizing the need for further research to optimize telemedicine's benefits for patients experiencing vestibular symptoms.

Falls constitute a significant public health concern worldwide and have been associated with increased morbidity and mortality across all ages. Identifying potentially modifiable risk factors for falls is a key public health priority. Literature surrounding the association between hearing loss (HL) and falls remains inconclusive.

To conduct a systematic review and meta-analysis to comprehensively synthesize evidence surrounding the impact of HL on falls.

PubMed, Embase, and Cochrane Library from database inception through April 9, 2024.

Observational studies investigating the association between HL and falls were selected. Only studies reporting covariate-adjusted estimates were included to minimize confounding.

Two independent reviewers evaluated studies for eligibility, extracted data, and assessed the risk of bias of included studies. Using a random-effects model, adjusted estimates were pooled in meta-analyses. Heterogeneity was evaluated using subgroup and sensitivity analyses, and publication bias was assessed.

The cross-sectional odds and longitudinal risk of falls among patients with HL compared with those without HL.

A total of 5 071 935 participants were included from 27 studies; approximately 49.2% of participants were female, and 14 studies were conducted in Asia, 7 in North America, 3 in Europe, and 3 in Oceania, represented by Australia. Patients with HL exhibited an increased cross-sectional odds of falls (odds ratio, 1.51; 95% CI, 1.37-1.67; I2 = 64%) and longitudinal risk of falls (risk ratio, 1.17; 95% CI, 1.06-1.29; I2 = 69%) than those without HL. Further stratification by self-reported or validated hearing assessments, fall reporting duration, continent, community-dwelling adults, and studies adjusting for other sensory deficits identified as fall risk factors by the World Falls Guideline did not change significance. These results remained robust to sensitivity analyses, and publication bias was absent.

This systematic review and meta-analysis found that overall, HL may be a risk factor for falls. With a rapidly aging global population, it is crucial to acknowledge the public health concerns surrounding falls and consider if HL could be a potentially modifiable risk factor. Nonetheless, further randomized clinical trials are needed to elucidate any benefit of treating HL on fall prevention.

Most women suffering from urinary incontinence (UI) report that leakage occurs during everyday movement. These precise observations raise a potential association between standing postural control and UI. The aim of this systematic review is to compile studies investigating the link between standing postural control and UI, according to the presence or absence of UI, the severity of UI and bladder fullness.

This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Observational studies providing data on standing postural control in women with and without UI were considered for inclusion.

Ten studies met the inclusion criteria, representing 4262 middle-aged and older active women. According to the modified version of the Newcastle-Ottawa quality assessment Scale, one was study rated as having a high risk of bias, 3 studies fair quality and 6 good quality. Four studies reported results using stabilographic measurement (p = 124 women). Six reported results using standing balance tests (p = 4138). All studies revealed some differences between UI and non-UI groups in standing postural control (p < 0.05).

Our analysis provides a high level of evidence that women with UI have more impaired standing postural balance control than women without UI. According to the dual-task theory, worsening continence control is associated with a decline in standing postural balance, and conversely, a decline in standing postural balance is associated with the development of UI. Developing prospective planned physiotherapy intervention studies that address the impact of standing postural control interventions on UI signs and symptoms seems advisable.

Geographic atrophy (GA) is a progressive retinal disease associated with late-stage age-related macular degeneration (AMD), a significant cause of visual impairment in senior adults. GA lesion segmentation is important for disease monitoring in clinical trials and routine ophthalmic practice; however, its manual delineation is time-consuming, laborious, and subject to inter-grader variability. The use of artificial intelligence (AI) is rapidly expanding within the medical field and could potentially improve accuracy while reducing the workload by facilitating this task. This systematic review evaluates the performance of AI algorithms for GA segmentation and highlights their key limitations from the literature. Five databases and two registries were searched from inception until 23 March 2024, following the PRISMA methodology. Twenty-four studies met the prespecified eligibility criteria, and fifteen were included in this meta-analysis. The pooled Dice similarity coefficient (DSC) was 0.91 (95% CI 0.88-0.95), signifying a high agreement between the reference standards and model predictions. The risk of bias and reporting quality were assessed using QUADAS-2 and CLAIM tools. This review provides a comprehensive evaluation of AI applications for GA segmentation and identifies areas for improvement. The findings support the potential of AI to enhance clinical workflows and highlight pathways for improved future models that could bridge the gap between research settings and real-world clinical practice.

Patient safety incidents, defined as deviations from standard healthcare practices, contribute to significant mortality and financial burdens for healthcare systems globally each year. In response, international agencies advocate for patient safety incident reporting and learning systems to prevent the recurrence of safety incidents and promote learning. The effective design and implementation of these systems require the identification of factors that influence incident reporting practices. Therefore, the aim of this review was to systematically appraise and synthesise the current literature on factors influencing patient safety incident reporting practices in African healthcare organisations.

A systematic integrative review was conducted. Five electronic databases, including PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL) via EBSCO host, Scopus, Web of Science, and Excerpta Medica Database (Embase), were searched to identify relevant articles. Peer-reviewed articles published in English were included in this review. Two independent reviewers screened the identified articles first by title and abstract, followed by full text evaluation. Quality appraisal was conducted using the Joanna Briggs Institute and the Quality Assessment with Diverse Studies tool. A thematic synthesis approach was used to analyse the data. The themes were presented with narrative descriptions.

A literature search identified 9,265 articles, of which 51 were included in the review, representing the perspectives of 15,089 healthcare professionals. Of the included articles, 88% were rated as moderate to high quality. Five descriptive themes were identified as barriers and facilitators that influenced patient safety incident reporting practices, including fear of reprisal within the prevailing patient safety culture, attitudes and perceptions towards patient safety incident reporting, the extent of knowledge and skills regarding patient safety incidents and reporting, the availability and attributes of reporting systems and processes, and the level of support from managers and rapport with staff.

The identified barriers and facilitators influencing patient safety incident reporting should be addressed to effectively design, implement, and improve patient safety incident reporting systems and practices.

The review protocol was registered at the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD42023455168.

Background/Objective: Sarcopenic obesity (SO), a pathological syndrome characterized by the co-existence of diminished muscle mass and excessive adipose accumulation, significantly compromises the quality of life in older adults. The purpose of this study was to systematically evaluate the efficacy of exercise, nutritional interventions, and neuromuscular electrical stimulation (NMES) in preventing and managing SO in middle-aged and older adults. Methods: A comprehensive search was conducted across PubMed, Web of Science, Embase, Cochrane Library, and CNKI for randomized controlled trials (RCTs) until January 2025. Meta-analyses were performed using the random-effects model and fixed-effects model based on the degree of heterogeneity and calculating the mean differences (MD) with 95% confidence intervals (CI). Subgroup analyses compared the intervention types. Results: Twenty-nine RCTs (1622 participants) were included. Exercise interventions significantly reduced the body fat percentage (MD = -2.79%, 95% CI: -3.94, -1.64, p < 0.001, I2 = 74%), fat mass (MD = -6.77 kg, 95% CI: -11.48, -2.06, p = 0.005, I2 = 98%), waist circumference (MD = -2.05 cm, 95% CI: -3.64, -0.46, p = 0.01, I2 = 0%) and LDL-C (MD: -7.45 mg/dL, 95% CI: -13.82, -1.07, p = 0.02, I2 = 0%), while improving handgrip strength (MD = 2.35 kg, 95% CI: 1.99, 2.70, p < 0.001, I2 = 52%) and gait speed (MD = 0.19 m/s, 95% CI: 0.13, 0.24, p < 0.001, I2 = 89%). Mixed training outperformed resistance-only regimens in reducing the body fat percentage and enhancing functional outcomes. NMES reduced the body fat percentage (MD = -2.01%, 95% CI: -3.54, -0.48, p = 0.01, I2 = 93%) and waist circumference (MD = -1.72 cm, 95% CI: -2.35, -1.09, p < 0.001, I2 = 0%) while increasing the Skeletal Muscle Index (MD = 0.26 kg/m2, 95% CI: 0.22, 0.29, p < 0.001, I2 = 38%). Synergy with nutritional supplementation amplified these effects. Nutritional interventions modestly improved total fat-free mass (MD = 0.77 kg, 95% CI: 0.04, 1.50, p = 0.04, I2 = 0%) and handgrip strength (MD = 1.35 kg, 95% CI: 0.71, 2.00, p < 0.001, I2 = 0%) but showed no significant impact on the metabolic markers (TG, TC, glucose, hemoglobin, and HOMA-IR). Conclusions: Exercise, particularly multimodal regimens combining aerobic and resistance training, is the cornerstone for improving body composition and physical function in SO. NMES serves as an effective adjunct for accelerating fat loss, while nutritional strategies require integration with exercise or prolonged implementation to yield clinically meaningful outcomes. Future research should prioritize standardized diagnostic criteria and long-term efficacy assessments of multimodal interventions.

Poor or insufficient sleep adversely affects various physiological and psychological functions, impacting body systems such as the endocrine, metabolic, and immune systems.

Despite available pharmacological and non-pharmacological treatments, the impact of chronic yoga interventions on sleep quality in individuals with sleep problem syndrome remains underexplored. This scoping review aims to consolidate existing research on yoga interventions and their effects on sleep quality, providing evidence for yoga as a non-pharmacological alternative to reduce reliance on medications.

A systematic search across PubMed, Web of Science, and Scopus identified 1,559 studies, with 57 meeting inclusion criteria for yoga's effects on sleep quality.

Overall, the included studies reported either significant improvements in sleep quality (or related) parameters or no change. Moderator analyses revealed that intervention duration and session frequency can influence sleep outcomes. Short-duration interventions (≤6 weeks) showed a large mean effect on sleep quality (9.41%; 95% CI 3.06 to 15.42%), with 54% of studies reporting statistically significant improvements. Medium-duration interventions (7-16 weeks) demonstrated consistent benefits, including a large mean effect on sleep quality (8.74%; 95% CI 2.93 to 14.55%) and a very large reduction in insomnia severity (13.19%; 95% CI 11.10 to 15.98%). However, sleep efficiency exhibited smaller effects (0.73%; 95% CI -1.99 to 3.45%). Long-duration interventions (≥17 weeks) produced the most robust results, with 100% of the studies reporting significant improvements, including a 7.92% increase in sleep quality (95% CI 3.23 to 12.60%). With regard to session frequency, low-frequency sessions (1-2 per week) yielded significant improvements in insomnia severity (13.66%; 95% CI 8.72 to 18.59%) and sleep quality (8.13%; 95% CI 2.67 to 13.59%). Moderate-frequency sessions (3-4 per week) balanced accessibility and efficacy, producing a large mean effect on sleep quality (9.21%; 95% CI 3.66 to 14.76%). High-frequency sessions (≥5 per week) demonstrated a similarly large effect on sleep quality (8.24%; 95% CI 2.28 to 14.20%), although the data were limited.

Tailoring yoga interventions by duration and frequency is valuable, with chronic practice offering a safe, effective alternative to medication. Future research should refine protocols for specific populations and sleep challenges.

Overcrowding in emergency departments (EDs) leads to delayed treatments, poor patient outcomes, and increased staff workloads. Artificial intelligence (AI) and machine learning (ML) have emerged as promising tools to optimize triage.

This systematic review evaluates AI/ML-driven triage and risk stratification models in EDs, focusing on predictive performance, key predictors, clinical and operational outcomes, and implementation challenges.

Following PRISMA 2020 guidelines, we systematically searched PubMed, CINAHL, Scopus, Web of Science, and IEEE Xplore for studies on AI/ML-driven ED triage published through January 2025. Two independent reviewers screened studies, extracted data, and assessed quality using PROBAST, with findings synthesized thematically.

Twenty-six studies met inclusion criteria. ML-based triage models consistently outperformed traditional tools, often achieving AUCs > 0.80 for high acuity outcomes (e.g., hospital admission, ICU transfer). Key predictors included vital signs, age, arrival mode, and disease-specific markers. Incorporating free-text data via natural language processing enhances accuracy and sensitivity. Advanced ML techniques, such as gradient boosting and random forests, generally surpassed simpler models across diverse populations. Reported benefits included reduced ED overcrowding, improved resource allocation, fewer mis-triaged patients, and potential patient outcome improvements.

AI/ML-based triage models hold substantial promise in improving ED efficiency and patient outcomes. Prospective, multi-center trials with transparent reporting and seamless electronic health record integration are essential to confirm these benefits.

Integrating AI and ML into ED triage can enhance assessment accuracy and resource allocation. Early identification of high-risk patients supports better clinical decision-making, including critical care and ICU nurses, by streamlining patient transitions and reducing overcrowding. Explainable AI models foster trust and enable informed decisions under pressure. To realize these benefits, healthcare organizations must invest in robust infrastructure, provide comprehensive training for all clinical staff, and implement ethical, standardized practices that support interdisciplinary collaboration between ED and ICU teams.