Our objective is to elucidate the reciprocal association between atopic dermatitis (AD) and attention deficit hyperactivity disorder (ADHD) by prespecified subgroups and determine potential modified factors.

Adhering to PRISMA 2020, we conducted a comprehensive database search up until March 11, 2024. Observational studies reporting on AD and ADHD as either exposure or outcome variables were included. A random-effects model meta-analysis was conducted to calculate pooled estimates. Subgroup and meta-regression analyses were undertaken to explore heterogeneity. Publication bias was investigated via funnel plots and Egger's test.

Overall, 49 studies were determined to meet the inclusion criteria after rigorous screening. Patients with AD were more likely to have ADHD (ORs = 1.34, 95% CI 1.25-1.44, p < 0.01; HRs = 1.42, 95% CI 1.20-1.68, p < 0.01), while patients with ADHD also had an increased risk of developing AD (ORs = 1.45, 95% CI 1.21-1.73, p < 0.01). Subgroup analyses indicated that the associations were particularly pronounced among studies that assessed patients with severe AD (ORs = 2.62, 95% CI 1.76-3.92, p < 0.01), suffered from multiple allergic conditions (ORs = 2.89, 95% CI 1.18-7.10, p < 0.01) and sleep disturbances (ORs = 2.43, 95% CI 2.14-2.76, p < 0.01) simultaneously.

This review substantiates the significant bidirectional association between AD and ADHD, indicating that they serve as mutually independent risk factors and may either exacerbate each other. These findings underscore the necessity for heightened awareness and early targeted interventions, especially in individuals with severe AD manifestations, sleep problems, and multiple allergic diseases.

This study evaluates the impact of different feedback elements in serious games (SGs) on nursing education outcomes.

Systematic review and meta-analysis.

6546 English-language studies published between 2000 and 2023 were retrieved from seven electronic databases.

This systematic review and meta-analysis followed the PRISMA guidelines. The Cochrane Risk of Bias tool was used for quality assessment. Meta-analysis and subgroup analysis were conducted using RevMan 5.4, and the certainty of evidence for each outcome was assessed using the GRADE approach.

Eight studies were included in the meta-analysis. Findings showed that, compared to traditional learning methods, outcome feedback had a moderate effect size on knowledge (SMD = 0.51, 95 % CI [0.09, 0.92]), while comparative feedback had a small, non-significant effect size (SMD = 0.38, 95 % CI [-0.36, 1.12]). Immediate feedback had a large effect size on skills (SMD = 0.87, 95 % CI [0.61, 1.14]), and outcome feedback had a moderate effect size (SMD = 0.50, 95 % CI [0.21, 0.79]). Serious games with feedback had a large effect size on motivation (SMD = 1.31, 95 % CI [0.45, 2.17]). For confidence, outcome feedback had a moderately large effect size (SMD = 0.64, 95 % CI [-0.22, 1.51]), and comparative feedback had a small effect size (SMD = 0.24, 95 % CI [-0.44, 0.91]), but neither reached statistical significance. GRADE assessment showed high certainty for immediate feedback on skills, moderate certainty for outcome feedback on knowledge and skills, and very low certainty for comparative feedback on knowledge. Evidence certainty for motivation and confidence was low or very low.

Serious games incorporating feedback elements can enhance nursing students' motivation. Immediate feedback significantly improves nursing skills, while outcome feedback improves knowledge acquisition. However, further research is needed to validate these findings due to the limited number of studies and high heterogeneity.

Microbial mediated carbon and nitrogen cycling response to cadmium are often observed in soil; however, a unified framework of this response has not yet been established. By analyzing 1232 observations from 166 publications, we found that cadmium decreased microbial biomass carbon (-16 %) and nitrogen (-21 %), dissolved organic nitrogen (-27 %), nitrification rate (-17 %), microbial respiration rate (-12 %), and β-1,4-glucosidase (-21 %) and urease (-16 %) activities, but increased microbial metabolic quotient (+11 %) and fungal-to-bacterial ratio (+39 %). The cadmium impact was concentration-dependent, becoming more pronounced at higher concentrations. Increasing cadmium concentration reduced soil N mineralization rate and total N content, but increased microbial biomass carbon-to-nitrogen ratio. These results indicate that cadmium reduced carbon and nitrogen assimilation into microbial biomass and limited soil inorganic nitrogen production. Soil bulk density drove soil microbial biomass and nitrogen availability response to cadmium. Lower soil bulk density and higher initial carbon and clay contents and soil pH reduced the negative impact of cadmium on microbial biomass and nitrogen availability, suggesting that anthropogenic activities that enhance soil quality may mitigate the inhibitory effect of cadmium on soil carbon and nitrogen cycling. Our analysis provides critical implications for improving our understanding of the ecological consequences of cadmium on soil carbon and nitrogen cycling.

Lower limb lymphoedema, characterized by persistent swelling in the legs due to lymphatic dysfunction, not only imposes a physical burden but is also associated with significant mental depression. While emerging research suggests a strong link between lower limb lymphoedema and depression, the extent of the problem remains underexplored. This study aims to investigate the relationship between lower limb lymphoedema and mental depression through a meta-analysis of existing studies.

A comprehensive search was conducted across databases including PubMed, MEDLINE, EMBASE, International Scientific Indexing, Web of Science, and Google Scholar. Study quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal tool. A weighted inverse variance random-effects model was used for pooled estimates, along with subgroup analysis, heterogeneity assessment, publication bias testing, and sensitivity analysis. The prediction interval was computed to estimate where future observations may fall. The review protocol was registered in PROSPERO (CRD42024541596).

Thirteen studies involving 3503 patients with lower limb lymphoedema due to lymphatic filariasis, podoconiosis, or leprosy were included. The pooled estimate of depression related to lower limb lymphoedema was 38.4 % (95 % CI: 26.3 %, 50.5 %). High heterogeneity (I2 = 81.48 %) highlighted significant variability among the studies. Depression was more prevalent among leprosy patients (38.1 %) and podoconiosis patients (36.4 %), showing little difference between the two. However, the prevalence was notably lower among those with lymphatic filariasis (22.4 %). A higher prevalence of depression was found in Africa (39.4 %) compared to other regions (36.1 %).

Patients with lower limb lymphoedema experience disproportionately high rates of mental depression compared to the general population. Integrating mental health assessment and treatment into care packages for lymphoedema management is essential, with special attention needed for leprosy patients.

Classifying problematic gaming/gaming disorder as a formal psychiatric diagnosis requires data on its level of temporal stability: are the dysfunctional symptoms transient or can they persist in the absence of treatment? To evaluate this question, we conducted a literature review and meta-analysis to investigate temporal stability in problematic gaming/gaming disorder. We identified 50 relevant longitudinal studies on PubMed, PsycINFO, and SCOPUS. Our review and meta-analysis engaged on two types of temporal stability: categorical stability and dimensional stability. We used MetaXL to run the meta-analysis for categorical stability. Our meta-analysis revealed that overall, the categorical stability rate was approximately 34-38% for the 2-year follow-up studies and approximately 43-45% for the 1-year follow-up studies. This indicates that between 1/3 and 1/2 of the gamers who initially met the threshold for problematic gaming/gaming disorder continued to meet such a threshold at follow-ups. Our meta-analysis included predominantly adolescent groups, which should be noted when generalizing the obtained categorical stability rates. Our review results also showed that overall, the dimensional stability was positive and statistically significant, indicating moderate or high correlations between symptom severity at baseline and at follow-ups. Temporal stability can be a complex concept. Our results suggest that although the categorical stability of problematic gaming/gaming disorder is not as strong as some major psychiatric disorders such as schizophrenia and bipolar disorder, it is similar to personality disorder and gambling disorder. Many complex factors may affect the temporal stability of problematic gaming/gaming disorder, possibly including severity of the disorder, whether the data is from clinical or nonclinical populations, and an individual's age group or developmental stage. More methodologically rigorous longitudinal studies that address these issues are needed.

Osteoporosis and hypertension are frequently co-occurring disorders which cause significant challenges to the public health. According to some researches, adult persons with hypertension often have low bone mass density (BMD). However, there are discrepancies in the reported results. Thus, the primary objective of our meta-analysis is to explore the potential link between low BMD and hypertension in adults.

Two authors systematically carried out a comprehensive review of the available literature on the connection of BMD and hypertension by retrieving PubMed, Web of Science, Cochrane and Embase up to March 2024. The confidence intervals (CIs) and odds ratios (ORs) and were estimated utilising the random effect model. Heterogeneity, subgroup analysis, sensibility analyses and publication bias were performed.

13 studies from the 6080 unique records were analyzed. Pooled analysis revealed that the danger of low BMD was significantly elevated in hypertensive patients than in non-hypertension (OR 1.33, 95 % CI 1.17-1.53, I 2 = 79.9 %, p < 0.01). Subgroup analysis revealed a more pronounced link between low BMD and hypertension in the untreated hypertension group (OR 1.64, 95 % CI 0.45-6.02) as opposed to the cohort receiving antihypertensive medication (OR 1.32, 95 % CI 1.16-1.51). The studies carried out in Europe were consistent with those of studies conducted in Asia and North America.

Low BMD is associated with hypertension in adults. Nevertheless, it remains uncertain whether this finding is influenced by shared risk factors, given the considerable heterogeneity between study types and methodologies. Further extensive epidemiological documents are necessary.

This study aims to comprehensively evaluate the correlation between parental affective disorders and four common digital addiction in children and adolescents.

The research was conducted in MEDLINE, PsycINFO, Embase, CINAHL, and Web of Science. The meta-analysis included studies focusing on parental affective disorders and digital addiction to the Internet, smartphones, social media, and gaming among children and adolescents, using longitudinal, cohort, or cross-sectional study designs, and reporting correlation effect sizes or other data that could be converted to correlation r. Pooled Pearson's correlations were calculated using the random-effect model.

Nineteen studies were included (sample sizes ranged from 104 to 4,385), with ten on gaming addiction, four on smartphone addiction, three on Internet addiction, and two on social media addiction. The meta-analysis revealed a small but significant correlation (pooled r [95 %CI] = 0.15 [0.11-0.19]) between parental affective disorders and digital addiction in children and adolescents. This correlation was stronger in studies focusing on offspring's smartphone addiction (r [95 %CI] = 0.25 [0.17, 0.33]), and studies conducted in Asia (r [95 %CI] = 0.17 [0.12, 0.22]), and increased slightly from 0.09 to 0.10 to 0.15-0.16 by years in 2017 and 2024.

Parental affective disorders were positively correlated with offspring's digital addiction, particularly on smartphone addiction and in Asian families. Improving parental mental health as a complementary strategy of clinical treatments might be more effective in reducing digital addiction in offspring. Further research is needed to explore the potential underlying mechanisms to gain a deeper understanding.

To systematically evaluate the efficacy of traditional Chinese exercises (TCEs) for neuropsychiatric symptoms (NPSs) in patients with Parkinson's disease.

A comprehensive literature search was performed across eight databases, including PubMed, Cochrane Library, Embase, Web of Science (WoS), SinoMed, China National Knowledge Infrastructure (CNKI), China Science and Technology Periodical Database (VIP), and Wanfang Database, covering studies published from their inception up to April 23, 2024. The search focused on identifying randomized controlled trials (RCTs) assessing the effectiveness of TCEs for NPSs in PD patients. The authors independently performed literature screening and data extraction. Meta-analysis was executed employing Review Manager V.5.3 software, and Stata 17.0 was used to detect publication bias and perform sensitivity analysis. GRADEpro GDT was used to grade the certainty of each outcome evidence.

Eighteen studies involving 937 participants were included. The meta-analysis showed significant improvements in depression-related scales (standardized mean difference (SMD) = -1.30, 95 % confidence interval (CI): -2.10 to -0.49, p = 0.002), anxiety-related scales (SMD = -1.11, 95 %CI: -2.14 to -0.08, p = 0.03), sleep disorder-related scales (SMD = -0.71, 95 %CI: -0.99 to -0.43, p < 0.00001), and cognition-related scales (SMD = 0.91, 95 %CI: 0.44-1.38, p = 0.0001). Quality of life also improved (SMD = -1.35, 95 % CI: -2.38 to -0.31, p = 0.01; SMD = 0.99, 95 % CI: 0.54-1.43, p < 0.0001). Subgroup analyses grounded in the duration of the intervention suggested that interventions lasting up to 12 weeks showed more significant anti-depression and anti-anxiety effects while those lasting beyond 12 weeks demonstrated greater improvements in sleep quality and cognitive function. Additionally, subgroup analyses based on the type of intervention revealed that both using TCEs alone and the combination of TCEs with conventional medications showed greater effects on anti-depression and cognitive function, while the latter yield more significant anti-anxiety effects. However, no statistical significance was found for fatigue-related scales. The clinical trials included in this review also lacked a thorough description of the randomization process, and only a small proportion reported adequate allocation concealment procedures, raising concerns about potential selection bias. Moreover, owing to the inherent characteristics of TCEs, blinding both participants and practitioners is challenging, which may result in performance bias. Additionally, the absence of blinding could allow assessors' subjective influences to affect the outcomes, leading to detection bias. The overall quality of the evidence, as assessed according to the GRADE criteria, was rated as very low or low for most of outcomes.

The findings indicated that the use of TCEs may have potential to alleviate the severity of NPSs including depression, anxiety, sleep disorders, and enhance cognition function and overall quality of life in PD patients. Nevertheless, given the limited number of studies and their methodologic issues such as the absence of blinding, along with the small sample sizes, significant heterogeneity across these primary studies, careful interpretation of the results is warranted. More high-quality research with larger sample sizes, including double-blind studies or those employing an active control group involving exercises such as walking, ought to be carried out to validate the above findings and strengthen the evidence base.

PROSPERO: CRD42024540164.

Providing the summary effect size and its uncertainty, a prediction interval, and a measure of statistical heterogeneity constitute good reporting practices in meta-analyses. Popular statistical heterogeneity measures comprise the τ2 and I2 statistics. However, researchers often rely unduly on the I2 statistic, using naive categorizations to gauge the extent of heterogeneity, leading to misuses of the meta-analysis models, deficiencies in reporting, and misleading conclusions. The present study aimed to provide empirical evidence on the reporting and interpretation of statistical heterogeneity in systematic reviews of oral health published between 2021 and 2023 in 21 leading specialty and general dental journals. Systematic reviews with at least 1 meta-analysis on binary or continuous outcomes with the most studies were identified. Characteristics were extracted at the systematic review and meta-analysis levels. In total, 313 systematic reviews with meta-analyses were analyzed. Within this cohort of meta-analyses, the random-effects model (89%, n = 278) was frequently applied. Almost all meta-analyses (98%, n = 308) reported the I2 value, and 51% (n = 160) reported the τ2 value. For this sample, the median I2 was 76% (range: 0%-100%), and the median τ2 was 0.29 (range: 0-2,632), with 13% (n = 20/160) of these meta-analyses reporting zero τ2. Most of the meta-analyses (96%, n = 299) based the heterogeneity interpretation on I2 and only 21 (7%) on τ2. Although 49% (n = 152) of the meta-analyses chose the meta-analysis model a priori, only 41% (n = 63/152) justified this choice. Furthermore, 42% (n = 131) of the 313 meta-analyses chose the meta-analysis model based on the I2. Within oral health meta-analyses, there is evidence of overreliance on I2 when reporting and interpreting statistical heterogeneity and selecting the meta-analysis model. The inappropriate use of I2 in meta-analysis model selection and interpretation of statistical heterogeneity may have implications for the quality of conclusions delivered to the end users of systematic reviews.

To systematically evaluate the efficacy of electrical stimulation (ES) in the treatment of patients with foot drop (FD) after stroke, and to compare the efficacy of different types of ES.

We searched 5 English database (PubMed, Web of Science, Embase, Cochrane Library and Scopus) and 4 Chinese databases (China National Knowledge Infrastructure (CNKI), SinoMed (CBM), VIP and Wanfang Data) from inception to June, 2024.

Traditional meta-analysis and network meta-analysis were performed using RevMan5.4 software and Stata 14.0 software respectively. A total of 37 RCTs were included, involving 2309 patients. The results of the traditional meta-analysis showed that compared with CRT, ES combined with CRT was effective in improving the range of motion (ROM) of ankle dorsiflexion in patients with FD after stroke and significantly improved the fugl-meyer assessment of lower extremity (FMA-LE) scores. For patients with FD with different disease duration, the subgroup analysis results showed that the ES improved the ROM of ankle dorsiflexion of patients in recovery phases (1-6 months) better than those in the acute phases (≤ 1 month) and sequelae phases (≥ 6 months), but the overall results of the three groups were not significantly different. The ES improved the lower limb motor function of patients in the recovery phases better than those in the acute phases, and the efficacy was not significant in patients in the sequelae phases (P > 0.05). The results of network meta-analysis showed that the best probability of improving the dorsiflexion angle of the ankle was electroacupuncture (EA) > transcranial direct current stimulation (tDCS) > transcutaneous electrical nerve stimulation (TENS) > functional electrical stimulation (FES) > neuromuscular electrical stimulation (NMES) > electromyographic biofeedback therapy (EMGBFT) > conventional rehabilitation therapy (CRT); the best probability of improving the dorsiflexion angle of the ankle was EA > EMGBFT > tDCS > FES > TENS > NMES > CRT.

The current evidence showed that the ES combined with CRT can effectively improve the ROM of ankle dorsiflexion and lower limb motor function in patients with FD after stroke, especially the patients in recovery phases. Among the different types of ES, EA had the best effect than other types of ES.

Considerable research has assessed the effectiveness of Cognitive Behavioural Therapy (CBT) for perinatal depression, however limited attention has been paid to its effectiveness when delivered during pregnancy. The primary aim of this review was to review evidence of the efficacy of CBT interventions delivered antenatally to treat symptoms of depression in women during the antenatal and postnatal periods. The review's secondary aim was to evaluate potential moderators of treatment outcome.

Electronic Databases; CINAHL, PsycINFO, Medline, Scopus, and Web of Science were searched for studies that employed CBT in response to symptoms of depression in pregnant women. Randomized control trials were included if they compared outcomes for pregnant women with outcomes of inactive controls. A systematic review and meta-analysis was conducted on n = 12 eligible studies.

CBT yielded statistically significant, within and between groups' effects on depressive symptoms during the antenatal period. CBT delivered at that time also yielded smaller yet statistically significant within and between groups' effects on depressive symptoms experienced postnatally. CBT was found to be more effective for women of greater age, higher number of weeks gestation, or who were multiparous. The facilitator of treatment, delivery mode, the assessment measures used to evaluate treatment outcome, and symptom severity also moderated treatment outcome.

Significant publication bias and heterogeneity were evident across studies indicating a need to focus future research.

Overall, findings support the use of CBT delivered antenatally to reduce depression experienced during, and following, pregnancy.

The increasing prevalence of psychological distress among mothers is outpacing the effectiveness of conventional coping methods like cognitive behavioral therapy. The efficacy of alternatives such as writing therapy for maternal psychological well-being remains uncertain due to a lack of extensive research and inconsistent findings.

The aim of this study was to evaluate the effectiveness of expressive writing therapy in comparison to standard postpartum care for alleviating psychological distress, encompassing symptoms of depression, anxiety, or stress, in postpartum women.

For this purpose, seven bibliographic databases, including CINAHL, Cochrane Library, EMBASE, PsycINFO, PubMed, Scopus, and Web of Science, and gray literature were examined up to December 27, 2022 for randomized controlled trials, comparing expressive writing against standard care or controlled writing among postpartum women with psychological distress.

Data was collected using a random effect model for meta-analysis.

A meta-analysis of five studies with 483 participants found that expressive writing therapy was more effective than standard care or controlled writing in reducing postpartum depression and stress among women with psychological distress. Expressive writing resulted in a significant reduction in initial depression with standard mean difference (SMD) = -0.65%, 95% confidence interval (CI) = -1.08 to -0.22, Z = 2.96, P = 0.003, in comparison to controlled writing as an intervention. Regarding expressive writing versus standard care, a narrative review was conducted due to an I2 above 75%. The results showed significant improvements compared to the baseline at the seventh day and third month post-intervention. In terms of stress scores, there was a significant difference favoring expressive writing over standard care at the first month (SMD = -0.80%, 95% CI = -1.35 to -0.24, Z = 2.81, P = 0.005) and third month (SMD = -0.53%, 95% CI = -0.86 to -0.20, Z = 3.13, P = 0.002) post-intervention. Stress scores are also greatly reduced for expressive writing versus controlled writing with SMD = -0.79%, 95% CI = -1.03 to -0.55, Z = 6.48, P < 0.00001. However, the effectiveness of expressive writing on postpartum anxiety should be interpreted cautiously due to low certainty.

Expressive writing serves as an effective alternative for non-pharmacological intervention for postpartum women with depression and stress, but more research is needed for postpartum anxiety. As substantial heterogeneity was detected, results must be interpreted cautiously. Postpartum women with psychological distress are encouraged to use expressive writing as an affordable way to promote maternal mental health for the benefit of both the mother and the child.

To summarize the existing evidence on prognostic factors (PFs) and prognostic models (PMs) for white spot lesions (WSLs) in orthodontic patients.

Electronic searches were conducted across PubMed, Embase, Cochrane Library, Web of Science, and Scopus (last search date: December 19th, 2024), supplemented by grey sources (Google Scholar and ProQuest). Manual searches were performed by checking the reference lists of key relevant publications.

Cohort and case-control studies reporting PFs and PMs for WSLs in orthodontic patients were included. The risk of bias was assessed with QUIPS and PROBAST tools for PF and PM studies, respectively. Prognostic estimates were pooled with risk ratio (RR) using the random effects model. The certainty of the evidence was assessed with an adapted GRADE system.

Thirty-two PF and one PM studies were included, involving 5101 participants and investigating 31 PFs and 1 PM. Pretreatment lesions [RR=3.87 (95 % CI, 2.06 to 7.27)] and pretreatment oral hygiene condition [RR=1.86 (95 % CI 1.20 to 2.88)] were significant PFs for WSL incidence, whereas there is insufficient evidence for gender and treatment duration. Only 1 PM was identified, which was developed via Fisher's discriminatory analysis without adjustment and validation. The certainty of evidence was rated as very low or low.

Based on low and very low certainty evidence, the existing lesions and oral hygiene condition before the commencement of orthodontic treatment are significant PFs for WSL incidence. Comprehensive pretreatment assessments are vital for preventing WSLs in orthodontic patients. The development of a novel, validated PM for WSL risk assessment is warranted.

Neonatal stabilization and resuscitation in preterm infants are critical interventions. Cerebral tissue oxygen saturation (CrSO2) measured with near-infrared spectroscopy monitoring offers potential benefits by providing real-time information on brain oxygenation. This systematic review aimed to determine if CrSO2-monitoring to guide neonatal resuscitation after birth can improve survival without cerebral injury. A systematic search of MEDLINE, Google Scholar, EMBASE, the Cumulative Index of Nursing and Allied Health Literature, Clinical Trials.gov, and the Cochrane Central Register of Controlled Trials was performed through December 2024. We included only human studies that investigated CrSO2-guided interventions during neonatal resuscitation after birth in preterm infants. A meta-analysis was performed using individual patient data and the Bayesian method. The main outcome assessed was survival without cerebral injury (Study registration:PROSPERO CRD42024512148). Two studies were identified, including a total of 667 preterm infants with less than 34 weeks of gestation, describing CrSO2-guided interventions during neonatal resuscitation. The meta-analysis revealed a high probability of treatment superiority for NIRS-guided interventions that demonstrated improved outcomes compared to standard care, with a 4.5% increase in the rate of survival without cerebral injury (93% probability) and 4.2% reduction of IVH of any grade (94% probability). The risk of bias can be described as low.

This meta-analysis suggests that CrSO2-guided interventions may offer a meaningful advantage in preterm infant resuscitation after birth, improving survival without brain injury. The analysis indicates a high probability of a clinically important benefit. This warrants consideration in clinical practice.

• Studies have shown that near-infrared spectroscopy can monitor brain oxygenation in preterm infants immediately after birth.

• This is the first meta-analysis to examine the impact of near-infrared spectroscopy based interventions on neonatal resuscitation outcomes. • Interventions based on monitoring preterm infants' cerebral oxygenation may improve their chances of surviving without severe brain injury, compared to standard care.

Dietary practices have a valuable impact on lowering the risk of complications associated with diabetes mellitus. The countries in the horns of Africa do not follow properly the approaches of dietary recommendation to prevent diet related complications among patients with type-2 diabetes mellitus. Numerous primary observational studies on the relationship between diabetes mellitus and dietary practices have been conducted in the horns of Africa up to this point. Inconsistent and variable findings across different countries in the Horn of Africa hinder the establishment of suitable intervention designs. To address this issue, this systematic review and meta-analysis was conducted.

We searched PubMed, Medline, EMBASE, Google Scholar, and Google for studies that had been conducted in the Horn of Africa. Searches were using the English language. A preferred reporting item for systematic reviews and meta-analysis (PRISMA) checklist was used. Two authors independently reviewed the studies. The effect size of the meta-analysis was dietary practices and the adjusted odds ratio (AOR) of the associated factors. Studies were summarized on the use of dietary practices quantitatively and qualitatively. A random-effects model was conducted to obtain the pooled estimates.

A total of twenty-one observational studies with 5,117 study participants were included 5,117 in this review. The pooled proportion of good dietary practices among patients with type 2 diabetes mellitus in the Horn of Africa was 44.0% (95% CI: 36.0-51.0). The pooled odds ratio showed that a significant association was found between educational status (AOR = 2.57; 95% CI: 1.79-3.70). Age of the patient (AOR = 2.59; 95% CI: 2.16-3.11), Wealth index status (AOR = 3.64; 95% CI: 2.71-4.89), nutrition education (AOR = 3.35; 95% CI: 2.50-4.49), knowledge about diabetes mellitus (AOR = 2.59; 95% CI: 1.18-3.59) and patients' attitude about diabetes mellitus (AOR = 2.64; 95% CI: 1.64-4.29).

The overall pooled proportion of good dietary practices among patients with type-2 diabetes mellitus was below half. Educational status wealth index, nutrition education, dietary knowledge and attitude about diabetes mellitus were significantly associated with good dietary practices. Therefore, establishing strategy to promote nutrition education at the health care facilities and raising awareness about the significance of healthy eating habits through various platforms can improve patients' eating behaviors.

Breastfeeding provides essential nutrients and benefits for newborns. However, its prolonged duration has raised concerns about potential risks for early childhood caries (ECC).

To determine if prolonged breastfeeding increases the risk of dental caries in children under 71 months.

Eligibility criteria included observational studies comparing ECC risk in children breastfed for over 12 months, with no language restrictions. Databases searched included PubMed, Scopus, and others, up to May 17, 2024. Risk of bias was assessed using the JBI Critical Appraisal Checklist. Meta-analyses were performed using a random-effects model.

Twenty-five studies involving 19 681 participants were included. Studies showed an increased risk of ECC in children breastfed for more than 24 months (RR = 2.44; 95% CI, 1.97 to 3.02). For the 12-24 months period, no significant risk increase was found. Meta-analyses also indicated higher ECC prevalence with breastfeeding beyond 12 months (OR = 1.86; 95% CI, 1.48 to 2.35).

Prolonged breastfeeding beyond 24 months is associated with an increased risk of ECC. This review highlights the need for future studies to address current research limitations and better understand the relationship between prolonged breastfeeding and ECC.

International Prospective Register of Systematic Reviews (PROSPERO): CRD42024509212.

Diabetes mellitus is a highly burdensome metabolic disorder, affecting over 100 million people worldwide and leading to numerous complications. Among these, diabetic neuropathy is one of the most common, with approximately 60% of individuals with diabetes developing this condition. Current pharmacological treatments for diabetic neuropathy are often inadequate, providing limited efficacy and accompanied by a range of adverse effects. Non-invasive brain and nerve stimulation techniques have been proposed as potentially beneficial for diabetic neuropathy, though existing evidence remains inconclusive. This systematic review and network meta-analysis (NMA) aimed to evaluate the comparative efficacy of various non-invasive brain and nerve stimulation interventions in patients with diabetic neuropathy.

A systematic search of electronic databases was conducted to identify randomized controlled trials (RCTs) of non-invasive brain or nerve stimulation in patients with diabetic neuropathy, from inception to September 6, 2024. The primary outcome was the change in pain severity, while secondary outcomes included changes in quality of life and sleep disturbance. Acceptability was assessed through dropout rates (i.e., withdrawal from the study before completion for any reason). A frequentist-based NMA was performed, utilizing odds ratios (OR) and standardized mean differences (SMD) with 95% confidence intervals (95%CIs) as effect size measures.

The NMA, which included 15 RCTs (totaling 1,139 participants, with a mean age of 61.2 years and a mean female proportion of 53.8%), evaluated 10 experimental interventions (1 control group, 4 non-invasive brain stimulation methods, and 5 non-invasive nerve stimulation methods). The analysis revealed that only transcutaneous electrical nerve stimulation (TENS) was associated with significantly greater improvements in pain severity (SMD = - 1.67, 95%CIs = - 2.64 to - 0.71) and sleep disruption (SMD = - 1.63, 95%CIs = - 2.27 to - 0.99) compared to the control group. None of the studied interventions showed significant differences in dropout rates or all-cause mortality compared to the control group.

This study provides comparative evidence supporting the use of specific brain and nerve stimulation interventions in managing diabetic neuropathy. Future well-designed RCTs with longer treatment durations are recommended to further validate the long-term efficacy of these interventions. Trial registration PROSPERO CRD42024587660.

The purpose of this systematic review and meta-analysis is to evaluate the global risk of preterm birth associated with passive smoking. Specifically, the study aims to examine whether passive smoking continues to impact preterm birth rates, with particular attention to the potential effects following the implementation of stricter smoking bans in recent years.

This systematic review and meta-analysis followed PRISMA guidelines and was preregistered in PROSPERO. A comprehensive literature search was conducted in PubMed, Embase, CINAHL, and Web of Science up to February 17, 2024, using keywords related to passive smoking and preterm birth. Eligible observational studies were selected, and data were independently extracted and assessed for quality by two authors. Statistical analysis used odds ratios (ORs) and the I2 statistic for heterogeneity. Subgroup analyses and publication bias assessments were conducted. Review Manager and Stata were used for the analysis, with significance set at p < 0.05.

Meta-analysis showed a 21% increase in the odds of preterm birth in women exposed to environmental tobacco smoke (ETS) (OR, 1.21; 95% CI, 1.10-1.32) with significant heterogeneity (I2 = 76.2%). Stronger associations were found in cohort and cross-sectional studies, studies in Asia, larger sample sizes, and recent publications. Findings were robust across various analyses.

Prenatal environmental tobacco smoke exposure significantly increases preterm birth risk. Effective public health interventions, including stringent smoke-free policies, public education, and awareness campaigns, are needed to reduce environmental tobacco smoke exposure and improve maternal and infant health outcomes.

Methyl nutrients can influence the one-carbon metabolic cycle and are important for cognitive function in older adults. We aimed to evaluate the effects of methyl nutrient supplementation, including the combination of folate and vitamin B12, and folate or vitamin B12 alone, on cognitive function and one-carbon metabolism in older adults with mild cognitive impairment.

Data were retrieved and collected from six electronic databases. Two authors independently appraised the methodological quality of included studies. Network meta-analysis was performed using the Bayesian method, R software.

The combined intervention of folate and vitamin B12 is an effective type of nutrient intervention to slow cognitive decline in the elderly with MCI, reduce serum homocysteine concentration, and elevate serum folate and vitamin B12 concentrations.

Combining vitamin B12 plus folate supplementation is the best option for improving cognitive function in older adults with MCI.

Muscle energy techniques (MET) for shoulder muscles improve both shoulder muscle tension and the range of motion of the glenohumeral joint. This systematic literature review will investigate the effects of MET on shoulder pain as a result of muscle tension in the glenohumeral joints of patients with shoulder disorders and collect clinical evidence regarding the effectiveness of muscle energy techniques on glenohumeral joint pain. Based on previous studies, we anticipate that MET may significantly affect shoulder joint pain. We expect to provide moderate to high levels of evidence regarding the effectiveness of MET in the treatment of shoulder pain.

Nine electronic databases will be searched for articles published up to November 2024, including PubMed, EMBASE, CENTRAL, KCI, KISS, KMbase, RISS, DBpia, and OASIS. Search terms will consist of terms related to the outcome (e.g., "shoulder") and intervention (e.g., "muscle energy technique," "post-isometric relaxation," "isometric stretching"). Studies selected for the systematic review and meta-analysis will include randomized controlled clinical trials and studies using MET applied to the human shoulder muscles. Qualitative and case studies will be excluded. Two authors will independently assess each study for eligibility and risk of bias and extract the data. This study will analyze the effects of MET on shoulder pain. Additionally, we intend to demonstrate the effect size of muscle energy techniques on factors such as range of motion. Our study will provide clinical evidence for the effects of muscle energy techniques on shoulder joint pain. Our study aims to provide clinical evidence supporting the moderate-to-high effectiveness of MET in treating shoulder joint pain.

ClinicalTrials.gov CRD42024532367.

Postoperative voice changes is a common complication following thyroidectomy, which usually decrease patient quality of life. Perioperative dexamethasone is hypothesized to mitigate these effects by reducing inflammation and edema. However, the evidence supporting its efficacy remains inconclusive. This study aims to evaluate the effectiveness of perioperative dexamethasone in reducing postoperative voice changes in patients undergoing thyroidectomy through a systematic review and meta-analysis.

Systematic review and meta-analysis of randomized controlled trials.

The current study was conducted under the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. This study systematically reviewed the MEDLINE, Cochrane, and EMBASE databases in September 2022, using keywords relevant to the study outcome.

Eight randomized controlled trials encompassing 1244 participants were included. Subjective outcomes revealed that dexamethasone significantly reduced voice dysfunction scores within the first 48 hours postoperatively (SMD: -0.55, 95% CI: -0.82 to -0.28, P < 0.001), with no significant differences observed after day 7. Objective outcomes, reported in two trials (n = 639), showed no significant improvement in fundamental voice frequency (MD: 11.18, 95% CI: -17.36 to 39.71, P = 0.44).

Our meta-analysis concluded that perioperative dexamethasone significantly reduces subjective voice dysfunction in the immediate postoperative period following thyroidectomy. However, no objective improvement was observed, and its effects deplete beyond 7 days. Future studies should focus on evaluating objective measures to confirm its clinical utility.

The objective of the study was to assess the effect of soft-tissue volume augmentation during early, delayed, and late dental implant therapy in terms of professionally determined esthetics and self-reported patient satisfaction on esthetics. For this, a comprehensive electronic literature search was performed to identify randomized clinical trials (RCTs) and controlled clinical trials (CCTs) reporting professionally determined esthetic outcomes and self-reported patient satisfaction on esthetics (primary outcomes) during early, delayed, and late dental implant placement comparing soft-tissue volume augmentation to the absence of soft-tissue grafting (control) (PICO 1) or comparing various soft-tissue augmentation techniques, procedures, and materials (PICO 2). Secondary outcomes were mucosal thickness (MT), intra- and postoperative complications, marginal soft-tissue-level changes, keratinized tissue width, radiographic marginal bone levels, and clinical parameters for the diagnosis of peri-implant tissue health. The standard mean differences (SMD)/weighted mean differences (WMD) were estimated for the Pink Esthetic Score (PES), self-reported patient satisfaction assessed by Visual Analog Scale (VAS) and MT gain for PICO 1 and PICO 2 by employing a random effect model. Five RCTs were included for PICO 1, whereas 7 RCTs and 1 CCT addressed PICO 2. PICO 1: The SMD for the PES between autogenous soft-tissue grafting (SCTG) and the absence of grafting (control group) was 0.47; 95% CI [-0.15, 1.09; p = 0.14] based on 5 RCTs. The SMD for the VAS values for patient-reported satisfaction on esthetics in the SCTG and control group was 0.46; 95% CI [-0.12, 1.03; p = 0.12] (2 RCTs). The WMD for gain of MT amounted to 1.06 mm; 95% CI [0.81, 1.31; p = 0.00] in favor of the SCTG group (3 RCTs). PICO 2: The SMD for the PES comparing collagen-based matrices (CM group) to the SCTG group was -0.32; 95% CI: (-0.57, -0.07; p = 0.01), in favor of the SCTG group (5 RCTs and 1 CCT). The SMD for the VAS for patient-reported satisfaction on soft-tissue esthetics was 0.24; 95% CI: (-0.31, 0.78; p = 0.40) (2 RCTs comparing CM vs. SCTG). The WMD for gain of MT was -0.27 mm; 95% CI: (-0.36, -0.17; p = 0.00), significantly favoring the SCTG group (4 RCTs). Professionally and patient-assessed outcomes showed no substantial differences between autogenous soft-tissue grafting and the absence of grafting for early, delayed, and late implant placement. However, autogenous soft-tissue grafts led to significantly improved esthetic outcomes as assessed by professionals compared to soft-tissue substitutes. Patient-assessed outcomes, nevertheless, were similar regardless of the grafting material (i.e., SCTG or soft-tissue substitute). Therefore, autogenous soft-tissue grafting, though, resulted in a considerably higher gain in mucosal thickness compared to both the absence of soft-tissue grafting and the use of soft-tissue substitutes. Complications and adverse events were rarely reported by the included studies, thus suggesting that many trials underreport harms (e.g., complications).

Chronic diseases (e.g., hypertension, diabetes, and heart diseases) have been proposed as marked predictors of incident dementia. However, synthesised evidence on the effect of multimorbidity on dementia is still lacking. We aim to summarise the association between multimorbidity and risk of dementia in longitudinal cohorts.

In this systematic review and meta-analysis, we conducted a systematic search in PubMed, Web of Science and Embase from inception to Dec 14, 2024, to identify longitudinal cohort studies reporting the association between multimorbidity or multimorbidity patterns and risk of dementia. Information of included studies were extracted by three reviewers (YaZ, YY and YuZ), and the quality assessment was conducted using the Newcastle-Ottawa Scale. The inverse-variance weighted random effects meta-analysis was performed to obtain the pooled hazard ratios (HRs) and 95 % confidence intervals (CIs) for dementia associated with multimorbidity and cardiometabolic multimorbidity (CMM). Cochran's Q test and the I2 statistic were used to indicate heterogeneity among the studies. Meta-regression analysis, subgroup analysis and sensitivity analysis were conducted to determine any valid sources of heterogeneity. This study was registered with PROSPERO (CRD42023403684).

We included 17 longitudinal cohort studies (2262,885 middle-aged and older participants) in the systematic review, of which seven were included in meta-analysis. All studies presented moderate to high methodological quality. Meta-analysis showed a positive association between multimorbidity and incident dementia (HR=1.53, 95 % CI=1.12 to 2.09), with substantial heterogeneity (I2=95.2 %). Studies using health records to measure dementia tend to find a stronger positive relationship between multimorbidity and risk of dementia than those using self-report (HRhealth records=1.94, 95 % CI=1.35 to 2.78, I2=94 %; HRself-report=1.17, 95 % CI=1.07 to 1.28, I2=0 %). The impacts of CMM were also observed, and the HRs for dementia ranged from 2.49 (combination of heart diseases and stroke: 95 % CI=1.64 to 3.78) to 3.77 (combination of diabetes, heart diseases and stroke: 95 % CI=2.02 to 7.02). The heterogeneity was moderate, with I2 ranging from 46.9 % (p for heterogeneity=0.152) to 84.1 % (p for heterogeneity=0.002). The impacts of number of diseases, multimorbidity clusters, and multimorbidity trajectory on risk of dementia were narratively summarised due to lacking comparable studies. Limited evidence (only one study) precluded quantitative synthesis for the association of physical and psychological multimorbidity with dementia.

Multimorbidity and CMM pattern were significantly associated with risk of dementia, while the effect of physical and psychological multimorbidity remain inconclusive. Individuals affected by multimorbidity should be prioritised in risk factor modification and dementia prevention. Preventing the development of multimorbidity is also crucial-particularly those who already have one chronic disease-in order to maintain cognitive health.

It is unclear whether recurrent cervical human papillomavirus type 16 (HPV16) infections can be prevented by naturally induced HPV16 antibodies in unvaccinated healthy women.

We systematically searched the literature for studies that prospectively evaluated the association between HPV16 naturally induced IgG, IgM, and neutralising antibodies and newly detected cervical HPV16 infection in unvaccinated women. Data were quantitatively summarised by random effect meta-analysis.

Naturally induced HPV16 IgG and neutralising antibodies were negatively associated with newly detected HPV16 infection (relative risk (RR) (95% confidence interval (CI))=0.71 (0.63 to 0.80) and 0.54 (0.36 to 0.73), respectively). HPV16 antibodies tend to offer protection against subsequent HPV16 DNA detection in young women (RR (95% CI)=0.65 (0.55 to 0.74)), but not in women aged over 25 years (RR (95% CI)=0.88 (0.73 to 1.04)). HPV16 IgG antibodies were also negatively associated with persistent HPV16 infection (adjusted RR=0.67 (0.56 to 0.78)). There was high heterogeneity between studies (I2 statistic=63.9%; p=0.007), and most had low risk of bias. We did not find studies evaluating IgM antibodies.

Seroreactivity to HPV16 infection seems to provide moderate protection against newly detected cervical HPV16 infection outcomes in unvaccinated women. However, protection seems to be affected by age. These findings should be considered when evaluating public health interventions against HPV.

CRD42022339579.

Emotional prosody recognition is vital for social interaction and has become a key focus in autism research. However, findings regarding emotional prosody recognition in individuals with autism spectrum disorder without intellectual disability (ASD-without-ID) remain inconsistent. This study aims to address this inconsistency through a systematic review and meta-analysis, exploring potential factors that may account for the inconsistent results. A search across four major electronic databases identified 29 eligible studies comparing emotional prosody recognition in ASD-without-ID and typically developing (TD) participants. We identified several participant- and methodology-related moderators across these studies. Using a random-effects model, we found a moderate-to-large pooled effect (Hedges' g = - 0.65) for emotional prosody recognition in ASD-without-ID participants, which remained stable after adjusting for publication bias through the trim-and-fill method. Emotional complexity and participant age significantly moderated the heterogeneity of effect sizes across studies. The results indicate moderate differences in the recognition of basic emotions through prosody between individuals with ASD-without-ID and TD individuals, with more pronounced differences for complex emotions. The findings emphasize the distinct developmental trajectories of ASD-without-ID individuals. We highlight the need for further investigation into the underlying factors and mechanisms affecting emotional prosody recognition in this population, including meta-analyses examining the moderate effects of various IQ measures and studies involving speakers of tonal languages.

The mental health of nurses is deteriorating. Maintaining nurses' resilience has become a focal point for future nursing development.

We aim to rank the effectiveness and acceptability of resilience-focused interventions for nurses.

A systematic review and network meta-analysis were conducted, with comprehensive searches across PubMed, Embase, Cochrane Library, Web of Science, and other databases. Frequentist random-effects network meta-analyses were employed, and RoB-2 was used to assess the quality of evidence.

Resilience-focused interventions were found to significantly enhance nurses' resilience (95%CI 0.61, 1.41). Offline field interventions (95%CI 0.64, 1.59) outperformed online interventions (95%CI -0.02, 0.45). Both group (95%CI 0.32, 0.87) and individual (95%CI 0.63, 1.59) interventions showed effectiveness. Anger Management Psychoeducation (95%CI 3.65,7.93, SUCRA = 98.2), Emotional Intelligence training (95%CI 3.32,6.51, SUCRA = 95), and Mindfulness-Based Stress Reduction (95%CI 2.60,5.88, SUCRA = 92.4) were the most effective interventions.

Anger Management Psychoeducation, Mindfulness-Based Stress Reduction, and Emotional Intelligence training are the most effective interventions for enhancing nurses' resilience.

CRD42021289477. REGISTRATION OF CLINICAL TRIAL AND REGISTRATION IDENTIFICATION NUMBER: Not applicable.

Surfactant decreases surface tension in the peripheral airways and plays a role in regulating the lung's immune responses. Several reports have documented changes in surfactant proteins levels, especially surfactant protein D (SP-D) and surfactant protein A (SP-A), suggesting their potential as biomarkers for asthma. However, the results of these studies are controversial. This systematic review was done to assess the levels of surfactant proteins in asthmatic patients compared to healthy individuals.

A systematic review was conducted according to PRISMA guidelines. Searches were performed in the Medline/PubMed, Web of Science, Embase, and ScienceDirect databases to identify studies that assessed surfactants proteins levels in asthmatic patients. Pooled standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated using R version 4.4.3 meta package.

A total of 16 studies met the inclusion criteria and were thus considered for this systematic review. Among these, SP-D was the most frequently studied protein in relation to asthma, asthma severity, and lung function parameters in asthmatic patients. Serum and sputum levels of SP-D in asthmatic patients were slightly elevated compared to non-asthmatic individuals. However, these differences were not statistically significant; the pooled SMDs were 0.27 (95% CI: -0.034 to 0.574, P = 0.082) for serum levels and 1.47 (95% CI, -0.197 to 3.103, P = 0.084) for sputum levels. Similarly, no significant difference was detected for the analysis of serum SP-A levels, with SMD = 0.18 (95% CI, -0.505 to 0.866, P = 0.606). Though, some of the reviewed studies showed an association between SP-D levels and disease severity in asthmatic patients.

Although alterations have been observed in asthma and proposed as biomarkers, this systematic review did not find significant differences in the levels between asthmatics and healthy individuals. However, some studies have suggested an association between SP-D levels and asthma severity. Given the limited number of studies investigating this association, further research is needed to validate the clinical relevance of correlation between SP-D levels and asthma severity.

The potential causal relationship between asthma and brain structures remains uncertain. We performed a two-sample Mendelian randomization to investigate the causal effects of various asthma phenotypes-unspecified asthma, moderate-to-severe asthma, childhood-onset asthma, and adult-onset asthma-on cerebral cortex structure.

We utilized phenotype data derived from genome-wide association studies (GWAS). The ENIGMA Consortium GWAS provided outcome variables for surface area and thickness across the whole brain and 34 region-specific areas of the cerebral cortex. Using the inverse variance-weighted method as our primary estimation approach, we employed several techniques, including Cochran's Q statistic, the MR-PRESSO global test, MR-Egger, and weighted median, to assess heterogeneity and pleiotropy, thereby ensuring the robustness of our findings. Additionally, we conducted enrichment analyses of gene sets with causal effects on cortical structure and applied bioinformatics techniques to construct interaction networks and identify hub nodes.

At the global level, adult-onset asthma was associated with a significant reduction in full cortical surface area (β = -58.4899, p = 0.0173). In regional analyses, moderate-to-severe asthma exhibited a more pronounced impact on the cerebral cortex compared to other phenotypes. Enrichment analysis revealed that pathways implicated in brain morphology among asthma patients were primarily linked to immune and inflammation-driven pathways.

Our findings provide new evidence supporting a causal relationship between asthma and alterations in cortical structure, offering potential explanations for cognitive and psychiatric impairments observed in individual post-asthma.

Perforated peptic ulcer (PPU) is a surgical emergency condition associated with substantial mortality and morbidity. Despite scattered studies, there exists a gap in comprehensive evidence on management outcomes of this condition in Ethiopia. Hence, this review aimed to assess the pooled mortality and complication rates along with their predictors in patients treated for PPU.

In this review, an extensive search across various electronic databases including PubMed, Africa Index Medicus, Science Direct, and Hinari was conducted. Additionally, searches were conducted in Google Scholar and online library repositories of Addis Ababa, Hawassa, and Bahir Dar Universities, complemented by manual searches of included studies. Data extraction was performed using Excel and the analysis was done using STATA 17 software. Pooled estimates of mortality and complication rates were determined using a random-effect model, while associated predictors were identified through the analysis using a fixed-effect model. Subgroup analysis for mortality rate was conducted by region. Sensitivity analysis was performed after assessing heterogeneity using the I2 test, and potential publication bias was examined through funnel plots, along with Egger's and Begg's tests.

This meta-analysis, encompassing 9 studies, revealed a pooled mortality rate of 6.68% (95% CI: 4.36, 9.00) with a high level of heterogeneity (I2 = 57%) and a complication rate of 23.21% (95% CI: 19.72, 26.69) with a moderate level of heterogeneity (I2 = 43%) in patients treated for PPU. Notably, presentation after 24 h exhibited 4 times higher odds (95% CI: 1.79-8.95) of developing complications, while low systolic blood pressure (AOR 4.81; 95% CI: 1.75-13.20) was associated with increased complication risk.

In Ethiopia, morbidity and mortality following PPU management are significant, influenced by delayed presentation, low systolic blood pressure, and advanced age. Timely interventions, early hemodynamic stabilization, and age-specific considerations are vital to improving outcomes.

CRD42024497946.

Depression affects more than 350 million people globally. Traditional diagnostic methods have limitations. Analyzing textual data from social media provides new insights into predicting depression using machine learning. However, there is a lack of comprehensive reviews in this area, which necessitates further research.

This review aims to assess the effectiveness of user-generated social media texts in predicting depression and evaluate the influence of demographic, language, social media activity, and temporal features on predicting depression on social media texts through machine learning.

We searched studies from 11 databases (CINHAL [through EBSCOhost], PubMed, Scopus, Ovid MEDLINE, Embase, PubPsych, Cochrane Library, Web of Science, ProQuest, IEEE Explore, and ACM digital library) from January 2008 to August 2023. We included studies that used social media texts, machine learning, and reported area under the curve, Pearson r, and specificity and sensitivity (or data used for their calculation) to predict depression. Protocol papers and studies not written in English were excluded. We extracted study characteristics, population characteristics, outcome measures, and prediction factors from each study. A random effects model was used to extract the effect sizes with 95% CIs. Study heterogeneity was evaluated using forest plots and P values in the Cochran Q test. Moderator analysis was performed to identify the sources of heterogeneity.

A total of 36 studies were included. We observed a significant overall correlation between social media texts and depression, with a large effect size (r=0.630, 95% CI 0.565-0.686). We noted the same correlation and large effect size for demographic (largest effect size; r=0.642, 95% CI 0.489-0.757), social media activity (r=0.552, 95% CI 0.418-0.663), language (r=0.545, 95% CI 0.441-0.649), and temporal features (r=0.531, 95% CI 0.320-0.693). The social media platform type (public or private; P<.001), machine learning approach (shallow or deep; P=.048), and use of outcome measures (yes or no; P<.001) were significant moderators. Sensitivity analysis revealed no change in the results, indicating result stability. The Begg-Mazumdar rank correlation (Kendall τb=0.22063; P=.058) and the Egger test (2-tailed t34=1.28696; P=.207) confirmed the absence of publication bias.

Social media textual content can be a useful tool for predicting depression. Demographics, language, social media activity, and temporal features should be considered to maximize the accuracy of depression prediction models. Additionally, the effects of social media platform type, machine learning approach, and use of outcome measures in depression prediction models need attention. Analyzing social media texts for depression prediction is challenging, and findings may not apply to a broader population. Nevertheless, our findings offer valuable insights for future research.

PROSPERO CRD42023427707; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023427707.

IntroductionCancer is a leading cause of global morbidity and mortality, significantly impairing patients' quality of life (QoL). Integrated Palliative Care (IPC) has been proposed as a holistic approach to enhance quality of life by addressing patients' physical, emotional, and psychosocial needs. While some studies suggest Integrated Palliative Care improves quality of life more than standard care, the evidence remains inconclusive. This systematic review and meta-analysis aim to evaluate the comparative impact of Integrated Palliative Care versus standard care on the quality of life in cancer patients. MethodsA comprehensive search of databases including PubMed, Cochrane Library, and Embase was conducted. We selected randomized controlled trials (RCTs) comparing Integrated Palliative Care and standard care for cancer patients, focusing on the quality of life as measured by validated tools such as the EORTC QLQ-C30 and FACT-G. Data were pooled using a random-effects model to account for study heterogeneity. Subgroup and sensitivity analyses were also performed. ResultsNine randomized controlled trials involving 1,794 patients met the inclusion criteria. Meta-analysis showed that Integrated Palliative Care significantly improved quality of life compared to standard care (SMD = 3.25; 95% CI: 1.20-5.30; p < 0.001). Studies conducted in Asia showed the highest standardized mean difference (SMD = 6.15; 95% CI: 3.07-9.23; p < 0.001), followed closely by studies from Africa (SMD = 6.0; 95% CI: 5.13-6.87; p < 0.001), compared to those from other regions. Similarly, research focusing on lung cancer patients showed the greatest standardized mean difference of (SMD = 6.15; 95% CI: 3.07-9.23; p < 0.001) relative to other cancer types. Furthermore, studies involving newly diagnosed cancer patients recorded the highest standardized mean difference of (SMD = 5.69; 95% CI: 4.57-6.80; p < 0.001). ConclusionIntegrated Palliative Care significantly enhances the quality of life in cancer patients compared to standard care. These findings support integrating Integrated Palliative Care into oncology practices to provide comprehensive, patient-centered care that addresses both physical and emotional needs. Further research should explore long-term benefits across diverse populations.

To assess the evidence for active group-based performing arts interventions for people with Parkinson's disease (PD).

Scholarly literature (published in English) from any country or countries (last search February 2025). This systematic review was not registered and received no funding.

Five bibliographic databases: AMED (Ebsco), APA PsycINFO (Ovid), CINAHL (Ebsco), EMBASE (Ovid) and MEDLINE (Ovid), plus supplementary searches.

Eligible studies used a quantitative design to assess the benefit of active group-based performing arts interventions on quality of life, functional communication, speech, motor function and cognitive status in PD. The risk of bias was assessed using the SURE, University of York Centre for Reviews and Dissemination and Newcastle-Ottawa Scale checklists. Data were synthesised using narrative synthesis and random-effects meta-analysis.

A total of 94 studies were included: 2453 people with PD (mean age 68 years, 55% male) from 18 countries. Narrative synthesis supported nine combinations of performing arts modalities and outcome domains, including a benefit for dance on motor function (supported by 50 out of 54 studies), dance on quality of life (supported by 24 out of 37 studies) and singing on speech (supported by 17 out of 20 studies). Meta-analysis supported five combinations of performing art modalities, comparators and outcomes, including a clinically significant benefit for PD-specific dance versus usual care PDQ-39, MD -7.81, 95% CI -11.87 to -3.75 and tango-based dance versus usual care on UPDRS-III, MD -9.89, 95% CI -16.65 to -3.13.

Evidence from both the narrative synthesis and the meta-analysis supports a benefit for some combinations of performing arts modalities and outcomes. Limitations of the evidence base included differences in comparators and outcomes, heterogeneity, lack of control arms and male underrepresentation. Future studies should compare the effectiveness of different performing arts modalities, assess functional communication and consider clinical significance.

The evidence on the relationship between insomnia and risk of dementia, Alzheimer's disease (AD), and Vascular dementia (VD) is not consistent. We conducted this meta-analysis to examine the evidence for the risk of developing dementia, AD, or VD in patients with all subtypes of insomnia.

A comprehensive search of PubMed, Embase, and the Cochrane Library was conducted using the following search strings: 'Insomnia OR Sleep initiation and Maintenance disorders OR Early morning awakening' AND 'Dementia OR Alzheimer's Disease OR Vascular Dementia' AND 'Risk'. Data extraction was done independently by two researchers. Pooled odds ratio (OR) accompanied by 95% confidence interval (CI) were calculated using either a random-effects model or a fixed-effects model. Sensitivity analyses were performed to assess the robustness of the findings. The potential for publication bias was evaluated through Egger's test and Begg's test.

This meta-analysis included 16 studies with a combined sample size of over 9 million individuals. Pooled analyses revealed a significant association between insomnia and dementia risk (OR = 1.36; 95% CI: 1.01-1.84), with increased risks for AD (OR = 1.52; 95% CI: 1.19-1.93) and VD (OR = 2.10; 95% CI = 2.06-2.14). Subgroup analyses showed no evidence of associations between initial insomnia (OR = 1.01; 95% CI = 0.71-1.31), sleep-maintenance insomnia (OR = 0.88; 95% CI = 0.66-1.17), and early morning awakening (OR = 0.94; 95% CI = 0.83-1.07) with dementia risk. Insomnia patients from Europe (OR = 1.24; 95% CI = 1.14-1.35), Asia (OR = 2.19; 95% CI = 2.06-2.32), and the Americas (OR = 1.05; 95% CI =  1.04-1.07) had varying risks of dementia. Subgroups with less than five years of follow-up (OR = 2.16; 95% CI = 1.81-2.60) exhibited higher dementia risks in insomnia patients, while those with more than five years of follow-up (OR = 1.17; 95% CI = 1.03-1.33) showed a lower risk.

Our meta-analysis reveals that insomnia is linked to the risk of dementia, AD, and VD. These findings suggest that insomnia may significantly contribute to the risk of all-cause dementia, highlighting the importance of early intervention and management of insomnia. Despite our efforts to minimize and explore the sources of heterogeneity, it still remained, and therefore our results should be interpreted with caution.

Adoptive cell therapy (ACT) with tumor-infiltrating lymphocytes (TIL) has consistently shown efficacy in advanced melanoma. Its combination with non-myeloablative but lymphodepleting (NMA-LD) chemotherapy and high-dose interleukin-2 (HD-IL-2) inevitably lead to severe treatment-related adverse events. The systematic recording of the observed toxicities, which is the aim of the present meta-analysis, will further enhance the implementation and management of this treatment schema.

A comprehensive search was conducted in PubMed up to 29 February 2024. In this meta-analysis we focused on studies of treatment-refractory advanced cutaneous melanoma with TILs administered in combination with NMA-LD chemotherapy and HD-IL-2 (≥600,000 IU/kg). Our primary endpoint was severe adverse events (AEs) of grade 3 or higher. The safety data was consistently coded using Common Terminology Criteria for Adverse Events (CTCAE) v5.0. Findings are synthesized using tables, while pooled estimates for groups of AEs of particular interest are derived from random effect models.

A total of 12 HD-IL-2 studies, of 670 patients, with available toxicity information were included in this meta-analysis. Blood toxicities were identified as the most common AEs. In the frame of the formal meta-analysis the pooled estimate of the probability of febrile neutropenia was 60% (95%CI: 36%-83%). The total pooled estimate for the probability of severe "immunologic reaction" events, was 4% (95% CI: 1%- 6%), while the respective probability for experiencing a severe AE in MedDRA SOC category 'Infections and infestations' was 8% (95% CI: 4%- 11%). In addition, in total, 9 fatal (grade 5) AEs have been reported, mostly stated as not attributed to the treatment or attributed to NMA/HD-IL-2.

TIL-ACT, a new approved and promising therapy for melanoma patients, presents a distinctive toxicity profile that is currently manageable with supportive care methods, with reported toxicities mainly arising from NMA-LD chemotherapy and HD-IL-2, and a low risk of severe immunologic reaction events. Continued systematic recording and publication of adverse events, even the rare ones, and its relation to treatment components, are essential to move the field forward.

Dysfunction of the autonomic nervous system (characterized by excessive sympathetic activation and reduced parasympathetic activity) is regarded as one of the primary mechanisms of heart failure. Theoretically, nerve stimulation or modulation targeting this autonomic imbalance could improve outcomes in heart failure, but current evidence is inconclusive.

This systematic review and network meta-analysis (NMA) aimed to compare the efficacy of various nerve stimulation/modulation approaches in patients with heart failure.

We conducted a frequentist-based NMA of randomized controlled trials (RCTs) investigating nerve stimulation or modulation techniques for heart failure management. The primary outcomes included objective measures (such as brain natriuretic peptide [BNP] serum levels) and subjective measures (such as psychosocial functioning and quality of life).

Interventions targeting both arms of the autonomic nervous system, including sympathetic and parasympathetic nervous systems, and the vasculature (carotid or renal arteries) demonstrated preferable results. Interventions dealing only with the autonomic nervous system did not provide significant results. Specifically, only renal sympathetic denervation was significantly associated with a more significant reduction in BNP levels than the control group. Additionally, baroreflex activation therapy was the only treatment significantly associated with improving quality of life.

This study provides comparative evidence supporting the use of specific nerve stimulation/modulation techniques in treating heart failure. Further well-designed RCTs, incorporating appropriate blinding, are recommended to minimize potential biases.

Maternal diabetes might alter fetal brain development. However, well-designed systematic analyses are needed to comprehensively assess and quantify the association between maternal diabetes and neurodevelopmental outcomes in children. We aimed to synthesise and evaluate the available evidence on the effects of maternal diabetes on neurodevelopmental outcomes in children.

For this systematic review and meta-analysis we searched PubMed, Web of Science, Embase, and EBSCO databases from inception to Dec 1, 2024, for studies exploring neurodevelopmental outcomes of children born to mothers with diabetes. The primary outcome was neurodevelopmental disorders, as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and International Classification of Diseases 11th Revision. Data were extracted from published reports. Data were pooled with random-effects models and presented as risk ratios or standard mean differences with 95% CIs. This study was prospectively registered on PROSPERO (CRD42023395464).

202 studies, involving 56 082 462 mother-child pairs, were included in the meta-analysis. Of these, 110 (54%) examined gestational diabetes, while 80 (40%) investigated pre-gestational diabetes. Among the total studies reviewed, 169 (84%) exclusively focused on children and adolescents aged up to 18 years. In studies adjusting for at least one key confounder, maternal diabetes was associated with increased risks of all types of neurodevelopmental disorders as well as lower intelligence and psychomotor scores. In studies adjusting for multiple confounders (n=98, 49%), children exposed to maternal diabetes had an increased risk of any neurodevelopmental disorder (risk ratio 1·28; 95% CI 1·24-1·31), autism spectrum disorder (1·25; 1·20-1·31), attention-deficit hyperactivity disorder (1·30; 1·24-1·37), intellectual disability (1·32; 1·18-1·47), specific developmental disorders (1·27; 1·17-1·37), communication disorder (1·20; 1·11-1·28), motor disorder (1·17; 1·10-1·26), and learning disorder (1·16; 1·06-1·26), compared with unexposed children. Maternal pre-gestational diabetes was more strongly associated with the risk of most neurodevelopmental disorders in children than gestational diabetes (risk ratio 1·39; [95% CI 1·34-1·44] vs 1·18 [1·14-1·23]; subgroup difference p<0·0001).

Maternal diabetes is associated with an increased risk of neurodevelopmental disorders and impaired neurodevelopmental performance in children. Further high-quality research is needed to establish causality and clarify the associations between specific types of diabetes and the full spectrum of neurodevelopmental disorders.

The National Natural Science Foundation of China, and the Science and Technology Innovation Program of Hunan Province.

For the Mandarin translation of the abstract see Supplementary Materials section.

Glucagon-like peptide-1 (GLP-1) receptor agonists and sodium-glucose cotransporter 2 (SGLT2) inhibitors represent a new generation of antihyperglycemic agents that operate through mechanisms distinct from conventional diabetes treatments. Beyond their metabolic effects, these medications have demonstrated neuroprotective properties in preclinical studies. While clinical trials have explored their therapeutic potential in established neurodegenerative conditions, their role in disease prevention remains unclear. We conducted a network meta-analysis (NMA) to comprehensively evaluate the prophylactic benefits of these agents across multiple neurodegenerative diseases and identify the most promising preventive strategies.

We systematically searched PubMed, Embase, ClinicalKey, Cochrane CENTRAL, ProQuest, ScienceDirect, Web of Science, and ClinicalTrials.gov through October 24th, 2024, for randomized controlled trials (RCTs) of GLP-1 receptor agonists or SGLT2 inhibitors. Our primary outcome was the incidence of seven major neurodegenerative diseases: Parkinson's disease, Alzheimer's disease, Lewy body dementia, multiple sclerosis, amyotrophic lateral sclerosis, frontotemporal dementia, and Huntington's disease. Secondary outcomes included safety profiles assessed through dropout rates. We performed a frequentist-based NMA and evaluated risk of bias with Risk of Bias tool. The main result of the primary outcome in the current study would be re-affirmed via sensitivity test with Bayesian-based NMA.

Our analysis encompassed 22 RCTs involving 138,282 participants (mean age 64.8 years, 36.4% female). Among all investigated medications, only dapagliflozin demonstrated significant prophylactic benefits, specifically in preventing Parkinson's disease (odds ratio = 0.28, 95% confidence intervals = 0.09 to 0.93) compared to controls. Neither GLP-1 receptor agonists nor other SGLT2 inhibitors showed significant preventive effects for any of the investigated neurodegenerative conditions. Drop-out rates were comparable across all treatments.

This comprehensive NMA reveals a novel and specific prophylactic effect of dapagliflozin against Parkinson's disease, representing a potential breakthrough in preventive neurology. The specificity of dapagliflozin's protective effect to Parkinson's disease might rely on its highly selective inhibition to SGLT2. These findings provide important direction for future research and could inform preventive strategies for populations at risk of Parkinson's disease.

PROSPERO CRD42021252381.

Postoperative recovery quality (QoR) is a key indicator for evaluating the restoration of patients' functional status and overall quality of life post-surgery. Moreover, it is an essential metric for assessing the effectiveness of patient-centered anesthetic care. The erector spinae plane block (ESPB) is an innovative regional analgesia technique that has garnered considerable attention for its potential use in spinal surgeries. Although some studies suggest that ESPB may improve QoR, the results remain contentious and inconclusive. This meta-analysis aims to systematically evaluate the effects of ESPB on the subjective quality of recovery in patients undergoing spinal surgery, with the objective of providing more robust evidence to support its clinical application.

On September 23, 2024, we conducted a systematic search across the PubMed, Embase, Web of Science, Cochrane Library, and Scopus databases to identify randomized controlled trials (RCTs) relevant to ESPB. The studies evaluated the effect of ESPB compared to conventional analgesia on QoR in patients undergoing spinal surgery. The primary outcome measure of this study was postoperative the 24-hour QoR score, as assessed by validated QoR scales (QoR-15 and QoR-40). Secondary outcome measures included the QoR score at 48 h postoperatively, the incidence of postoperative nausea and vomiting (PONV), and the consumption of opioid analgesics in the first 24 h postoperatively.

This meta-analysis included eight studies, with a total of 578 patients. The results demonstrated that, compared to the control group, the ESPB group showed improvements in overall QoR-15 scores (mean difference [MD]: 9.76; 95% confidence interval [CI]: 8.39-11.13; P < 0.01; I² = 0%) and QoR-40 scores (MD: 11.8; 95% CI: 6.35-17.25; P = 0.000), indicating clinically meaningful benefits. Additionally, although the QoR-15 (MD: 3.69; 95% CI: 2.60-4.78; P < 0.01; I² = 2.31%) and QoR-40 scores (MD: 5.70; 95% CI: 0.11-11.29; P = 0.046) at 48 h postoperatively demonstrated a statistical improvement, the magnitude of this change did not reach the threshold for clinical relevance. Moreover, ESPB reduced the incidence of PONV (log odds ratio [log(OR)]: -0.63; 95% CI: -1.11--0.14; P = 0.01; I² = 24.62%) and the 24-hour postoperative opioid consumption(SMD: -0.56; 95% CI: -0.83--0.29; P < 0.01; I² = 0%).

ESPB was associated with an improvement in the quality of recovery within the first 24 h postoperatively in patients undergoing spinal surgery, along with a reduction in the incidence of PONV and opioid consumption. However, while the improvement in recovery quality at 48 h postoperatively was statistically significant, its clinical significance was limited. These findings suggest that ESPB may be a beneficial adjunct for enhancing postoperative recovery, but further studies are needed to validate its long-term impact and clinical applicability.

Age at menarche may influence the onset of depression later in life. We aim to assess the association between early/late menarche and depressive outcomes in females by updating a systematic review and meta-analysis.

The search of the original systematic review was updated for studies published in PubMed, Embase, and Cochrane Library from 2013 to 2023. The early/late and on-time menarche divisions were generally based on each study. Depression or depressive symptoms could be measured through various validated tools and diagnostic criteria. We assessed the quality of the evidence using the GRADE approach and performed a random-effect meta-analysis with age at menarche and the cases of depression as outcomes.

We included eight cohort and three cross-sectional studies (138,819 participants). Females with early menarche were more likely to have depression later in life compared with those who had on-time menarche (early vs. on-time menarche: odds ratio (OR) = 1.11; 95% confidence interval (CI): 1.03, 1.20; I2 = 44.5%). We found a null association between late menarche and depression for females (late vs. on-time menarche: odds ratio (OR) = 1.00; 95% confidence interval (CI): 0.87, 1.15; I2 = 73.2%). Sensitivity analyses showed that the results were robust. The quality of the available evidence was rated as very low.

Existing evidence suggests that early menarche may be associated with an increased risk of depression in females. But it remains unclear about late menarche. More high-quality studies are warranted.

Depression represents a major global public health challenge, particularly among young individuals aged between 10 and 25. This age bracket is notably critical, as the onset of depression during these years tends to be more severe and consequential. In response to the growing demand for mental health services, internet-based psychological interventions have gained traction as a flexible and convenient alternative to traditional face-to-face treatment. This systematic review and network meta-analysis aims to rigorously assess the comparative efficacy and acceptability of internet-based psychological interventions in addressing depression within the young population over the past three decades.

We conducted a comprehensive search of seven electronic databases for eligible randomized controlled trials published from January 1995 to July 2024. The literature screening process adhered to the principles of population, intervention, comparator, outcome, and study design. The quality of the included studies was assessed using the Cochrane Risk of Bias Assessment Tool. To evaluate the ranking probability of each intervention, we calculated the surface under the cumulative ranking curve values. Network meta-analysis (NMA) was conducted using RStudio and Stata software.

The NMA incorporated a total of 27 studies involving 3,451 participants. Among these studies, 18 assessed internet-based cognitive behavioral therapy (iCBT) interventions, whereas 12 employed a waitlist as a control group. At the end of the interventions, internet-based acceptance and commitment therapy (iACT), iCBT, internet-based dialectical behavior therapy (iDBT), and internet-based psychodynamic therapy (iPDT) all demonstrated statistically significant reductions in depression scores. Notably, no intervention measure was found to be statistically more acceptable than the others.

Our NMA indicated that iDBT appeared to be more effective, whereas internet-based mindfulness-based therapy (iMBT) may be more acceptable. These findings offered preliminary evidence regarding the comparative effectiveness and acceptability of internet-based psychological interventions in treating depression among young people. However, the limited number of eligible studies underscored the importance and necessity of further research to evaluate novel intervention measures.

The study was registered with the International Prospective Register of Systematic Reviews (PROSPERO), with the registration number CRD42024580958.

Febrile neutropenia (FN) is a serious complication in patients with hematologic malignancies following treatments such as chemotherapy and hematopoietic stem cell transplantation. It is typically managed with broad-spectrum antibiotics (BSA), but the optimal duration of BSA therapy remains controversial. This meta-analysis aimed to assess the clinical efficacy and safety of early antibiotic de-escalation in patients with hematologic malignancies with FN before hematopoietic recovery, compared to those who continued BSA until hematopoietic recovery. Statistical analysis included pooled odds ratios (OR) for mortality and secondary adverse outcomes, along with subgroup analysis to identify patient populations that may benefit from early de-escalation. Ten studies, mostly retrospective observational designs, were included. Early de-escalation significantly reduced mortality risk (OR 0.20, 95% CI 0.06-0.69). Subgroup analyses showed mortality benefits in older patients (>55 years old, OR 0.42, 95% CI 0.18-0.98) and in higher-quality studies (OR 0.07, 95% CI 0.01-0.62). No significant differences were observed for infection-related ICU admissions, bacteremia, recurrent fever, or Clostridium difficile infection (CDI). In conclusion, early de-escalation of BSA in patients with hematologic malignancies and developing FN after treatment significantly reduces mortality risk without increasing major adverse events. These findings support the use of early de-escalation and highlight the need for personalized strategies to improve patient outcomes.