Adults experiencing homelessness in high income countries often also face issues of problematic substance use, mental ill health, in addition to housing instability, so it is important to understand what interventions might help address these issues. While there is growing evidence of the effectiveness of psychosocial interventions for the general population, limited evidence exists specifically for those experiencing homelessness.

To summarise the existing evidence of whether psychosocial interventions work in reducing problematic substance use, mental ill health, and housing instability for adults experiencing homelessness in high income countries.

We used searches undertaken for the Homelessness Effectiveness Evidence and Gap Map (EGM) 5th edition. These were supplemented with hand searches of key journals and a call for evidence.

We included all Randomised Control Trials and non-randomised studies where a comparison group was used and which examined psychosocial interventiONS for adults experiencing homelessness. 'Psychosocial intervention' is a broad term and covers several interventions, including cognitive behavioural therapy (CBT), contingency management, and motivational interviewing. We focused on studies that measure at least one of three outcomes: reduction in problematic substance use (alcohol and/or drugs); reduction in mental ill-health; reduction in housing instability.

For included studies sourced from the EGM, we used the risk of bias assessments reported in the EGM. For included studies sourced from our own searches, we used the same tools used in the EGM to undertake our own assessments. We carried out meta-analysis where possible, and where not possible, presented included studies narratively.

We included 26 papers covering 23 individual intervention studies. All of the included studies were from the United States. Of the 26 papers, 14 were assessed as having medium or high risk of bias, with main issues being lack of masking/blinding, lack of power calculations, and high levels of drop-out.

We found that psychosocial interventions overall were better than standard care (-0.25 SD, 95% confidence intervals [CI] [-0.36, -0.13]). This finding covered six different interventions and was subject to a high level of between-study differences (heterogeneity). We also found that psychosocial interventions were more effective than standard care in relation to all three of our outcomes of interest, although were statistically significant only for substance abuse and mental ill-health. For substance use, we found an average effect size of (-0.34 SD, 95% CI [-0.48, -0.21]); for mental ill health of (-0.18 SD, 95% CI [-0.34, -0.01]); and for housing instability of (-0.10 SD, 95% [-0.90, 0.70]).

We were able to undertake five meta-analyses (statistical summaries) with respect to four types of intervention: CBT, Contingency Management, Motivational Interviewing, and Brief Motivational Interventions, in relation to specific outcomes. Of these five analyses, we found significant effects for the effectiveness of Contingency Management in reducing problematic substance use (-0.49 SD, 95% CI [-0.85, -0.14]), and of Motivational Interviewing in reducing mental ill-health (-0.19 SD, 95% CI [-0.26, -0.12]). We also found non-significant effects in relation to CBT and reducing mental ill health (-0.30 SD, 95% CI [-0.61, 0.002]), Motivational Interviewing and reducing problematic substance use (-0.27 SD, 95% CI [-0.56, 0.01]), and Brief Motivational Interventions and reducing problematic substance use (-0.24 SD, 95% CI [-0.61, 0.13]). Meta-analysis was not possible for any other interventions or outcomes.

This systematic review sought to understand the effectiveness of psychosocial interventions for adults in high income countries experiencing homelessness, for reducing problematic substance use, reducing mental ill-health, and increasing housing stability. The review shows potential benefits of these interventions, with some encouraging results for some interventions and outcomes. Where we could calculate effect sizes, these were often small and, in many cases, crossed the line of no effect (i.e., there is a chance that they are equally or less effective than treatment as usual). Significant heterogeneity between studies and high rates of drop-out in many studies reduces the confidence in the interventions.There are some limitations with the evidence base. The included studies were entirely from the United States. There was a clear gender bias in the included studies, with nearly two-thirds of participants being men. (This is despite 4 of the 26 included studies focusing on women only.) We also found that the theoretical basis for the approach of interventions was not sufficiently considered, so it was difficult to understand why the intervention expected the outcomes they measured. Finally, many of the studies included were assessed as having high or medium risk of bias.

Neuroactive steroids including allopregnanolone are implicated in the pathophysiology of peripartum depressive symptoms (PDS). We performed a systematic review searching PubMed/Embase/PsychInfo/Cinhail through 08/2023 (updated in 07/2024), and conducted a random-effects meta-analysis of studies comparing allopregnanolone blood concentrations in women with versus without PDS at various timepoints during the 2nd and 3rd trimester and the postpartum period, calculating standardized mean differences (SMDs) and 95% confidence intervals (CIs). Meta-regression and subgroup analyses included age, diagnoses of affective disorders before pregnancy, antidepressant treatment, analytical methods, and sample type. Study quality was assessed using the Newcastle-Ottawa-scale. The study protocol was registered on PROSPERO (registration number CRD42022354495). We retrieved 13 studies with 2509 women (n = 849 with PDS). Allopregnanolone concentrations did not differ between women with versus without PDS at any timepoint (p > 0.05). Allopregnanolone concentrations assessed during pregnancy did not differ for women with versus without PDS at postpartum follow-up (p > 0.05). Subgroup analyses indicated higher allopregnanolone concentrations in women with versus without PDS at gestational weeks 21-24 and 25-28 (SMD = 1.07, 95% CI = 0.04, 2.11 and SMD = 0.92, 95% CI = 0.26, 1.59 respectively). Moreover, we reported differences between studies using mass-spectrometry combined with chromatography versus immunoassays at gestational weeks 25-28 (p = 0.01) and plasma versus serum samples at gestational weeks 21-24 (p = 0.005). Study quality was rated as poor, good, and fair for two, one and ten studies respectively. PDS were not associated with differences for allopregnanolone concentrations. The use of heterogenous peripartum time points, study cohorts, depression symptom measures and analytical methods has hampered progress in elucidating neuroactive steroid signaling linked to PDS.

People use social media platforms to chat, search, and share information, express their opinions, and connect with others. But these platforms also facilitate the posting of divisive, harmful, and hateful messages, targeting groups and individuals, based on their race, religion, gender, sexual orientation, or political views. Hate content is not only a problem on the Internet, but also on traditional media, especially in places where the Internet is not widely available or in rural areas. Despite growing awareness of the harms that exposure to hate can cause, especially to victims, there is no clear consensus in the literature on what specific impacts this exposure, as bystanders, produces on individuals, groups, and the population at large. Most of the existing research has focused on analyzing the content and the extent of the problem. More research in this area is needed to develop better intervention programs that are adapted to the current reality of hate.

The objective of this review is to synthesize the empirical evidence on how media exposure to hate affects or is associated with various outcomes for individuals and groups.

Searches covered the period up to December 2021 to assess the impact of exposure to hate. The searches were performed using search terms across 20 databases, 51 related websites, the Google search engine, as well as other systematic reviews and related papers.

This review included any correlational, experimental, and quasi-experimental study that establishes an impact relationship and/or association between exposure to hate in online and traditional media and the resulting consequences on individuals or groups.

Fifty-five studies analyzing 101 effect sizes, classified into 43 different outcomes, were identified after the screening process. Initially, effect sizes were calculated based on the type of design and the statistics used in the studies, and then transformed into standardized mean differences. Each outcome was classified following an exhaustive review of the operational constructs present in the studies. These outcomes were grouped into five major dimensions: attitudinal changes, intergroup dynamics, interpersonal behaviors, political beliefs, and psychological effects. When two or more outcomes from the studies addressed the same construct, they were synthesized together. A separate meta-analysis was conducted for each identified outcome from different samples. Additionally, experimental and quasi-experimental studies were synthesized separately from correlational studies. Twenty-four meta-analyses were performed using a random effects model, and meta-regressions and moderator analyses were conducted to explore factors influencing effect size estimates.

The 55 studies included in this systematic review were published between 1996 and 2021, with most of them published since 2015. They include 25 correlational studies, and 22 randomized and 8 non-randomized experimental studies. Most of these studies provide data extracted from individuals (e.g., self-report); however, this review includes 6 studies that are based on quantitative analysis of comments or posts, or their relationship to specific geographic areas. Correlational studies encompass sample sizes ranging from 101 to 6829 participants, while experimental and quasi-experimental studies involve participant numbers between 69 and 1112. In most cases, the exposure to hate content occurred online or within social media contexts (37 studies), while only 8 studies reported such exposure in traditional media platforms. In the remaining studies, the exposure to hate content was delivered through political propaganda, primarily associated with extreme right-wing groups. No studies were removed from the systematic review due to quality assessment. In the experimental studies, participants demonstrated high adherence to the experimental conditions and thus contributed significantly to most of the results. The correlational and quasi-experimental studies used consistent, valid, and reliable instruments to measure exposure and outcomes derived from well-defined variables. As with the experimental studies, the results from the correlation and quasi-experimental studies were complete. Meta-analyses related to four dimensions were performed: Attitudinal changes, Intergroup dynamics, Interpersonal behaviors, and Psychological effects. We were unable to conduct a meta-analysis for the "Political Beliefs" dimension due to an insufficient number of studies. In terms of attitude changes, exposure to hate leads to negative attitudes (d Ex = 0.414; 95% confidence interval [CI] = 0.005, 0.824; p < 0.05; n = 8 and d corr = 0.322; 95% CI = 0.14, 0.504; p < 0.01; n = 2) and negative stereotypes (d Ex = 0.28; 95% CI = -0.018, 0.586; p < 0.10; n = 9) about individuals or groups with protected characteristics, while also hindering the promotion of positive attitudes toward them (d exp = -0.227; 95% CI = -0.466, 0.011; p < 0.10; n = 3). However, it does not increase support for hate content or political violence. Concerning intergroup dynamics, exposure to hate reduces intergroup trust (d exp = -0.308; 95% CI = -0.559, -0.058; p < 0.05; n = 2), especially between targeted groups and the general population, but has no significant impact on the perception of discrimination among minorities. In the context of Interpersonal behaviors, the meta-analyses confirm a strong association between exposure to hate and victimization (d corr = 0.721; 95% CI = 0.472, 0.97; p < 0.01; n = 3) and moderate effects on online hate speech perpetration (d corr = 0.36; 95% CI = -0.028, 0.754; p < 0.10; n = 2) and offline violent behavior (d corr = 0.47; 95%CI = 0.328, 0.612; p < 0.01; n = 2). Exposure to online hate also fuels more hate in online comments (d = 0.51; 95% CI = 0.034-0.984; p < 0.05; n = 2) but does not seem to affect hate crimes directly. However, there is no evidence that exposure to hate fosters resistance behaviors among individuals who are frequently subjected to it (e.g. the intention to counter-argue factually). In terms of psychological consequences, this review demonstrates that exposure to hate content negatively affects individuals' psychological well-being. Experimental studies indicate a large and significant effect size concerning the development of depressive symptoms due to exposure (d exp = 1.105; 95% CI = 0.797, 1.423; p < 0.01; n = 2). Additionally, a small effect size is observed concerning the link between exposure and reduced life satisfaction(d corr = -0.186; 95% CI = -0.279, -0.093; p < 0.01; n = 3), as well as increased social fear regarding the likelihood of a terrorist attack (d corr = -0.206; 95% CI = 0.147, 0.264; p < 0.01 n = 5). Conversely, exposure to hate speech does not seem to generate or be linked to the development of negative emotions related to its content.

This systematic review confirms that exposure to hate in online and in traditional media has a significant negative impact on individuals and groups. It emphasizes the importance of taking these findings into account for policymaking, prevention, and intervention strategies. Hate speech spreads through biased commentary and perceptions, normalizing prejudice and causing harm. This not only leads to violence, victimization, and perpetration of hate speech but also contributes to a broader climate of hostility. Conversely, this research suggests that people exposed to this type of content do not show increased shock or revulsion toward it. This may explain why it is easily disseminated and often perceived as harmless, leading some to oppose its regulation. Focusing efforts solely on content control may then have a limited impact in driving substantial change. More research is needed to explore these variables, as well as the relationship between hate speech and political beliefs and the connection to violent extremism. Indeed, we know very little about how exposure to hate influences political and extremist views.

Studies have shown that there are protective and risk factors related to cyber dating violence. However, the effect size of these factors is unclear. This study aims to clarify the effect size of the associations of protective and risk factors, as well as symptoms of mental health conditions, with cyber dating violence perpetration and victimization. Databases, including PubMed, Web of Science (WoS), ProQuest, Scopus, and EBSCOhost were searched to identify relevant studies. Forty-nine studies were included in the current study. Results revealed statistically significant and medium relationships between cyber dating violence perpetration and some risk factors, including offline dating violence perpetration-related factors (i.e., physical, psychological, sexual, relational, verbal/emotional, and threat) and offline dating violence victimization-related factors (i.e., physical and psychological); and small relationships with other risk factors (i.e., sexual offline dating violence victimization, attachment styles, and jealousy), protective factors (i.e., family support and emotional regulation), and mental health symptoms (i.e., depression, anxiety, and alcohol use). There was also statistically significant and robust relationship between cyber dating violence victimization and verbal/emotional offline dating violence victimization (i.e., risk factor); medium relationships with some risk factors, including offline dating violence perpetration-related factors (i.e., psychological and verbal/emotional) and offline dating violence victimization-related factors (i.e., physical, psychological, sexual, relational, and threat); small relationships with other risk factors (i.e., physical offline dating violence perpetration, attachment styles, childhood sexual abuse), protective factors (i.e., family support, emotional regulation, and self-esteem), and mental health symptoms (i.e., depression, anxiety, stress, alcohol use, and drug use). The study's results highlight risk and protective factors associated with cyber dating violence and demonstrate its association with mental health symptoms.

Physical activity (PA) identity (i.e., categorisation of oneself in a particular role) has been linked to PA behaviour in observational research, yet experimental research has seen less attention. The purpose of this meta-analysis was to examine the effectiveness of interventions to change identity and subsequent PA. Eligible studies were published in a peer-reviewed journal in English, included an experimental or quasi-experimental design in the PA domain with a measure of identity as the dependent variable, among an adult (>18 yrs.) sample. A literature search was completed in March 2024 using five common databases. The search yielded 40 independent effect sizes, representing 4939 participants. Random-effects meta-analysis showed positive changes in identity favouring the intervention over the control group g = 0.18 (95% CI = 0.11-0.24) and positive changes in a sub-sample (k = 30) of these studies that also measured PA g = 0.61 (95% CI = 0.41-0.81). Changes in identity did not have significant (Q = 43.08, p = 0.30) heterogeneity, yet changes in PA showed heterogeneity (Q = 204.62, p < .001) and follow-up moderator analyses found potential publication bias, and differences by methods (comparison group, length of intervention) and theoretical approach. Overall, PA identity can change as a result of interventions, but the effect may be smaller than changes in behaviour in these interventions.

A higher prevalence of post-traumatic stress disorder (PTSD) exists among racial and ethnic minority groups who experience trauma; however, little is known about cultural adaptations of trauma assessments and interventions, or whether those adaptations meet cultural needs. This systematic review examined the effectiveness and experiences of culturally adapted trauma assessments and interventions for adults from racial and ethnic minority groups. Empirical studies investigating culturally adapted trauma assessment and/or interventions targeting adults from racial and ethnic minority groups were searched for in MEDLINE, PsycINFO, Embase, Scopus, CINAHL, Cochrane Central Register of Controlled Trials, Web of Science, from inception to May 2022. A total of 21 articles were included, and 8 common themes of adaptations were identified: socio-cultural integrations, collaboration, psychoeducation, language, cultural matching, addressing stigma, training for providers, and practical considerations. Random effects meta-analyses on intervention effects showed that culturally adapted interventions were more effective in reducing PTSD symptoms (7 randomized controlled trials [RCTs], n = 213, Standardized Mean Difference -0.67, 95% CI [-1.06, -0.25], I2 = 39%) and in ameliorating anxiety symptoms (5 RCTs, n = 168, SMD -1.92, 95% CI [-3.18, -0.67], I2 = 89%) when compared with non-adapted interventions at immediate post-intervention. No statistical difference in effects was found on depression, nor on PTSD or anxiety sustained beyond the post-intervention time-point. Thematic synthesis on participants' experiences showed that adapted interventions had positive influences on attitudes toward mental health and engagement with services. Future research should employ large-scale trial methods to test adapted trauma interventions over longer follow-up periods as well as to explore the subjective experiences of users of adapted interventions.

The hypothesis that maladaptive emotion regulation plays a central role in anger problems has driven the development of cognitive-behavioral interventions for anger and has stimulated a wealth of studies. However, this work is heterogeneous, drawing on multiple theories from clinical psychology and affective science, and focusing on multiple dimensions of emotion regulation. In addition, previous findings have not always been consistent. The present meta-analysis aimed to characterize associations between anger and emotion regulation strategies (i.e., avoidance, acceptance, distraction, reappraisal, rumination, suppression). A systematic search was conducted, and 81 studies (115 effect sizes) were included in the analysis. The results indicated consistent positive associations between anger and avoidance, rumination, and suppression, and consistent negative associations between anger and acceptance, and reappraisal. The relation between anger and distraction could not be analyzed. Heterogeneity was large in all analyses, and multiple differences between studies, including type of anger, clinical status, criminal status, type of culture, study quality, and sample sex distribution, influenced the effect sizes. Overall, the present findings support the view that anger is consistently associated with the differential use of multiple emotion regulation strategies and suggest methodological improvements for future studies.

This study aimed to summarize the main information from published studies on the effects of dietary supplementation on the ingestive behavior and consumption of grazing sheep and to support efficient feeding strategies. The guiding question formulated based on the PICOS strategy was: Does dietary supplementation influence the ingestive behavior and voluntary forage consumption of sheep kept on pasture? Four databases were used: SCOPUS (Elsevier), Web of Science (main collection), Science Direct (Elsevier), and CAB Direct, and the search was carried out from January to July 2023. Only complete research articles, available in full, well-designed, and published in any language, with no time frame, were considered. A total of 8,132 documents were retrieved and after applying the eligibility criteria, 7 were considered eligible and included in the final sample. 28.6% evaluated ingestive behavior for 24 uninterrupted hours, 28.6% for 12 h, 14.3% for 11 h, and 28.6% for 9 h evaluated. The interval for observing behavior was every five minutes for 42.9% and every 10 min for 57.1% of the studies. The studies that evaluated grazing, rumination, and idle time, only 14% evaluated supplement intake time and water drinking time, 43% evaluated the bite rate, and 29% the bite mass. Among the methods for estimating dry matter intake (DMI), the most used were chromium oxide and titanium dioxide (42.5% each), and the estimate by formula corresponded to 14.29%. It was observed that 57.14% of the studies were published in national journals, the most used animal breed was Santa Inês (42.85%), and the most evaluated grazing method was continuous (57.14%). The use of supplementation, as well as the different levels and types of ingredients, influenced the ingestive behavior and voluntary dry matter intake of grazing sheep. By increasing the level of supplementation, the substitutive associative effect of the animals also increases the consumption of the supplement to the detriment of the pasture. Providing concentrated supplements with ingredients that have lower fiber content and higher TDN alters ingestive behavior, with a decrease in grazing and rumination time and an increase in idle time.

Problematic sexual behavior (PSB) are behaviors that involve sexual body parts and that are developmentally inappropriate or potentially harmful among children ages 12 and younger. PSB has been associated with different types of maltreatment as well as clinical difficulties, albeit inconsistently. The aim of this meta-analysis was to summarize the current research on correlates of PSB, specifically child demographic factors (i.e., gender, age), maltreatment history (i.e., childhood sexual abuse [CSA], childhood physical abuse [CPA]), and comorbid clinical symptoms (i.e., externalizing and internalizing problems). A total of 47 samples (n = 15,562 children) were included. Males and younger children were slightly more likely to exhibit PSB (g = .12 and -.21, respectively). CSA was associated with PSB (g = .71); however, the strength of this relationship differed by caregiver gender and publication year. CPA was also related to PSB (g = .32), but was more strongly associated when PSB was limited to the interpersonally intrusive subtype of PSB (g = .46). Externalizing (g = .95) and internalizing (g = .63) symptoms were also linked with PSB, with externalizing difficulties evincing the strongest association of all of the correlates. These results are discussed in the context of advancing research on PSB, specifically addressing several limitations in the current literature. These include inconsistent assessment of PSB and CSA, as well as the pressing need to develop a more robust measure of PSB. Finally, a more comprehensive assessment of the correlates of PSB is needed to address significant common method variance.

Public speaking can be a fear-inducing and anxiety-provoking experience for individuals, potentially resulting in poor performance and missed educational, social, and professional opportunities. In order to provide applied practitioners with effective methodologies for the reduction of public speaking anxiety (PSA), this paper aims to systematically review and meta-analyse theoretically driven interventions that successfully reduce PSA or maintain/increased public speaking performance. Following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, a systematic review and meta-analysis examined articles from 1 January 2000 to 1 June 2023. Of the 1293 articles identified, 26 studies with 2253 participants met the inclusion criteria. Research was of a moderate to high methodological standard, with interventions varying in type, duration, and focus (e.g., symptom vs. source). Intervention types included exposure, cognitive modification, combined, and other strategies. Although, the overall effect of psychological interventions for PSA across 42 interventions was g = 1.17 (95% CI = 0.88-1.45), with high heterogeneity, individual effect sizes varied greatly. While this review provides support for the efficacy of psychological interventions in reducing anxiety related to public speaking, rigorous research is warranted to examine long-term efficacy, real-world implications, self-efficacy development, and individual differences in treatment assignment. Finally, this review provides practitioners with a quick and easy guide to implementing successful interventions that reduce PSA or maintain/increase performance.

Sleep disorders are common in people on the autistic spectrum and can affect their development, daily function, and overall well-being. This study examined the effectiveness of non-pharmacological intervention to improve sleep in autistic children and adolescents without intellectual disability. We considered 11 studies of non-pharmacological treatments for autistic children and adolescents. The results indicate that these interventions help to improve several sleep parameters, either by increasing, for example, the total time and quality of sleep, or by reducing the time needed for falling asleep. These approaches offer important treatment options especially for those cases where medication is not feasible, allowing physicians and specialists to propose more targeted and safer solutions for managing sleep difficulties in this population.

Seafood is a source of essential nutrients to support neurocognitive development of children and adolescents, but there are concerns about contaminant exposure. Assessing seafood as a food group, rather than a source of nutrients or contaminants, can inform future dietary guidance.

To update and assess relationships between seafood consumption during childhood and adolescence and neurocognitive development.

Three electronic databases were searched up to Sept 2024 to update a previous search from 2000-2019. Articles were included if associations were assessed between seafood during childhood and adolescence and neurocognitive development outcomes (cognitive development, behavior, movement/physical development, language/communication development, depression, anxiety, ADHD, and autism spectrum disorder). All articles were screened at title, abstract, and full-text levels by two independent analysts. Data were extracted, quality checked by a second analyst, and synthesized narratively by two analysts independently, considering direction, magnitude, and statistical significance of results for each outcome; discrepancies were resolved via discussion. Risk of bias was assessed using ROBINS-E and ROB 2.0. Certainty of evidence was assessed with GRADE.

Eighteen articles from 5 short-term (12-16 weeks) randomized controlled trials (RCTs) conducted in Northern Europe and 9 prospective cohort studies (PCSs) conducted in various countries were included. The evidence suggested a relationship between higher seafood consumption and improved cognitive development outcomes for children and adolescents aged 0-18 years old (GRADE: low). This conclusion was informed by 5 short-term RCTs in which children aged 10 months to 15 years were provided fatty fish vs meat, poultry, or fish oil supplements. These RCTs were largely supported by results from 5 longer-term PCS. Evidence was inconsistent for behavior outcomes and was lacking for other outcomes.

Seafood consumption within current recommended intake amounts consumed mainly as fatty fish likely improves cognitive development outcomes in children and adolescents. REGISTRY AND REGISTRY NUMBER FOR SYSTEMATIC REVIEWS OR META-ANALYSES: PROSPERO: CRD42023432844.

Consuming seafood within current recommended intake amounts as mainly fatty fish likely improves cognitive development outcomes in children and adolescents. Seafood intake for all individuals in the US, including children and adolescents, is below current recommendations, thus increasing intake may support better developmental outcomes.

This paper reviews the literature evaluating psychological treatments to improve sleep quality in young adult university students.

Participants (N = 6179) were young adult (aged 18-30 years) university students. Databases (PubMed, PsychInfo, EMBASE and Medline) were searched for randomized controlled trials evaluating psychological treatments for sleep disturbance in university students. The search date was 20 September 2024.

22 original trials met inclusion criteria. Meta-analysis showed that psychological interventions outperformed control groups (n = 14) on improving sleep quality (g = 0.50, 95%CI:0.26-0.73). There were significantly different effect sizes found between studies that evaluated cognitive behaviour therapy for insomnia (CBT-I; n = 6, g = 0.72, CI: 0.43-1.02) versus studies that evaluated mindfulness interventions (n = 5, g = 0.16, 95% CI: -0.18-0.51).

Psychological treatments improve sleep quality for young adult university students. While CBT-I showed larger effect sizes than interventions focused on mindfulness, further research is needed to verify if this reflects a true difference in the efficacy of the interventions.

To conduct meta-analyses of occupational asbestos exposure and oesophageal, stomach and colorectal cancer risk, including a critical exposure assessment approach.

The search strategy was executed on MEDLINE, Embase, CINAHL, Scopus and Web of Science databases (March 2022, March 2024). Effect estimates (ORs, HRs, standardised incidence ratio and standardised mortality ratio) from eligible cohort and case-control studies were combined in random effects models. Meta-relative risks (mRRs) were calculated by cancer site and exposure characteristics. Investigators with occupational epidemiology and hygiene expertise came to a consensus on the estimates where there was confidence in significant asbestos exposure.

A total of 82 (oesophageal), 153 (stomach) and 144 (colorectal) papers met the inclusion criteria. Elevated mRRs were observed for any occupational asbestos exposure for oesophageal (1.17 (95% CI 1.07 to 1.29)), stomach (1.14 (95% CI 1.05 to 1.23)) and colorectal cancer (1.16 (95% CI 1.08 to 1.24)). There was consistency of mRR estimates and higher mRRs in meta-analyses where there was increased confidence in the categorisation of highly exposed workers, including among the highest exposed workers in exposure-response studies (oesophageal: 1.63 (95% CI 1.29 to 2.06); stomach: 1.28 (95% CI 1.09 to 1.52); colorectal: 1.29 (95% CI 1.09 to 1.53)), among asbestos insulation workers (oesophageal: 1.68 (95% 1.19 to 2.36); stomach: 1.53 (95% 0.93 to 2.51); colorectal: 1.59 (95% 1.14 to 2.23)) and among workers in cohorts with a twofold or greater risk of asbestos-related lung cancer (oesophageal: 1.40 (95% CI 1.14 to 1.71); stomach: 1.33 (95% CI 1.14 to 1.56); colorectal: 1.47 (95% CI 1.34 to 1.61)).

The meta-analyses support a causal link between occupational asbestos exposure and the risk of oesophageal, stomach and colorectal cancer.

The majority of the Earth's land area is currently occupied by humans. Measuring how terrestrial plants reproduce in these pervasive environments is essential for understanding their long-term viability and their ability to adapt to changing environments.

We conducted hierarchical and phylogenetically independent meta-analyses to assess the overall effects of anthropogenic land-use changes on pollination, and male and female fitness in terrestrial plants.

We found negative global effects of land-use change (i.e. mainly habitat loss and fragmentation) on pollination and on female and male fitness of terrestrial flowering plants. Negative effects were stronger in plants with self-incompatibility systems and in plants pollinated by invertebrates, regardless of life form and sexual expression. Pollination and female fitness of pollination-generalist and pollination-specialist plants were similarly negatively affected by land-use change, whereas male fitness of specialist plants showed no effects.

Our findings indicate that angiosperm populations remaining in fragmented habitats negatively affect pollination, and female and male fitness, which will probably decrease the recruitment, survival and long-term viability of plant populations remaining in fragmented landscapes. We underline the main current gaps of knowledge for future research agendas and call not only for a decrease in the current rates of land-use changes across the world but also to embark on active restoration efforts to increase the area and connectivity of remaining natural habitats.

Fire may favour plant flowering by opening up the vegetation and increasing abiotic resource availability. Increased floral display size can attract more pollinators and increase absolute fruit and seed production immediately after a fire. However, anthropogenic increases in fire frequency may alter these responses. We aim to assess the effects of fire on the pollination and reproductive success of plants at the global scale.

We performed a systematic literature review and meta-analyses to examine overall fire effects as well as different fire parameters on pollination and on plant reproduction. We also explored to what extent the responses vary among pollinators, pollination vectors, plant regeneration strategies, compatibility systems, vegetation types and biomes.

Most studies were conducted in fire-prone ecosystems. Overall, single fires increased pollination and plant reproduction but this effect was overridden by recurrent fires. Floral visitation rates of pollinators were enhanced immediately following a wildfire, and especially in bee-pollinated plants. Fire increased the absolute production of fruits or seeds but not fruit or seed set. The reproductive benefits were mostly observed in wind-pollinated (graminoids), herbaceous and resprouter species. Finally, fire effects on pollination were positively correlated with fire effects on plant reproductive success.

Fire has a central role in pollination and plant sexual reproduction in fire-prone ecosystems. The increase in the absolute production of fruits and seeds suggests that fire benefits to plant reproduction are probably driven by increased abiotic resources and the consequent floral display size. However, reproduction efficiency, as measured by fruit or seed set, does not increase with fire. In contrast, when assessed on the same plant simultaneously, fire effects on pollination are translated into reproduction. Increased fire frequency due to anthropogenic changes can alter the nature of the response to fire.

Several studies have examined performance on the Wechsler batteries in typically developing children and adolescents. In particular, some studies suggest that cognitive functioning may differ between males and females. In this framework, the present study aims to investigate, through a meta-analytical approach, whether there are sex differences in the profiles emerging from the WISC battery in children with a Specific Learning Disability. For this purpose, a systematic search was conducted, resulting in a final selection of 12 published studies which utilized the WISC and included at least one group of SLD children of similar ages. Scores obtained in each scale and subtest of the battery were then examined according to the CHC/WISC-V classification. A series of mixed-effects models were fitted to meta-analyze the data. The results highlight some differences favoring males, and others advantaging females. On the one hand, males exhibited higher performances in crystallized intelligence, visual processing, and quantitative knowledge. On the other hand, females showed better performance in short-term memory and processing speed. Nevertheless, no differences in fluid reasoning emerged, which probably did not prompt differences in overall intellectual functioning. From a practical and implications point of view, understanding sex-specific differences seems to be of pivotal importance, since it might trigger the development of ad hoc intervention programs in the clinical and educational context.

DnaJ heat shock protein family member C5 beta (DNAJC5B), also known as cysteine-string protein beta, exhibits a prominent expression in testicular tissue and plays an important role in acrosomal exocytosis in vitro. Nevertheless, the precise role and underlying mechanism of DNAJC5B in spermatogenesis and male fertility remain poorly understood. The meta-analysis of RNA-sequencing datasets from porcine and murine testes reveals that Dnajc5b could be a pivotal factor in spermatogenesis. This study illustrates that male fertility declines with an increased ratio of abnormal spermatozoa in germ-cell knockout Dnajc5b mice. DNAJC5B has been identified as a mitochondrial protein with high expression in spermatids. The absence of DNAJC5B induces a cascade of mitochondrial damages, including oxidative stress, mitochondrial stress in the testes, and lower mitochondrial membrane potential of spermatozoa. In vivo and in vitro evidence demonstrates that DNAJC5B mitigates excessive cellular autophagy and mitophagy via DNAJ domain under environmental stress conditions, such as starvation or exposure to mitochondrial uncouplers FCCP and CCCP. This study highlights the important role of DNAJC5B in safeguarding male fertility by preserving mitochondrial function and regulating autophagy during spermiogenesis.

Non-invasive brain stimulation (NIBS) is an emerging treatment for mental disorders that is painlessness and easy to administer. However, its effectiveness for modulating fear extinction requires further elucidation. We searched eight bibliographical databases and identified randomized controlled trials of NIBS and fear extinction in healthy populations. Outcomes were evaluated based on skin conductance responses (SCRs) under three experimental stimuli: threat condition stimulation (CS+), safe condition stimulation (CS-), and their discrimination (CS+ minus CS-). We applied a random-effects model to determine effect sizes (Hedge's g) post-stimulation and assessed article quality using Physiotherapy evidence database (PEDro) scale. Twenty-one studies meeting systematic review criteria were included in this analysis, incorporating 40 independent effect sizes and data from 11 studies (n = 632) in the meta-analysis. Compared with the control group, SCRs in CS+ and discrimination were significantly reducted in the intervention group. Fear extinction was more effective in the 24-h test than immediately after NIBS. In conclusion, NIBS enhanced fear extinction, and the time interval between stimulation and testing may serve as a moderating variable.

Accurate management of acute nasoseptal fractures can mitigate cosmetic and functional complications. There is a lack of consensus on the ideal approach to manage acute nasoseptal fractures, which are often addressed with closed nasal and/or septal reduction (CN/SR) but sometimes addressed using an open approach with septoplasty. We aimed to systematically assess and compare outcomes of CN/SR versus open approaches to treat acute nasoseptal fractures.

PubMed, Scopus, and CINAHL.

Studies evaluating outcomes of adults with acute nasoseptal fractures treated within 3 weeks of injury with either CN/SR or open approach were included. Meta-analysis was performed to examine the pooled frequency of complications including persistent obstruction, cosmetic deformity, and need for revision surgery.

Of 1630 unique articles identified, 27 were included (63% retrospective, 29.6% prospective, 7.4% randomized controlled trial). Data included 1117 patients (n = 712 CN/SR, n = 423 open approach), with a mean age of 30.5 years. Patients who underwent CN/SR only were more likely to experience persistent obstruction compared to patients who underwent open approach (22.2% [95% confidence interval, CI, 8.7%-39.5%] vs 5.9% [95% CI, 2.4%-10.7%], P < .0001). Patients who underwent CN/SR were more likely to require revision surgery within 3 years (30.9% [95% CI, 15.8%-48.4%] vs 6.0% [95% CI, 3.3%-9.9%], P < .0001.

Patients with nasoseptal fractures who underwent open septoplasty in the acute period were less likely to experience complications. Prospective trials are needed to confirm results of this meta-analysis.

The poultry population is an integral part of Ethiopia's Gross Domestic Product (GDP) but, due to various infectious diseases such as infectious bursal disease (IBD), the expected economic impact in the country remains limited. The status of the disease in Ethiopia is obscured; thus, a systematic review and meta-analysis were employed to estimate the overall pooled prevalence of IBD in Ethiopia. Meta-analysis was conducted to determine the effects of each identified risk factor, while meta-regression and sub-group analysis were employed to assess the relationship between study-level covariates and effect size. The pooled prevalence of IBD in Ethiopia was 69.4% (95% CI 30.7-96.2), while the pooled logit prevalence was 0.94 (95% CI: 0.68-1.20) with significant inter-study variance (Q test = 948.28, df = 43, P < 0.001; τ2 = 0.71, I2 = 95.47%). A small-study effect was detected in the regression-based Egger test (Prob > |z| < 0.0001). Significant variation was observed among different groups such as sex, age, breed, and type of farm of the chickens. The effect size for the study period from 2018 to 2021 was significantly lower by -0.204 compared to the study period from 2009 to 2015 (P < 0.0001. In conclusion, the IBD pooled prevalence estimate is high, even though the number of studies in the country is insufficient. The high prevalence of the disease requires prompt attention from all stakeholders in the sector to bring it under control through comprehensive disease prevention and control intervention strategies.

Zoos and aquariums are well placed to connect visitors with the issues facing biodiversity globally and many deliver interventions that seek to influence visitors' beliefs and behaviors with respect to conservation. However, despite primary studies evaluating the effect of such interventions, the overall effect of engaging with zoos and the factors that influence this effect remain unclear. We conducted a systematic review to investigate the effect of zoo-led interventions on knowledge, beliefs (attitudes, intentions, self-efficacy, and social norms), and behavior among zoo visitors. These outcomes were identified using the Theory of Planned Behavior as a theoretical lens. We identified and described the nature of zoo-led interventions in 56 studies and used the behavior change technique (BCT) taxonomy to identify 6 specific BCTs used in interventions to date. Multilevel meta-analyses revealed a small to medium positive effect of engaging with zoo-led interventions on outcomes (d+ = 0.40, 95% confidence interval = 0.28-0.51). Specifically, visitors were more knowledgeable about conservation issues, held more favorable attitudes toward conservation, and reported being more likely to act for the benefit of biodiversity. No evidence of publication bias was present. Effect sizes were, however, heterogeneous and subgroup analyses revealed that the nature of the intervention or type of outcome did not explain this variance. Larger effects were, however, found in studies conducted at a single institution relative to research at multiple institutions and studies that used within-participant designs relative to between-participant designs. Taken together, these findings demonstrate how behavior change frameworks can be used to describe zoo-led interventions and supports the assertion that zoos and aquariums can promote changes in beliefs and behaviors that may help protect biodiversity.

Primary progressive aphasias (PPA) represent a group of neurodegenerative conditions affecting verbal communication abilities for which no effective medication is currently available. Noninvasive brain stimulation (NiBS) has been mainly explored as adjunctive therapy to conventional speech and language therapy (SLT) with promising results. The present meta-analysis of randomized-controlled trials (RCTs) aims to evaluate the efficacy of NiBS in PPA patients on a range of linguistic tasks (naming, phonemic fluency, semantic fluency). A literature search was carried out using EMBASE and PUBMED, searching for multi-session RCTs administering NiBS on PPA patients as stand-alone or with SLT. The results were not significant overall, indicating a null difference between the active and the sham condition on language functions; pooled effects tended to be higher in parallel than in crossover studies and for follow-ups than post-treatment. In the naming analyses, the combined effects for the studies that coupled NiBS with SLT were slightly higher than the overall effect at each time point, although not significant. These results need to be considered with caution given the low number of included studies and small sample sizes, but offer relevant indications for future research in terms of optimal treatment protocols and personalization of therapies.

Tobacco use spreads through social networks influencing social norms around tobacco use. However, the social norms scholarship is extremely diverse and occasionally conflicting, complicating efforts to understand how best to leverage social norms to reduce tobacco use. This study systematically reviewed and meta-analyzed this vast terrain by focusing on social norms measurement and mechanism, and intervention effectiveness and modality aimed at changing social norms around tobacco use and actual tobacco use.

We searched Scopus, PubMed, PsycInfo, Clinicaltrials.gov, ProQuest Dissertations, the Cochrane Trial Registry, as well as the websites of the Society for Research on Nicotine and Tobacco, the Open Science Framework, medrXiv and the Truth Initiative for experimental and quasi-experimental evaluation studies of interventions designed to shift tobacco use. We included studies written in English from inception to 30 May 2024. We only included studies which noted social norms or social influence as part of the intervention design or set of measured variables. We excluded studies with only one time point, without an intervention being evaluated and those not published in English. Study screening followed the PRISMA 2020 guidelines, and was conducted by at least two independent reviewers who resolved discrepancies through discussion and consensus. All included studies were analyzed in a narrative synthesis, and those providing sufficient statistics for tobacco and social norms outcomes were included in meta-analyses, which were performed separately for tobacco outcomes and social norms outcomes. Study outcomes were transformed into a standardized mean difference (Hedges' g) and several meta-regressions were fit to explore sources of heterogeneity using a robust variance estimation specification to handle effect size dependency.

A total of 95 studies met inclusion criteria for the narrative synthesis, 200 effect sizes from 86 studies were included in the tobacco outcomes meta-analysis, and 66 effect sizes from 29 studies were included in the social norms outcomes meta-analysis. Nearly 90% of included studies were conducted in high-income settings, with the remainder conducted in middle-income settings. No studies were conducted in Latin America or on the African continent. Social norms change interventions had a statistically significant effect on reducing tobacco use and pro-tobacco social normative perceptions [g = 0.233, 95% confidence interval (CI) = 0.166, 0.301, P < 0.001 and g = 0.292, 95% CI = 0.090, 0.494, P = 0.007, respectively]. Interventions were commonly conducted among schoolchildren in classrooms through multicomponent education sessions, often coupled with regular 'booster' sessions over time. Among adult populations, motivational interviewing and other counselling approaches were used in some cases, and few interventions leveraged digital technologies to change social norms.

Social norms change interventions appear to be effective for reducing tobacco use and pro-tobacco social normative perceptions. In particular, leveraging role models appears to be the most effective social norms change mechanisms for tobacco control.

The pathophysiology of optic disc drusen (ODD) has long been discussed. According to one leading theory, they develop from calcified mitochondria extruded from axons compressed by an unusually small scleral canal. To examine this hypothesis, we conducted a systematic review and meta-analysis evaluating the scleral canal size in patients with ODD (PO) in comparison to healthy subjects (HS). We searched MEDLINE, Cochrane Central, EMBASE and gray literature to identify relevant articles. A subgroup analysis compared patients with buried ODD (POb) and patients with visible ODD (POv). The study was registered with the International Prospective Register of Systematic Reviews on December 9th, 2022 (Registration: CRD42022375110). We included fifteen articles in the review and fourteen in the meta-analysis. The mean diameter of the scleral canal computed using both fundus photography (DF) and spectral-domain with enhanced depth imaging optical coherence tomography (DO-EDI) was significantly smaller in PO compared to HS (standardized mean difference -1.21 [-1.85 to -0.56] and -0.66 [-0.94 to -0.37] respectively). DO-EDI, but not DF, was higher in POv as compared to POb. When including all-generation OCT in the analysis, the difference between POv and POb, but not between PO and HS, remained. Several intertwined hypotheses can explain these subgroup and sensitivity results: an enlargement of the canal as the ODD grow, an enlargement with time, or a measurement bias (artefactual enlargement of the canal due to a posterior shadow on OCT). In conclusion, this review and meta-analysis further supports the role of a small scleral canal in the development of ODD.

Understanding the functional outcomes achieved with new enhanced monofocal intraocular lenses (IOLs) is crucial for adequately managing patient expectations. This study evaluated visual and patient-reported outcomes of an enhanced range of field IOL versus other monofocal IOLs in cataract patients. A systematic review and meta-analysis, pre-registered on PROSPERO (CRD42024561611), included studies from Medline (PubMed), Embase (Ovid), and trial registries (2019-2024) focused on binocular cataract surgeries with various IOL models. Primary outcomes assessed were monocular distance-corrected visual acuities (CDVA, DCIVA, DCNVA), defocus curves, and contrast sensitivity; secondary measures included binocular visual acuities and patient-reported outcomes such as spectacle independence and photic phenomena. Out of 31 studies (8 randomized clinical trials, 23 case series), high-certainty evidence indicated no significant difference in CDVA between enhanced and conventional IOLs. However, enhanced IOLs demonstrated better intermediate (DCIVA: -0.11 logMAR, CI 95%: -0.13 to -0.10) and near (DCNVA: -0.12 logMAR, CI 95%: -0.17 to -0.07) visual acuities, supported by defocus curves, though with lower-certainty evidence. No significant differences were observed in contrast sensitivity or photic phenomena, and evidence for positive dysphotopsia was moderate to low. Enhanced IOLs significantly favored intermediate-distance spectacle independence, with an odds ratio of 7.85 (CI 95%: 4.08-15.09), though no differences were observed for distance spectacle independence. Near-distance spectacle independence also favored enhanced IOLs, though with low-certainty evidence. In summary, enhanced IOLs provide improved intermediate and near visual acuities compared to conventional monofocal IOLs, though further studies are needed to confirm outcomes in contrast sensitivity and patient-reported outcomes across various enhanced monofocal IOLs.

Neurotrauma is the leading cause of death in individuals <45 years old. Many of the published articles on UCHL1 and GFAP lack rigorous methods and reporting.

Due to the high heterogeneity between studies, we evaluated blood GFAP and UCHL1 levels in the same subjects. We determined the biomarker congruence among areas under the ROC curves (AUCs), sensitivities, specificities, and laboratory values in ng/L to avoid spurious results. The definitive meta-analysis included 1,880 subjects in eight studies. The items with the highest risk of bias were as follows: cut-off not prespecified and case-control design not avoided. The AUC of GFAP was greater than the AUC of UCHL1, with a lower prediction interval (PI) limit of 50.1 % for GFAP and 37.3 % for UCHL1, and a significantly greater percentage of GFAP Sp. The PI of laboratory results for GFAP and UCHL1 were 0.517-7,518 ng/L (diseased), 1.2-255 ng/L (nondiseased), and 3-4,180 vs. 3.2-1,297 ng/L, respectively.

Only the GFAP positive cut-off (255 ng/L) appears to be reliable. The negative COs appear unreliable.

GFAP needs better standardization. However, the AUCs of the phospho-Tau and phospho-Tau/Tau proteins resulted not significantly lower than AUC of GFAP, but this result needs further verifications.

Desert dust and sandstorms raise concerns about their adverse effects on human health. Over the last decade, special attention has been given to mineral dust particles from desert sand. However, evidence from previous literature reviews has yielded inconclusive results regarding their health effects. We aim to systematically synthesize evidence on the short-term health effects of desert dust exposure from major dust source areas.

The bibliographic search was conducted using the MEDLINE (PubMed), Scopus, and Web of Science databases to investigate the health effects of short-term exposure to desert dust in human populations, using time series or case-crossover study designs. Study selection and reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We evaluated the risk of bias (RoB) for individual studies and the certainty of evidence (CoE) for environmental exposures, as developed by a group of experts convened by the World Health Organization (WHO). Publication bias was examined using funnel plots and Begg's asymmetry test.

A total of 71 studies were included in the review, covering data from 1993 to 2024. Most studies focused on Asian and African desert dust, with fewer studies from Arabian, American, and Australian regions. We found a significant increase in the risk for all-cause mortality (Relative Risk, RR = 1.0121, 95 %CI = [1.0045, 1.0199]). In addition, the mortality risk associated with particulate matter less than 10 μm (PM10) was slightly higher on dust days compared to non-dust days, while for particulate matter less than 2.5 μm (PM2.5), the risk was higher on non-dust days. We also observed a significant increase in the risk for cardiovascular mortality (RR = 1.0252, 95 % CI = [1.0100, 1.0407]) during dust days compared to non-dust days, but not for respiratory mortality (RR = 1.0001, 95 % CI = [0.9773, 1.0277]). The risk also increased for cardiovascular (RR = 1.0094, 95 % CI = [1.0014, 1.0174]) and respiratory morbidity (RR = 1.0693, 95 % CI = [1.0188, 1.1224]).

Exposure to desert dust and sandstorms is linked to increased risks of all-cause and cardiovascular mortality, as well as respiratory morbidity. The overall evidence quality for each exposure-outcome combination was assessed as moderate, although data limitations prevent the establishment of specific air quality thresholds for desert dust particles. This review highlights the need for targeted public health interventions in affected regions.

This systematic review aimed to verify whether anatomic, semi-anatomic, or nonanatomic occlusal morphology of artificial teeth improves the masticatory function of complete or removable partial denture wearers.

According to the PICO strategy, six databases and the grey literature were searched to identify randomized (RCT) and non-randomized clinical trials (N-RCT) comparing masticatory function, in terms of masticatory performance and efficiency, and muscle activity as primary outcomes; and patient-reported results (O) in individuals using removable dentures (P) with different occlusal morphologies of artificial teeth (I/C). Masticatory ability, satisfaction with the prosthetic treatment, and oral health-related quality of life (OHRQoL) were evaluated as secondary outcomes. Risk of bias was assessed using the Cochrane risk-of-bias tool for randomized trials (RoB 2.0) for RCT and Risk of Bias for non-randomized studies with intervention (ROBINS-I) for N-RCT studies. Meta-analyses were performed to compare primary outcomes and masticatory ability between the occlusal morphologies of artificial teeth of complete or removable partial dentures (α = 0.05). Certainty of the evidence was verified using the GRADE approach.

Eleven studies (seven RCTs and four N-RCTs) were included. The risk of bias was considered low for two studies, some concerns for five, and high for the last four studies. Meta-analyses showed that removable partial dentures with anatomic artificial teeth improved masticatory efficiency for carrot chewing (MD 6.31; 95% CI [3.39, 9.22], I2 = 0%). However, masseter and temporal muscle activities increased when removable partial dentures with nonanatomic teeth were used (MD -756.97; 95% CI [-892.25, -621.68], I2 = 100%). Masticatory ability was not influenced by occlusal morphology during chewing of all foods in complete denture users: Carrot (MD -0.88, 95% CI [-8.98, 7.23], I2 = 57%); sausage (MD -8.86, 95% CI [-23.05, 5.33], I2 = 71%); apple (MD -5.78, 95% CI [-28.82, 17.26], I2 = 87%); and cheese (MD -4.16, 95% CI [-15.14, 6.82], I2 = 62%). The certainty of evidence for all evaluated outcomes was very low, mainly due to very serious problems found in the parameters of inconsistency, indirectness, and imprecision.

Despite the very low certainty of evidence, the occlusal morphology of artificial teeth influences masticatory function. Anatomic teeth improved the masticatory efficiency and muscle activity of removable partial denture wearers. Nonanatomic teeth increased temporal and masseter muscle activity, which negatively affected chewing in removable partial denture users. However, patients using complete dentures with anatomic and semi-anatomic teeth presented similar masticatory ability.

Walled-off necrosis (WON) is a potentially fatal condition best treated endoscopically with metal or plastic stents. This study compares the clinical outcomes of these stents.

PubMed and Cochrane were searched for trials comparing metal and plastic stents for WON. Primary outcomes were clinical and technical success.

Seven studies with 230 metal stent patients and 226 plastic stent patients were included. Metal stents showed significantly shorter procedure times (SMD -0.80, 95% CI: -1.25 to -0.34), better 4-week clinical success (OR 1.94, 95% CI: 1.00 to 3.77), and higher procedure costs (SMD 1.38, 95% CI: 0.56 to 2.20). No significant differences were observed in hospital stay (SMD -0.05, 95% CI: -0.35 to 0.25), technical success (OR 1.45, 95% CI: 0.22 to 9.43), clinical success (OR 1.13, 95% CI: 0.54 to 2.39), interventions (SMD -0.02, 95% CI: -0.34 to 0.29), need for necrosectomy (RR 1.10, 95% CI: 0.59 to 2.04), necrosectomy sessions (SMD 0.35, 95% CI: -0.42 to 1.11), need for percutaneous drainage (RR 0.82, 95% CI: 0.36 to 1.85), stent migration (RR 0.88, 95% CI: 0.29 to 2.66), bleeding (RR 0.97, 95% CI: 0.53 to 1.75), WON recurrence (RR 1.66, 95% CI: 0.70 to 3.92), treatment failure (death) (RR 0.75, 95% CI: 0.37 to 1.53), disconnected pancreatic duct (RR 0.93, 95% CI: 0.79 to 1.11), and total cost (SMD -0.02, 95% CI: -0.29 to 0.26).

Metal stents offer shorter procedure time and better 4-week clinical success, although at a higher cost, with most clinical outcomes showing no significant differences between stent types.

To develop a systematic review with meta-analysis to summarize the effectiveness of exercise, regular physical activity, and mind-body exercise on harmful exercise habits, psychological factors, and quality of life in people clinically diagnosed with feeding and eating disorders.

Randomized clinical trials and pilot randomized clinical trials were considered.

Twelve studies were included. No studies evaluated athletes. No studies examined regular physical activity as the targeted intervention. Quality of life could not be meta-analyzed. Overall, meta-analyses showed that exercise or mind-body exercise was not more effective than controls in reducing depression symptoms, harmful exercise habits, eating behaviors, or emotional regulation skills. However, important methodological and clinical issues were detected in the included studies. This affected the certainty of evidence of the meta-analyzed outcomes which ranged from low to very low. No studies reported in sufficient detail their interventions to be replicated.

Overall, exercise and mind-body exercise may be ineffective in improving meta-analyzed outcomes. However, the certainty of evidence ranged from low to very low and the body of knowledge in this field needs to be increased to reach robust conclusions.

Pornography is one of the most popular forms of media and pornography research is common in high impact sexological journals. Many studies on U.S. adults' pornography consumption have utilized the National Science Foundation funded General Social Survey (GSS), which has provided nationally representative publicly available data since the early 1970s; however, there are multiple reasons to question the validity and predictive capacity of the GSS's traditional pornography measure. The present study compared the traditional GSS pornography measure with a new, experimental GSS pornography measure following the methodology of an early study of adult U.S. women's pornography use published in this journal. The results supported the validity and predictive capacity of the traditional GSS measure while simultaneously suggesting the superiority of the GSS's new measure. Implications for the GSS and pornography measurement beyond the GSS are discussed.

The World Health Organization (WHO) and the International Labour Organization (ILO) are the producers of the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury (WHO/ILO Joint Estimates). The WHO International Agency for Research on Cancer has classified welding fumes as carcinogenic to humans (Group 1). A previous systematic review and meta-analysis from the WHO/ILO Joint Estimates reported that there was "sufficient evidence of harmfulness" that compared with no (or low) occupational exposure to welding fumes, any (or high) occupational exposure to welding fumes increased the risk of developing trachea, bronchus, and lung cancer. It concluded that WHO/ILO Joint Estimates could be produced of the attributable burden of trachea, bronchus, and lung cancer. However, occupational exposure to welding fumes must be considered in greater detail, as there may be differences in risk between those with regular occupational exposure to welding fumes and those with occasional occupational exposure, the latter of which has previously been estimated to be highly prevalent. Regular and occasional occupational exposure to welding fumes have not previously been considered in a systematic review. Here, we present a supplementary analysis to our previous systematic review and meta-analysis, providing parameters for estimating the number of deaths and disability-adjusted life years from trachea, bronchus, and lung cancer attributable to regular and to occasional occupational exposure to welding fumes, to inform the development of WHO/ILO Joint Estimates of this burden of disease.

We sought to systematically review and meta-analyse estimates of the effect of regular occupational exposure to welding fumes and of occasional occupational exposure to welding fumes, compared with no (or very rare) occupational exposure to welding fumes, on trachea, bronchus, and lung cancer (three outcomes: prevalence, incidence, and mortality).

We developed and published a protocol for our previous systematic review, applying the Navigation Guide as an organizing systematic review framework where feasible. We searched electronic databases for potentially relevant records from published and unpublished studies, including Medline, EMBASE, Web of Science, CENTRAL and CISDOC, up until 27 May 2024. We also searched grey literature databases, internet search engines, and organizational websites; hand-searched reference lists of previous systematic reviews; and consulted additional experts.

We included studies of working-age workers (≥15 years) in the formal and informal economy in any Member State of WHO and/or ILO but excluded studies of children (<15 years) and of unpaid domestic workers. We included randomized controlled trials, cohort studies, case-control studies, and other non-randomized intervention studies with an estimate of the effect of regular and/or occasional occupational exposure to welding fumes, compared with no (or very rare) occupational exposure to welding fumes, on trachea, bronchus, and lung cancer (prevalence, incidence, and mortality).

At least two review authors independently: screened titles and abstracts against the eligibility criteria, screened full texts of potentially eligible records, and extracted data from the included studies. We combined effect estimates using random-effects meta-analysis. Two or more review authors assessed the risk of bias, quality of evidence, and strength of evidence, using the Navigation Guide's tools and approaches adapted to the WHO/ILO Joint Estimates. We conducted subgroup analyses and sensitivity analyses.

Twenty-eight records from 19 studies (17 case control studies and two cohort studies) met the inclusion criteria, comprising over 2.4 million participants (unclear number of females, but N < 4388) and conducted in 17 countries in three WHO Regions (Region of the Americas, European Region, and Western Pacific Region). Across included studies, we judged risk of bias as generally probably low/low, but the risks of selection bias as probably high for several studies and of exposure assessment bias as high for one study. Our search identified no evidence on the outcome of having trachea, bronchus, and lung cancer (prevalence). Compared with no (or very rare) occupational exposure to welding fumes, regular occupational exposure to welding fumes increased the risk of developing trachea, bronchus, and lung cancer (incidence) by an estimated 39% (RR 1.39, 95% confidence interval [CI] 1.15-1.67, 15 studies, 29,785 participants, I2 23%; high quality of evidence), and occasional occupational exposure to welding fumes increased the risk of developing trachea, bronchus, and lung cancer (incidence) by an estimated 16% (RR 1.16, 95% CI 1.06-1.27, 16 studies, 32,838 participants, I2 15%; moderate quality of evidence). Compared with no (or very rare) occupational exposure to welding fumes, regular occupational exposure to welding fumes increased the risk of dying from trachea, bronchus, and lung cancer (mortality) by an estimated 25% (RR 1.25, 95% CI 0.88-1.77, 1 study, 3583 participants; low quality of evidence), and occasional occupational exposure to welding fumes increased the risk of dying from trachea, bronchus, and lung cancer (mortality) by an estimated 31% (RR 1.31, 95% CI 1.07-1.59, 1 study, 4215 participants, low quality of evidence). Subgroup analyses found no evidence for differences by WHO Region and sex. Sensitivity analyses supported the main analyses' findings.

Overall, for incidence of trachea, bronchus, and lung cancer, we judged the existing body of evidence for human data as "sufficient evidence of harmfulness" for both regular and occasional occupational exposure to welding fumes; a positive relationship is observed between exposure and outcome where chance, bias, and confounding can be ruled out with reasonable confidence. For mortality of trachea, bronchus, and lung cancer, we judged the existing body of evidence for human data as "inadequate evidence of harmfulness"; the available evidence is insufficient to assess effects of the exposure. The summary effect estimates presented in this systematic review could be used as input data for the WHO/ILO Joint Estimates to produce estimates of proportions of the working-age population with regular and occasional occupational exposure to welding fumes and the attributable burden of trachea, bronchus, and lung cancer.

The mnemic neglect effect describes a memory phenomenon in which individuals selectively forget negative information that threatens their core self-beliefs. While most studies support this phenomenon, some have shown that individuals do not always neglect self-relevant negative information and may even focus on it more. This study aims to validate the stability of mnemic neglect and explore the factors contributing to its variability under different conditions. This meta-analysis includes 18 studies with 93 independent samples (N = 4,989). The findings reveal: (1) The overall effect size of mnemic neglect is robust, g = 0.365, with a 95% CI [0.253, 0.476], Z = 6.416, p < 0.001; (2) there is a significant difference between recall performance for central and peripheral information, with individuals exhibiting better recall for self-relevant central information; (3) individuals recall fewer self-relevant central negative information compared to other-relevant central negative information; and (4) subgroup analysis indicates significant moderation of the mnemic neglect effect by anxiety levels and two fundamental dimensions of social cognition. This study provides empirical support for the robustness of mnemic neglect and further explores its underlying motivational mechanisms and influencing factors.

Studies evaluating how water, sanitation, and/or handwashing (WASH) interventions in low- and middle-income countries impact diarrheal diseases have shown inconsistent results. The prevalence of enteric pathogen infections and diarrhea are highly seasonal and climate-sensitive, which could explain heterogeneous findings. Understanding how season influences the effectiveness of WASH interventions is critical for informing intervention approaches that will be resistant under the varying weather conditions that climate change will bring.

We conducted a systematic review of the literature and meta-analysis to test whether and to what extent the impact of WASH interventions on diarrhea differs by season. We searched the literature for randomized and nonrandomized controlled WASH intervention trials and identified the season in which data were collected-rainy, dry, or both-for each study using proximate land station weather datasets. We compared the relative risk (RR) estimates for the impact of interventions on diarrhea for each study, stratified by season, and analyzed estimates using meta-analysis and meta-regression. This study is registered with PROSPERO, CRD42021231137.

A total of 50 studies met the inclusion criteria, resulting in 34 drinking water intervention estimates, 8 sanitation intervention estimates, and 14 handwashing intervention estimates. Of the total studies, 60% (n = 30 ) spanned more than one season, with most single-season studies (75%, n = 15 ) occurring exclusively in the dry season. The effect of WASH interventions was stronger in dry seasons than in rainy seasons, with a 33% [95% confidence interval (CI): 24%, 41%] and 18% reduction (95% CI: 5%, 29%) in diarrhea risk, respectively. When stratified by type of intervention, the stronger effect size in dry seasons was consistent for water and handwashing interventions but not for sanitation interventions.

Estimates of the seasonal impact of WASH interventions revealed larger effects in the dry season than in the rainy season overall and for water and handwashing interventions in particular. These patterns likely affected previous estimates of intervention effectiveness, which included more dry season estimates. These findings suggest the need to collect data across seasons and report seasonally stratified results to allow for more accurate estimates of the burden of disease impacted by WASH investments and to improve projections of potential impacts of these interventions under future climate conditions. These findings also underscore the need for robust WASH interventions designed to be resistant to seasonal variations in temperature and rainfall now and under future climate change scenarios. https://doi.org/10.1289/EHP14502.

Adolescence is a vulnerable period for the onset of mental disorders and risk behaviours. Based on the Health-Promoting Schools Framework, whole-school interventions offer a promising strategy in this developmentally-sensitive cohort, through championing a systems-based approach to promotion and prevention that involves the key stakeholders in an adolescent's life. The evidence-base surrounding the effectiveness of whole-school interventions, however, remains inconclusive, partly due to the insufficient number of studies in previous meta-analyses. An updated systematic review and meta-analysis was thus conducted on the effectiveness of whole-school interventions promoting mental health and preventing risk behaviours in adolescence. From 12,897 search results, 28 studies reported in 58 publications were included. Study characteristics and implementation assessments were synthesized across studies, and quality appraisals and meta-analyses performed. Analyses identified a significant reduction in the odds of cyber-bullying by 25%, regular smoking by 31% and cyber-aggression by 37% in intervention participants compared to the control. Whole-school interventions thus offer substantial population health benefits through the reduction of these highly-prevalent issues affecting adolescents. The non-significant findings pertaining to the remaining eleven outcomes, including alcohol use, recreational drug use, anxiety, depression and positive mental health, are likely attributable to suboptimal translation of the Health-Promoting Schools Framework into practice and inadequate sensitivity to adolescents' local developmental needs. Given the ongoing challenges faced in the implementation and evaluation of these complex interventions, this study recommends that future evaluations assess the implementation of health-promoting activities in both intervention and control conditions and actively use this implementation data in the interpretation of evaluation findings.Preregistration: A pre-registered PROSPERO protocol (ID: CRD42023491619) informed this study.

Patients with life-limiting conditions are often cared for at home by family, typically without adequate training to carry out the challenging tasks performed. This systematic review assessed the efficacy of interventions designed to help family caregivers manage pain and other symptoms in adults and children with life-limiting conditions at home.

A systematic search was performed on seven databases. A narrative synthesis was conducted, along with a meta-analysis comparing outcomes in those who received an intervention to those who did not, or to preintervention scores.

84 eligible studies were identified. Significant improvements in pain and fatigue in patients with cancer were found compared with patients in the control group and baseline. Caregivers of patients with cancer receiving an intervention, compared with the control group caregivers, showed significant improvements in self-efficacy and active coping and lower avoidant coping. This group also showed significant improvements in burden, self-efficacy, anxiety and depression, and decreases in avoidant coping pre- to post intervention. Patients with dementia whose caregivers received an intervention showed significantly reduced pain intensity and improvements in quality of life pre- to post intervention. Caregivers of patients with dementia showed significantly reduced distress pre- to post intervention. No beneficial effects were found for caregivers of patients with Parkinson's disease or heart failure, although only limited analyses could be performed.

Interventions targeting family caregivers can improve both patient symptoms and caregiver outcomes, as demonstrated in cancer and dementia care. Future mixed-methods research should collect data from caregiver and patient dyads, identifying key intervention components. There is also need for more studies on caregivers of paediatric patients.

Time spent in nature leads to significant physical and mental benefits, but research is mixed on how much time in nature is necessary to affect change in adults' mental health. This meta-analysis aimed to answer the question: what effect does length and interval of nature dosage have on adults with mental illness? The authors defined nature exposure as an experience in nature lasting at least 10 minutes and taking place in an actual natural setting. Because some studies indicated single experiences of exposure to nature (one-time) while others utilized multiple exposures to nature (interval), these studies were separated to determine differences between one-time versus interval exposure to nature. Following Cochrane Handbook for Systematic Reviews of Interventions and PRISMA reporting guidelines, this review included 78 studies published between 1990 and 2020. The present study found that one-time and interval nature exposure yielded different results for adults with a diagnosed mental illness and adults with symptoms of mental illness. Notably, shorter nature exposure delivered in intervals appeared to show positive significant effects, even more than one-time exposure. This finding has important implications for public health and green space preservation, as being outside for as little as 10 minutes and even in urban nature can improve adults' mental health.

Artificial oocyte activation (AOA) is used to improve fertilisation rates in intracytoplasmic sperm injection (ICSI) cycles.

To assess the effectiveness of AOA on fertilisation, embryo development, and clinical outcomes, including live birth.

We searched PubMed, Cochrane, and Scopus from January 1990 to March 2024 using terms related to 'artificial oocyte activation' and 'ICSI.'

Study designs included randomised trials (RCTs), quasi-experimental, cohort, and case-control studies that evaluated AOA's effects on ICSI outcomes, provided quantitative data and were published in English.

Reviewers independently performed data extraction using a standardised form. Study quality was appraised using Joanna Briggs Institute (JBI) Checklists. Meta-analyses employed a random-effects model, and evidence was classified using a comprehensive numerical framework.

We included 45 studies covering 56 787 mature oocytes, 7463 women for clinical pregnancies, and 7063 women for live births. AOA showed potential in increasing fertilisation rates in patients with a history of low or absent fertilisation but did not enhance embryo development or clinical outcomes. This effect diminished when excluding low-quality studies or focusing solely on RCTs. In other patient groups, AOA showed limited or nonsignificant benefits.

Applying comprehensive evidence assessment, AOA showed potential in improving fertilisation rates in patients with fertilisation problems but no benefits for embryo development or live birth rates. This underscores the critical importance of rigorous evidence credibility in informing clinical practice in assisted conception.

Antimicrobial resistance (AMR) is a major global health concern. One of the most important causes of AMR is the excessive and inappropriate use of antimicrobial drugs in healthcare and community settings. Most countries have policies that require antimicrobial drugs to be obtained from a pharmacy by prescription. The term 'non-prescription antimicrobial sale' refers to the dispensing and selling of antimicrobial drugs without a prescription in countries where the pharmaceutical policy does not permit the sale of antimicrobial drugs without a prescription. Pharmacies, drugstores, and other medicine outlets are major sources of non-prescription antimicrobial sales in the community setting.

To assess the effects of interventions for reducing non-prescription antimicrobial sales by pharmacists and non-pharmacists in community pharmacies, drugstores, and other medicine outlets. To assess whether the effects of interventions differ according to types of interventions (single or multicomponent), community pharmacy personnel (pharmacists or non-pharmacists), and countries (low to lower-middle-income and upper-middle to high income).

We searched five databases, including CENTRAL, MEDLINE, and Embase, and two trial registers to 26 September 2022. We also conducted reference checking and citation searches.

We included randomized trials, cluster-randomized trials, and quasi-randomized trials evaluating interventions targeted at pharmacists and non-pharmacists in community pharmacies, drugstores, and other medicine outlets. Our primary outcomes were non-prescription antimicrobial sales, symptomatic or asymptomatic infections caused by antimicrobial-resistant pathogens among pharmacy clients or community residents, and adverse events associated with non-prescription antimicrobial drug use in pharmacy clients. Our secondary outcomes were history taking and provision of advice to pharmacy clients, and knowledge of pharmacists and non-pharmacists.

We followed standard Cochrane methods.

We included four trials conducted in pharmacies and drugstores. Three studies were published between 2000 and 2010, and the fourth in 2016. In total, 942 community pharmacies and drugstores participated, including both pharmacists and non-pharmacists. One study conducted in Scotland was a four-arm trial that included educational outreach visits, continuing professional education, and a combination of both as interventions, in comparison to a control group supplied with guideline materials only. Two studies conducted in Portugal and Uganda compared the combination of training and distribution of written materials with a control of no intervention. One study conducted in Thailand and Vietnam compared a sequence of three interventions (regulatory enforcement, education, and peer-monitoring) with a control of no intervention. Only non-prescription antimicrobial sales, history taking and provision of advice to pharmacy clients, and knowledge of pharmacists and non-pharmacists were assessed in the included studies; no study assessed other outcomes. We judged the overall risk of bias for non-prescription antimicrobial sales to be high risk and for the other two outcomes to be some concerns. One study conducted in Scotland assessed single-component interventions (in two intervention arms) versus a control of written guidelines, and reported one primary outcome and one secondary outcome. Non-prescription antimicrobial sales: the study reported the sale or non-sale of antifungal drugs according to simulated patient scenarios. It did not report any differences between the intervention and control groups for the scenarios in which antifungal drugs should not have been sold without a prescription. The certainty of evidence for this outcome was very low. Knowledge of pharmacists and non-pharmacists: the study reported knowledge scores at baseline and follow-up, but did not compare the scores between two single-component intervention arms and the control arm at both time points. Four studies assessed multicomponent interventions versus a control of written guidelines or no intervention, and reported one primary outcome and two secondary outcomes. Non-prescription antimicrobial sales:two studies conducted in Uganda, Thailand, and Vietnam involving 337 randomized community pharmacies and drugstores reported the proportion of non-prescription antimicrobial sales to the total number of requests using a simulated client method. Based on vote counting, both studies favored the intervention, that is multicomponent interventions reduced the sales of non-prescription antimicrobial drugs by pharmacists and non-pharmacists. The information in the other two studies was inadequate to address this primary outcome. One study in Portugal reported that total antibiotic consumption at the municipal level (comprising both prescribed and non-prescribed antibiotic sales) was reduced after a multicomponent intervention. The study conducted in Scotland assessed a multicomponent intervention (in one intervention arm) and reported the sale or non-sale of antifungal drugs according to simulated patient scenarios. It did not report any differences between the intervention and control groups for the scenarios in which antifungal drugs should not have been sold without a prescription. The certainty of evidence for this outcome was very low. History taking and provision of advice to pharmacy clients:two studies conducted in Uganda, Thailand, and Vietnam reported this outcome. In Thailand and Vietnam, there was an improvement in the practices of pharmacists and non-pharmacists in the intervention groups, while Uganda reported a paradoxical decline. Knowledge of pharmacists and non-pharmacists:the study conducted in Scotland reported knowledge scores at baseline and follow-up, but did not compare the scores between the multicomponent intervention arm and control arm at both time points.

No firm conclusions can be drawn about the effects of single-component interventions due to limited evidence. Multicomponent interventions may not reduce the sales of non-prescription antimicrobial drugs in community pharmacies, drugstores, and other medicine outlets; however, the evidence is of very low certainty. Further studies on this topic are needed, particularly to assess the effects of important single interventions such as improving pharmaceutical policies.

The digital shift in higher education is moving from teacher-focused models to active learning with digital technologies, including the integration of game-based learning strategies. We aim to identify, assess, and summarize the findings of evidence and determine the effectiveness of game-thinking on learning outcomes in nursing education.

A comprehensive search for relevant literature was conducted between April and May 2022 Seven databases ERIC, Scopus, ProQuest Education Source, MEDLINE, CINAHL, Web of Science, and Embase were utilized to locate original, peer-reviewed papers published in English. The review was conducted and reported in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines.

Overall, 3302 studies were initially screened based on their titles and abstract. From this selection 281 studies were then assessed for full-text eligibility. In the end, 70 studies, consisting of 27 Randomized Controlled Trials (RCTs) and 43 Quasi-experimental studies were included in the review. These studies encompassed data from a total of 8348 participants. The results from the narrative synthesis of the results revealed consistencies across the included studies and their findings. The meta-analysis suggested that game-thinking could be beneficial in nursing education, notably improving students' academic achievement (Pooled ES = 0.99, [95%CI 0.53, 1.44]). The most significant effect of game-thinking on academic achievement was observed in the academic knowledge performance of nursing students (Pooled ES = 1.06, [95%CI 0.55, 1.57]), followed by academic skill performance (Pooled ES = 0.54, [95%CI 0.06, 1.03]).

The systematic review and meta-analysis provide evidence supporting the effectiveness of game-thinking in nursing education. The findings highlight the potential of game-based learning in enhancing nursing education through knowledge acquisition, albeit with a nuanced effect on skill development. As nursing education continues to adapt to the digital era, integration of game-thinking strategies could serve as a valuable method for creating engaging and effective learning experiences for nursing students.

Bacterial gastroenteritis is a significant public health concern, capable of causing severe infections. Among the various pathogens involved, those belonging to the Enterobacteriaceae family are the most frequently isolated and associated with gastrointestinal disorders. This study aimed to investigate the prevalence of common diarrheagenic Enterobacteriaceae in Iran over the past two decades, from 2000 to 2023.

A comprehensive systematic search was conducted across multiple databases, including EMBASE, HINARI, MEDLINE, PubMed, Google Scholar, and the Cochrane Library. The focus was on observational published studies reporting the prevalence of diarrheagenic Enterobacteriaceae in Iran during 2000 and 2023. The criteria did not restrict patient demographics such as age, gender, health conditions, or occupation. This meta-analysis employed a 95% confidence interval (CI) for analysis. Evidence of heterogeneity was determined using an I² value greater than 50%. To explore potential sources of heterogeneity, subgroup analysis and meta-regression analysis were performed. Statistical analyses were executed using R version 4.3.2 along with the meta package. A p-value less than 0.05 was considered statistically significant.

Out of 3,701 papers reviewed, 56 studies met the inclusion criteria and were analyzed. The overall pooled prevalence of diarrheagenic Enterobacteriaceae species from 2000 to 2023 was 14.0% (95% CI: 0.11-0.17). Subgroup analysis revealed Shigella spp. had the highest prevalence at 18.0% (95% CI: 0.13-0.24; I²=99%), followed by diarrheagenic Escherichia coli at 11.0% (95% CI: 0.09-0.15; I²=97%), Salmonella spp. at 9.0% (95% CI: 0.05-0.17; I²=99%), and Yersinia spp. at 2.0% (95% CI: 0.00-0.10; I²=94%). Prevalence trends showed Shigella spp. increasing from 4% (95% CI: 0.03-0.08) in 2000-2004 to 36% (95% CI: 0.20-0.55) in 2021-2023. Diarrheagenic E. coli (DEC) showed no clear pattern, ranging from 5% (95% CI: 0.01-0.24) to 17% (95% CI: 0.07-0.36). Salmonella spp. exhibited more significant fluctuations, rising from 6% (95% CI) in both 2000-2004 and 2005-2008 periods to 20% (95% CI: 0.03-0.66) in 2009-2012 and 30% (95% CI: 0.11-0.60) in 2017-2020. Yersinia spp. was only determined in 2000-2004 with a pool prevalence of 12% (95% CI: 0.00-0.91). Sub-species analysis revealed Shigella sonnei was the most prevalent species among Shigella spp. in Iran, accounting for 42% of cases (95% CI: 0.33-0.52). Regarding DEC species, Enteroaggregative E. coli (EAEC) and Enterotpathogenic E. coli (EPEC) had the highest rate at 15% (95% CI). Furthermore, a pool prevalence of 2% (95% CI: 0.00-0.89) was reported for Yersinia enterocolitica among diarrheagenic Enterobacteriaceae in Iran.

This meta-analysis provides valuable insights into the prevalence of diarrheagenic Enterobacteriaceae in Iran over the past two decades. The findings highlight the significant impact of these pathogens on public health, with Shigella spp. showing the highest prevalence and increasing trends. Further research should investigate the factors contributing to the prevalence of diarrheagenic Enterobacteriaceae, including genetic diversity of diarrheagenic Enterobacteriaceae isolates, molecular mechanisms underlying the virulence of these pathogens, or antibiotic resistance patterns.

Virtual reality-based interventions (VRBI) are a gamified approach to therapy that can improve balance and motor skills in children diagnosed with Developmental Coordination Disorder (DCD). The aim was to investigate the effectiveness of VRBI in improving balance and motor skills in children with DCD.

According to PRISMA guidelines, meta-analyses were conducted by searching randomized controlled trials (RCTs) that investigated the effect of VRBI on balance and motor skills in children with DCD. The global search was carried out in PubMed, SCOPUS, WOS, CINAHL and PEDro during the period from April 1st to 24th, 2024, without publication date restrictions. Standardized mean difference (SMD) and its 95% confidence interval (95%CI) was calculated as the pooled effect measure.

Nine RCTs, with a moderate mean methodological quality (5.11 points in PEDro) providing data from 266 participants, were included. All studies included used non-immersive virtual reality (NIVR) devices to carry out the VRBI. Meta-analyses revealed that NIVR was effective in increasing balance (SMD = 0.4; 95%CI 0.09-0.71), as well as running and agility skills (SMD = 0.45; 95%CI 0.03-0.87). However, no statistical differences were found in improving motor skills.

Findings reported in this meta-analysis support that VRBI that use NIVR devices can be effective in improving balance in children with DCD.