Eligible Papers Research Articles

Who is the PROM King? Patient-reported Outcome Measures in Pediatric Musculoskeletal Oncology: A Systematic Review.

Patient-reported outcome measures (PROMs) are important companions to traditional, physician-reported measures. The purpose of this study was to systematically review and identify PROMs used in pediatric musculoskeletal oncology and evaluate these instruments. A systematic literature review was conducted for studies pertaining to pediatric musculoskeletal tumors from 2010 to 2024. Two experts selected eligible papers for inclusion through a systematic approach. PROMs used in the eligible papers were cataloged, and the top 10 most frequently used instruments were evaluated with Evaluating Measures of Patient-Reported Outcomes (EMPRO), which is a standardized evaluation tool for PROs. A total of 316 publications were included in the final analysis, reporting a total of 82 unique PROMs. Of the papers, 24% reported no PROMs, whereas 67% of the instruments were only reported once. Nine out of the 10 top PROMs scored over 50 on EMPRO, meeting the minimum acceptable criteria. Musculoskeletal Tumor Society, Toronto Extremity Salvage Score, Disabilities of the Arm, Shoulder, and Hand (DASH), and Quick DASH were disease-specific instruments scoring high on EMPRO. Short Form-36, Pediatric Quality of Life Questionnaire, Quality of Life Questionnaire-30, BSI-18, and TNO AZL Child Quality Of Life met the requirements in the general instruments. Short Form-12 was the lowest-scored PROM. Our results show minimal consensus on the ideal PROM in pediatric musculoskeletal oncology. We recommend using instruments that are already in widespread use instead of obscure PROMs, which defy the purpose of reporting outcomes from a patient perspective. All 4 disease-specific instruments scored highly and are already widely used, including Musculoskeletal Tumor Society, Toronto Extremity Salvage Score, DASH, and Quick DASH. However, we found no consensus on general instruments. With the development and increasing popularity of Patient-Reported Outcomes Measurement Information System, it may replace other general instruments that are proprietary, unreliable, or not developed with pediatric patients in mind. Level IV-systematic review of level II to IV studies.

Identification of the most cost-saving disease-modifying therapies and factors affecting the budget in the pharmacotherapy of multiple sclerosis: a systematic review.

Multiple sclerosis (MS) is an immune-mediated disease that has a considerable health-related quality of life interference. Various disease-modifying therapies (DMTs) in MS management have been approved by the Food and Drug Administration or are currently used off-label. DMTs aim to slow down the progression of MS and decrease the frequency of relapses. This systematic review aimed to evaluate the budget impact of DMTs worldwide. A systematic search query was made to identify related articles in scientific databases. Eligible papers included their characteristics and model inputs, and results were extracted and reported. To critique the standard reporting of studies, a 32-item quality assessment checklist was used. From 1865 records, 22 original budget-impact analyses (BIAs) were included. All BIAs were accepted in the quality assessment (Mean score: 84.4). The most used DMT was β-interferons and natalizumab among novel DMTs. The results of BIAs were highly sensitive to the route of administration, costs of side effects and administration, and presence of biosimilars. However, glatiramer acetate has not experienced significant discounts was the most reported budget-saving DMT. From the results, it can be concluded the budget impact of DMTs in managing symptoms and improving the quality of life of MS patients according to the setting included in the modeling and according to specific conditions and context is different and significantly affects the results of BIAs. For accurate predictions of the effects of DMTs on the distribution of budgets in the MS population, more specific BIAs with higher quality should be done.

Addressing the commercial determinants of mental health: an umbrella review of population-level interventions.

There is increasing evidence that commercial determinants impact mental health. Addressing the commercial determinants may therefore be a way of improving population-level mental health. This umbrella review aimed to provide an overview of evidence in this field and identify knowledge gaps. Five databases (MEDLINE, Embase, PsycINFO, Scopus and Cochrane Library) were searched on the 18/19 of July 2022. Eligible papers were systematic reviews published after 31 December 2011. No geographical limits were applied. Eligible interventions were those that targeted the behaviours or products of commercial actors. Ineligible interventions included individual behaviour change interventions, such as those seeking to educate consumers. Included mental health outcomes were anxiety, depression, self-harm and suicide, whilst surrogate outcomes included product consumption. Industry involvement and the quality of included reviews (critical components of A MeaSurementTool toAssess systematicReviews -AMSTAR 2) were assessed. A narrative synthesis was used to compare the findings by industry, and a typology of interventions was developed. Eight reviews with mental health outcomes were included, each with multiple methodological weaknesses. There is some evidence that reducing the availability of alcohol or pesticides may lower suicide rates. Despite the known links, no evidence on the mental health impacts of population-level interventions tackling the social media, tobacco, gambling and ultra-processed foods industries were located. All gambling reviews were identified as having links to industry. Future high-quality evaluations of commercial determinants interventions developed specifically with the aim of achieving positive mental health outcomes and/or that evaluate mental health outcomes and are free from industry links are needed. PROSPERO ref. number CRD42022346002.

The practice, nature, and impact of nurse-led type 2 diabetic foot prevention services and educational programs in Sub-Saharan Africa: a scoping review.

The objective of this study is to assess the scope of existing practice, nature, and impact of nurse-led type 2 diabetic foot prevention services and educational programmes in Sub-Saharan Africa (SSA). Type 2 diabetes mellitus (T2DM) in SSA imposes a heavy burden on current healthcare services. Complications such as foot ulcers can have a significant impact on patient care and healthcare resources. It is imperative to identify patients at risk of developing diabetic foot complications and empower them with diabetes self-management education and support from specialised foot clinics is crucial. However, the availability of such programmes and services in SSA is limited. Studies of nurse-led diabetic foot prevention services and/or educational programmes in low- or middle-income countries in SSA for adults with T2DM, written in English, between August 2013 and March 2024 were considered. Following the standard Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for conducting and reporting scoping reviews, searches were conducted on four electronic databases (CINAHL, ProQuest, MEDLINE, and Scopus) and Google Scholar. The titles and abstracts were scrutinised. All eligible papers were retrieved and screened for full text. The review included ten studies (across 14 papers), all of which focused on nurse-led diabetes self-management education (DSME) programmes in SSA. There are no specific educational programmes or services led by nurses that focus exclusively on diabetic foot prevention. The analysis highlighted the components of successful nurse-led DSMEs that led to positive glycaemic control and self-care behaviors, including the focus on behavior change and the DSME should be co-produced with service users. The theoretical aspects of the DSME include evidence-based, structured, interactive, culturally and linguistically appropriate group-based activities. The DSME should be delivered over a period of several weeks, and sessions should last between 1.5 and 2 h. Barriers to delivery and participation include the rainy season, stockouts, time and resources needed, and a DSME that meets diverse levels of literacy and education. There is a heightened need for nurse-led, co-produced, culturally congruent, frugal, and sustainable education interventions or programmes. There is also a need for diabetic foot screening and foot ulcer prevention services that can operate sustainably alongside these educational interventions through task-shifted, simple, and frugal initiatives.

Interposition versus transposition technique in microvascular decompression for trigeminal neuralgia secondary to vertebrobasilar dolichoectasia: a systematic review and pooled meta-analysis.

Limited data are available comparing the interposition and transposition techniques for microvascular decompression (MVD) in patients with trigeminal neuralgia (TN) secondary to vertebrobasilar dolichoectasia (VBD); this study aims to review current findings on TN associated with VBD and compare the interposition and transposition techniques in terms of surgical morbidity and patient outcomes. Following the PRISMA guidelines, PubMed/Medline, Web of Science, and SCOPUS databases were searched to identify studies reporting patients undergoing MVD for TN secondary to VBD. The studies were divided into two groups, interposition and transposition, based on the microvascular decompression technique used. Studies not reporting the diagnostic criteria, included less than five cases, or were not available in English were excluded. Fourteen eligible papers were retrieved, of which five studies reported cases undergoing the interposition technique, eight studies for the transposition technique, and one study reported cases from both groups. Data including preoperative and postoperative BNI class, comorbidities, and postoperative complications were retrieved to analyze and compare the two techniques in terms of efficacy and long-term outcomes in treating TN secondary to VBD. Both interposition and transposition techniques for MVD yield high rates of pain relief in patients with TN secondary to VBD. While both approaches demonstrate similar efficacy, the interposition method is associated with a lower rate of long-term complications. Further research, preferably through randomized prospective studies, is needed to refine surgical strategies and improve patient outcomes.

Investigating the Role of Inositol: Myo-inositol and D-Chiro-inositol in Diabetes: A Review

The sugar alcohol known as inositol and its derivatives are becoming more and more interesting in metabolism-related research studies due to its physiological roles. Inositol derivatives mainly myoinositol and d-chiroinositol have gained so much attention these days in the context of managing and treating metabolic issues such as diabetes and polycystic ovarian syndrome. For a long time, it was considered as the vitamin B, but later we got to know it is produced from glucose so considered non-essential. Nowadays rising rates of obesity which are further linked with diabetes and polycystic ovarian syndrome have fuelled demand for artificial sweeteners. Many people are searching for options to maintain their weight, which has led to the widespread usage of sucrose and fructose substitutes in the food industry. Sugar alcohols such as myoinositol and d chiroinositol (which are not been commonly used) in particular can be metabolized without the need for insulin control and have little effect on blood sugar levels. These sugar substitutes have the potential to provide sweetness without raising blood sugar levels and adding calories. These have half of the sweetness of sucrose. This paper aims to thoroughly investigate and understand the various roles played by inositol in the complex field of managing metabolic diseases. To find out the eligible papers for review paper screening has been performed through PubMed, Science Direct, Web of Science and Google Scholar. Different sets of keywords such as inositol, d chiro inositol, myo-inositol, insulin-resistance, diabetes, insulin sensitivity, DCI and type 2 diabetes mellitus were used. Studies which full text article were present used for the review. Research articles have been included the studies specifically to find out the relation between myoinositol and diabetes or any metabolic disease. The development of many diseases, such as PCOS and diabetes, is linked with inositol deficiency. Myoinositol is derived from the food we eat as well as from within. The low levels of MI can be the result of several factors, including decreased dietary intake, increased catabolism, alterations in the gut and reduced biosynthesis. These two forms, myoinositol and d-chiroinositol play significant roles in regulating lipid metabolism and glycaemic control. glycaemic metabolism and this are also supported by many research studies. Therefore, it can be a possible treatment or management option for people suffering from metabolic issues such as diabetes and PCOS. Future studies should focus on how we can increase the intake of myoinositol through diet and dietary food products.

Approaches, enablers and barriers to govern the private sector in health in low- and middle-income countries: a scoping review

IntroductionThe private sector plays a substantial role in delivering and financing healthcare in low- and middle-income countries (LMICs). Supporting governments to govern the private sector effectively, and so improve outcomes...

The promise and peril of Coding & Robotics education in South Africa: A scoping review of teacher preparation and generative artificial intelligence's potential for delivering equity

Integrating the Coding & Robotics (C&R) subject in South African schools signifies the nation's commitment to Fourth Industrial Revolution preparedness. However, challenges like inadequate teacher preparation and limited technological infrastructure must be addressed to ensure equity. Although Generative Artificial Intelligence (GenAI) may not address the infrastructural deficiencies directly, in this scoping review we examine its potential to complement existing resources and support teachers in delivering C&R instruction. Following Arksey and O'Malley's framework, we conducted a systematic literature search in numerous databases, followed by a screening procedure: 10 of the 61 eligible papers satisfied the inclusion criteria. Our findings reveal that GenAI can optimise C&R teacher development through personalised learning, content generation, feedback on teaching methods, and fostering collaboration with other teachers. Despite its potential, issues including equity, ethical concerns, technological fluency gaps, and overreliance on GenAI tools, must be navigated to enhance equitable C&R instruction and prepare learners for the digital era.

Outcomes of external versus internal fixation for traumatic lower limb fractures in low- and middle-income countries.

Lower limb fractures are common in low- and middle-income countries (LMICs) and represent a significant burden to the existing orthopaedic surgical infrastructure. In high income country (HIC) settings, internal fixation is the standard of care due to its superior outcomes. In LMICs, external fixation is often the surgical treatment of choice due to limited supplies, cost considerations, and its perceived lower complication rate. The aim of this systematic review protocol is identifying differences in rates of infection, nonunion, and malunion of extra-articular femoral and tibial shaft fractures in LMICs treated with either internal or external fixation. This systematic review protocol describes a broad search of multiple databases to identify eligible papers. Studies must be published after 2000, include at least five patients, patients must be aged > 16 years or treated as skeletally mature, and the paper must describe a fracture of interest and at least one of our primary outcomes of interest. We did not place restrictions on language or journal. All abstracts and full texts will be screened and extracted by two independent reviewers. Risk of bias and quality of evidence will be analyzed using standardized appraisal tools. A random-effects meta-analysis followed by a subgroup analysis will be performed, given the anticipated heterogeneity among studies, if sufficient data are available. The lack of easily accessible LMIC outcome data, combined with international clinical guidelines that are often developed by HIC surgeons for use in HIC environments, makes the clinical decision-making process infinitely more difficult for surgeons in LMICs. This protocol will guide research on surgical management, outcomes, and complications of lower limb shaft fractures in LMICs, and can help guide policy development for better surgical intervention delivery and improve global surgical care.

Good quality end-of life care for people with an intellectual disability: A critical interpretive synthesis protocol.

People with an intellectual disability face inequality accessing healthcare that extends to end-of-life care. Furthermore, end-of-life care for people with an intellectual disability is more complex than that for the general population. This protocol sets out how our review will explore the available evidence and identify the key characteristics of care that are required for people with an intellectual disability to have a good end-of-life experience. A critical interpretive synthesis approach will be adopted, combining some elements of a systematic review with interpretive synthesis. This approach has been selected as it allows a diverse body of literature to be considered. Furthermore, it is compatible with theory generation allowing new insights to emerge in an iterative process. Electronic databases and grey literature sources will be searched using pre-defined search terms. Following initial title and abstract screening, eligible papers will undergo full text screening. Papers that are deemed to be 'fatally flawed' will be excluded and remaining papers appraised for relevance. Resultant papers will be included in the sampling frame from which data extraction will occur. An existing framework outlining key factors in the provision of excellent end-of-life care to people with an intellectual disability will be used to support data extraction and synthesis. Data extracted will be integrated into a synthesising argument in the form of a theoretical framework. This will identify the key characteristics in the provision of care that are required for people with an intellectual disability to have a good end-of-life experience. The developing theoretical framework will guide further selection of relevant literature to fill any conceptual gaps until saturation is reached. Our review will add to the existing body of evidence, shedding light on the key factors necessary in the provision of care to ensure that people with an intellectual disability have a good end-of-life experience.

Effects of Arnica Phytotherapeutic and Homeopathic Formulations on Traumatic Injuries and Inflammatory Conditions: A Systematic Review.

Arnica L. genus (Asteraceae) comprises perennial herbs native to the temperate and boreal parts of the northern hemisphere. Arnica montana is the main species. It shows different biological activities, such as antioxidant, anti-inflammatory, antibacterial, antifungal, and antitumor effects. The Arnica formulations are mainly used for pain management. This systematic review is aimed at summarizing the studies focusing on the use of Arnica products on pain and inflammatory signs due to traumatic injuries related to sport and surgical interventions as well as to arthritis and other inflammatory conditions. Both phytotherapeutic and homeopathic formulations are taken into account. This paper only includes manuscripts published in mainstream journals. A literature search from Scopus, Web of Science, and PubMed databases has been carried out using a combination of the keywords "Arnica", "trauma", "sport", "injury", "injuries", and "pain". According to the search strategy and inclusion criteria for this study, 42 eligible papers, focusing on both Arnica alone and formulations containing a mixture of plant extracts, have been finally selected. This review critically discusses the in vitro, in vivo, and clinical studies dealing with Arnica products, reporting both positive and negative outcomes, thus providing perspectives for future research on the plant pharmacological potential.

The effects of literacy on health in Gypsies, Roma and Travellers (GRT): a systematic review and narrative synthesis

IntroductionGypsies, Roma and Travellers (GRT) frequently experience poorer health outcomes than the general population and represent the most socially and economically disadvantaged individuals in many countries. In general, GRT in...

A healthcare workforce assessment model using reimbursement data in Luxembourg

Abstract Background The assessment of the healthcare professional (HCP) headcount and level of activity is a real challenge for policy makers. In Luxembourg, there is no uniform definition of practicing HCP. This work focused on identifying a method to assess HCP headcount and their level of activity in Luxembourg, while finding national consensus. Methods A thorough literature review was conducted to find methods that assess practicing HCP and identify their level of activity. Eligible were scientific papers or national reports discussing methods on employed and self-employed HCP. National reimbursement data were used for preliminary data explorations conducted alongside the ‘General Inspectorate of Social Security’ in Luxembourg and discussed with the ‘Institut national d’assurance maladie-invalidité (INAMI)’ in Belgium. Two working groups were planned with national stakeholders to discuss HCP assessment methodologies. Both the collaborations and the working groups led to a preliminary validated HCP assessment method. To reach national consensus, a Delphi study is planned in June 2024, using the eDelphi.org platform. Invited panelists include researchers, professionals, healthcare practitioners, decision makers and policy makers, patient representatives, and insurers. Results The literature review found 16 eligible papers on HCP headcount and HCP’ level of activity. Finally, the Belgian method, developed by experts from INAMI, using reimbursement data and establishing a median reimbursement for each medical specialty was retained for Luxembourg. The results of the Delphi study will inform on the level of agreement on relevance, clarity and completeness of the proposed methodology for Luxembourg. Discussion Finding national consensus represents a strong foundation for efforts to advance the use of the proposed methodology in healthcare workforce assessment and planning. Key messages • Counting something as simple as healthcare professionals requires a strong methodology that held the buy-in of all major stakeholder. • As working behavior of HCP evolves over time, it is crucial to not only count professionals but also full-time equivalents for policy makers to plan ahead in an accurate manner.

The Psychological Contract Theory on Student Retention: A Systematic Literature Review

The purpose of this article is to cover the themes central to psychological contract theory as well as its impact on student retention. While psychological contract theory has been extensively studied and applied in work-related settings, its influence in educational settings has not been fully explored. To address this gap, this study collected and analyzed data following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data was collected from studies published between 2013 and 2023, resulting in the analysis of 24 eligible papers from various academic databases in the review. Based on the number of eligible papers within a ten-year timeframe indicates a scarcity of research on psychological contracts in educational contexts, particularly concerning student retention. The findings from the 24 eligible papers were synthesized and reported using descriptive analysis and tabulation, thus shedding light on how psychological contract theory influences student retention. The analysis suggests that unfulfilled psychological contracts between students and academic staff can contribute to student attrition, especially when students' expectations, formed during earlier educational experiences, are not met. This systematic literature review emphasizes the importance of the psychological contract in educational settings particularly in managing the dynamic student and academic relationship. The review made suggestions for practical implications for academic leaders, policymakers, and education administrators, stressing the need for adaptive, inclusive, and forward-looking approaches in education, and recommendations for future studies.

The Value of Fractal Analysis in Ultrasound Imaging: Exploring Intricate Patterns

Fractal analysis is a mathematical approach employed to study and describe complex patterns and structures across various disciplines, including mathematics, physics, computer science, biology and finance. Introduced by mathematician Benoit Mandelbrot in the 1970s, fractals are intricate, self-similar patterns that repeat at different scales, exhibiting consistent structures upon magnification or reduction. This analysis involves generating fractals through iterative processes or recursive equations, resulting in highly detailed and complex formations. Fractal analysis enhances medical images by removing noise while preserving details and improving diagnostic quality in magnetic resonance and computed tomography scans. However, there is a lack of comprehensive studies on its application in ultrasound imaging, prompting this narrative review to investigate its use and methodology in this context. Selected papers on the use of fractal analysis in ultrasound imaging were analyzed. Out of 186 records screened, 60 duplicates were removed and 28 were discarded. The text content of 98 potentially eligible papers was checked, with 65 not meeting inclusion criteria. Finally, 33 studies were included in the review. Fractal analysis enhances ultrasound imaging by providing detailed tissue texture characterization, aiding in the diagnosis of conditions like breast and lung cancer, osteoporosis and hypertensive disorders in pregnancy. It quantifies biological structure complexity and improves diagnostic accuracy and reliability. This technique supports clinicians in making informed decisions by offering critical insights into various medical conditions.

A systematic review of international students’ experiences transitioning from non-Anglophone high schools to universities in Anglophone settings

ABSTRACT This systematic review explores the extent and nature of research on the experiences of international students transitioning from non-anglophone high schools to universities in anglophone settings and then curates and synthesises the empirical evidence on their experiences. An extensive and systematic search of the literature revealed 1247 potentially eligible papers. After screening, eleven empirical studies were deemed suitable for data extraction for narrative synthesis focusing on students’ transitional experiences. The university destinations in the included studies were the USA (n = 8), Canada (n = 2) and a variety of English-speaking university destinations (n = 1). Seven of the included studies were cross-sectional, and four studies were longitudinal. Results showed that previous studies have explored students’ decision-making processes, university and international readiness, and language and identity development. Five studies suggested the need for longitudinal perspectives to better understand student participants’ transition. Four studies proposed to incorporate the perspectives and impact of relevant stakeholders in investigating students’ transitional experiences, including students’ families, teachers, peers, and university professors. This review calls for more targeted, rigorous, and longitudinal studies to better understand and enhance international students’ experiences studying abroad.

Sleep disturbances in anorexia nervosa.

Sleep is crucial for physical and psychological health, and disturbances are closely linked to psychiatric disorders, making their management essential for improving treatment outcomes and preventing relapse. Although sleep disturbances are implicated in psychopathology of eating disorders, its role in anorexia nervosa (AN) remains unclear. This review aimed to characterise sleep in AN. A systematic search was conducted in four scientific databases, including papers from inception to 25 May 2024. A machine learning algorithm (ASReview) was utilised to screen titles and abstracts for eligibility. Sleep quantity, architecture, and quality were investigated. Meta-analyses were conducted to investigate the difference between patients with AN and healthy controls (HC) in total sleep time (TST), wake after sleep onset (WASO), sleep onset latency (SOL), sleep efficiency, Sleep Stage 1, 2, slow wave sleep, rapid eye movement (REM) sleep and REM latency. Certainty of evidence was assessed using the GRADE approach. Out of 67 potentially eligible papers, 31 were included in this review, with 15 in the meta-analyses. Statistically significant average mean differences were found for TST (-32.1min [95% CI: -50.9, -13.4]), WASO (19.0min [95% CI: -2.4, 40.3]), and sleep efficiency (-4.4% [95% CI: -7.9, -0.9]). Additionally, Sleep stage 1 was significantly increased (2.4% [95%-CI: 0.05, 4.7]), while REM sleep was reduced (-2.1% [95%-CI: -4.2, -0.02]). Subgroup analysis showed that TST and WASO did not improve significantly after weight restoration. Sleep in patients with AN is impaired, with lower TST and sleep efficiency, higher WASO, more time in stage 1 sleep, and less in REM. Weight restoration alone may not improve sleep. While more research is needed, substantial accompanying sleep disturbances in AN justifies addressing these in current treatment practice, also because of the chronic character of AN and importance of sleep for long term (mental) health.

ICU nutrition research: did the evidence get better? Remaining sources of bias.

To assess the quality of recently published (18 months from date of article request) randomized trials/systematic reviews of such trials that addressed the use of nutritional support in critically ill patients. Eligible papers were published between October 1, 2022 and April 7, 2024, only enrolled adults, described a comparison of a nutritional intervention to something else, and reported a clinically relevant outcome. Thirteen randomized trials and four systematic reviews of randomized trials were identified. Quality was assessed by determining the risks of bias of each trial. Two of these trials were at low risk of bias, six were rated as having some concern(s) about bias, and five were at high risk of bias. The four systematic reviews included 55 randomized trials; four were at low risk, 31 had some concerns, and 20 were at high risk. No randomized trial comparing nutritional support to a true control (no nutritional support) was identified in this search; seven older trials, all small and containing risks of bias, failed to demonstrate any consistent differences in clinical outcomes. The quality of the trials underlying the use of nutritional support in the intensive care unit is not very high.

Social media and caregivers’ well-being: A scoping review and future research directions

Caregivers’ well-being has become a major social concern, given the growing demand for long-term care support to meet the challenges of an aging society. As social media becomes substantially pervasive in daily life, the impacts of social media on caregivers’ well-being are increasingly gaining public attention. Although research activities are active, studies on social media and caregivers’ well-being lack consolidation and receive limited attention from researchers. To bridge the gaps, this study aims to consolidate the existing knowledge through a scoping review (with four databases: PubMed, Web of Science, Scopus, and CINAHL) and call for research on caregivers from the perspective of social media and well-being. Review results from forty eligible papers indicate that impacts of social media use on caregivers’ well-being are not always positive, which encourages future research to provide more understanding of how to achieve positive effects and avoid adverse effects simultaneously. We also further discuss the findings and suggest future investigation opportunities.

Cannabis Use Variations and Myocardial Infarction: A Systematic Review.

Background: Cannabis use is associated with an increased risk of coronary heart disease (CHD), including angina pectoris (AP), and myocardial infarction (MI). However, it is not clear whether cannabis use is an independent risk factor of AP and/or MI, because cannabis is often smoked together with tobacco. We investigated whether cannabis is an independent risk factor of MI and whether this risk is similar in cannabis smokers, cannabis vapers, and those who use cannabis edibles. Methods: A systematic review was performed, according to the PRISMA guidelines and using Medline (PubMed), Embase, and Google Scholar as databases. Results: Twenty-two eligible papers were identified. After adjustment for concurrent tobacco use, cannabis smoking remained significantly associated with incidents of MI, with aORs ranging between 1.03 and 5.24, and particularly high aORs in the younger age group. In never-tobacco smokers, frequent cannabis smoking was also associated with a significant MI risk (aOR = 1.88). Frequent and current cannabis use in any form other than smoking (e.g., vaping, but mostly ingestion) was not associated with a significantly increased cardiovascular risk (frequent use: aOR = 1.00 ns; current use: aOR = 1.31 ns). Conclusions: Like tobacco smoking, cannabis smoking may independently provoke MI. Vaping and ingestion of cannabis might be less harmful, probably because absence of combustion prevents exposure to certain toxins in cannabis smoke, including carbon monoxide.