Methodological Heterogeneity Research Articles

Effects of clear aligners treatment in growing patients: a systematic review.

In recent years, the use of Clear aligners (CA) has been diffused among children and adolescents. This systematic review aimed to summarize the literature regarding the effects of CA therapy in growing patients, including dentoalveolar and skeletal effects, periodontal changes, and quality of life measurements. An electronic search on four databases was performed until September 2023, and studies including patients <18 years, treated with CA were selected. Studies with less than 10 patients and in vitro/laboratory studies were excluded. Study selection, data extraction, and risk of bias assessment were independently performed by two reviewers. The "Risk of Bias 2" (RoB 2) and the "Risk of Bias in Non-randomized Studies of Interventions" (ROBINS-I) tools were applied to assess the methodological quality of the included studies. Due to the heterogeneity in methodologies and outcomes encountered in the included studies, a qualitative synthesis of the results was provided. The search resulted in 32 papers (3 RCTs), with sample sizes ranging between 15 and 113. The overall risk of bias in the RCT was low, while the risk of bias in the non-RCT ranged between moderate and serious for most of the included studies. Dentoskeletal and periodontal effects were the most frequently reported outcomes. The most common comparison group was multibracket fixed therapy, while only 5 studies had an untreated control group. Significant changes in the transversal maxillary arch width after treatment with CA were reported in some studies. However, while dentoalveolar effects have been reported consistently, controversial findings were found regarding the changes in skeletal bases after treatment with CA. Concerning the results on the sagittal plane, the current literature does not support the effectiveness of CA with mandibular advancement features in correcting dentoskeletal Class II, compared to traditional functional orthopedic appliances. In the short-term evaluation, periodontal variables and bacterial levels seemed to be better controlled during CA therapy, compared to the fixed multibracket therapy. With regard to quality of life measurements, there are inconsistent findings to support differences between CA therapy and fixed multibracket appliances. Nevertheless, additional high-quality studies are required to formulate more reliable conclusions. https://osf.io/wmerq.

Evidence-based Interventions for Youth With Concurrent Mental Health and Substance Use Disorders: A Scoping Review: Interventions fondées sur des données probantes pour les jeunes atteints de troubles concomitants de santé mentale et liés à l'usage de substances psychoactives : une étude de la portée.

Mental health and substance use disorders typically onset during youth and commonly co-occur. Integrated treatment of two or more co-existing mental health and substance use disorders (i.e., concurrent disorders) is increasingly prevalent in real-world clinical settings. However, the depth of the evidence base on best practices remains unclear. This scoping review aimed to identify, map and summarize peer-reviewed studies of interventions for concurrent disorders in youth. Six electronic health databases were systematically searched, in addition to a hand search of the reference lists of relevant systematic reviews. Only peer-reviewed studies of interventions treating concurrent disorders (i.e., simultaneous treatment of two or more disorders) in youth (10-29 years old) were eligible. Two independent reviewers conducted screening and data extraction. Results were charted according to studies employing pharmacological and non-pharmacological interventions. Thirty peer-reviewed studies were included, 19 (63.3%) were randomized controlled trials (RCTs). Most studies enrolled participants with an unspecified substance use disorder (n=17, 56.7%), while alcohol use was the primary substance use disorder in seven (23.3%) studies, followed by cannabis use disorder in six (20.0%) studies. Mood disorders (e.g., depression, dysthymia) were the most common concurrent mental health disorders comprising 15 (50%) studies, followed by nine (30.0%) studies of behavioural disorders (e.g., ADHD) and five (16.7%) studies of unspecified psychiatric disorders. Eighteen (60.0%) studies (n=1,699 participants) investigated the effectiveness of various non-pharmacological interventions, while 12 (40.0%) studies examined pharmacotherapies (n=765 participants). Although several RCTs were identified, substantial clinical and methodological heterogeneity was evident among the studies (e.g., patients with multiple disorders, and multi-faceted interventions). Smaller systematic reviews focused on specific interventions (e.g., behavioural therapies) and concurrent disorders (e.g., depression and substance use) may be warranted. Due to considerable heterogeneity, more RCTs are needed before conducting larger systematic reviews or meta-analyses.

Pharmacist-Mediated Deprescribing in Long-Term Care Facilities: A Systematic Review.

Multimorbidity and polypharmacy are prevalent among Long-Term Care (LTC) users. Older people, who most use LTC services, are more prone to drug-related problems, which polypharmacy aggravates. Deprescribing is a key intervention to address polypharmacy and inappropriate medication. Evidence shows that pharmacists' expertise in medicines and their growing involvement in clinical-oriented activities have proven to play an essential role across many healthcare settings, including LTC. Thus, this study aimed to identify and assess LTC pharmacist-mediated deprescribing. A systematic review was undertaken following the PRISMA checklist, using three literature databases (PubMed, Scopus, and Web of Knowledge). A set of 18 keywords, divided into three domains (professional, type of care, and type of setting), were combined into search equations. The studies selected were assessed through the Quality Assessment Tool for Quantitative Studies. Fifteen studies met the inclusion criteria out of 288 initial hits. Pharmacist-mediated deprescribing was divided into specific (targeted to a medicine group) and non-specific. Half of the studies were graded as low quality (53%). In total, the studies enrolled 6928 patients and 45 pharmacists. The ATC groups A, C, M, and N, as well as medicines with anticholinergic properties, were the most addressed medicines groups. Acceptance rates of pharmacists' recommendations ranged between 30% and 100%. Generically, the number of medicines was reduced after the intervention. Mixed results were found for falls and quality of life outcomes. Cost savings associated with the interventions ranged from neutral to as high as 3800 €/patient/year. Barriers to deprescribing were mainly linked to patients' or family members' refusal to change. In conclusion, pharmacist-mediated deprescribing seems feasible in LTC. The studies' methodological heterogeneity hampers robust comparisons and conclusions. The medicine groups targeted by deprescribing can help tailor interventions to optimize the use of medicines in LTC. A detailed understanding of barriers and enablers to deprescribing would support developing and implementing these interventions.

Electrophysiological findings of brainstem auditory evoked potentials in infants with down syndrome: A systematic review and meta-analysis.

to summarize the evidence on the electrophysiological findings in the auditory brainstem response (ABR) in infants with DS. This is a systematic review study, whose protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO CRD42023424139) and conducted in accordance with the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Observational studies were included: cross-sectional and cohort studies that performed ABR evaluation in infants with DS up to two years of age, which had their results compared with normal infants, of the same age group. The search for studies was performed in the following databases: PubMed, LILACS, Scopus, CINHAL, Web of Science, Scielo, Embase and LIVIVO, and in the gray literature: Google Scholar and Proquest. There were no restrictions on language or publication date. The methodological quality of the included studies was assessed using the JBI (Joanna Briggs Institute) checklist. Phases 1 (reading of titles and abstracts) and 2 (reading in full), data extraction, assessment of methodological quality and certainty of evidence were performed independently by the reviewers. Existing disagreements were resolved in a consensus meeting. A total of 494 articles were obtained, which after removal of duplicates and independent analysis by the reviewers, ten studies were selected for qualitative synthesis and four studies were selected for meta-analysis. There was heterogeneity between the effects observed in the ABR parameters (I2=78%) with an overall pooled effect size of -0.05 (95% confidence interval of -0.13-0.03; p=0.22) indicating no significant difference in ABR responses between groups. The certainty of the evidence assessed by GRADE was considered very low due to inconsistency and imprecision. The results of the meta-analysis indicate that there are no significant diferences in ABR parameters, including waves I, III, and V and the I - V interpeak interval, between infants with and without DS up to two years of age. However, the limitations found, such as methodological heterogeneity, small sample sizes and variability in the age range of the participants, generated uncertainty in the results. Therefore, the certainty of the evidence was classified as very low, according to the GRADE methodology.

Rest-activity rhythm and cognitive function in older adults: A scoping review and integrative framework

Rest-activity rhythm (RAR) encompasses sleep, activity, and rest across a 24-hour cycle and over time (i.e., peak activity timing, mean activity level, activity amplitude, and rhythmicity). While the link between sleep, exercise, and cognitive function is established, the specific relationship between RAR and cognitive function in older adults remains unclear. This review synthesizes the literature on RAR and cognition, identifying 26 eligible studies from databases including PubMed, CINAHL, PsycINFO, and Web of Science. Although it was difficult to draw definitive conclusions due to the limited number of available studies focusing on each of cognitive domain and methodological heterogeneity among them, the collective findings broadly indicate that later peak activity timing, higher mean activity levels, higher activity amplitude, and more stable rhythmicity were associated with better global cognition. Future research with larger, diverse samples, more accurate RAR and cognition measurements, and incorporating biomarkers will provide deeper insights into these relationships.

Efficacy and safety of anti-thrombotic therapy after surgical mitral valve repair: a scoping review

BackgroundMitral valve repair (MVr) is the gold standard treatment for degenerative mitral regurgitation, yet there is ongoing controversy regarding optimal anti-thrombotic therapy post-MVr. This scoping review aimed to summarise current...

House dust mites eradication treatments: Current updates emphasizing on tropical countries.

House Dust Mites (HDMs) like Dermatophagoides farinae (D. farinae), Dermatophagoides pteronyssinus (D. pteronyssinus) and Blomia tropicalis (B. tropicalis) were found all over the world. Their relationship with allergy diseases was one of the focal points of epidemiological investigations spanning various geographical regions globally but specifically in regions with warm temperatures. Their omnipresence underscores their pivotal role in the etiology and exacerbation of some respiratory disorders, emphasizing their significance as environmental allergens. Despite the availability of numerous eradication treatments ranging from sun exposure to ozone-based approaches, the quest for efficacious HDM eradication encounters obstacles due to the diversity in study methodologies employed to evaluate these different intervention strategies. This methodological heterogeneity complicates the quantification of treatment efficacy, impeding the establishment of definitive criteria distinguishing "effective" from "ineffective" approaches. Despite the urgency of developing solutions, current efforts are hindered by this lack of consensus. This review aims to bridge this gap by synthesizing existing knowledge on HDM eradication strategies and discussing their efficacy, safety, and practicality. By addressing these discrepancies, this article endeavors to provide insights and clues for the future development of evidence-based interventions aimed at mitigating HDM infestations and ultimately reducing its sensitization rate worldwide.

Food insecurity as a target for suicide prevention (literature review)

Background. The review presents a summary of English-language sources that explore the relationship between food insecurity and suicidal behavior in humans. The study was conducted to analytically identify a new target for suicide prevention. The hypothesis was tested that food insecurity could be a pro-suicidal factor, i.e., one that increases levels of suicidal activity and mortality, and thus serves as a potential target for suicide prevention. Relevance: The lack of access to adequate and quality nutrition poses a significant psychological, socio-economic, and medical challenge. It contributes to elevated levels of depression, anxiety, and suicidal behavior, particularly among vulnerable population groups such as adolescents, students, older adults, and veterans. Purpose – the study aims to analyze the impact of food insecurity on mental health and suicidal behavior. It identifies the potential of leveraging food security improvement approaches for suicide prevention. Materials and Methods. A systematic review of the literature from the past five years using international databases (PubMed, Scopus, Web of Science). Content analysis of studies and reports to uncover key hypotheses and relationships. A multidisciplinary approach, integrating insights from psychology, sociology, economics, and medicine. Results and discussion. The study confirms that food security plays a vital role in supporting mental health, while its absence is a significant risk factor for developing suicidal behavior. Impact of Food Insecurity on Mental Health: Individuals experiencing food deficits are more prone to anxiety, depression, and suicidal thoughts. For example, in the United States, youth with insufficient food security were three times more likely to develop suicidal ideation compared to their food-secure peers. In Tanzania, schoolchildren suffering from food scarcity had twice the frequency of suicide attempts as their well-fed counterparts. Global Trends: Regions in Africa with chronic food shortages report high levels of suicidal thoughts – up to 30% among adults. In Canada, acute food deprivation was linked to reduced life expectancy and increased suicide risk. Among older adults in low-income countries, inadequate nutrition tripled the likelihood of suicide attempts. Youth and Students as Vulnerable Groups: Food insecurity profoundly impacts the mental health of adolescents and students. In Canada, up to 13% of adolescents facing food insecurity reported suicidal thoughts. Similarly, in Bangladesh, 75.5% of university students experienced food insecurity, which was associated with high rates of suicidal ideation, plans, and attempts. Challenges Faced by Military Veterans: Among U.S. military veterans, food insecurity was associated with nearly a fourfold increase in the risk of suicidal thoughts. This risk was particularly pronounced among those with co-existing mental health disorders. Social Mechanisms of Influence: Food insufficiency leads to stress, feelings of social isolation, and hopelessness – factors that significantly increase the likelihood of suicidal thoughts. It was found that up to 46% of this link is mediated by stress and isolation. Heterogeneity in Data and Methodology: Some aspects of the research remain unevenly addressed. Differences in measuring food insecurity complicate the comparison of results; however, all sources confirm its substantial impact on mental well-being. Results. The results highlight the need for a comprehensive approach to addressing food security issues. Recognizing the absence of food security as a major risk factor for mental health opens new avenues for developing targeted suicide prevention programs. Ensuring access to quality food, conducting localized research, and integrating food security parameters into national policy plans can significantly reduce suicide risks. Notably, the creation of regional support programs targeting vulnerable groups can ensure both physical and psychological well-being. Conclusion: The findings confirm that food security is not merely a socio-economic issue but also a crucial psychological category that demands attention from both the scientific community and governments. Ensuring food security transcends the fulfillment of physical needs, encompassing complex socio-economic and psychological challenges. Its provision is a vital step toward preserving mental health and saving lives globally. Recognizing food insecurity as a target for suicide prevention offers new opportunities to alleviate social tension and safeguard human lives.

The Effects of Gender on Mesenchymal Stromal Cell (MSC) Proliferation and Differentiation In Vitro: A Systematic Review.

Mesenchymal stromal cells (MSCs) have the potential for novel treatments of several musculoskeletal conditions due to their ability to differentiate into several cell lineages including chondrocytes, adipocytes and osteocytes. Researchers are exploring whether this could be utilized for novel therapies for joint afflictions. The role of gender in the ability of MSCs to differentiate and proliferate into different cells has not been clearly defined. This systematic review aims to report the current literature on studies, characterized by high quality and in-depth analysis even though quantitatively limited, that have looked at the role of gender in the differentiation and proliferation of MSCs. Sixteen studies were identified during the literature search, reporting 533 patients, of which 202 were male and 331 were female. MSC proliferation, phenotypic analysis and differentiation are reported and contrasted in terms of donor gender. Heterogeneity in methodologies across studies likely contributes to the inconclusive findings presented here, with no discernible statistical disparity observed between genders in differentiation traits. Nevertheless, the proliferation results indicate a notable gender-related impact. Future investigations should aim to ascertain the potential influence of gender on MSC proliferation capacities more conclusively, emphasizing the necessity of standardized protocols for MSC analyses to enhance accuracy and comparability across studies.

Acute stress differentially influences risky decision-making processes by sex: A hierarchical bayesian analysis.

How does stress influence our decision-making? Although numerous studies have attempted to answer this question, their results have been inconsistent-presumably due to methodological heterogeneity. Drawing on cumulative prospect theory, we examined how acute stress influenced risky decision-making. To this end, we randomly assigned 147 participants to an acute stress induction or control condition and subsequently assessed participants' risky decision-making. We found that stress increased risky decision-making overall, but more importantly, that stress exerted multiple effects on risky decision-making processes that differed between male and female participants. For female participants, relative to the control condition, stress produced a pattern of decision-making characterized by risk seeking with respect to gains, slightly reduced loss aversion, accurate outcome probability assessment, and greater choice stochasticity. For male participants, stress, relative to the control condition, produced to a pattern of decision-making characterized by very low loss aversion and poorer outcome probability assessment. These results suggest that some of the heterogeneity in existing literature may be explainable by task differences in risk type, risk amount, and outcome certainties, and further that these effects will differ by sex. In short, stress changes how we make decisions, and it does so differently by sex.

The quantity, reliability, transparency, reporting, and interpretation of pharmacovigilance signal detection studies in pregnancy: a meta-epidemiological study.

To systematically review the characteristics of the available pharmacovigilance signal detection studies in pregnancy, and comprehensively assess the reliability, transparency, reporting, and interpretation of these studies. We searched five databases from inception to February 2024 to identify the available pharmacovigilance signal detection studies in pregnancy. We extracted three aspects of information (basic information, data processing modes, signal detection analyses) to assess the reliability, transparency, and reporting of each study. Moreover, we adopted the criteria of Mouffak et al.'s study to assess the misinterpretation of signal detection results in these studies. A total of 33 pharmacovigilance signal detection studies in pregnancy were identified. Among them, there were great methodological heterogeneities in the data processing modes (restriction to the population, comparator, standardization of drug names and adverse event names, the assigned roles of drugs, counting unit, etc.) and signal detection analyses (signal detection method, sensitivity analysis, subgroup analysis, adjustment for confounding factors, etc.). Moreover, 13 (39%) studies had at least one type of inappropriate interpretation and/or extrapolation of signal detection results. Our results reveals that the quantity of pharmacovigilance signal detection studies in pregnancy is relatively limited. Furthermore, the reliability, transparency, reporting, and interpretation of the existing studies are less optimistic. The main issues existing in the available pharmacovigilance signal detection studies in pregnancy consist of two aspects: (1) great methodological heterogeneities exist in the data processing modes and signal detection analyses among different studies and (2) inappropriate interpretation and extrapolation of signal detection results are frequent.

Diet and Microbiota Modulation for Chronic Pouchitis: Evidence, Challenges, and Opportunities

Chronic pouchitis occurs in about 50% of patients undergoing a restorative proctocolectomy for ulcerative colitis. This affection represents a significant therapeutic challenge, particularly for symptomatic patients who do not respond to antibiotic treatments and biologic therapies. Several dietary approaches, including low FODMAP diets and the Mediterranean diet, have shown promising results in improving symptoms and disease burden. The rationale for dietary intervention lies in the reduction in inflammation and modulation of gut microbiota. However, conflicting results and methodological heterogeneity jeopardize the transition of these approaches from the field of research to clinical practice. Together with a nutritional approach, innovative methods of microbiota modulation, including probiotics and fecal microbiota transplantation, are emerging as safe and effective strategies in managing chronic pouchitis. This narrative review analyzes recent advancements in nutritional therapies and microbiota modulation as innovative and complementary approaches for managing chronic pouchitis. After examining microbiota modulation strategies, specifically the effectiveness of probiotics, prebiotics, and fecal microbiota transplantation in restoring microbial diversity and their potential role in alleviating symptoms, the review assesses the available clinical evidence concerning dietary interventions and their impact on gut microbiota. A comprehensive understanding of interventions aimed at modulating the microbiota is crucial for enhancing the effectiveness of conventional therapies. Such strategies may lead to significant improvements in patients’ quality of life and their perception of the disease. However, the variability in microbiota composition, the use of restrictive diets, and the lack of standardized methods for evaluating these interventions remain significant challenges. Future research is essential to improve our understanding of the underlying mechanisms and optimize clinical application.

Suture tapes show superior biomechanical properties and greater meniscal healing compared to conventional sutures in posterior meniscal root tear repairs: A systematic review.

This study aims to perform a systematic review to determine whether ultra-high molecular weight polyethylene (UHMWPE) tapes have superior biomechanical properties compared to conventional sutures in posterior meniscal root tear (PMRT) repairs, and whether this translates into superior clinical outcomes. The Cochrane Controlled Register of Trials, PubMed and Embase were used to perform a systematic review using the following search terms: (meniscus OR meniscal) AND (root OR posterior horn) AND (suture OR tape OR wire OR cord). Data pertaining to certain biomechanical properties (load to failure, stiffness, displacement during cyclical loading and at failure), meniscal healing and patient-reported outcome measures (PROMs) were extracted. Seven biomechanical and two clinical studies were included. There were 232 knees for biomechanical testing: 81 with UHMWPE tapes and 151 with conventional sutures (133 with UHMWPE sutures and 18 with Ethibond [Ethicon]). Testing set-up was similar across studies, but there were differences in repair techniques, including suture configuration, location and method of fixation. In general, the consensus was that tapes had a higher load to failure and stiffness, with similar displacement at failure to that of UHMWPE sutures. A similar trend was also observed when tapes were compared to Ethibond, except for FiberTape (Arthrex). This particular UHMWPE tape showed greater displacement during cyclical loading, resulting from knot slippage. Clinically, there were 73 patients, 41 with UHMWPE tapes and 32 with either UHMWPE sutures (n = 18) or braided polyester sutures (n = 14). Tapes led to greater meniscal healing 1 year postoperatively, with PROMs similar across groups. UHMWPE tapes generally demonstrated superior biomechanical properties compared to conventional sutures in PMRT repairs with a simple stitch configuration. However, further biomechanical studies are required to determine the extent to which tapes contribute to the repaired construct, especially with more complex repair configurations, as the existing evidence displayed a notable amount of methodological heterogeneity. Level IV systematic review of level IV evidence.

The association between glycaemic variability and sleep quality and quantity in adults with type 1 and type 2 diabetes: A systematic review.

Individuals with diabetes frequently encounter sleep disturbances, which can detrimentally impact glycaemic management. We reviewed the relationship between sleep outcomes and glycaemic variability in adults with diabetes. We systematically searched Medline, EMBASE and Cochrane Library (2002-March 2023) for studies evaluating sleep and glycaemic variability in adults with type 1 and type 2 diabetes. Among the 3049 records, 27 met the inclusion criteria (type 1 diabetes studies = 22). Due to methodological heterogeneity, a qualitative analysis was conducted. Most studies measuring sleep quality (5 out 7; 71%) reported a significant association with glycaemic variability in type 1 and type 2 diabetes. Sleep duration was not significantly associated with glycaemic variability in type 1 diabetes, whereas other sleep metrics yielded inconclusive results. Hybrid closed-loop pump interventions (n = 12) demonstrated varying sleep outcomes with improved glycaemic variability. Similarly, sleep interventions (n = 3) consistently enhanced sleep but not glycaemic variability. Limitations included moderate to high risk of study bias, confounders, methodological heterogeneity and limited type 2 diabetes data. A potential association between sleep quality and glycaemic variability exists. However, associations with other sleep metrics remain elusive, with no discernible association between sleep duration and glycaemic variability in type 1 diabetes. Despite advancements in continuous glucose monitoring and ambulatory sleep monitoring, standardised sleep assessment methodologies are lacking in real-world studies. Establishing standard protocols for sleep assessment and defining optimal sleep targets are crucial for meaningful comparisons between studies. Understanding the complex interplay between sleep and glycaemic variability holds promise in improving diabetes management and sleep health.

Early antibiotic exposure and risk of psychiatric and neurocognitive outcomes: systematic review and meta-analysis.

The prenatal and early-life periods pose a crucial neurodevelopmental window whereby disruptions to the intestinal microbiota and the developing brain may have adverse impacts. As antibiotics affect the human intestinal microbiome, it follows that early-life antibiotic exposure may be associated with later-life psychiatric or neurocognitive outcomes. To explore the association between early-life (in utero and early childhood (age 0-2 years)) antibiotic exposure and the subsequent risk of psychiatric and neurocognitive outcomes. A search was conducted using Medline, PsychINFO and Excerpta Medica databases on 20 November 2023. Risk of bias was assessed using the Newcastle-Ottawa scale, and certainty was assessed using the grading of recommendations, assessment, development and evaluation (GRADE) certainty assessment. Thirty studies were included (n = 7 047 853 participants). Associations were observed between in utero antibiotic exposure and later development of autism spectrum disorder (ASD) (odds ratio 1.09, 95% CI: 1.02-1.16) and attention-deficit hyperactivity disorder (ADHD) (odds ratio 1.19, 95% CI: 1.11-1.27) and early-childhood exposure and later development of ASD (odds ratio 1.19, 95% CI: 1.01-1.40), ADHD (odds ratio 1.33, 95% CI: 1.20-1.48) and major depressive disorder (MDD) (odds ratio 1.29, 95% CI: 1.04-1.60). However, studies that used sibling control groups showed no significant association between early-life exposure and ASD or ADHD. No studies in MDD used sibling controls. Using the GRADE certainty assessment, all meta-analyses but one were rated very low certainty, largely owing to methodological and statistical heterogeneity. While there was weak evidence for associations between antibiotic use in early-life and later neurodevelopmental outcomes, these were attenuated in sibling-controlled subgroup analyses. Thus, associations may be explained by genetic and familial confounding, and studies failing to utilise sibling-control groups must be interpreted with caution. PROSPERO ID: CRD42022304128.

The study on agitation and structure of orbitofrontal cortex subregion in first-episode drug-naïve patients with schizophrenia.

Agitation is one of the core symptoms of schizophrenia. The occurrence of agitation may be related to orbitofrontal cortex dysfunction. However, due to methodological heterogeneity, the relationship between agitation and orbitofrontal cortex subregions remains unclear. Based on the multi-dimensional structure of the orbitofrontal cortex subregion, this study aims to explore the relationship between orbitofrontal cortex structure and agitation in first-episode drug-naïve patients with schizophrenia. The study subjects included 50 first-episode drug-naïve patients with schizophrenia and 29 healthy controls. All participants underwent structure magnetic resonance imaging scanning. The patients' clinical symptoms were assessed using the Positive and Negative Syndrome Scale, and the agitation were evaluated using the Brief Agitation Rating Scale. SPSS 26.0 was used to compare the differences in the orbitofrontal cortex subregion between the two groups in different structure dimensions and then conduct a Pearson's partial correlations analysis to observe the relationship between orbitofrontal cortex subregion structure and agitation. There were no significant differences in demographic factors between the two groups. Our results show the folding index of the orbitofrontal cortex subregion in patients with schizophrenia were significantly smaller compared to the healthy controls. The surface area in the orbitofrontal cortex subregion is significantly negatively correlated with agitation in first-episode drug-naïve schizophrenia patients. These results suggest that structure alterations in the orbitofrontal cortex subregion may be involved in schizophrenia agitation.

Associations of smoke-free policies in multi-unit housing with smoking behavior and second-hand smoke exposure: A systematic review.

Although considerable progress has been made regarding the implementation of smoke-free policies (SFPs), many people continue to be exposed to second-hand smoke (SHS) in the home environment. The aim of this study was to conduct a systematic review on the association of SFPs in multi-unit housing (MUH) with smoking behavior and SHS exposure. In August 2022, we searched five online databases: PubMed, Embase, Web of Science, PsycINFO and CENTRAL. Keywords included terms for SFPs, MUH, smoking behavior and exposure to SHS. We searched for studies that focused on regular combustible cigarettes. Due to the high heterogeneity in methodology and outcomes of the included studies, a meta-analysis was not performed. Our search yielded 4750 articles. All of them were screened (24 based on full-text), and 17 met the inclusion criteria. All studies were published between 2001 and 2022. Most studies were conducted in the United States (n = 16) and used a cross-sectional design (n = 7) or a longitudinal design (n = 7). Seven studies evaluated smoking behavior. Five of them reported that SFPs in MUH were statistically significantly associated with decreases in either current smoking, smoking quantity, smoking frequency or smoking cessation. Fourteen studies evaluated exposure to SHS. Ten reported that SFPs in MUH were statistically significantly associated with decreases in self-reported exposure to SHS, airborne nicotine levels and particulate matter levels. Smoke-free policies in multi-unit housing appear to be associated with reduced smoking behavior and second-hand smoke exposure. Successful implementation depends on accessible cessation support and effective enforcement.

Systematic review of prognostic models for predicting recurrence and survival in patients with treated oropharyngeal cancer

ObjectivesThis systematic review aims to evaluate externally validated models for individualised prediction of recurrence or survival in adults treated with curative intent for oropharyngeal cancer.DesignSystematic review.SettingHospital care.MethodsSystematic searches were conducted...

Review article: Evaluating the effectiveness of arterial pressure point techniques as a first aid method for external haemorrhage control: A systematic review.

The current ANZCOR guidelines for first aid management of life-threatening bleeding from a limb, where bleeding cannot be controlled with direct pressure, recommends the use of an arterial tourniquet. However, tourniquets required specialised training and equipment, which may not be accessible in all emergencies. This systematic review evaluated the effectiveness of arterial pressure point techniques (APPT) as a first aid measure for controlling life-threatening, non-compressible bleeding from limbs and anatomical junctions. A comprehensive literature search was conducted following the PRISMA guidelines. The search was used in five databases: PubMed, CINAHL, SportDiscuss, Proquest Central and Embase. Eligible studies included adult participants in and out of hospital settings, focusing on extremities and junctional areas. Studies assessing APPT alone or compared with other first aid techniques were included. The review included nine quasi-experimental articles, with eight having low levels of evidence. Although most reported high success rates (87.5-100%) for APPT achieving blood flow cessation, its effectiveness compared to alternative methods, such as arterial tourniquets, remains inconclusive because of methodological heterogeneity and differing success benchmarks. APPT shows promise in external haemorrhage control. Additional research with higher levels of evidence, standardised protocols and larger sample sizes is needed. Investigation in real-world scenarios is crucial to compare methods like tourniquets. Future research will determine APPT's effectiveness and its potential role as a bridging technique before tourniquet application or medical assistance.

Cognitive Effects of Heading in Professional Football: A Systematic Review.

Large cohort studies have reported that former professional football players have an increased risk of mortality from neurodegenerative disease. Due to emerging concerns regarding the safety of heading the technique is now banned for players under 12. The aim of this systematic review was to evaluate the association between heading exposure and cognitive function in professional football players. A search strategy was devised and entered into seven electronic databases: MEDLINE, Embase, Web of Science, PsycINFO, CENTRAL, SportDiscus and PEDro. The search identified 563 records. After screening records and applying the eligibility criteria, nine cross-sectional studies (n=925) were included in the review, investigating 452 current and 473 former players (859 males, 66 females). Six studies (n=595) reported evidence for an association between heading and impaired cognitive function, while three studies (n=330) reported no association. Diverse cognitive domains were investigated, which might underline the disparity in these results. The association between heading and cognitive function in professional football appears likely but remains inconclusive. Methodological heterogeneity and variability in the presentation of results limits the conclusions drawn. Prospective longitudinal studies using standardised methods, and including females, are required to provide evidence to support or refute an association.