JBI SUMARI Research Articles

The global prevalence of human fascioliasis: a systematic review and meta-analysis.

Fascioliasis is a parasitic zoonosis that can infect humans and be a source of significant morbidity. The World Health Organization lists human fascioliasis as a neglected tropical disease, but the worldwide prevalence of fascioliasis data is unknown. We aimed to estimate the global prevalence of human fascioliasis. We performed a systematic review and prevalence meta-analysis. We used the following inclusion criteria: articles published in the English, Portuguese, or Spanish languages from December 1985 to October 2022 and studies assessing the prevalence of Fasciola in the general population with an appropriate diagnostic methodology, including longitudinal studies, prospective and retrospective cohorts, case series, and randomized clinical trials (RCTs). We excluded animal studies. Two reviewers independently reviewed the selected studies for methodological quality, performing critical standard measures from JBI SUMARI. A random-effects model was conducted of the summary extracted data on the prevalence proportions. We reported the estimates according to the GATHER statement. In all, 5617 studies were screened for eligibility. Fifty-five studies from 15 countries were selected, including 154,697 patients and 3987 cases. The meta-analysis revealed a pooled prevalence of 4.5% [95% confidence interval (CI): 3.1-6.1; I2 = 99.4%; T2 = 0.07]. The prevalence in South America, Africa, and Asia was 9.0%, 4.8%, and 2.0%, respectively. The highest prevalence was found in Bolivia (21%), Peru (11%), and Egypt (6%). Subgroup analysis showed higher prevalence estimates in children, in studies from South America, and when Fas2-enzyme-linked immunosorbent assay (ELISA) was used as a diagnostic method. A larger study sample size (p = 0.027) and an increase in female percentage (p = 0.043) correlated with a decrease in prevalence. Multiple meta-regression showed a higher prevalence for hyperendemic than hypoendemic (p = 0.002) or mesoendemic (p = 0.013) regions. The estimated prevalence and projected disease burden of human fascioliasis are high. Study findings support that fascioliasis continues to be a globally neglected tropical disease. Strengthening epidemiological surveillance and implementing measures to control and treat fascioliasis is imperative in the most affected areas.

Physicians' Perspectives on Inpatient Portals: Systematic Review.

Inpatient portals are online platforms that allow patients to access their personal health information and monitor their health while in the acute care setting. Despite their potential to improve quality of care and empower patients and families to participate in their treatment, adoption remains low. Outpatient portal studies have shown that physician endorsement can drive patients' adoption of these systems. Insights on physicians' perspectives on use of these platforms can help improve patient and physician satisfaction and inpatient portal uptake. The purpose of this systematic review is to better understand physicians' perspectives toward inpatient portals. A systematic literature review was conducted for studies published between 1994 and November 2021 using keywords for physicians' perspectives toward patient portals and personal health records. Databases included PubMed, MEDLINE, Web of Science, and Scopus. Articles solely focused on nonphysician clinicians or addressing only outpatient settings or shared notes were excluded from this review. Two reviewers performed title, abstract, and full-text screening independently. Bias assessment was performed using the JBI SUMARI Critical Appraisal Tool (Joanna Briggs Institute). Inductive thematic analysis was done based on themes reported by original authors. Data were synthesized using narrative synthesis and reported according to overarching themes. In all, 4199 articles were collected and 9 included. All but 2 of the studies were conducted in the United States. Common themes identified were communication and privacy, portal functionality and patient use, and workflow. In studies where physicians had no prior patient portal experience, concerns were expressed about communication issues created by patients' access to laboratory results and potential impact on existing workflow. Concerns about negative communication impacts were not borne out in postimplementation studies. Physicians perceived inpatient portals to be beneficial to patients and saw improvement in communication as a result. This is consistent with outpatient studies and highlights the need to improve training on portal use and include physicians during the design process. Health care organizations and information technology entities can take steps to increasing clinician comfort. Physician concerns involving patient portal usage and managing patient expectations also need to be addressed. With improved clinician support, initial pessimism about communication and workload issues can be overcome. Limitations of this review include the small number of pre- and postimplementation studies found. This is also not a review of perspectives on open notes, which merits separate discussion.

Web-Based Software Tools for Systematic Literature Review in Medicine: Systematic Search and Feature Analysis.

BackgroundSystematic reviews (SRs) are central to evaluating therapies but have high costs in terms of both time and money. Many software tools exist to assist with SRs, but most tools do not support the full process, and transparency and replicability of SR depend on performing and presenting evidence according to established best practices.ObjectiveThis study aims to provide a basis for comparing and selecting between web-based software tools that support SR, by conducting a feature-by-feature comparison of SR tools.MethodsWe searched for SR tools by reviewing any such tool listed in the SR Toolbox, previous reviews of SR tools, and qualitative Google searching. We included all SR tools that were currently functional and required no coding, and excluded reference managers, desktop applications, and statistical software. The list of features to assess was populated by combining all features assessed in 4 previous reviews of SR tools; we also added 5 features (manual addition, screening automation, dual extraction, living review, and public outputs) that were independently noted as best practices or enhancements of transparency and replicability. Then, 2 reviewers assigned binary present or absent assessments to all SR tools with respect to all features, and a third reviewer adjudicated all disagreements.ResultsOf the 53 SR tools found, 55% (29/53) were excluded, leaving 45% (24/53) for assessment. In total, 30 features were assessed across 6 classes, and the interobserver agreement was 86.46%. DistillerSR (Evidence Partners; 26/30, 87%), Nested Knowledge (Nested Knowledge; 25/30, 83%), and EPPI-Reviewer Web (EPPI-Centre; 24/30, 80%) support the most features followed by Giotto Compliance (Giotto Compliance; 23/30, 77%), LitStream (ICF), and SRDB.PRO (VTS Software). Fewer than half of all the features assessed are supported by 7 tools: RobotAnalyst (National Centre for Text Mining), SRDR (Agency for Healthcare Research and Quality), SyRF (Systematic Review Facility), Data ion Assistant (Center for Evidence Synthesis in Health), SR Accelerator (Institute for Evidence-Based Healthcare), RobotReviewer (RobotReviewer), and COVID-NMA (COVID-NMA). Notably, of the 24 tools, only 10 (42%) support direct search, only 7 (29%) offer dual extraction, and only 13 (54%) offer living/updatable reviews.ConclusionsDistillerSR, Nested Knowledge, and EPPI-Reviewer Web each offer a high density of SR-focused web-based tools. By transparent comparison and discussion regarding SR tool functionality, the medical community can both choose among existing software offerings and note the areas of growth needed, most notably in the support of living reviews.

Prevalence of domestic violence in a time of catastrophic disease outbreaks including COVID-19 pandemic: a systematic review protocol

BackgroundDomestic violence is a public health issue that has a long-term and irreversible effect on the victims. There are vulnerable groups like children, women, and elders. The problem becomes worse for these populations in the time of catastrophic events including disease pandemics. However, few attempts have been made to systematically review the prevalence and pattern of domestic violence during these times all over the world.MethodsAn initial search of PubMed will be followed by CINAHL, Scopus, Google Scholar, Embase, and ProQuest Health. The titles and abstracts of studies will be reviewed, and full-text articles will be selected if the inclusion criteria are met. Studies that meet the eligibility criteria will then be assessed by two independent reviewers. Full-text articles will be selected if the inclusion criteria are met. A standardized critical appraisal checklist for studies reporting prevalence data will be used to assess the methodological quality, and a standardized data extraction tool will be used. The results from the included studies will be analysed using the JBI SUMARI software.DiscussionThis systematic review will provide solid evidence on the magnitude of domestic violence of any forms during catastrophic disease outbreaks including the current pandemic, COVID-19.Systematic review registrationPROSPERO CRD42020192255.

LGBTQ2S+ childbearing individuals and perinatal mental health: A systematic review.

The perinatal period may uniquely impact the mental health and wellbeing of lesbian, gay, bisexual, transgender, queer, and Two-Spirit (LGBTQ2S+) childbearing individuals. To characterise and synthesise the experiences of LGBTQ2S+ childbearing individuals regarding perinatal mental health, including symptomatology, access to care and care-seeking. We conducted and reported a systematic review following PRISMA guidelines of eight databases (EMBASE, MEDLINE-OVID, CINAHL, Scopus, Web of Science: Core Collection, Sociological Abstracts, Social Work Abstract, and PsycINFO) from inception to 1 March 2021. Original, peer-reviewed research related to LGBTQ2S+ mental health was eligible for inclusion if the study was specific to the perinatal period (defined as pregnancy planning, conception, pregnancy, childbirth, and first year postpartum; includes miscarriages, fertility treatments and surrogacy). Findings were synthesised qualitatively via meta-aggregation using the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI SUMARI), and the ConQual approach. Our systematic search included 26 eligible studies encompassing 1199 LGBTQ2S+ childbearing participants. Using the JBI SUMARI approach, we reported 65 results, which we synthesised as six key findings. The studies described unique considerations for LGBTQ2S+ individuals' perinatal mental health, including heteronormativity, cisnormativity, isolation, exclusion from traditional pregnancy care, stigma, and distressing situations from the gendered nature of pregnancy. Many participants described a lack of knowledge from healthcare providers related to care for LGBTQ2S+ individuals. In addition, LGBTQ2S+ individuals described barriers to accessing mental healthcare and gaps in health systems. Strategies to improve care include provider education, avoidance of gendered language, documentation of correct pronouns, trauma-informed practices, cultural humility training and tailored care for LGBTQ2S+ people. Pregnancy, postpartum, and the perinatal period uniquely impacts the mental health and wellbeing of LGBTQ2S+individuals, largely due to systems-level inequities and exclusion from perinatal care. Healthcare providers should implement the identified strategies to improve perinatal care and address inequities.

Nurses' knowledge of heart failure self-care education: A systematic review.

The prevalence of heart failure is increasing, associated with high mortality and rehospitalization rate. The complexity and progressive clinical syndromes of heart failure have massively affected patients' quality of life. Heart failure self-care education provided by nurses seems to improve patients' knowledge and the clinical outcomes despite being in critical care or community settings. Nurses often gained heart failure self-care knowledge from formal and informal educational resources. However, the extent of knowledge acquired by nurses needs to be investigated before patient education could be successfully carried out. This systematic review identified the nurses' knowledge of heart failure self-care education according to the topics and factors that would be substantial to increase their knowledge. Literature resources from Medline, CINAHL, Ovid, Science Direct, Scopus and Google Scholar from 2002 to 2020 were studied and reviewed. This systematic review included nurses that take care of heart failure patients and studies that measured their knowledge score. The quality of all studies was determined using the JBI SUMARI Critical Appraisal tool, and a narrative approach was used to analyse the results. 15 studies were selected, involving 1644 nurses that had experience in taking care of heart failure patients. The overall mean ± SD score of nurses' knowledges was unsatisfactory with 12.1 ± 2.7 to 17.3 ± 1.4, respectively, and it showed a significant increase in the level of knowledge after attending a heart failure speciality course or educational intervention. The majority of the nurses were uncertain about the deteriorating symptoms and fluid management for heart failure patients. The nurses' level of knowledge was unsatisfactory, and therefore they need more in-depth learning and understanding of the heart failure topic through educational interventional. Critical care nurses needed to have in-depth knowledge to recognize symptoms of deterioration in heart failure patients, especially during the decompensated stage.

Role of mHealth applications for emergency medical system activation in reducing mortality in low-income and middle-income countries: a systematic review protocol

IntroductionPrehospital care is an essential component in reducing mortality for patients presenting with emergency medical conditions. Prehospital systems tend to be underdeveloped or non-existent in these areas, with less than...

The association between physical fitness parameters and in-season injury among adult male rugby players: a systematic review.

The high prevalence of injury among rugby players emphasizes the need for research related to injury risk factors. Physical fitness-related risk factors are likely culprits contributing to both contact and non-contact injuries. Establishing associations between preseason measured physical fitness aspects and injury risk, not only provide players' baseline fitness parameters but could also identify injury prone players, thereby contributing to injury prevention strategies. Therefore, the objective of this review was to assess and summarize scientific literature related to the association between preseason measured physical fitness tests and in-season injury among male rugby players. A systematic review was performed in compliance with the PRISMA 2020 Guidelines. This review considered observational, prospective cohort study designs. Studies that included male rugby (rugby union, rugby league, Australian football rules and rugby sevens) players aged 18 years or above from all levels of participation, evaluating the association between physical fitness test outcome and injury, were considered for inclusion. The three-step search strategy aimed at finding both published and unpublished studies in any language. Searched databases included Medline via PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Physiotherapy Evidence Database (PEDro), the Cochrane Controlled Trials Register in the Cochrane Library, ProQuest 5000 International, ProQuest Health and Medical Complete, EBSCO MegaFile Premier, SPORTDiscus with Full Text, SCOPUS and Science Direct. Key words used were "rugby," "injury," "physical fitness," and "risk factors." Papers that met the inclusion criteria were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal tool for cohort studies from the Joanna Briggs Institute (JBI SUMARI). A total of 16 studies were eligible for inclusion in this review. The mean critical appraisal score was 82.63% (SD=17.86). Forty-meter sprint speed was associated with injury in all three (100%) studies that included the test. Inconsistencies in the statistical analysis, however, make comparison difficult. None of the studies that investigated upper (N.=1) and/or lower body power (N.=3) identified power as a risk factor. Conflicting results were found for the association between strength, flexibility, cardiorespiratory fitness, and injury. Identifying factors associated with injury risk is an important step in the injury prevention paradigm. Once identified, players can be screened for risk factors prior to participation in sport. Interventions, based on screening results, which not only improve performance but also decrease players' risk of sustaining injuries (i.e., physical fitness related risk factors), provide additional incentive for compliance. Overall, this review highlights the inconsistency in testing methods used to gauge specific physical fitness constructs among rugby players, limiting the extent to which comparison of results and pooling of data is possible.

Adult patients’ experiences of patient-professional communication in patient portals: a qualitative systematic review protocol

ABSTRACTObjective:The objective of the review is to identify, critically appraise, and synthesize the best available evidence on adult patients’ experiences of patient-professional communication in patient portals.Introduction:Alongside face-to-face communication, patient portals can improve care quality and patients’ self-management of chronic diseases. It is important to examine how patients experience patient-professional communication in patient portals because this digital environment inherently lacks non-verbal messages, which can lead to misunderstandings.Inclusion criteria:Qualitative studies that describe patients’ experiences of reciprocal patient-professional communication in patient portals will be included. Patients must be over the age of 18 years and have a need for long-term care delivered by a health care professional (eg, patients with chronic diseases, such as cancer or diabetes). The health care professionals considered for inclusion are the members of the patient's health care team who communicate with the patient using patient portals. A patient portal is defined as a personal health record, which is either an independent webpage or interconnected with an electronic health record.Methods:The following databases will be searched: MEDLINE (PubMed), CINAHL (EBSCO), ProQuest (Abi/Inform), Scopus, Medic, Google Scholar, Science Direct and Cochrane CENTRAL. Gray literature will be searched in MedNar. Studies published in English, Finnish, or Swedish will be considered, and there is no date limitation. Studies will be screened and critically appraised for methodological quality by two independent researchers. Data will be extracted using a standardized tool from JBI SUMARI. Data synthesis will be conducted according to the meta-aggregation approach. Confidence in the evidence will be assessed using the ConQual approach.Systematic review registration number:PROSPERO CRD42021286177

Registered Nurses' and Medical Doctors' Experiences of Patient Safety in Health Information Exchange During Interorganizational Care Transitions: A Qualitative Review.

This systematic review aimed to identify, critically appraise, and synthesize the best available literature on registered nurses' and medical doctors' experiences of patient safety in health information exchange (HIE) during interorganizational care transitions. The review was conducted according to the JBI methodology for systematic reviews of qualitative evidence. A total of 5 multidisciplinary databases were searched from January 2010 to September 2020 to identify qualitative or mixed methods studies. The qualitative findings were pooled using JBI SUMARI with the meta-aggregation approach. The final review included 6 original studies. The 53 distinct findings were aggregated into 9 categories, which were further merged into 3 synthesized findings: (1) HIE efficiency and accuracy support patient safety during interorganizational care transitions; (2) inaccuracies in content and structure, along with poor HIE usability, jeopardize patient safety during interorganizational care transitions; and (3) health care professionals' (HCP) actions in HIE are associated with patient safety during interorganizational care transitions. The results of this review identified several advantages of HIE, namely, improvements in patient safety based on reduced human error. Nevertheless, a lack of usability and functionality can amplify the effects of human error and increase the risk of adverse events. In addition, HCPs' individual actions in HIE were found to influence patient safety. Hence, the cognitive and sociotechnical perspectives of work related to HIE should be studied. In addition, HCPs' experiences of each stage of HIE deployment should be clarified to ensure a high standard of patient safety. Registration: PROSPERO CRD42020220631, registered on November 13, 2020.

Bar fracture of implant-retained overdenture: Protocol of a systematic review and meta-analysis

Aim The fractured bar is a common prosthetic complication that deteriorates the patient’s experience and prosthesis functionality; therefore, we aim to determine risk factors, prevalence, and incidence of bar fracture. Methods We will conduct a systematic review using the guidelines of Cochrane’s Handbook and Joanna Briggs Institute’s (JBI) Manual and will adhere to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A three-step search strategy will be conducted to retrieve interventional and observational studies from biomedical bibliographic databases as well as grey literature. Two authors will assess the retrieved studies according to the predefined eligibility criteria. Data collection will be conducted using Extraction Forms. Risk of bias of included interventional studies will be assessed using the Risk of Bias 2 tool, while observational studies will be evaluated by ROBINS-E. Studies findings will be qualitatively and quantitively synthesized using JBI SUMARI. Results The results of this systematic review will be presented to clinicians and researchers in speciality conferences and a peer-reviewed journal. Conclusion This review is the first to identify the clinical and biological risk factors of bar fracture and to evaluate its prevalence and incidence rates; aiming to provide evidence-based recommendations for treatment planning and maintenance of implant-retained overdenture using bar-clip attachment system.

Dental Health Inequalities among Indigenous Populations: A Systematic Review and Meta-Analysis

The aim of this systematic review and meta-analysis was to document the disparity in dental caries experiences among indigenous and nonindigenous populations globally by measuring dental caries prevalence and severity. An electronic database (MEDLINE) was initially searched using relevant keywords. This was followed by use of the search string in the following electronic databases: Scopus, EBSCOhost, Cochrane, and Open Grey. Two independent reviewers conducted the study search and screening, quality assessment, and data extraction, which was facilitated using JBI SUMARI software. The primary outcome was the decayed missing filled teeth (DMFT) score and dental caries prevalence. Subgroup analysis was done by country of publication to identify causes of heterogeneity. Forest plots were used with the standardized mean difference (SMD) and publication bias was assessed using the Egger test with funnel plot construction. For the final review, 43 articles were selected and 34 were meta-analyzed. The pooled mean DMFT for both the permanent dentition (SMD = 0.26; 95% CI 0.13–0.39) and deciduous dentition (SMD = 0.67; 95% CI 0.47–0.87) was higher for the Indigenous population than for the general population. Indigenous populations experienced more decayed teeth (SMD = 0.44; 95% CI 0.25–0.62), a slightly higher number of missing teeth (SMD = 0.11< 95% CI –0.05 to 0.26), and lesser filled teeth (SMD = –0.04; 95% CI –0.20 to 0.13) than their nonindigenous counterparts. The prevalence of dental caries (SMD = 0.27; 95% CI 0.13–0.41) was higher among indigenous people. Globally, indigenous populations have a higher caries prevalence and severity than nonindigenous populations. The factors which have led to such inequities need to be examined.

What is and what ought to be: A meta-synthesis of residential aged care staffs' perspectives on quality care.

As places of both residence and work, what constitutes "good quality care" in residential aged care requires consideration of staffs' perspectives. A meta-synthesis of the qualitative literature was conducted exploring residential aged care staff perspectives on "quality of care." Six electronic databases were searched for articles that met the screening inclusion criteria. This meta-synthesis was informed by the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, and included studies were critically appraised using JBI SUMARI. Two independent reviewers conducted thematic network mapping and analysis of included articles, with oversight from three additional reviewers. Forty-seven articles were included, with findings summarised into four organising themes and nine basic themes. The four organising themes about quality care from staff perspectives include direct care, professional values and competence, the care environment and organisational/regulatory factors. Staff describe a wide range of factors that they perceived to influence the quality of care. Some may feel motivated to leave employment in aged care, due to organisational pressures that make staff unable to uphold what they perceive as an acceptable standard of care. There is tension between professional values and organisation/regulatory factors-regulation should be enacted at a level that supports good practice and staff's moral integrity. This review found that while person-centred care is now well established as the benchmark of quality care in residential aged care homes, achieving it in reality remains challenged by limitations on staff members' time, resources and sometimes their competencies and the regularity of their employment.

Effect of post-storage filters vs. pre-storage filters for leukoreduction of blood components on clinical outcomes: a systematic review protocol.

This review will synthesize the best available evidence on the effectiveness of leukocyte reduction by comparing post-storage and pre-storage filters. The review will consider the following clinical outcomes: transfusion reactions, bacterial infection, length of stay, and mortality. Transfusion is a relevant therapy, but it is not risk-free. Leukocyte reduction can be performed either by apheresis or by pre- or post-storage filters in order to reduce the risk of transfusion reactions, transmission of some diseases, alloimmunization, and platelet refractoriness. It can also reduce the length of hospital stay and the use of antibiotics. Studies comparing the transfusion of leukocyte reduction through post-storage filters with pre-storage filters in patients of any age who received a transfusion and the clinical outcomes resulting from the transfusion will be considered for inclusion. Studies in Portuguese, English, and Spanish will be considered, with no publication time limit. The research sources will include MEDLINE (PubMed), CINAHL (EBSCO), PsycINFO, Scopus, The Cochrane Library, Web of Science Core Collection, Embase, LILACS, and gray literature sources. The selection of titles and abstracts will be carried out by two independent reviewers, and the critical evaluation of the studies will be based on JBI tools. The data of interest for the review question will be extracted using JBI SUMARI. A narrative synthesis will be performed as will a meta-analysis and risk assessment of publication bias, if possible. PROSPERO: CRD42020192202.

Prevalence of dental caries among Indigenous populations compared to non-Indigenous populations: a quantitative systematic review protocol.

The objective of this review is to evaluate if the prevalence of dental caries is higher among Indigenous populations compared to non-Indigenous populations. Globally, Indigenous populations have experienced substantial inequalities in health, including oral health care, when compared to their non-Indigenous counterparts. Indigenous populations experience a higher prevalence of dental caries, but most of this data has been collected from convenience samples not involving non-Indigenous groups. This review will highlight differences in the prevalence of dental caries globally among Indigenous groups compared to non-Indigenous groups. The systematic review will include all studies that have compared the prevalence of dental caries (% of decayed teeth>0) and dental caries experience (mean score of decayed, missing, filled teeth) among Indigenous and non-Indigenous populations across all ages. Initially, articles will be searched in MEDLINE, followed by a more comprehensive search on Scopus, EBSCO (Dentistry and Oral Sciences Sources), Cochrane Database, and OpenGrey. The search will be conducted independently by two reviewers from database inception to September 2020. A reference list will be made identifying all eligible studies. Titles and abstracts will be reviewed, as well as the full text of articles that meet the inclusion criteria. To assess methodological quality, a standardized critical appraisal checklist for studies reporting prevalence will be selected, followed by standardized data extraction using the JBI tool. The results from included studies will be analyzed using JBI SUMARI. PROSPERO CRD42020204311.

Effectiveness of educational interventions for health care staff to prevent and manage aggressive behaviors in patients admitted to an acute hospital: a systematic review protocol.

The objective of this review is to determine the most effective strategies for educating health care staff to manage or prevent aggressive patient behaviors within an acute care setting. Health care workers in acute settings are frequently at risk of being injured by aggressive patients. Staff are often ill-prepared to de-escalate such behaviors and, therefore, are at greater exposure to verbal or physical injury. This protocol outlines methods for a systematic review on the effectiveness of educational strategies to manage and/or prevent aggressive patient behaviors in hospitals. Quantitative studies that report on programs used to educate or train hospital staff in managing or preventing an episode of aggressive behavior by an adult patient while in an acute health care facility will be included. Individual, program, and organizational outcomes, such as confidence, behavior, knowledge, or attitudes, as well as recorded rates of injury, sick leave, stress, anxiety, or detection/prevention of aggression before and/or after the intervention will be analyzed. Psychiatric patients or settings are excluded from this review. Two reviewers will independently select and appraise eligible studies and extract data following methods outlined by JBI for systematic reviews of effectiveness. Multiple databases will be searched for studies in English and Chinese from 2008 to the present. The JBI System for the Unified Management, Assessment and Review of Information (JBI SUMARI) will be used to manage studies and, where possible, meta-analysis will be undertaken. Results will be presented in a Summary of Findings following the GRADE approach. PROSPERO CRD42020190538.

Fear-of-falling activity-avoidance behavior in people with Parkinson's disease: a scoping review protocol.

The objective of this review is to explore existing literature related to fear of falling activity avoidance behavior and identify what is known about this phenomenon in people with Parkinson's disease. Falling and fear of falling are significant concerns for persons with Parkinson's disease. Fear of falling is a significant problem over and above falling itself and can lead to activity avoidance. Activity-avoidance behavior is a risk factor for increased falls and can lead to further functional decline. A better understanding of the fear of falling and the associated avoidance behavior can inform screening, evaluation, and interventions to decrease fall risk and improve activity engagement and quality of life for persons with Parkinson's disease. This review will consider studies published in English that include individuals diagnosed with Parkinson's disease experiencing fear of falling that impacts activity engagement with no limit on participant age or time of publication. JBI methodology will be used to conduct this scoping review. A three-step search strategy will be utilized. The databases to be searched include MEDLINE (PubMed), Embase (Elsevier), Scopus (Elsevier), APA PsycINFO (EBSCO), CINAHL (EBSCO), Papers First (OCLC), and ProQuest Dissertations and Theses (ProQuest). Two independent reviewers will screen the titles, abstracts, and full text of the selected studies. Data collection will be performed with a tool developed by the researchers based on the standardized tool from JBI SUMARI. Data will be presented in a comprehensive narrative summary.

Understanding the experience of diagnostic overshadowing associated with severe mental illness from the consumer and health professional perspective: a qualitative systematic review protocol.

The objective of this review is to identify, appraise, and synthesize available qualitative evidence related to diagnostic overshadowing in mental health consumers who present with clinical manifestations of physical illness. A lived experience of mental illness is associated with compromised physical health and decreased life expectancy. Mental health consumers face greater barriers to accessing treatment for physical illnesses and are less likely to receive appropriate physical care than those without mental illness. Physical illnesses may go underdiagnosed and undertreated in mental health consumers because clinicians tend to focus on the mental illness to the exclusion of other health problems, a phenomenon called diagnostic overshadowing. This systematic review will combine the experiences of mental health consumers and health care professionals to gain deeper understanding of diagnostic overshadowing. This review will consider qualitative studies that include the experiences of diagnostic overshadowing in mental health consumers and/or the health care professionals who treat them. Studies conducted in any health care facility or service offering care for physical illnesses will be considered. MEDLINE, CINAHL, PsycINFO, and Scopus will be searched along with sources of gray literature. Studies in English published from 2004 onward will be considered. Retrieval of full-text studies, assessment of methodological quality, and data extraction will be performed independently by two reviewers. Findings will, where possible, be pooled using JBI SUMARI with the meta-aggregation approach. A ConQual Summary of Findings will be presented. PROSPERO CRD42020186418.

Circulating leptin levels in patients with myalgic encephalomyelitis, chronic fatigue syndrome or fibromyalgia: a systematic review protocol.

The objective of the review is to evaluate circulating levels of leptin in people diagnosed with myalgic encephalomyelitis chronic fatigue syndrome or fibromyalgia syndrome and to investigate the differences compared with healthy controls. Myalgic encephalomyelitis chronic fatigue syndrome is a condition that has major symptoms, including self-reported fatigue, post-exertional malaise, and unexplained pain across the body. The widespread pain is measured in a systematic way and is often referred to as fibromyalgia. The two disorders have many similarities, but their association with leptin has indicated that leptin may affect the role of pro-inflammatory cytokines and symptom severity. This review will consider observational studies of varying study designs including prospective and retrospective cohort studies, case-control studies, time-series, and analytical cross-sectional studies that include both cases and healthy comparators. Cases will include a diagnosis of myalgic encephalomyelitis, chronic fatigue syndrome, and/or fibromyalgia. Controls are people without this diagnosis, usually healthy participants. Only studies published in English will be included due to limited resources for translation. This protocol will be reported based on the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) checklist and will follow the JBI methodology for systematic reviews of etiology and risk. A comprehensive search strategy will include PubMed, Embase, Scopus, Science Direct, and PsycINFO. Two reviewers will screen, critically appraise eligible articles, and extract data using a standardized data extraction tool informed by JBI SUMARI. The authors will complete a quantitative analysis that synthesizes findings across studies using pooled effect sizes and confidence intervals of the measures provided. PROSPERO CRD42020169903.

Ambient Air Pollution, Extreme Temperatures and Birth Outcomes: A Protocol for an Umbrella Review, Systematic Review and Meta-Analysis.

Prenatal exposure to ambient air pollution and extreme temperatures are among the major risk factors of adverse birth outcomes and with potential long-term effects during the life course. Although low- and middle-income countries (LMICs) are most vulnerable, there is limited synthesis of evidence in such settings. This document describes a protocol for both an umbrella review (Systematic Review 1) and a focused systematic review and meta-analysis of studies from LMICs (Systematic Review 2). We will search from start date of each database to present, six major academic databases (PubMed, CINAHL, Scopus, MEDLINE/Ovid, EMBASE/Ovid and Web of Science Core Collection), systematic reviews repositories and references of eligible studies. Additional searches in grey literature will also be conducted. Eligibility criteria include studies of pregnant women exposed to ambient air pollutants and/or extreme temperatures during pregnancy with and without adverse birth outcomes. The umbrella review (Systematic Review 1) will include only previous systematic reviews while Systematic Review 2 will include quantitative observational studies in LMICs. Searches will be restricted to English language using comprehensive search terms to consecutively screen the titles, abstracts and full-texts to select eligible studies. Two independent authors will conduct the study screening and selection, risk of bias assessment and data extraction using JBI SUMARI web-based software. Narrative and semi-quantitative syntheses will be employed for the Systematic Review 1. For Systematic Review 2, we will perform meta-analysis with two alternative meta-analytical methods (quality effect and inverse variance heterogeneity) as well as the classic random effect model. If meta-analysis is infeasible, narrative synthesis will be presented. Confidence in cumulative evidence and the strength of the evidence will be assessed. This protocol is registered with PROSPERO (CRD42020200387).