Low Risk Of Bias Research Articles

Prevalence and associated factors of depression among refugees in East Africa: a systematic review and meta-analysis

Introduction: Depression is a common and debilitating mental health issue among refugees in East Africa, who face numerous challenges. However, there is a lack of systematic reviews and meta-analyses that have explored the pooled prevalence and associated factors of depression among refugees in East Africa. This study aims to investigate the pooled prevalence of depression and its associated factors among refugees living in East Africa.MethodsA systematic search was conducted across several databases, including PubMed/MEDLINE, CINAHL, ScienceDirect, African Journals of Online (AJOL), and Google Scholar. The quality of the included studies was assessed using a Joanna Briggs Institute (JBI) quality appraisal tool. Statistical analysis was carried out using STATA-17 software packages, and a meta-analysis was conducted using a random-effects model. Heterogeneity among the studies was assessed using the I2 statistic. Publication bias was evaluated using the DOI plot, Luis Furuya Kanamori (LFK) index, and Egger’s test. For associated factors of depression, effect sizes (odds ratio) with 95% confidence intervals were analyzed.ResultA total of eight studies involving 6,388 participants were included in this systematic review and meta-analysis, all of which were assessed to have a low risk of bias. The pooled prevalence of depression was 50.60%, with a 95% CI (35.49%, 65.71). Regarding factors associated with depression; being female [(OR = 2.01; 95% CI (1.06, 3.82)], having poor social support [OR 5.88; 95% CI (2.53, 13.67)], and experienced eight or more traumatic events [OR = 3.31;95% CI (1.74, 6.31) were positively associated factors with depression.ConclusionThe pooled prevalence of depression among refugees in East Africa was found to be significantly high. Female participants, poor social support, and experienced eight or more traumatic events were factors affecting depression among refugees in East Africa. Therefore, policymakers and health personnel in East Africa should prioritize addressing the needs of female participants, individuals with poor social support, and those who have experienced eight or more traumatic events.

Comparative Effectiveness of Regenerative Endodontic Treatment Versus Apexification for Necrotic Immature Permanent Teeth With or Without Apical Periodontitis: An Umbrella Review.

The evidence related to the superiority of the recommended treatment protocols for necrotic immature permanent teeth is unclear. We aimed to compare the clinical, radiographic, and overall success rates of apexification and regenerative endodontic treatment (RET), assess the methodological quality, and assess the strength of evidence for outcomes. A search was performed in PubMed, Scopus, LILACS, EMBASE, Web of Science, and the Cochrane Library. The titles, abstracts and full texts of systematic reviews (SRs) comparing RET and apexification were screened. The quality and strength of evidence were analyzed via AMSTAR-2, ROBIS, and modified Kohler's criteria. Twelve SRs were included, with nine having meta-analytic outcomes. The quality of only one study was high, and the risk of bias was low in two studies. Comparable success and survival rates for RET and apexification, with no superiority of any treatment, were reported. RET was superior in stimulating root thickness and lengthening. Weak evidence was noted for a higher clinical and radiographic success rate of the apical plug technique and for root lengthening and an increase in root thickness in RET. RET and apexification exhibited comparable success rates of > 85% across all domains. Most comparisons did not reveal significant differences in clinical, radiographic, or overall success. However, the quality of evidence was weak (class IV) for both outcomes, and the majority of systematic reviews exhibited low or critically low quality and high risk of bias.

A Systematic Review and Meta-Analysis of the Effectiveness of Mulligan Mobilization with Movement on Pain, Range of Motion, Function, and Flexibility in Patients with Sciatica

Background The Mulligan techniques address lumbar disc lesions and related dysfunctions. However, the current body of evidence of its effectiveness remains limited. Aims To assess the effectiveness of the Mulligan concept on pain alleviation, range of motion, function, and flexibility in patients with sciatica. Methods This meta-analysis included randomized controlled trials that applied Mulligan techniques to patients with sciatica and assessed outcomes such as pain, range of motion, function, or flexibility. We searched six electronic databases to identify the relevant trials. The methodological quality of the studies was evaluated using the Cochrane risk of bias assessment. Results A total of 21 randomized controlled trials (RCTs) were included in this study. Three primary Mulligan techniques were performed: spinal mobilization with leg movement (SMWLM), bent leg raise (BLR), and traction straight leg raise (TSLR). In this review, seven trials exhibited a high to moderate risk of bias, while the remaining trials demonstrated a low risk of bias. The analysis revealed that SMWLG could be beneficial in improving pain (standardized mean difference [SMD] = −0.58, 95% confidence interval [CI] = −0.82 to −0.33, p < .001) and function (SMD = −1.02, 95% CI = −1.87 to −0.17, p = .02). Additionally, BLR showed potential benefits in improving flexibility, particularly when combined with standard treatment (SMD = 0.59, 95% CI = 0.30 to 0.88, p < .001). Conclusions SMWLG demonstrates greater improvements in pain and function compared to other Mulligan techniques in patients with sciatica. However, the limited number of trials and the overall low quality of the existing literature highlight the need for future high-quality research that encompasses all related Mulligan techniques.

The Effectiveness of Exercise Referral Schemes on Patient Health & their Cost: An Umbrella Review.

Exercise referral schemes (ERS) involving referrals from primary care providers to exercise programs and professionals may be a useful strategy for helping patients lead more active lifestyles. We performed an umbrella review to determine the impact of ERS on patient activity/fitness, clinical outcomes, and their cost-effectiveness. The review was pre-registered in Prospero (CRD42023443094) and conducted in July 2023. PRISMA reporting was followed. Our umbrella review screened 2129 citations with 12 studies meeting our inclusion criteria (n=8 meta-analyses) that included 110 unique individual studies of 62815 unique participants. The average study quality was 8.9±1.9 (out of 11). Studies examined patient physical activity or fitness (n=9/12), a clinical outcome (n=8/12), and/or cost-effectiveness (n=4/12). Earlier reviews observed that physical activity or fitness was unchanged following ERS, but more recent (post-2015), larger studies observe low-to-moderate improvements. Similarly, recent reviews reported that ERS lowered blood pressure, body mass index, and depression. ERS cost-effectiveness was conflicting. Altogether our umbrella review of high-quality reviews with a low risk of bias demonstrated that although early work indicated null effects, more up-to-date reviews of ERS observe improved patient activity/fitness, cardiometabolic, and mental health. ERS are an effective strategy to improve patient health.

Educational outcomes of digital serious games in nursing education: a systematic review and meta-analysis of randomized controlled trials

BackgroundAdvancements in digital technologies and the coronavirus disease pandemic have rapidly shifted educational practices towards engaging digital methods, such as serious games, significantly influencing healthcare education. Digital serious games enhance nursing education by effectively overcoming limitations such as limited training time and inadequate resources, thereby improving knowledge and skills. Few high-quality systematic reviews and meta-analyses were focused exclusively on randomized controlled trials (RCTs) of digital serious games to determine their effects in nursing education.ObjectiveTo evaluate the effects of digital serious games on nursing education through a systematic review and meta-analysis using the Kirkpatrick model to evaluate learning and behavioral changes.MethodsA systematic review and meta-analysis of RCTs was performed. Six databases were searched for articles published before April 2024. Risk of bias was assessed using the Revised Cochrane Risk of Bias tool for randomized trials. A sensitivity analysis was performed. Outcome variables were categorized according to the Kirkpatrick model. Effect sizes were determined using Hedges’ g in a random-effects model. Subgroup analysis was performed.ResultsThe quality appraisal results revealed that all the studies exhibited a low risk of bias across these domains. Eleven studies were included in the systematic review, and eight studies, in the meta-analysis. The intervention group showed significant improvements in knowledge (Hedges’ g = 0.75, 95% confidence interval (CI) = [0.27, 1.22], p = .002, I² = 90.51%), confidence (Hedges’ g = 0.73, 95% CI = [0.23, 1.24], p = .005, I² = 82.71%), and performance (Hedges’ g = 0.49, 95% CI = [0.17, 0.80], p = .003, I² = 56.60%). Subgroup analysis showed a significant improvement in knowledge when the intervention period exceeded 2 weeks (Hedges’ g = 0.53, 95% CI = [0.32, 0.74], p < .001, I² = 25.41%).ConclusionThis study demonstrates that digital serious games significantly enhance knowledge, performance, and confidence of nursing students, offering a valuable alternative to traditional methods and equipping them with essential clinical competencies. However, the observed high heterogeneity and limitations like brief intervention durations necessitate caution in result interpretation and highlight the need for further research to explore long-term effects and behavioral changes in nursing education.

Thinking outside the shoulder: A systematic review and metanalysis of kinetic chain characteristics in non-athletes with shoulder pain.

The kinetic chain is important in the proximal-distal energy transfer along body segments. Although biomechanical impairments in components of the kinetic chain have already been reported in athletes with shoulder pain, such investigations in non-athlete individuals have not yet been synthesized. To systematically review the literature and analyze the quality of evidence on the characteristics of the kinetic chain of non-athletes with shoulder pain compared to asymptomatic individuals. Studies published until February 2024 (without language restrictions) that quantitatively assessed outcomes related to the kinetic chain of non-athlete individuals were searched in five databases (MEDLINE, CINAHL, Web of Science, EMBASE, and SCOPUS). The risk of bias and quality of evidence were analyzed using the Joanna Briggs Institute Critical Appraisal Tool for Analytical Cross-Sectional Studies and the Grading of Recommendations, Assessment, Development, and Evaluation approach, respectively. To summarize the findings, meta-analyses with random-effects models were performed. Six cross-sectional studies (n = 562 [282 with shoulder pain], mean age = 48.7 ± 8.1 years) with low risk of bias were included in this review. Very low-quality evidence suggests that individuals with shoulder pain may present a lower active range of motion and muscular endurance/strength in the cervical spine, thoracolumbar region, and hip, as well as deficits in neuromuscular control of the lower extremities. Findings related to thoracic spine posture were conflicting and no differences were found in cervical spine isometric muscular strength between individuals with and without shoulder pain. Individuals with shoulder pain may present alterations in active mobility, muscular endurance, and neuromuscular control in kinetic chain segments. These findings suggest that broader physical assessments considering components of the kinetic chain may be clinically relevant in this population. However, based on the very low quality of evidence, the findings of this review should be interpreted with caution.

The therapeutic potential of exercise in post-traumatic stress disorder and its underlying mechanisms: A living systematic review of human and non-human studies

Background Exercise for post-traumatic stress disorder (PTSD) is a potentially effective adjunct to psychotherapy. However, the biopsychosocial mechanisms of exercise are not well understood. This co-produced living systematic review synthesizes evidence from human and non-human studies. Methods We Included controlled human and non-human studies involving searches of multiple electronic databases (until 31.10.23). Records were screened, extracted, assessed for risk of bias, and reconciled by two independent reviewers. The primary outcome for human studies was PTSD symptom severity, while outcomes of interest for non-human studies included freezing behaviour, fear memory, fear generalization, startle response, and locomotion. Data were synthesised with random-effects meta-analysis. Results Eleven human studies met the eligibility criteria. Overall, exercise was not associated with symptom severity improvement compared to control (standardized mean difference [SMD] -0.08, 95% confidence interval [CI] -0.24 to 0.07; 8 studies, one at low risk of bias). High-intensity exercise reduced PTSD symptoms scores more than moderate-intensity exercise. There was insufficient data to examine the effects of exercise on functional impairment, PTSD symptom clusters, and PTSD remission. Only three studies, all at high risk of bias, examined mechanisms of exercise with inconclusive results. Exercise was associated with improvement in all behavioural outcomes, including locomotor activity (SMD 1.30, 95% CI 0.74 to 1.87, 14 studies), and changes in several neurobiological markers, including increase in brain-derived neurotrophic factor (SMD 1.79, 95% CI 0.56 to 3.01). Conclusions While non-human studies provide compelling evidence for the beneficial effects of exercise, human trials do not. Evidence from non-human studies suggest that exercise might increase the levels of brain-derived neurotrophic factor, enhance cognitive appraisal, and improve perceived exertion. Overall, the paucity of data on the effectiveness of exercise in PTSD and mechanisms of action underscore the need for rigorous trials. Registration The protocol was registered with PROSPERO (ID:453615; 22.08.2023).

A Narrative Review in Hip Surgery: Key Findings from a Leading Orthopedic Journal in 2022–2023

Background/Objectives: Orthopedic hip surgery has undergone advances driven by innovations in surgical techniques and improved patient care protocols. The aim was to synthesize and appraise all studies relevant to hip surgery published in Knee Surgery, Sports Traumatology, Arthroscopy (KSSTA) in 2022–2023. Methods: The search included all studies published in KSSTA from 1 January 2022 to 31 December 2023. Quality assessment was performed using appropriate tools for randomized controlled trials (RCTs), non-RCTs, and systematic reviews. Due to the diverse nature of the included studies, a narrative synthesis approach was used. Results: A total of 33 primary studies were included in this narrative review, of which 10 were reviews (5 systematic reviews), 1 was an RCT, and 22 were non-RCTs. A total of 11 were from the UK, 10 studies were from the USA, and 5 were from Canada. Femoroacetabular impingement (FAI) was investigated in a total of 23 studies, followed by hip micro-instability in 7 studies, dysplasia in 5 studies, and gluteal and hamstring tears in 4 studies. The RCT had a low risk of bias. Of the 22 non-RCTs, 16 had a low risk of bias, 5 had a moderate risk of bias, and 1 had a high risk of bias. All systematic reviews were of moderate quality. Conclusions: Hip arthroscopy is an effective treatment for FAI with promising early outcomes, especially when combined with closed capsular repair and appropriate rehabilitation. Surgeons should tailor their approach to capsular management to optimize recovery, as closed capsular repair may enhance functional outcomes. Additionally, preoperative tools like the HAR Index can help identify patients at higher risk of requiring hip arthroplasty after surgery. The conclusions of the included primary studies align with current general recommendations and contribute valuable insights to the field of hip orthopedics.

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...

Computed tomography assessment of neurocranial structures for sexual dimorphism identification: a meta-analysis.

The human neurocranium exhibits significant sexual dimorphism, making it a valuable resource for anthropological studies. This systematic review aggregated and analyzed data from literature on sex differences in neurocranial dimensions as measured by computed tomography (CT). Following registration of the review protocol with PROSPERO (#CRD 42023442451), comprehensive searches were conducted in six databases and gray literature. From an initial pool of 1,499 articles, 14 met the inclusion criteria and were analyzed for data extraction, meta-analysis of linear measurements, risk of bias (RoB), and certainty of evidence (GRADE) evaluation. In the meta-analysis (Sample size- 1726 female and 1837 male), the inverse variance method and a random-effects model were employed using Review Manager (version 5.4.1). Statistical heterogeneity was quantified using the I2 coefficient. The studies primarily involved linear measurements between specific cranial landmarks, manually delineated using imaging software. Measurements analyzed included Maximum Cranial Length (G-Op), Cranial Base Length (N-Ba and N-Pfm), Cranial Height (Ba-Br), Frontal Chord (N-Br), Maximum Cranial Breadth (Eu-Eu), Minimum Frontal Breadth (Ft-Ft), Upper Facial Breadth (Fmt-Fmt), and Bimastoid Breadth (Ms-Ms). Results indicated that the mean values were significantly lower in females (p < 0.001), with no differences between the subgroups of dry skulls and living patients. The largest differences between sexes were observed in G-Op [-8.64 (-9.69, -7.59) mm] and N-Pfm [-8.83mm (-12.75, -4.91)]. Our meta-analysis showed a low risk of bias, and measurements of N-Ba, Ba-Br, N-Br, and Ms-Ms demonstrated high certainty of evidence according to the GRADE approach. This research underscores the reliability of specific neurocranial measurements for sex differentiation in CT scans, with smaller dimensions consistently found in females.

High-intensity interval training effects on people with multiple sclerosis; a systematic review and meta-analyses for exercise capacity and fatigue.

This study was to examine the effects of high-intensity interval training (HIIT) interventions on exercise capacity and fatigue in people with MS. We performed a systematic review and meta-analysis. PubMed/Medline, Web of Science, Scopus and Google Scholar databases were systematically searched from inception to January 2024. We reviewed randomized controlled trials (RCTs) that focused their intervention on HIIT for people with MS to improve exercise capacity or fatigue. Two researchers performed the search process independently in the different databases and assessed methodological quality and risk of bias. Eleven studies were included in the systematic review and seven of them were meta-analyzed. The overall pooled effect favored HIIT interventions in improving exercise capacity (SMD = 0.29; 95% CI = 0-05,0.53; p = 0.02) and reducing fatigue (SMD = -0.26; 95% CI = -0.50, -0.02; p = 0.03) in people with MS. We generally found a low risk of bias and a good methodological quality. The results of this review and meta-analysis provide evidence that HIIT interventions improved and reduced fatigue in people with MS. HIIT intervention may be a good option to improve exercise capacity and reduce fatigue of these people.

Efficacy of 18FDG-PET/CT in Detecting Synchronous Malignancies in Patients With Head and Neck Cancer: A Systematic Review and Meta-analysis.

To assess the diagnostic accuracy of fluorine-18 fluorodeoxyglucose positron emission tomography and computed tomography (18FDG-PET/CT) in detecting second primary malignancies (SPMs) in patients with treatment naïve head and neck squamous cell carcinoma (HNSCC). Medline, Embase, Cochrane Library, and Scopus searched from 1946 to December 2022. Studies reporting the performance of 18FDG-PET/CT in patients with treatment-naïve, index HNSCC for detection of SPMs were included. The reference standard was histopathology, clinical follow-up over the duration of study, and other imaging modalities. Multiple investigators completed depth full-text analysis. Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines were followed. Methodologic and diagnostic accuracy data were abstracted independently by multiple investigators. Risk of bias assessment was conducted using the Quality Assessment of Diagnostic Accuracy Studies tool independently. Bivariate random-effects model meta-analysis and multivariable meta-regression modeling were used. Seventeen studies examining 4624 patients with a total of 475 SPMs were included in the final analysis. Eleven studies were found to be at low risk for bias, while the rest were in the high-risk category. 18FDG-PET/CT demonstrated pooled sensitivity and specificity of 0.73 (95% confidence interval [CI]: 0.49-0.88) and 0.99 (95% CI: 0.98-1.00) in detecting SPMs. Further subsite analysis revealed varied diagnostic performance across different anatomical regions, with sensitivity and specificity of esophageal SPMs being 0.47 (0.30-0.64) and 0.99 (0.98-1.00), and sensitivity and specificity of 0.86 (0.73-0.94) and 0.99 (0.98-1.00) for head and neck SPMs. Finally, this imaging modality showed sensitivity and specificity of 0.92 (0.84-0.96) and 0.99 (0.98-1.00) for lung SPMs. The findings of this study suggest varied accuracy of 18FDG-PET/CT in detecting SPMs during initial workup for HNSCC, highlighting the importance of screening modalities such as esophagoscopy in high-risk patients.

Exercise on Crepitus in Knee Osteoarthritis: A Systematic Review and Meta-Analysis

ABSTRACT Background Crepitus is one of the primary symptoms of knee osteoarthritis (OA). Exercise and education are key components of evidence-based recommendations for management of OA. However, evidence if these approaches alter knee crepitus is limited. We aimed to determine if knee crepitus improves with exercise either alone or combined with education in healthy adults or people with early or established OA. Methods Five electronic databases (Embase, CINAHL, PsycINFO, PubMed, and SportDISCUS) were searched from inception to July 1, 2022, for studies of adults with knee crepitus who undertook exercise compared to nonexercise control. Data were analyzed using a random-effects meta-analysis. Risk of bias was appraised using the Cochrane tool. Results Seven studies of adults with established knee OA were included. All studies measured crepitus with the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscale following varied exercise interventions, 3 of which included education. Compared with control, no effect of exercise on modifying knee crepitus was found (mean difference −0.01 (95% confidence interval = −0.23, 0.21) on the 0–4 KOOS subscale). Two studies were at low risk of bias. The others had some concern (n = 3) or high risk of bias (n = 2). Conclusion Based on studies with mixed risk of bias, knee crepitus is unlikely to change in individuals with established OA following exercise. Thus, exercise-based practitioners can provide reassurance to people who are concerned about crepitus that exercise should not exacerbate crepitus. Authors of future studies could explore the impact of crepitus on patient’s beliefs about and engagement with exercise.

Low-dose colchicine for stroke prevention: a systematic overview of systematic reviews and meta-analyses.

Stroke incidence remains a significant concern despite optimized prevention strategies. Colchicine shows potential for improving stroke prevention globally. To summarize efficacy and safety estimates from systematic reviews and meta-analyses (SRMAs) of randomized controlled trials (RCTs) comparing colchicine to usual care or placebo for stroke prevention. We conducted an overview of SRMAs according to the Preferred Reporting Items for Overviews of Reviews guidelines through a systematic search in Pubmed, Embase, and the Cochrane Library. Statistical analysis was performed using RevMan Web. Heterogeneity was assessed with I² statistics. Thirty-two studies were included. Colchicine significantly reduced stroke recurrence (RR 0.46; 95% CI 0.41-0.52; p < 0.0001; I² = 0%; OR 0.44, 95% CI 0.36-0.55; p < 0.0001; I² = 0%) but increased gastrointestinal adverse events (RR 1.54, 95% CI 1.33-1.79; p < 0.0001; I² = 63%; OR 1.60, 95% CI 1.08-2.38; p = 0.0007; I² = 82%). Most SRMAs (93.75%) showed reduced stroke incidence (RR 0.26-0.54), while 65.22% reported increased gastrointestinal events (RR 1.05-2.66). No significant differences were observed in mortality, infection or cancer rates. Overall quality was appraised as high in 28.12%, moderate in 6.25%, low in 40.06%, and critically low in 25% of SRMAs. Data were primarily derived from seven RCTs with low risk of bias. Moderate-quality evidence supports colchicine's benefits and reasonable safety for preventing stroke among high-risk populations. However, stroke was not the primary endpoint in analyzed studies. RCTs directly assessing colchicine for stroke prevention are warranted.

Methodological expectations for demonstration of health product effectiveness by observational studies

The issue of assessing the effectiveness of health technologies (drugs, devices, etc.) through observational studies is becoming increasingly important as registration and market access agencies consider them in their evaluation process. In this context, observational studies must be able to provide real demonstrations of a level of reliability comparable to those produced by the conventional randomized controlled trial (RCT) approach. The objective of the roundtable was to establish the acceptability criteria for an observational study (non-randomized, non-interventional study) to be able to provide these demonstrations, and possibly serve as a confirmatory study for registration and market access authorities, the construction of therapeutic strategies or the development of recommendations. In order to do this, the study must be a real confirmatory study respecting the hypothetical-deductive approach and guaranteeing the absence of HARKing and p-hacking by attesting to the establishment of a protocol and a statistical analysis plan, recorded before any inferential analysis. It must also be part of a formalized approach to causal inference and demonstrate that it correctly identifies the causal estimand sought. The study should ensure that there is no residual confusion bias by taking into account all confounding factors affecting the comparison, which should be determined by a formal approach (such as a graphical causality approach, DAGs). Residual confusion bias diagnoses by forgery and nullification analysis should be non-existent. The study shall be at low risk of bias, in particular selection bias, among others by using a target test emulation design. Overall type I error risk should be strictly controlled. The absence of selective publication of results and selection bias should be ensured.

Effectiveness and side effects of orthodontic traction of impacted maxillary incisors in a labially inverted position: A systematic review

Treatment of impacted upper incisors in a labially inverted position is challenging for orthodontists, and its prognosis has not been established in the literature. Thus, this systematic review aimed to determine the effectiveness and side effects of orthodontic traction of impacted maxillary incisors in a labially inverted position. A comprehensive search was conducted in multiple databases, including MEDLINE (via PubMed), Scopus, Embase, Science Direct, and LILACS, up to June 30, 2024. Initially, 1640 articles were identified, and after applying specific selection criteria, 11 articles were selected for full-text evaluation. Following the review, only six studies were deemed relevant, comprising one before-and-after study, two longitudinal retrospective studies, and three cross-sectional studies. Newcastle-Ottawa and Risk of Bias (ROB-2) tools were used to assess the risk of bias in the selected studies. The average duration of traction for maxillary labially inverted impacted central incisors ranged from 8.60±1.26months to 18±6.0months, with all cases being successfully treated. Following traction, the clinical crown height of the incisors was significantly higher compared to the control group (P<0.01). Similarly, the root length of the impacted incisors after traction was shorter in the impaction group (approximately 2mm) compared to the control group. Likewise, the thickness of the alveolar bone varied among different studies. Some authors noted that the treatment group had a smaller thickness (about 0.5mm) compared to the control group (P<0.05), while other authors found similar thickness after treatment. Although there are few reported studies with a low risk of bias, it is clear that it is possible to successfully treat labially inverted impacted maxillary central incisors with apparently few side effects. Following traction, the clinical crown height of these incisors increased, while the root length was shorter than their normally erupted contralateral teeth.

The effectiveness of aromatic extract on insomnia: a meta-analysis.

Insomnia is a global health issue that imposes social and economic burdens. Aromatherapy is regarded as a promising alternative medicine for improving sleep quality. This meta-analysis was conducted to explore the potential of aromatherapy for addressing insomnia. Seven databases were searched for relevant randomized controlled trials (RCTs) from their inception through August 12, 2023. Data were synthesized using random-effect pairwise meta-analysis, with standardized mean difference (SMD) and 95% confidence interval (CI) reported. The risk of bias of each RCT was appraised using the Cochrane risk of bias tool. Subgroup and sensitivity analysis, publication bias diagnosis were also performed. A total of 14 studies with 1043 participants were included. The meta-analysis revealed a significant difference between the intervention and control groups (SMD: -1.63, 95% CI: -2.20 to -1.04). Sensitivity analysis showed that, whichever study was omitted, the conclusions of the remaining studies did not reverse. Among the 14 RCTs included, 6 were deemed to have a low overall risk of bias, and 8 were found to have some concerns. Subgroup analysis revealed that Iran had a more significant therapeutic effect than other regions. The effects of rose and citrus aurantium are more obvious than those of lavender. The different treatments in the control groups, intervention durations and sleep quality questionnaires had impacts on therapeutic effects, while discrepancies were not significant for different health conditions. Aromatic essential oil has a significant therapeutic effect on insomnia. Further research on the mechanisms and guidelines for implementing aromatherapy is needed. This meta-analysis has been registered in PROSPERO with the ID CRD42023454070.

Evaluating instruments to assess spinal health knowledge in adolescents aged 14–17: a scoping review

Introduction: appropriate habits related to the spine affect the performance of activities of daily living as well as the quality of life of the general population. Therefore, assessing spinal health knowledge, especially that of adolescents, is crucial to body awareness and health promotion. For this, instruments are used, mostly self-reported controls that measure pain, its causes and knowledge of it. The standardization of these instruments is essential, as it facilitates and consolidates their use and credibility. This scoping review analyzed the existing instruments for assessing the spinal health knowledge of adolescents from 14 to 17 years old. Research was performed using the PubMed, Embase, CINAHL, and Cochrane Library databases. Articles were selected by two independent reviewers. Disagreements were resolved by a third senior reviewer. The methodological quality analysis was evaluated using the Brink and Louw checklist, and the risk of bias was determined using the Downs and Black checklist. Of the 6773 studies found, seven articles were included. These seven articles described the following three instruments that were used to assess spinal health knowledge: the Standardized Nordic Questionnaire (original and adapted versions); an instrument used to assess knowledge and attitudes of adolescents regarding low back pain and its occurrence (no specific name); and the Health Questionnaire on Back Care Knowledge Concerning Physical Activities in Daily Life for Adolescents. Six of the seven articles had high methodological quality, and all showed a low risk of bias. The present study identified three instruments (Norwegian, Spanish and Indian) that assess knowledge about spinal health in adolescents aged 14 to 17 years. Therefore, more instruments should be created and validated.

Can Fiber-reinforced Composites Increase the Fracture Resistance of Direct Composite Restorations in Structurally Compromised Teeth? A Systematic Review and Meta-analysis of Laboratory Studies.

Systematic review and meta-analysis on laboratory studies aimed to answer whether there is a difference in fracture resistance and fracture mode of structurally compromised teeth restored with direct composite restorations reinforced with short glass-fiber or bidirectional polyethylene fiber substructure, and between the two different fiber-reinforcement types. An electronic literature search was conducted in Medline, Scopus, Web of Science, Lilacs, Google Scholar, Cochrane Library, and University Library databases. The last search was conducted on 16 November 2023. Only studies looking at Ribbond-reinforced restorations and/or the use of EverX Posterior within restorations were included. Data were categorized and analyzed based on specific outcome measures including fracture resistance and fracture mode. Data from individual studies were divided into premolars and molars for each material category and then collated to compare the mean differences in fracture resistance between control groups (composite restorations) and intervention groups (fiber-reinforced composite restorations). From the initial 1266 articles identified, 23 laboratory-based studies were included for quantitative analysis. Twenty articles had an overall low risk of bias and 3 had an overall unclear risk of bias. The pooled estimate of the effect favored the intervention groups as having statistically significant higher fracture resistance when compared to control groups. Both fiber types improve fracture resistance and the fracture mode of structurally compromised teeth is equally efficient. Application technique deserves attention. Ribbond could be placed in a single layer at the cavity floor, whereas EverX Posterior should replace missing dentin in an anatomically shaped way.

The epidemiology of low back pain in chiropractors and chiropractic students: a systematic review of the literature.

Chiropractors and chiropractic students commonly report low back pain (LBP). However, the burden of LBP in this occupational group has not been synthesized in the literature. This systematic review aims to describe the epidemiology of LBP in chiropractors and chiropractic students. We searched MEDLINE, Embase, CINAHL, and PsycINFO from inception to May 1, 2023. Eligible studies were cross-sectional, cohort, or case-control studies investigating the prevalence, incidence, associated factors, or risk factors of LBP in chiropractors or chiropractic students. Reviewers independently screened articles and assessed risk of bias using the appropriate JBI Checklists for the observational study design. We descriptively synthesized studies that were rated as low or moderate risk of bias. Of 2012 citations screened, we included 2 cross-sectional studies in the evidence synthesis (1 study rated as moderate risk of bias on chiropractors, and 1 rated as low risk of bias on chiropractic students). For chiropractors, the 12-month prevalence of work-related overuse injuries to the low back was 35.6% (95% CI 29.1, 42.0) in women and 22.4% (95% CI 16.3, 29.6) in men. The 12-month prevalence of work-related acute physical injuries to the low back in chiropractors were 3.4% (95% CI 1.6, 6.8) for women and 0.7% (95% CI 0.1, 3.7) for men. Among chiropractic students, the 1-week prevalence of LBP was 69% (95% CI 64.8, 73.0). This was higher among female students (72.5%, 95% CI 67.1, 77.4) and lower among male students (64%, 95% CI 57.0, 70.6). There is limited high-quality evidence on the epidemiology of LBP in chiropractors and chiropractic students. Our systematic review provides a synthesis of the body of literature, highlighting that chiropractors and chiropractic students commonly report LBP. Future high-quality research is needed to address the incidence, associated factors, and risk factors of LBP.