Globally, in 2020, less than one-third of individuals with psychosis accessed mental health services. These services are essential for reducing distress and burden, improving symptoms, and preventing adverse outcomes. However, people may not benefit from these services if they do not seek help. Factors contributing to the help-seeking remain poorly understood in South and Southeast Asia, regions with a majority of low- and middle-income countries. We aimed to synthesise evidence reporting the views and experiences of key stakeholders towards help-seeking for psychosis in these regions. This is the first review in this topic area to employ a multiple-perspective approach and to focus on the understudied regions. The PRISMA checklist guided reporting. We systematically searched primary qualitative, quantitative, and mixed-method research in bibliographic databases (CINAHL, MEDLINE, PsycINFO, Embase, ASSIA, Scopus, and PQDT Global), from inception to March 2025. Each article was independently screened by two reviewers. Eligible articles were extracted and synthesised using narrative synthesis, with JBI checklists utilised for methodological quality assessments. We included 57 studies published across 62 articles, 80% of which were rated as moderate or low quality. We inductively developed five themes, comprising 11 subthemes, which highlighted factors influencing and experiences of help-seeking across multiple stakeholders, including perceptions of problems, service quality, stigma, structural circumstances, and social support. Carers' perspectives were dominant and differed slightly from those of service users in their perceptions of problems, suggesting the value of more widely adopting a multiple-perspective approach in help-seeking research.

Balance control in adult spinal deformity: systematic review of the literature.

Abstract Purpose The Syrian civil war has created a profound refugee crisis, with millions, especially children, seeking refuge in neighboring countries. These children face a high risk of malnutrition, a critical public health issue. This study aims to systematically review and synthesize the existing literature on the prevalence and types of malnutrition among Syrian refugee children in Turkey and neighboring countries. Methods This systematic review was conducted following the PRISMA 2020 guidelines. A comprehensive search of PubMed, Scopus, Web of Science, TR Dizin, and the YÖK National Thesis Center databases was performed for studies published between January 2011 and August 15, 2024. Search terms included “Syrian refugee,” “child,” “malnutrition,” “stunting,” “wasting,” and “anemia.” Included studies underwent a methodological quality assessment using a modified Newcastle-Ottawa Scale (NOS) adapted for cross-sectional studies. Results Nine studies met the inclusion criteria. The findings reveal that chronic malnutrition (stunting) and anemia are more prevalent among Syrian refugee children than acute malnutrition (wasting). Stunting prevalence in studies from Turkey ranged from 14.7% to 31.7%. Anemia was also a significant concern, with reported rates as high as 48.4%. The quality assessment showed variable quality, with most studies carrying a risk of bias in the “Comparability” domain. Malnutrition rates were generally higher among children living outside of camps. Conclusion While acute malnutrition appears to be largely controlled, chronic nutritional problems such as stunting and anemia persist as significant public health challenges for Syrian refugee children. These findings underscore the urgent need for long-term, sustainable public health interventions that focus on maternal and child health services, continuous nutritional surveillance, and targeted support programs for this vulnerable population.

Patient-Reported Outcomes (PROs) are increasingly important in oncology, providing a unique patient perspective for evaluating treatment efficacy, symptom burden, and quality of life. The psychometric properties of Patient-Reported Outcome Measures (PROMs), particularly test-retest reliability, form the cornerstone of ensuring the stability and credibility of their measurement results. However, the clinical status of cancer patients often fluctuates rapidly due to disease progression or treatment side effects, posing unique methodological challenges for assessing test-retest reliability, especially in determining appropriate retest intervals and evaluating patient stability. Currently, there is a lack of systematic reviews on methodological elements of test-retest reliability studies for PROMs in cancer populations. This study aims to systematically search, summarize, and critically appraise published studies on test-retest reliability of PROMs in cancer patients, focusing on their methodological quality and key design elements, including retest intervals, sample size, patient stability assessment, and statistical analysis methods. This protocol adheres to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. A comprehensive literature search will be conducted across five electronic databases (PubMed, EMBASE, CINAHL, PsycINFO, Web of Science) and two supplementary sources (ClinicalTrials.gov and PROQOLID) from their inception to December 2025. All original studies reporting test-retest reliability assessments of PROMs for adult cancer patients will be included. Two reviewers will independently conduct literature screening, data extraction, and methodological quality assessment. Extracted data will include basic study information, PROMs characteristics, patient characteristics, and detailed information on test-retest reliability design. Methodological quality will be appraised using the COSMIN Risk of Bias checklist, while reporting completeness will be evaluated against the COSMIN reporting guideline (version 2.0). Due to study heterogeneity, we will perform a narrative synthesis, summarizing results in tables and figures. This study will be the first to comprehensively depict the current status of test-retest reliability assessment of PROMs in oncology, identifying strengths and weaknesses in current practices. The findings will provide evidence-based methodological recommendations for designing and reporting PROMs validation studies in cancer populations. By enhancing the rigor of PROMs validation studies, this research ultimately aims to improve the quality of patient-centered evidence in cancer clinical research and practice. PROSPERO CRD420251070381.

Climate change represents a major global health challenge with potential implications for mental health. Exposure to climate-related stressors is associated with an elevated risk of psychiatric disorders, including trauma- and stressor-related disorders (e.g., PTSD), depressive disorders, and anxiety disorders. Vulnerable populations-including children, women, older adults, individuals with pre-existing mental health conditions, and communities in low-income or disaster-prone regions-may be disproportionately affected. This umbrella review synthesizes current evidence on the mental health impacts of climate change, focusing on clinically relevant outcomes and underlying mechanisms. A systematic literature search was conducted across Web of Science, PubMed, Scopus, and Google Scholar for systematic reviews published between January 2014 and October 2024. Data extraction and methodological quality assessment were performed using the Joanna Briggs Institute Critical Appraisal Checklist, which evaluates methodological rigor, clarity of research questions, and appropriateness of data synthesis. Only English-language systematic reviews scoring ≥ 5/11 on the JBI checklist-reflecting moderate to high methodological quality-were included. Non-systematic reviews and studies without accessible full texts were excluded. The review protocol was registered in PROSPERO (CRD420251133963). Climate change may affect mental health through both direct and indirect pathways. Direct impacts include elevated risk or worsening of PTSD, depressive disorders, anxiety disorders, and suicidal behaviors, which may be precipitated or exacerbated by climate-related stressors. Indirect effects operate via socioeconomic disruptions, such as food insecurity, forced migration, poverty, and weakened social networks. Psychological responses described as eco-anxiety and solastalgia further illustrate the range of mental health outcomes associated with environmental changes. Climate change is associated with clinically relevant psychiatric outcomes across established diagnostic categories. The mechanisms underlying these associations involve complex neurobiological, socioeconomic, environmental, and cultural pathways. These findings underscore the importance of targeted psychiatric interventions, including cognitive behavioral therapy, trauma focused therapies, resilience-building, strengthening social support, promoting adaptive coping strategies, and enhancing preparedness of mental health services. Prioritizing vulnerable populations for psychiatric assessment, prevention, and intervention is essential. Integrating these strategies into clinical practice and public health planning is critical to support evidence-based mental health care.

This systematic review will aim to evaluate the evidence on the cost-effectiveness of artemisinin-based combination therapies (ACTs) when used as a first-line treatment for malaria, providing evidence-based guidance for policymakers in resource-limited settings. ACTs have become the World Health Organization's recommended first-line treatment for uncomplicated Plasmodium falciparum malaria due to their efficacy. Economic constraints in endemic regions necessitate the assessment of their cost-effectiveness. Studies will be eligible if they report on the cost-effectiveness or cost-utility of ACTs and non-ACT or different ACT dose regimens as first-line treatments for malaria among pediatric and adult populations. This review will follow the JBI methodology for systematic reviews of economic evidence. PubMed was used to conduct a preliminary search using MeSH terms such as malaria, artemisinin combination therapy, non-artemisinin combination therapy, and cost-effectiveness. This initial search strategy will be adapted to other academic and non-academic databases as well as gray literature. Two reviewers will independently screen records at the title/abstract and full-text levels, with disagreements resolved by a third reviewer. Two reviewers will then conduct a methodological quality assessment and extract data in accordance with JBI guidelines. A summary and comparison of the included studies will be based on the JBI Dominance Ranking Matrix for economic evaluations. The measures of cost-effectiveness/cost-utility will consist of the incremental cost-effectiveness ratio (ICER), the ICER per disability-adjusted life year averted, or the quality-adjusted life years gained. The GRADE (Grading of Recommendations, Assessment, Development and Evaluations) approach will be used to appraise the certainty of economic evidence. CRD420251058688.

Clinical trial regulations recommend a dynamic and risk-based approach to the quality management strategy for a medicinal product development program. Sponsor companies are required to identify factors that are critical to quality, to perform ongoing evaluation of the changing risks and quality status in clinical trials and adapt their quality strategy accordingly. The Inter-Company Quality Analytics (IMPALA) not for profit consortium supports the shift towards dynamic quality management of clinical trials by providing publicly available data analytics packages to measure changing risks to patient safety and data reliability. The Critical to Quality Assessment Methodology is the latest initiative developed by the IMPALA consortium in support of dynamic quality assurance and risk management. This paper describes the methodology, which is an iterative process conducted throughout a clinical trial, beginning with risk factor identification and assessment, and development of the initial quality strategy based on this evaluation. It continues with the generation of quality evidence through the execution of a variety of activities, including quality assurance audits, process compliance monitoring, real-time study surveillance activities, etc., utilizing both traditional and analytical methods. From there quality conclusions are determined and documented in the Critical to Quality Assessment Report (CAR). These steps are executed on a continuous basis throughout the development of a medicinal product across all clinical trials and the CAR serves as a pivotal knowledge management tool, disclosing Good Clinical Practice compliance conclusions for stakeholders.

Molar incisor hypomineralization (MIH) is a qualitative developmental defect of enamel and one of the most prevalent oral health conditions in childhood. Over the last two decades, increasing attention has been given to its prevalence and etiology; however, marked heterogeneity in diagnostic criteria and indices has limited the comparability of epidemiological findings. This systematic review aimed to identify and describe the diagnostic indices used for the epidemiological assessment of MIH in the general pediatric population. A systematic literature search was conducted in PubMed, Scopus, and Google Scholar to identify epidemiological studies published between January 2001 and December 2024 reporting MIH prevalence in children. Study selection, data extraction, and methodological quality assessment were performed independently by two reviewers in accordance with PRISMA guidelines. The review protocol was registered in PROSPERO (CRD42022345224). A total of 198 articles were included, corresponding to 201 independent epidemiological studies, as three articles reported results from two distinct study populations. The European Academy of Paediatric Dentistry (EAPD) criteria were used in 171 studies (75.7%), representing the most widely adopted diagnostic index. Other indices, including the modified Developmental Defects of Enamel index (mDDE), Mathu-Muju and Wright, Wetzel and Reckel, MIH Severity Scoring System (MIH-SSS), the MIH Treatment Need Index (MIH TNI) criteria, and FDI criteria, were used infrequently. Studies using EAPD criteria accounted for the largest cumulative sample size and showed a descriptively aggregated MIH prevalence of 12.9%, whereas prevalence estimates varied across alternative diagnostic indices. In conclusion, the lack of uniform diagnostic standards and nomenclature hampers global surveillance and limits the comparability of prevalence data. The adoption of MIH-specific diagnostic criteria, supported by adequate examiner calibration and transparent reporting, is essential to improve the quality, consistency, and interpretability of future epidemiological research.

Comparative analysis of volatile profiles in 39 cultivars of Chinese chives and establishment of flavor fingerprints.

ImportanceAccurate risk prediction is essential for targeted prevention of type 2 diabetes mellitus (T2DM). However, the global applicability and methodological rigor of existing prediction models remain uncertain.ObjectiveTo systematically review and meta-analyze the geographic distribution, methodological quality, and predictive performance of all published T2DM risk prediction models.Data sourcesPubMed, Embase, Web of Science, Cochrane Library, CNKI, WanFang, and VIP were searched from inception to December 2025 (eAppendix S1 in the Supplement).Study selectionStudies that developed or validated a multivariable prediction model for incident T2DM in general adult populations and reported at least one performance measure.Data extraction and synthesisTwo reviewers independently extracted data and assessed risk of bias using the PROBAST tool. A random-effects meta-analysis was used to pool C-statistics. Heterogeneity was explored via subgroup analyses and meta-regression. The study followed TRIPOD-SRMA and PRISMA reporting guidelines.Main outcomes and measuresThe primary outcome was the geographic origin of models. Secondary outcomes included pooled measures of discrimination (C-statistic/AUC) stratified by region and an overall assessment of methodological quality (PROBAST).ResultsA total of 65 studies comprising 97 distinct prediction models were included (eTable 1). Geographic distribution was highly skewed, with 70.1% of models developed in Asian populations (China: 47.4%; Japan: 13.4%; South Korea: 9.3%), while only 7.2% originated from the US and 4.1% from Europe. Logistic regression was used in 97.9% of models. External validation was performed for only 21 models (21.6%). According to PROBAST, 91.8% of models were at high risk of bias (eTable 2), primarily due to inadequate handling of missing data, lack of external validation, and poor calibration reporting. Meta-analysis revealed wide variation in discrimination by geographic region (eTable 7). US-based models achieved the highest pooled AUC (0.97; 95% CI, 0.94–0.99), but this finding is likely influenced by overfitting, small sample bias, and publication bias (see Discussion). European models showed a pooled AUC of 0.84 (0.81–0.87), while Chinese models showed the lowest performance (AUC, 0.79; 0.76–0.82). Due to very high heterogeneity (I² > 80% in most regions), these pooled estimates should be interpreted as descriptive summaries rather than precise estimates of true regional performance. Performance was lowest in prediabetic cohorts (AUC, 0.72; 0.68–0.76); however, this finding is preliminary due to the limited number of models and high heterogeneity. Funnel plot asymmetry suggested potential publication bias (Egger's test p=0.03); The most frequently included predictors were age (69.1%), body mass index (64.9%), family history of diabetes (44.3%), and waist circumference (39.2%) (eFigure 4 and eTable 3).Conclusions and relevanceT2DM prediction models exhibit striking geographic inequity and poor methodological quality, with over 90% at high risk of bias. The substantial variation in performance by region and the lack of external validation critically limit their global clinical utility. These findings underscore an urgent need for rigorous external validation in diverse populations and de novo model development in under-represented regions, guided by PROBAST and TRIPOD standards.Trial registrationNot applicable.Clinical trial numberNot applicable.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12902-026-02301-2.

The burden of cardiometabolic diseases (CMDs) is rising in people with HIV (PWH). While extensive data exist on CMD prevalence in PWH receiving antiretroviral therapy (ART), comprehensive data on ART-naïve PWH are scarce. We aimed to estimate the global prevalence of hypertension, diabetes, obesity and dyslipidaemia among ART-naïve PWH and compare estimates with those on ART and HIV-negative populations. This systematic review and meta-analysis included a search of PubMed-MEDLINE, CINAHL, SCOPUS, Academic Search Premier, Africa-Wide Information and Africa-Journals Online for original articles published up to June 2024. Cross-sectional, cohort and case-control studies providing baseline data on CMD prevalence were included. Studies had to include ART-naïve PWH aged ≥15 years. Two independent reviewers conducted studies screening, data extraction and methodological quality assessment. A random-effects meta-analysis with double arc-sine transformation was used for prevalence estimates. The study was registered with PROSPERO (CRD42021226001). We included 184 studies published between 2000 and 2024, involving a total of 424 629 participants. The global pooled prevalence among ART-naïve PWH was 14.2% (95% CI: 12.4-16.1) for hypertension, 3.6% (2.9-4.3) for diabetes, 11.5% (10.3-12.9) for body mass index-based obesity, 18.3% (12.7-24.6) for waist circumference-based obesity, 14.8% (12.1-17.8) for elevated total cholesterol, 17.6% (11.3-24.8) for elevated low-density lipoprotein cholesterol, 22.9% (19.3-26.7) for elevated triglycerides and 54.6% (48.2-61.0) for low high-density lipoprotein cholesterol, all with high heterogeneity. Significant regional variations in the prevalence of diabetes, obesity and dyslipidaemia were observed according to UNAIDS regions. We found a notable prevalence of CMDs in ART-naïve PWH, with significant regional variations in the prevalence of diabetes, obesity and dyslipidaemia. This highlights the need for targeted interventions and early screening to address the growing CMD burden among PWH. ART-naïve PWH face a considerable CMD burden, emphasizing the importance of early detection and management. Regional differences in CMD prevalence call for tailored public health strategies and integration of CMD prevention into HIV care protocols.

Unintentional wellbore deviation presents persistent challenges in drilling operations, often leading to cumulative trajectory irregularities that can compromise downhole equipment reliability and production performance. This study presents an integrated framework that combines machine learning (ML)-based prediction of deviation risk with a tortuosity-based engineering diagnostic to interpret the geometric and operational consequences of deviation. Using well-log-derived formation and geomechanical properties, multiple supervised ML classifiers are developed and evaluated, with the Random Forest (RF) model demonstrating robust performance in identifying deviation-prone intervals. The RF model demonstrated strong predictive performance, achieving a test accuracy of 96.67%, cross-validation accuracy of 98.31%, precision of 97%, recall of 99%, F1-score of 98%, ROC-AUC of 0.9975, PR-AUC of 0.9946, MCC of 0.963, and a log-loss of 0.647. A comprehensive feature importance and sensitivity analysis revealed features such as formation density, shale volume, and Poisson's ratio as the top classifiers, accounting for 46.4%, 28.5%, and 19.2%, respectively, of the model's decision-making criteria. To translate the deviation risk into physically interpretable trajectory complexity, a three-dimensional tortuosity index is incorporated, capturing cumulative curvature arising from frequent inclination and azimuth changes along the wellbore. Application to field wells from a major onshore unconventional basin in the United States with documented artificial lift system failures indicated that elevated vertical-section tortuosity is associated with specific failure mechanisms, including sucker rod and tubing-related failures, highlighting the mechanical relevance of trajectory quality beyond directional control. In contrast, analysis of lateral-section tortuosity showed no observable association with first-year production normalized by lateral length, consistent with prior findings that tortuosity in the lateral section does not directly impair production performance. By linking formation-driven deviation risk, trajectory complexity, and mechanical implications, the proposed framework provides a practical methodology for planning-stage deviation risk characterization and post-drill assessment of wellbore quality, supporting informed well design and artificial lift decision-making.

A systematic review of the bidirectional relationship between psychosis and loneliness.

BackgroundBreast cancer is one of the most prevalent cancers worldwide, with a 5-year survival rate exceeding 90%. Despite advances in treatment, survivors frequently experience persistent cancer- and treatment-related symptoms that negatively impact their quality of life. Body-oriented interventions (BOIs) have demonstrated effectiveness in symptom management; however, systematic reviews focused exclusively on BOIs for women who survived breast cancer (WSBC) remain limited. This systematic review protocol outlines the methodology for evaluating the scientific evidence on the effects of BOIs on cancer- and treatment-related symptoms in WSBC.ObjectiveThe aim of this study is to examine the scientific evidence on the effects of BOIs on cancer- and treatment-related symptoms, well-being, and quality of life in WSBC.MethodsThis protocol follows PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols) guidelines. We will conduct searches in 6 electronic databases: PubMed, Cochrane, Web of Science, Scopus, APA PsycNet, and Portal Regional da BVS. Studies will be considered for inclusion if they are written in English, French, Portuguese, or Spanish, with no restrictions on publication date; they consist of WSBC (aged 18 to 64 years); they are randomized controlled trials, quasi-randomized controlled trials, and pilot studies focusing on BOIs; they include a control group receiving no intervention, standard care, or a non-BOI; and the primary outcomes of interest include preintervention and postintervention measures of cancer- and treatment-related symptoms, well-being, and quality of life. The methodological quality of the studies and the risk of bias will be assessed using the PEDro scale and version 2 of the Cochrane risk-of-bias tool, respectively. The synthesis of results will be measured through the Best Evidence Synthesis. Two experienced independent reviewers will conduct study selection, data extraction, methodological quality assessment, and scientific evidence assessment. Disagreements will be resolved by a third reviewer.ResultsThis protocol describes the prespecified methodology for the systematic review. At the time of publication of this protocol, the corresponding full systematic review manuscript was under peer review. The outcomes will synthesize the scientific evidence on the effects of BOIs on cancer- and treatment-related symptoms in WSBC. It is anticipated that this systematic review will identify benefits and directions for future research to support the integration of BOIs tailored to this population.ConclusionsConsidering that previous systematic reviews focused on the effects of BOIs in survivors of all cancer types, challenges related to study risk of bias such as heterogeneity in intervention types, study designs, and outcome measures are anticipated, potentially leading to some inconsistency and imprecision. To mitigate these issues, PRISMA guidelines will be followed, and methodological quality and best evidence strength will be rigorously assessed. This review will systematically synthesize the effects of BOIs on cancer- and treatment-related symptoms in WSBC. These findings will provide health professionals with reliable evidence and methodological guidance for further research.Trial RegistrationPROSPERO CRD42023452519; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=452519International Registered Report Identifier (IRRID)DERR1-10.2196/76858

MS-DQI: A methodology for data quality assessment in medical sensor networks with a case study on a temperature sensor network for breast cancer detection

Explainable deep learning for grading of Edible Bird's Nest (EBN)

This paper presents a validation of a hybrid model for remote physiological monitoring and patient deterioration prediction using the MIMIC-IV (51,981 patients) with external validation on MIMIC-III (30,528 patients, zero overlap). The objective is to develop and substantiate a methodology for the quantitative assessment of prediction quality using four vital signs (HR, SpO₂, RR, Temp) and to evaluate a hybrid model combining a rule-based composite index with machine learning results: A(t)+ML. The methods employed comprise the recalibration of the A(t); analysis of 4 conditions (Full, NEWS2-set, CAS-4 and CAS-4 hybrid); supervised machine learning for classification and regression (XGBoost), the high-performance gradient boosting framework (LightGBM), logistic regression (LR), and recurrent neural network architecture (LSTM). Statistical tools include FDR Benjamini-Hochberg correction, SHAP, regression analysis for determining the VIF (Variance Inflation Factor); and a methodology for determining the Net Reclassification Improvement index (NRI). Results. Using quantitative assessments, an adequate level of prediction quality for the early detection of physiological deterioration was demonstrated when using only four vital sign parameters available from low-cost wearable sensors. It was also shown that the hybrid combination of an analytical risk index with machine learning can compensate for the absence of laboratory data and comprehensive electronic health records. Conclusions. The use of only four basic parameters combined with machine learning procedures for determining a patient's current physiological state of a patient provides clinically meaningful predictions for a broad class of remote monitoring systems, including those currently deployed.

Introduction: Major Depressive Disorder (MDD) has been increasingly associated with inflammatory dysregulation, particularly involving tumor necrosis factor-alpha (TNF-α). Genetic polymorphisms within the TNFA promoter region have been investigated as potential modulators of depressive susceptibility, symptom expression, treatment response, and inflammatory comorbidity. However, findings remain inconsistent across populations and clinical contexts. Methods: This systematic review adhered to PRISMA 2020 guidelines and was registered in PROSPERO (CRD420251242724). Observational and interventional studies evaluating associations between TNFA polymorphisms-specifically rs1800629 (-308 G/A), rs1799724 (-857 C/T), and rs1799964 (-1031 T/C)-and MDD-related outcomes in adults were included. Data extraction and methodological quality assessment were performed independently using an adapted GRIPS framework. Results: Eleven studies met the inclusion criteria, with eight investigating MDD without cardiovascular comorbidity and three assessing cardiovascular populations. Across diverse cohorts, rs1800629 and rs1799724 did not demonstrate consistent associations with MDD susceptibility. Although isolated population-specific findings were reported, genotype and allele distributions were generally comparable between cases and controls. Rs1799724 was associated with symptom dimensions and altered TNF-α expression in two cohorts. Rs1799964 was not linked to disease occurrence but showed potential association with antidepressant response and adverse cardiovascular outcomes in patients with chronic heart failure and comorbid depression. Overall, findings were heterogeneous and influenced by population characteristics, sample size, and clinical context. Conclusions: Current evidence does not support a robust etiological role for TNFA promoter polymorphisms in major depressive disorder. These variants may exert context-dependent modulatory effects on symptom expression, treatment response, or inflammatory-cardiovascular interactions rather than serving as primary susceptibility determinants. Larger, ethnically diverse studies integrating genetic, inflammatory, and clinical data are required to clarify the contribution of inflammatory genetic variability in depressive disorders.

A methodological quality assessment was conducted on meta-analyses investigating the detection of human papillomavirus (HPV) in urine samples. A systematic review of meta-analyses was performed using the search term “HPV in urine” in the PubMed, Embase, and Scopus databases. After removing duplicates and studies unrelated tothe topic or not meta-analyses during the title and abstract screening, seven studies were included for analysis. The methodological quality of the selected meta-analyses was assessed using the AMSTAR 2 tool, and all were classified as critically low quality.Although the results of these metanalyses suggest that HPV DNA detection in urine could be useful for identifying cervical HPV infection, the significant methodological limitations observed substantially reduce confidence in their conclusions. Overall,the assessment showed that overall confidence in the results was critically low

General anaesthesia for caesarean delivery carries specific maternal and neonatal risks. Drug choice, dose and timing during induction of general anaesthesia may influence maternal and neonatal physiology and outcomes. The objective of this umbrella review was to systematically identify, summarise and appraise evidence for pharmacological techniques for induction of general anaesthesia for caesarean delivery. Databases were searched for eligible studies, including meta-analyses, systematic reviews, randomised controlled trials not previously synthesised and relevant observational studies. Data extraction, methodological quality assessment and evaluation of evidence certainty were conducted. Interventions were grouped into four categories: induction opioids; induction hypnotics; drugs to obtund the pressor response to laryngoscopy; and neuromuscular blocking drugs. Seven meta-analyses, two systematic reviews, 26 randomised controlled trials and 15 observational studies were included. Moderate quality evidence indicated short-acting opioids offered maternal haemodynamic benefit without negative neonatal consequences. Low quality evidence indicated propofol was associated with equivalent early neonatal resuscitation requirements compared with thiopental, but with lower risk of maternal accidental awareness during general anaesthesia. Labetalol, dexmedetomidine, lidocaine and remifentanil attenuated maternal haemodynamic response to laryngoscopy, with minimal neonatal adverse effects. Rocuronium at dose of ≥ 1 mg.kg-1 provided comparable tracheal intubation conditions to suxamethonium without affecting neonatal outcomes, based on moderate quality evidence. Current evidence supports the safety of short-acting opioids, propofol as the preferred induction drug and rocuronium as a suitable alternative to suxamethonium during induction of anaesthesia for caesarean delivery. Overall, the evidence base is constrained by exclusion of high-risk pregnancies and emergency cases, thus limiting generalisability.