Narrative Synthesis Of Evidence Research Articles

Ultra-processed foods, allergy outcomes and underlying mechanisms in children: An EAACI task force report.

Consumption of ultra-processed foods [UPFs] may be associated with negative health outcomes. Limited data exist regarding the potential role of UPFs in the occurrence of allergic diseases. The underlying mechanisms underpinning any such associations are also poorly elucidated. We performed a systematic review and narrative evidence synthesis of the available literature to assess associations between UPF consumption and pediatric allergy outcomes (n = 26 papers), including data on the association seen with the gut microbiome (n = 16 papers) or immune system (n = 3 papers) structure and function following PRISMA guidelines. Dietary exposure to fructose, carbonated soft drinks, and sugar intake was associated with an increased risk of asthma, allergic rhinitis, and food allergies in children. Commercial baby food intake was associated with childhood food allergy. Childhood intake of fructose, fruit juices, sugar-sweetened beverages, high carbohydrate UPFs, monosodium glutamate, UPFs, and advanced glycated end-products (AGEs) was associated with the occurrence of allergic diseases. Exposure to UPFs and common ingredients in UPFs seem to be associated with increased occurrence of allergic diseases such as asthma, wheezing, food allergies, atopic dermatitis, and allergic rhinitis, in many, but not all studies. More preclinical and clinical studies are required to better define the link between UPF consumption and the risk of allergies and asthma. These observational studies ideally require supporting data with clearly defined UPF consumption, validated dietary measures, and mechanistic assessments to definitively link UPFs with the risk of allergies and asthma.

Barriers to and enablers of quality improvement in primary health care in low- and middle-income countries: A systematic review.

The quality of health care remains generally poor across primary health care settings, especially in low- and middle-income countries where tertiary care tends to take up much of the limited resources despite primary health care being the first (and often the only) point of contact with the health system for nearly 80 per cent of people in these countries. Evidence is needed on barriers and enablers of quality improvement initiatives. This systematic review sought to answer the question: What are the enablers of and barriers to quality improvement in primary health care in low- and middle-income countries? It adopted an integrative review approach with narrative evidence synthesis, which combined qualitative and mixed methods research studies systematically. Using a customized geographic search filter for LMICs developed by the Cochrane Collaboration, Scopus, Academic Search Ultimate, MEDLINE, CINAHL, PSYCHINFO, EMBASE, ProQuest Dissertations and Overton.io (a new database for LMIC literature) were searched in January and February 2023, as were selected websites and journals. 7,077 reports were retrieved. After removing duplicates, reviewers independently screened titles, abstracts and full texts, performed quality appraisal and data extraction, followed by analysis and synthesis. 50 reports from 47 studies were included, covering 52 LMIC settings. Six themes related to barriers and enablers of quality improvement were identified and organized using the model for understanding success in quality (MUSIQ) and the consolidated framework for implementation research (CFIR). These were: microsystem of quality improvement, intervention attributes, implementing organization and team, health systems support and capacity, external environment and structural factors, and execution. Decision makers, practitioners, funders, implementers, and other stakeholders can use the evidence from this systematic review to minimize barriers and amplify enablers to better the chances that quality improvement initiatives will be successful in resource-limited settings. PROSPERO registration: CRD42023395166.

Frailty in acute coronary syndromes. A systematic review and narrative synthesis of frailty assessment tools and interventions from randomised controlled trials

AimWe aimed to review all randomised controlled trial (RCT) data to explore optimal identification and treatment strategies of frail patients with Acute Coronary Syndromes (ACS). MethodsThe protocol was preregistered (PROSPERO - CRD42021250235). We performed a systematic review including RCT's that 1; used at least one frailty assessment tool to assess frailty and its impact on outcomes in patients diagnosed with ACS and 2; used at least one intervention where change in frailty was measured in patients diagnosed with ACS. The Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE were searched on the 1st April 2021 and updated on 4th July 2023. Owing to low search output results are presented as a narrative synthesis of available evidence. ResultsA single RCT used a frailty assessment tool. A single RCT specifically targeted frailty with their intervention. This precluded further quantitative analysis. There was indication of selection bias against frail participants, and a signal of value for physical activity measurement in frail ACS patients. There was a high level of uncertainty and low level of robustness of this evidence. ConclusionsData from RCT's alone is inadequate in answering the reviews question. Future RCT's need to address ways to incorporate frail participants, whilst mitigating selection biases. Physical performance aspects of the frailty syndrome appear to be high yield modifiable targets that improve outcomes. Intervention trials should consider using change in frailty status as an outcome measure. Any trials that include frail participants should present data specifically attributable to this group.

Fathers' mental Ill-health and child maltreatment: A systematic review of the literature

BackgroundParental mental ill-health is often described as a risk factor for child maltreatment. Yet the literature commonly foregrounds maternal mental ill-health. To obtain a more complete picture, it is crucial to also understand the associations between fathers’ mental health and child maltreatment. AimTo provide a narrative synthesis of evidence about the relationship between fathers’ mental health and child maltreatment. MethodFour electronic databases were searched, identifying 5479 citations. 151 studies were brought to full-text review. 37 were included in the study. ResultsStudies revealed mixed evidence for associations between forms of paternal mental ill health and child maltreatment, with stronger evidence for paternal depression and weak or no evidence for PTSD and anxiety. Many confounding factors were identified across the papers. DiscussionThe small number and limited range of good quality studies indicate the need to correct the relative invisibility of fathers within research about mental health and child maltreatment. At present, the available evidence is not sufficient to draw firm conclusions about the association between fathers’ mental health and child maltreatment or appropriate policy and practice responses.

Treatment outcomes of cutaneous leishmaniasis due to Leishmania aethiopica: A systematic review and meta-analysis.

Leishmania aethiopica is a unique species that causes cutaneous leishmaniasis (CL), and studies evaluating treatment outcomes for this condition reported inconsistent findings. This study aimed to summarize the evidence on treatment outcomes of CL caused by L. aethiopica to support decisions or propose further study. We searched PubMed, Scopus, and ScienceDirect. In addition, we searched grey literature on Google Scholar and performed manual searching on the reference list of articles. Two authors did the screening, selection, critical appraisal, and data extraction. With the narrative synthesis of evidence, we performed a random effects model meta-analysis using the metaprop package in Stata 17. We did sensitivity and subgroup analyses after assessing heterogeneity using the I-squared test and forest plots. The funnel plot and Egger's test were used to assess publication bias. The review included 22 studies with 808 participants, and the meta-analysis included seven studies with 677 participants. Most studies documented treatment outcomes with antimonial monotherapy, and only one study reported outcomes with combination therapy. The overall pooled proportion of cure was 63% (95% CI: 38-86%). In the subgroup analysis, systemic antimonial monotherapy showed a cure rate of 61%, and the proportion of cure was 87% with topical therapy. Topical therapy showed a better cure for the localized clinical phenotype. A cohort study documented a cure rate of 94.8% with combination therapy for the localized, mucocutaneous, and diffuse clinical phenotypes. The pooled proportion of unfavourable outcomes was partial response (19%), relapse (17%), discontinuation (19%), and unresponsiveness (6%). The pooled proportion of cure is low with antimonial monotherapy. Despite limited evidence, combination therapies are a promising treatment option for all clinical phenotypes of CL caused by L. aethiopica. Future high-quality randomized control trials are needed to identify effective monotherapies and evaluate the effectiveness of combination therapies.

Crisis and acute mental health care for people who have been given a diagnosis of a ‘personality disorder’: a systematic review

BackgroundPeople who have been given a diagnosis of a ‘personality disorder’ need access to good quality mental healthcare when in crisis, but the evidence underpinning crisis services for this group is limited. We synthesised quantitative studies reporting outcomes for people with a ‘personality disorder’ diagnosis using crisis and acute mental health services.MethodsWe searched OVID Medline, PsycInfo, PsycExtra, Web of Science, HMIC, CINAHL Plus, Clinical Trials and Cochrane CENTRAL for randomised controlled trials (RCTs) and observational studies that reported at least one clinical or social outcome following use of crisis and acute care for people given a ‘personality disorder’ diagnosis. We performed a narrative synthesis of evidence for each model of care found.ResultsWe screened 16,953 records resulting in 35 studies included in the review. Studies were published between 1987–2022 and conducted in 13 countries. Six studies were RCTs, the remainder were non randomised controlled studies or cohort studies reporting change over time. Studies were found reporting outcomes for crisis teams, acute hospital admission, acute day units, brief admission, crisis-focused psychotherapies in a number of settings, Mother and Baby units, an early intervention service and joint crisis planning. The evidence for all models of care except brief admission and outpatient-based psychotherapies was assessed as low or very low certainty.ConclusionThe literature found was sparse and of low quality. There were no high-quality studies that investigated outcomes following use of crisis team or hospital admission for this group. Studies investigating crisis-focused psychological interventions showed potentially promising results.

Trigger warnings as tools for learning-theorising an evolving cultural concept.

While definitions of trigger warnings vary, it is generally accepted that they caution about potential reactions arising from exposure to distressing material. Controversy surrounds use of warnings in education, with concerns noted regarding impacts on academic freedom, "coddling", thereby undermining resilience, reinforcement of traumatised identity and enablement of avoidance. Proponents of warnings position them as accommodations for those affected by trauma, enhancing inclusion, and suggest warnings empower choice and enable informed engagement in learning. Arecent meta-analysis of warnings' efficacy demonstrated no effect on affective responses or comprehension. Findings regarding avoidance suggested warnings may increase engagement with material. Synthesis of heterogeneous results relating to context of warning application necessitates cautious interpretation of findings. Furthermore, controlled experimental designs do not reflect complex ecologies of social learning environments. Evidence relating to warnings in healthcare professions education remains limited. We undertake a narrative review and synthesis of evidence regarding the role and functions of trigger warnings from a range of disciplines, to inform healthcare education practice. We apply this evidence in considering how warnings may act within a range of theoretical frameworks for healthcare professionals educations including andragogy, self-directed learning and, ultimately, transformative learning. Tensions between exposure to emotionally stimulating learning episodes and the necessity of emotion for learning while simultaneously attending to learners' needs and fulfilling educators' responsibilities are explored. We probe gaps and contentions in existing theoretical frameworks for learning, and consider implications of recognised limitations with reference to warnings. We summarise by proposing a conceptual model for the role of warnings that considers wider salient factors for fostering effective learning. Difficulties associated with deriving contextually-relevant evidence and conclusions relating to warnings as an evolving cultural concept are highlighted. We propose warnings as tools to enable critical reflection and emotional literacy, to curate effective learning environments and support humanistic healthcare professional identity formation, within wider trauma-informed pedagogies and educator practice.

Protocol for a systematic literature review of smartphone apps to support the self-management of rheumatic and musculoskeletal diseases: development strategies, theoretical underpinnings and barriers to engagement

BackgroundRheumatic and musculoskeletal diseases (RMDs) cause significant burden to the individual and society, requiring lifelong management and specialist healthcare resource use. Costing over 200 billion euros per year in Europe, RMDs are the most expensive of all diseases for European healthcare systems. The incidence and burden of RMDs are projected to rise with the ageing global population and increase in sedentary, obesogenic lifestyles. In parallel, there is a global crisis in the rheumatology workforce, whereby capacity to deliver specialist care is being exceeded by demand. Pervasive, scalable mobile health technologies, such as apps, are being developed to support the self-management of RMDs and reduce pressure on healthcare services. However, it is unknown whether these apps are informed by theory or their use supported by an appropriate evidence base. The purpose of this review is therefore to provide a comprehensive overview of the development strategies, interventional components and theoretical underpinnings of existing smartphone apps, designed to support the self-management of RMDs.MethodsSearches will be conducted within PubMed, Scopus, Web of Science, Embase, MEDLINE and PsycINFO. Reference lists and citing articles of the included studies will be searched. Identified publications will be screened for eligibility by two independent reviewers. Any discrepancies between reviewers will be resolved by consensus, with input from a third reviewer if required. Data will be extracted on study designs, methods, populations, setting, utilised theoretical frameworks, intervention components, behaviour change techniques, methods to evaluate effectiveness and barriers/facilitators to intervention engagement. Exploratory outcomes include reported effectiveness, acceptability and usability. A systematic, narrative synthesis of evidence will be presented. If appropriate (depending on quality and pool of evidence identified), qualitative meta-summary techniques will be used to combine and summarise qualitative findings regarding barriers/facilitators to intervention engagement.DiscussionThe results of this systematic literature review will provide insights for healthcare professionals, researchers, app designers and policy makers, to inform future development and implementation of smartphone apps to support self-management of RMDs. Evidence gaps for future research will be identified. Findings will be disseminated through a final manuscript/publication of results and via a conference abstract, patient organisations and social media.Systematic review registrationPROSPERO CRD42022359704.

Social connection in long‐term care home residents: A review of research on health outcomes and strategies during COVID‐19

AbstractBackgroundThe infection control measures enacted to prevent COVID‐19 in long‐term care (LTC) homes have highlighted the important role of social connection in the wellbeing and care of people living in these settings. Yet, issues of loneliness and social isolation in LTC home residents pre‐date COVID‐19, as does the research to address them.MethodWe conducted a scoping review of published research that quantified the association of any aspect of social connection among LTC residents with mental health outcomes. We also sought studies of modifiable risk factors and interventions that identified strategies that could be implemented and adapted by LTC residents, families and staff during COVID‐19. We searched eight databases from inception to search date (July 2019), extracted data and conducted a narrative synthesis of evidence. We involved knowledge users representing LTC residents, families and staff in priority‐setting (defining the review questions), analyzing data, interpreting and contextualizing the results, and disseminating the findings. In this presentation, to further characterize the evidence, we compare the measures used in these studies to those identified from an ongoing systematic review of measures developed specifically to assess social connection in people living in LTC homes.ResultWe located 61 studies that reported the association between social connection and mental health outcomes, including depression; responsive behaviors; mood, affect, and emotions; anxiety; medication use; cognitive decline; and, others. We located 72 studies that informed 12 strategies for building and maintaining social connection during COVID‐19; some strategies represented fundamental aspects of resident care whereas others that would need to be considered in context with a LTC resident’s and home’s needs and circumstances.ConclusionOur review identifies a body of research on social connection in LTC that pre‐dates the COVID‐19 pandemic. The evidence points to quality of social connection for residents being associated with better mental health, and we identified strategies that may help to build and maintain social connection in this setting. We found that the studies assessed numerous aspects of social connection, however, only some used measures developed specifically for this population.

The stigma associated with cutaneous leishmaniasis (CL) and mucocutaneous leishmaniasis (MCL): A protocol for a systematic review.

Leishmaniasis is a neglected tropical disease with three main clinical types; cutaneous leishmaniasis (CL), mucocutaneous leishmaniasis (MCL), and visceral leishmaniasis (VL). CL and MCL are considered to be highly stigmatizing due to potentially disfiguring skin pathology. CL and MCL-associated stigma are reported across the world in different contexts assimilating different definitions and interpretations. Stigma affects people with CL, particularly in terms of quality of life, accessibility to treatment, and psycho-social well-being. However, evidence on CL- and MCL-associated stigma is dispersed and yet to be synthesized. This systematic review describes the types, measurements, and implications of the stigma associated with CL and MCL and identifies any preventive strategies/interventions adopted to address the condition. This study was developed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) statement which is registered in the International Platform of Registered Systematic Review and Meta-analysis Protocols PROSPERO (ID- CRD42021274925). We will perform an electronic search in MEDLINE, Embase, Scopus, PubMed, EBSCO, Web of Science, Global Index Medicus, Trip, and Cochrane Library databases, and in Google Scholar, using a customized search string. Any article that discusses any type of CL- and/or MCL-associated stigma in English, Spanish and Portuguese will be included. Articles targeting veterinary studies, sandfly vector studies, laboratory-based research and trials, articles focusing only on visceral leishmaniasis, and articles on diagnostic or treatment methods for CL and MCL will be excluded. Screening for titles and abstracts and full articles and data extraction will be conducted by two investigators. The risk of bias will be assessed through specific tools for different study types. A narrative synthesis of evidence will then follow. This review will identify the knowledge gap in CL-associated stigma and will help plan future interventions.

Usability of Telehealth Systems for Noncommunicable Diseases in Primary Care From the COVID-19 Pandemic Onward: Systematic Review.

During the COVID-19 pandemic, telehealth was expanded without the opportunity to extensively evaluate the adopted technology's usability. We aimed to synthesize evidence on health professionals' perceptions regarding the usability of telehealth systems in the primary care of individuals with noncommunicable diseases (NCDs; hypertension and diabetes) from the COVID-19 pandemic onward. A systematic review was performed of clinical trials, prospective cohort studies, retrospective observational studies, and studies that used qualitative data collection and analysis methods published in English, Spanish, and Portuguese from March 2020 onward. The databases queried were MEDLINE, Embase, BIREME, IEEE Xplore, BVS, Google Scholar, and grey literature. Studies involving health professionals who used telehealth systems in primary care and managed patients with NCDs from the COVID-19 pandemic onward were considered eligible. Titles, abstracts, and full texts were reviewed. Data were extracted to provide a narrative qualitative evidence synthesis of the included articles. The risk of bias and methodological quality of the included studies were analyzed. The primary outcome was the usability of telehealth systems, while the secondary outcomes were satisfaction and the contexts in which the telehealth system was used. We included 11 of 417 retrieved studies, which had data from 248 health care professionals. These health care professionals were mostly doctors and nurses with prior experience in telehealth in high- and middle-income countries. Overall, 9 studies (82%) were qualitative studies and 2 (18%) were quasiexperimental or multisite trial studies. Moreover, 7 studies (64%) addressed diabetes, 1 (9%) addressed diabetes and hypertension, and 3 (27%) addressed chronic diseases. Most studies used a survey to assess usability. With a moderate confidence level, we concluded that health professionals considered the usability of telehealth systems to be good and felt comfortable and satisfied. Patients felt satisfied using telehealth. The most important predictor for using digital health technologies was ease of use. The main barriers were technological challenges, connectivity issues, low computer literacy, inability to perform complete physical examination, and lack of training. Although the usability of telehealth systems was considered good, there is a need for research that investigates factors that may influence the perceptions of telehealth usability, such as differences between private and public services; differences in the level of experience of professionals, including professional experience and experience with digital tools; and differences in gender, age groups, occupations, and settings. The COVID-19 pandemic has generated incredible demand for virtual care. Professionals' favorable perceptions of the usability of telehealth indicate that it can facilitate access to quality care. Although there are still challenges to telehealth, more than infrastructure challenges, the most reported challenges were related to empowering people for digital health. PROSPERO International Prospective Register of Systematic Reviews CRD42021296887; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=296887. RR2-10.21801/ppcrj.2022.82.6.

Association between friendship quality and subjective wellbeing among adolescents: a systematic review

BackgroundSocial integration with friends has an important role in shaping adolescents’ behavior and determining their wellbeing. Friendship features such as companionship, trust, closeness, intimacy, and conflicts all form the concept of friendship quality. The quality of friendships can either enhance or impede mental development during adolescence. Therefore, this systematic review was conducted to understand the association between friendship quality and adolescents’ mental wellbeing.MethodsIn November 2020 and later in August 2022, the search for evidence was conducted on five databases (Medline, Embase, ProQuest, Scopus, and PsycINFO). Only peer-reviewed quantitative studies published from January 2000 to August 2022 that investigated friendship quality as their exposure variable in relation to six constructs of subjective wellbeing (mood, loneliness, life satisfaction, happiness, self-esteem, and subjective wellbeing) were included. After screening for eligibility, two reviewers independently extracted the data based on population characteristics, study design, exposure and outcome variables, outcome measures used, and results. Risk of bias assessment was performed utilizing the NIH Quality Assessment Tool. Narrative evidence synthesis was performed based on the constructs of subjective wellbeing.ResultsForty-three articles out of 21,585 records were included in the review. The relationship between friendship quality and depression has been investigated extensively in the literature and negative (beneficial) associations were found in eighteen studies out of twenty-three. Poor peer relationship was associated with loneliness in nine studies out of ten. All seven studies on life satisfaction and quality of peer connection found a positive association. In five studies, better peer relationship was found to be associated with happiness. A positive association between friendship quality and self-esteem was observed in five out of six applicable studies. Friendship quality was found to be positively associated with subjective well-being in all of five included studies.ConclusionsAlthough majority of the included studies were cross-sectional in nature, this review demonstrates the paramount value of promoting healthy friendship to adolescents’ subjective wellbeing constructs. Interventions that aim to promote subjective wellbeing among adolescents should consider the development and maintenance of healthy friendships.Systematic review registrationPROSPERO CRD42020219312.

Interventions to support the mental health and well-being of front-line healthcare workers in hospitals during pandemics: an evidence review and synthesis

ObjectivePandemics negatively impact healthcare workers’ (HCW’s) mental health and well-being causing additional feelings of anxiety, depression, moral distress and post-traumatic stress. A comprehensive review and evidence synthesis of HCW’s mental...

Contributions and challenges of healthcare financing towards universal health coverage in Ethiopia: a narrative evidence synthesis

BackgroundHigh burden of healthcare expenditure precludes the poor from access to quality healthcare services. In Ethiopia, a significant proportion of the population has faced financial catastrophe associated with the costs of healthcare services. The Ethiopian Government aims to achieve universal health coverage (UHC) by 2030; however, the Ethiopian health system is struggling with low healthcare funding and high out-of-pocket (OOP) expenditure despite the implementation of several reforms in health care financing (HCF). This review aims to map the contributions, successes and challenges of HCF initiatives in Ethiopia.MethodsWe searched literature in three databases: PubMed, Scopus, and Web of science. Search terms were identified in broader three themes: health care financing, UHC and Ethiopia. We synthesised the findings using the health care financing framework: revenue generation, risk pooling and strategic purchasing.ResultsA total of 52 articles were included in the final review. Generating an additional income for health facilities, promoting cost-sharing, risk-sharing/ social solidarity for the non-predicted illness, providing special assistance mechanisms for those who cannot afford to pay, and purchasing healthcare services were the successes of Ethiopia’s health financing. Ethiopia's HCF initiatives have significant contributions to healthcare infrastructures, medical supplies, diagnostic capacity, drugs, financial-risk protection, and healthcare services. However, poor access to equitable quality healthcare services was associated with low healthcare funding and high OOP payments.ConclusionEthiopia's health financing initiatives have various successes and contributions to revenue generation, risk pooling, and purchasing healthcare services towards UHC. Standardisation of benefit packages, ensuring beneficiaries equal access to care and introducing an accreditation system to maintain quality of care help to manage service disparities. A unified health insurance system that providing the same benefit packages for all, is the most efficient way to attain equitable access to health care.

Predicting Major Adverse Cardiovascular Events in Acute Coronary Syndrome: A Scoping Review of Machine Learning Approaches.

Acute coronary syndrome is the topmost cause of death worldwide; therefore, it is necessary to predict major adverse cardiovascular events and cardiovascular deaths in patients with acute coronary syndrome to make correct and timely clinical decisions. The current review aimed to highlight algorithms and important predictor variables through examining those studies which used machine learning algorithms for predicting major adverse cardiovascular events in patients with acute coronary syndrome. To predict major adverse cardiovascular events in patients with acute coronary syndrome, the preferred reporting items for scoping reviews guidelines were used. In doing so, PubMed, Embase, Web of Science, Scopus, Springer, and IEEE Xplore databases were searched for articles published between 2005 and 2021. The checklist "Quality assessment of machine learning studies" was used to assess the quality of eligible studies. The findings of the studies are presented in the form of a narrative synthesis of evidence. In total, among 2,558 retrieved articles, 22 studies were qualified for analysis. Major adverse cardiovascular events and mortality were predicted in 5 and 17 studies, respectively. According to the results, 14 (63.64%) studies did not perform external validation and only used registry data. The algorithms used in this study comprised, inter alia, Regression Logistic, Random Forest, Boosting Ensemble, Non-Boosting Ensemble, Decision Trees, and Naive Bayes. Multiple studies (N = 20) achieved a high area under the ROC curve between 0.8 and 0.99 in predicting mortality and major adverse cardiovascular events. The predictor variables used in these studies were divided into demographic, clinical, and therapeutic features. However, no study reported the integration of machine learning model into clinical practice. Machine learning algorithms rendered acceptable results to predict major adverse cardiovascular events and mortality outcomes in patients with acute coronary syndrome. However, these approaches have never been integrated into clinical practice. Further research is required to develop feasible and effective machine learning prediction models to measure their potentially important implications for optimizing the quality of care in patients with acute coronary syndrome.

Effectiveness of Workplace Interventions for Improving Working Conditions on the Health and Wellbeing of Fathers or Parents: A Systematic Review.

Evidence on the effectiveness of workplace interventions for improving working conditions on the health and wellbeing of fathers is scarce. We reviewed studies on the effectiveness of various workplace interventions designed to improve working conditions for the health and wellbeing of employed fathers and their families. Randomized controlled trials (RCTs) and quasi-randomized controlled trials of workplace interventions applied to employees with the aim of improving working conditions of employed parents, compared with no intervention, other active arms, placebo, wait list, or usual practice were included. Studies involving only women were excluded. An electronic search of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, ERIC and SSCI was done for eligible studies. Studies were screened against predetermined criteria and assessment of risk of bias done using the Cochrane Handbook for Systematic Reviews of Interventions for RCTs and the Risk of Bias Assessment tool for Non-randomized Studies for non-RCTs. Of the 8229 records identified, 19 reports were included in this review: 14 reports from five RCTs and five reports from two quasi-RCT studies. The studies were conducted in four different countries among working populations from various sectors. Studies addressing issues related to improving working conditions of fathers alone were lacking. All included studies assessed intervention effects on various health-related outcomes, the most common being sleep disturbances and mental health outcomes. Interventions administered yielded positive effects on various health outcomes across all seven studies. All included studies had methodological limitations, while study designs and methodologies lacked comparability. Consequently, a narrative synthesis of evidence is provided. Based on our findings, providing workplace interventions for improving working conditions may improve some aspects of the health and wellbeing of employed parents, including fathers.

Participatory design application in obesity prevention targeting young adults and adolescents: a mixed-methods systematic scoping review protocol

BackgroundPrevention of obesity is economically and sociologically preferable to treatment, with early intervention key to preventing excess weight gain and obesity. The transition from adolescence to young adulthood is a critical intervention period. An expert-led, top-down model has dominated obesity prevention research and practice with limited success. Participatory design (PD) offers potential in transforming obesity prevention research and practice by delivering bottom-up solutions that young people value and may therefore voluntarily engage with over time. An evidence synthesis of PD application in obesity prevention targeting adolescents and young adults is currently lacking.ObjectivesReport the protocol for a mixed-methods systematic scoping review which aims to integrate and synthesise available evidence on PD application in obesity prevention targeting adolescents and young adults. Specifically, the review will address three research questions:RQ1: How is PD defined in obesity prevention interventions targeting adolescents and young adults?RQ2: To what extent is PD applied in obesity preventions interventions targeting adolescents and young adults?RQ3a: How is the utility of PD evaluated in obesity preventions interventions targeting adolescents and young adults?RQ3b: What is the utility of PD application in obesity prevention interventions targeting adolescents and young adults?MethodsThis mixed-methods systematic scoping review protocol adheres to the PRISMA-P guidelines and is informed by the PRISMA extension for scoping reviews (PRISMA-ScR). The search strategy and eligibility criteria are informed by the sample, phenomenon of interest, design, evaluation, and research type tool. Eligible studies will be peer-reviewed literature published in English, reporting on PD application in obesity prevention interventions (including intervention development, implementation, and/or evaluation) targeting adolescents and young adults (aged 10–35 years). Study designs will include qualitative, quantitative, and mixed methods. The review will comprise a systematic literature search, eligibility screening, data extraction, quality assessment using the Mixed-Methods Appraisal Tool (MMAT), and data analysis using an iterative narrative evidence synthesis approach. Evidence on PD application will be thematically integrated in terms of who was involved, when they were involved, and how and why they were involved. Further thematic analyses will be conducted according to the MATE taxonomy and the United Kingdom Medical Research Council (UK MRC’s) key functions of process evaluations. The MATE taxonomy classifies PD application in terms of methodology, agent of change, training, and engagement. The MRC describes three functions of process evaluations: implementation, mechanisms of impact, and context. Applying both in the evidence synthesis is intended to provide a more complete picture of PD application. Exploratory analyses will be conducted to assess any potential associations between PD application and effectiveness across key outcomes (weight, physical activity, sedentary time, nutrition and dietary habit, mental health, and sleep) reported within intervention evaluations.ConclusionsElucidating PD application is a prerequisite to establishing its utility. Through the location and synthesis of available evidence on PD application in obesity prevention targeting adolescents and young adults, this review will categorise and describe different methods of PD application and explore the utility of PD application including whether any differences may be observed between PD method applied and the effectiveness of obesity prevention interventions. Implications will be delineated from the narrative evidence synthesis to inform future research and advance practice in this context.Systematic review registrationPROSPERO CRD42021268240

Interventions for Instrumental Activities of Daily Living Among Adults With Multiple Sclerosis: A Systematic Review.

Occupational therapy practitioners need updated information about interventions that may improve or maintain functional changes in instrumental activity of daily living (IADL) engagement caused by multiple sclerosis (MS). To conduct a narrative synthesis of updated evidence on interventions within the scope of occupational therapy to improve or maintain performance of and participation in IADLs among adults with MS. CINAHL, MEDLINE in PubMed, Cochrane, OTseeker, and PsycINFO. Study Selection and Data Collection: This systematic review followed the Cochrane Collaboration methodology and is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for conducting a systematic review. Inclusion criteria were Level 1 or 2 evidence, published in English, published from January 2011 to December 2018, intervention within the occupational therapy scope of practice, and at least one IADL outcome measure. Nineteen randomized controlled trials (including pilot and feasibility trials) and 1 preintervention-postintervention study met inclusion criteria. Results of this review show strong strength of evidence for coaching interventions in addressing physical activity (PA) routines and moderate support in addressing medication routines. Moderate strength of evidence was found with mixed results for interventions involving coaching plus prescribed PA in improving PA participation. This systematic review supports occupational therapy practitioners addressing PA and medication health management and maintenance IADLs through the use of coaching interventions when treating people with MS. Other IADLs were addressed by the articles in this review but require more evidence to make clinical recommendations. What This Article Adds: Occupational therapy practitioners' skills in promoting habits and routines paired with utilization of evidence-supported coaching interventions can support independence with health management and reduce the negative impact of MS on daily activity participation.

How Electronic Cigarette Affects the Vascular System.

The popularity of the electronic cigarette has soared in the last decades. However, the health effect of smoking electronic cigarettes on the vascular system is unclear. This systematic review examines the electronic cigarettes' effect on the vascular system from recent evidence. A systematic search was conducted in MEDLINE (PubMed) database from January 2016 to August 2021 for studies assessing the vascular effect of chronic use of electronic cigarettes on human and animal. The Cochrane Risk of Bias 2, NIH Quality Assessment for Cross-Sectional Study, and SYRCLE's Risk of Bias were used to assess the risk of bias in interventional, observational, and animal study, respectively. A narrative synthesis of evidence is provided to describe results. From 101 retrieved studies related to electronic cigarettes effect on the vascular system, a total of 16 studies are included in this review. The overall results indicated that electronic cigarette use is associated with adverse events in the vascular, including the incident of elevated oxidative stress, endothelial dysfunction, inflammation, arterial stiffness, and the development of atherosclerotic lesion. Further studies should broaden perspectives and reveal more about the mechanism of how electronic cigarettes impact on vascular system.

Telehealth interventions for mobility after lower limb loss: A systematic review and meta-analysis of randomized controlled trials.

Mobility is a crucial component for healthy aging after lower limb loss (LLL). Telehealth technologies, for example, smart devices, are novel approaches for health programs delivery regardless of geographical boundaries. To assess the effect of telehealth interventions on mobility, quality of life, and antecedents of health behavior compared with a control condition (usual care or simpler telehealth interventions with fewer number of behavior change techniques [BCTs]) for community-dwelling adults (>50 years) with an LLL and the effect of mode of delivery and BCTs used in telehealth interventions on health outcomes. Systematic review and meta-analysis. We systematically searched MEDLINE, PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane, PsycINFO, and SPORTDiscus on January 28, 2021, to identify relevant randomized controlled trials. Two authors independently screened records and assessed risk of bias. We conducted a narrative synthesis of evidence and, when appropriate, used the standardized mean difference (SMD) and mean difference for meta-analyses and the Grading Recommendations Assessment, Development, and Evaluation approach for practice recommendations. We identified six randomized controlled trials. Telephone was the most common delivery mode (n = 3), and "instructions for performing behaviors" was the most common BCT (n = 5). Very low certainty evidence showed no changes in mobility (six studies: SMD = 0.33 [95% confidence interval [CI] = -0.08, 0.75]), quality of life (two studies: mean difference = -0.08 [95% CI = -0.30, 0.15]), and antecedents of behavior (five studies: SMD = 0.04 [95% CI = -0.28, 0.36]). Our review highlights a knowledge gap for the effect of telehealth interventions for people with LLL. Although no promising effect was shown for telehealth interventions, very low certainty evidence precludes making a definitive clinical recommendation.