Knowledge Networks Research Articles

Efficacy and safety of moderate-intensity rosuvastatin plus ezetimibe versus high-intensity rosuvastatin monotherapy in the treatment of composite cardiovascular events with hypercholesterolemia: A meta-analysis

Background Statins are the gold standard in the treatment of dyslipidemia, significantly reducing the risk of cardiovascular disease. Objective To systematically review the efficacy and safety of Moderate-intensity Rosuvastatin Plus Ezetimibe compared with High-intensity Rosuvastatin in treating Composite Cardiovascular Events. Methods PubMed, Embase, Cochrane Library, CINAHL, Web of Science, China Knowledge Network, China Biological Literature Database, Wan Fang Database, and Weipu Database were searched to retrieve randomized controlled trials assessing the safety and efficacy of the two therapies from the time of construction to December 2023. The Jadad scale assessment tool was used to evaluate the quality of the included literature, and Review Manager 5.4 software was used for meta-analysis. The heterogeneity of outcomes was estimated by the I2 test, where we applied risk ratios (RR) and 95% confidence intervals (CI) to assess dichotomous outcomes and mean difference (MD) and 95% CI to present continuous outcomes. We used funnel plots to assess study publication bias and sensitivity analysis was used to address significant clinical heterogeneity. Results The meta-analysis described 21 RCTs involving 24592 participants. The findings indicated that moderate-intensity statin combination therapy improved low-density lipoprotein cholesterol (LDL-C) (MD -8.06, 95% CI [-9.48, -6.64] p < 0.05), total cholesterol (TG) (MD -5.66, 95% CI [-8.51, -2.82] p < 0.05), and non-high-density lipoprotein cholesterol (non-HDL-C) (MD -17.04, 95% CI [-29.55, -4.54] p < 0.05) to a greater extent and superior in achieving LDL-C <70 (RR1.26, 95% CI [1.22, 1.29] p < 0.05) and LDL-C <55 (RR1.66, 95% CI [1.56, 1.77] p < 0.05) ratios and in the incidence of adverse events than the high-intensity Rosuvastatin monotherapy group. However, there was no statistical difference between the two in improving HDL-C, total cholesterol (TC), and preventing long-term composite adverse cardiovascular events (ACE). Funnel plots indicated publication bias. Sensitivity analysis suggested instability in long-term composite cardiovascular events, HDL-C, and TC results. Conclusions Moderate-intensity statin plus ezetimibe with combination therapy had better efficacy and safety than high-intensity statins. Future validation is needed with more long-term high-quality large samples.

Global research hotspots and trends of Buyang huanwu decoction: A visual analysis of the literature based on CiteSpace

Background: Buyang huanwu decoction (BYHWD) has shown significant clinical efficacy in the treatment of several diseases, particularly stroke. However, bibliometric research has not been comprehensive. Methods: BYHWD articles were collected from literature databases published from January 1, 1915, to March 31, 2024, including the China National Knowledge Infrastructure, Weipu, Wanfang, Pubmed, Scopus, and Web of Science Core Collection. Knowledge network graphs of annual publication volume, authors, institutions, countries, keywords, and references were constructed. Results: Nine thousand two hundred thirty-eight Chinese literature and 559 English articles published between 1915 and 2024 showed an overall upward trend. The countries, institutions, journals, and authors with the highest output were China, Hunan University of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangxian Cai, and Changqing Deng, respectively. Research teams outside China were located at Daejeon University, Gachon University, Aga Khan University, Yale University, etc. The results of keyword co-occurrence and burst analysis included clinical applications, animal experiments, action mechanisms, clinical efficacy, and safety evaluations based on systematic reviews and meta-analyses. Literature co-citation analysis revealed that BYHWD was highly correlated with neuroprotection and reduction of cerebral ischemia/reperfusion injury. Conclusion: Both Chinese and English literature have shown overall growth trend since 1984 and 1989, respectively. Clinical applications, pharmacological effects, mechanisms, active ingredients, evaluation of clinical efficacy and safety, modified BYHWD, methods, and biological techniques may be hotspots and focus of future research on BYHWD. Hotspot analytical methods and biological techniques include systematic reviews, meta-analyses, data mining, network pharmacology, and molecular docking. Future valuable research fields may include studies on neuroprotection, anti-inflammatory activity, ischemic stroke, bioactive compounds, and their underlying mechanisms.

ACTIVE, ACTUATED, AND ASSISTIVE: A SCOPING REVIEW OF EXOSKELETONS FOR THE HANDS AND WRISTS

BACKGROUND: Assistive technology is often incorporated into rehabilitation and support for those impacted by upper limb impairments. When powered, these devices provide additional force to the joints of users with muscle weakness. Actuated devices allow dynamic movement compared to splints, therefore improving the ability to complete activities of daily living. However, these devices are not often prescribed and are underrepresented in research and clinical settings. OBJECTIVE: This review examines the current body of literature concerning devices designed to aid the hands and wrists in daily activities. Focusing on active, powered, and actuated devices, to gain a clearer understanding of the current limitations in their design and prescription. METHODOLOGY: The scoping review was conducted using the PRISMA-ScR guidelines. A systematic search was done on MEDLINE, EMBASE, Scopus, Web of Science, and NHS the Knowledge Network from inception to May 2023. Articles were included if the device was portable; supported the hands and wrist actively using an actuator; and could be used for assistive living during or post-rehabilitation period. FINDINGS: A total of 135 studies were included in the analysis of which 34 were clinical trials. The design and control methods of 121 devices were analyzed. Electrical stimulation and direct mechanical transmission were popular actuation methods. Electromyography (EMG) and joint movement detection were highly used control methods to translate user intentions to device actuation. A total of 226 validation methods were reported, of which 44% were clinically validated. Studies were often not conducted in operational environments with 69% at technology readiness levels ≤ 6, indicating that further development and testing is required. CONCLUSION: The existing literature on hand and wrist exoskeletons presents large variations in validation methods and technical requirements for user-specific characteristics. This suggests a need for well-defined testing protocols and refined reporting of device designs. This would improve the significance of clinical outcomes and new assistive technology. Layman's Abstract Assistive devices are often incorporated into rehabilitation and support for those impacted by upper limb impairments. When powered, these devices provide additional force for users with muscle weakness. Unlike splints, these devices do not constrict movement, therefore improving the ability to complete activities of daily living. However, these devices are rarely prescribed or presented in research and clinical settings. This review examines the current literature concerning powered devices that aid the hands and wrists to investigate who uses them, how they are designed and how they are validated. The scoping review was conducted using a validated guideline. A systematic search was done on 5 databases up to May 2023. Articles were included if the device was portable; supported the hands and wrist using motors; and could be used for everyday tasks. A total of 135 studies were included in the analysis, of which 34 were clinical trials. The design and method of device function of 121 devices were analysed. Muscle and joint movement detection were highly used to control device movement. A total of 226 validation methods were reported, of which 44% were clinically validated. Studies were often conducted in research and clinical environments (69%) rather than at home settings. In conclusion, existing literature on hand and wrist exoskeletons presents large variations in design, control methods and validation practices. This suggests a need for well-defined testing protocols. This would improve the significance of clinical outcomes of new assistive technology. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/43827/33279 How To Cite: Galbert A, Buis A. Active, actuated, and assistive: A scoping review of exoskeletons for the hands and wrists. Canadian Prosthetics & Orthotics Journal. 2024; Volume 7, Issue 1, No.9. https://doi.org/10.33137/cpoj.v7i1.43827 Corresponding Author: Professor Arjan Buis, PhDDepartment of Biomedical Engineering, Faculty of Engineering, University of Strathclyde, Glasgow, Scotland.E-Mail: arjan.buis@strath.ac.ukORCID ID: https://orcid.org/0000-0003-3947-293X

A Meta-analysis of the Effect of Aerobic Exercise during Pregnancy on Maternal Labor Pains

Objective: Systematically evaluate the effect of prenatal aerobic exercise on maternal labor pain.Methods: Systematic search: Cochrane Library, Embase, Web of science, PubMed, China Biomedical Database, China Knowledge Network (CNKI), Wanfang Data Knowledge Service Platform, Wipu.com, etc., and the time limit of the search was from the establishment of the library to June 2024, and randomized controlled trials (RCTs) related to the purpose of the study were collected and included by the after 2 researchers independently screened the literature, extracted information and evaluated the risk of bias of the included studies, RevMan5.3 software was applied to analyze the data. Results: A total of 10 RCTs were included, including 1144 cases of labor. Meta-analysis showed that prenatal aerobic exercise was effective in relieving labor pain level throughout the entire laboring process, with an MD [95% CI] of -1.80 [-2.75,-0.84], (P<0.05), when compared with the control group. However, the effect was not significant in relieving 3-4 cm of uterine opening and when the uterine opening was more than 4 cm. Conclusion: Current evidence suggests that prenatal aerobic exercise relieves labor pain levels throughout labor, but is not significantly effective in relieving uterine opening of 3-4 cm and 4 cm or more. Due to the limitations of the number and quality of included studies, the above conclusions need to be verified by more high-quality studies.

Building a Nation at War: Transnational Knowledge Networks and the Development of China during and after World War II, written by J. Megan Greene

Building a Nation at War: Transnational Knowledge Networks and the Development of China during and after World War II, written by J. Megan Greene

Trends in Global Agricultural Carbon Emission Research: A Bibliometric Analysis

As climate change intensifies and countries actively pursue carbon peaking and carbon neutrality targets, agriculture has emerged as a significant source of carbon emissions. A comprehensive analysis of global agricultural carbon emission research can enhance the agricultural environment and achieve a mutually beneficial outcome for environmental protection and economic development. Despite the evolution of research domains and methodologies, the global context remains closely connected to the current state of the discipline. Drawing on the Web of Science core collection, this paper develops a knowledge network framework, examines the current status and hotspots of agricultural carbon emissions, forecasts future development trends, and analyzes the findings using CiteSpace visualization software. The findings indicate that the number of papers on agricultural carbon emissions has been increasing annually, with minor fluctuations; time series analysis and sustainable development have emerged as the current focal points, and relevant institutions are collaborating increasingly closely. However, cooperation among scholars requires further enhancement. Countries such as China, the United States, and Germany are the primary nations for paper publication. The hotspot analysis reveals a high frequency of keywords such as greenhouse gas emissions and climate change, indicating that research on agricultural carbon emissions has matured and the emphasis has shifted from accounting to management. This paper develops a domain knowledge framework to assist readers in understanding agricultural carbon emission patterns and provide resources for further research. Follow-up studies should enhance both comprehensiveness and breadth, promote interdisciplinary cooperation, provide a scientific foundation for policymakers, and outline future research directions.

How do network embeddedness and knowledge stock influence collaboration dynamics? Evidence from patents

Science, technology, and innovation are becoming increasingly collaborative, prompting concerted efforts to understand and measure the factors influencing these collaborations. This study aims to explore the driving factors and underlying mechanisms of collaboration dynamics based on patent data. Multilayer longitudinal networks are constructed to scrutinize interactions among organizations as well as the embedding of their knowledge elements in the network fabric. We then analyze the structures and characteristics of collaboration and knowledge networks from global and local perspectives, in which process topological indicators and graphlets are used to feature each organization's collaborative patterns and knowledge stock. Knowledge elements are extracted to present the core concepts of patents, overcoming the limitations of predefined categorizations, such as IPC, when representing technological content and context. By performing a longitudinal analysis using a stochastic actor-oriented model, we integrate network structures, node characteristics, and different dimensions of proximity to model collaboration dynamics and reveal the driving factors behind them. An empirical study in the field of lithography finds that organizations with a larger number of partners or a higher number of annular graphlets in their collaboration networks are less likely to collaborate with others. If an assignee has a more extensive range of knowledge elements and demonstrates a higher capability for knowledge combination, or if its local knowledge network exhibits weaker connectivity, its propensity to seek new collaborators increases. Both cognitive and organizational proximity play important roles in fostering collaboration.

Complex Words as Shortest Paths in the Network of Lexical Knowledge.

Lexical models diverge on the question of how to represent complex words. Under the morpheme-based approach, each morpheme is treated as a separate unit, while under the word-based approach, morphological structure is derived from complex words. In this paper, we propose a new computational model of morphology that is based on graph theory and is intended to elaborate the word-based network approach. Specifically, we use a key concept of network science, the notion of shortest path, to investigate how complex words are learned, stored, and processed. The notion of shortest path refers to the task of finding the shortest or most optimal path connecting two non-adjacent nodes in a network. Building on this notion, the current study shows (i) that new complex words can be segmented into morphemesthrough the shortest path analysis; (ii) that attested English words tend to represent the shortest paths in the morphological network; and (iii) that novel (unattested) words receive higher acceptability ratings in experiments when they are formed along established optimal paths. The model's performance is tested in two experiments with human participants as well as against the behavioral data from the English Lexicon Project. We interpret our empirical results from the perspective of a usage-based model of grammar and argue that network science provides a powerful tool for analyzing language structure.

Research Dynamics of Human Resources for Community Health in China

This paper takes community health human resources as the research theme, based on the three core journals covered by China Knowledge Network as the research material, and adopts Citespace and VOSviewer analysis software to analyse the literature, aiming to reveal the laws and trends of community health human resources research and formulate sustainable development strategies. In order to make more effective use of the potential of community health human resources, it is necessary to improve the job analysis of community health human resources, achieve the coordinated allocation of community health human resources, and improve the scientific evaluation of community health human resources.

Crafting innovative paths in non-linear professional learning for bilingual education: the role of connectivism in the age of AI

ABSTRACT This study introduces a novel Connectivist model for professional development (PD) aimed at enhancing AI literacy among bilingual/ESL teachers in K-12 education. As AI technologies rapidly reshape educational landscapes, effective PD programs are essential to equip educators with the skills to integrate AI responsibly and equitably. Grounded in Connectivism, which emphasizes non-linear learning and dynamic knowledge networks, this research explores how PD can transform educators’ perceptions of AI from apprehension to empowerment. The study involved a two-phase PD program with 30 elementary teachers and administrators, incorporating in-person AI training sessions, asynchronous tutorials, and collaborative activities. Data were collected through a phenomenological approach to capture educators’ lived experiences, with triangulation methods using surveys, interviews, observations, and Q&A sessions. The analysis revealed significant improvements in participants’ attitudes toward AI and their openness to integrating it into their teaching practices. The Connectivist model developed in this study fosters ongoing collaborative learning networks and equips educators to leverage AI in addressing resource gaps in bilingual education. This model offers a transformative, sustainable, and adaptive framework for integrating AI into K-12 education, providing a forward-looking approach to professional development in the digital age.

Dealing with Student Mistakes in Mathematics at Primary School

The article focuses on how teachers deal with student mistakes during mathematics instruction at primary school. The theoretical framework encompasses a constructivist culture of teaching and learning and dialogic teaching. Two general strategies are distinguished: avoiding mistakes and using mistakes as opportunities to learn. The presented qualitative study is based on 24 audio recordings of mathematics instruction, supplemented by interviews with six teachers. Through axial coding, we arrived at seven categories that describe specific ways of dealing with mistakes: not responding; making students aware of a mistake; encouraging students to present proofs; leading students to a level where they do not fail; expanding the student network of mathematical knowledge; creating opportunities for presenting content to clarify mistakes; and providing opportunities for students to find the cause of their mistakes. The findings are discussed in the context of the constructivist approach to instruction.

Does the high-intensity zone of lumbar intervertebral disc at magnetic resonance imaging have diagnostic value for discogenic low back pain? A meta-analysis

ObjectiveThe correlation between high-intensity zone (HIZ) of lumbar disc magnetic resonance imaging (MRI) and discogenic low back pain (DLBP) is currently controversial, this study aimed to systematically evaluate the correlation between HIZ of lumbar disc MRI and positive discography, as well as its diagnostic value for DLBP.MethodDatabases were searched to include research literature on high intensity zone (HIZ) related to discography and DLBP diagnosis. HIZ is a separate small, confined area of high signal located at the posterior border of the annulus fibrosus on MRI T2-weighted images of the lumbar spine, which is separated from the nucleus pulposus but has a higher signal than the nucleus pulposus. Studies on the correlation of HIZ with discography and DLBP diagnosis were searched in the Pubmed, EMBASE, Cochrane Central, Science Direct, China Knowledge Network, Wanfang Database, and China Biomedical Literature Databases, Scopus from January 1992 to June 2024. The outcomes were diagnostic values of HIZ for DLBP. The risk assessment was performed by Deeks’ funnel methods in the Stata 17.0 software after 2 investigators independently screened the literature, extracted information and evaluated the risk of bias of the included studies.ResultsA total of 25 studies including 5889 patients were included. meta-analysis showed that the sensitivity of HIZ for the diagnosis of DLBP was (0.49, 95% CI [0.37,0.61]) and specificity was (0.89, 95% CI [0.85,0.93]); the positive likelihood ratio was (4.52, 95% CI [3.28,6.25]) and the negative likelihood ratio was (0.58, 95% CI [0.46,0.71]). The diagnostic ratio was (7.87, 95% CI [5.05,12.26]).ConclusionThe available evidence suggests that HIZ has acceptable sensitivity and high specificity in the diagnosis of DLBP. Due to the limitation of the number and quality of included studies, the above conclusions need to be validated by more high-quality studies.

Health policy analysis for stewardship of rehabilitation services

Background and aimThere have been a growing interest in investigating the effect of stewardship on other functions of rehabilitation service delivery. Effective stewardship of rehabilitation services can ensure that these services are of high quality, accessible, affordable, and sustainable, and can help achieve the goals of universal health coverage. The purpose of this study was to identify and analyze the policies adopted in the field of rehabilitation services in Iran and in the international arena, and finally to identify policy gaps, areas for improvement, and areas that have been overlooked.MethodThis research is a policy analysis, carried out through document analysis and Dalglish et al.’s READ approach. Data were analyzed and interpreted using qualitative methodology and directed content analysis. For this purpose, Veillard et al.‘s health system stewardship framework was used to analyze the stewardship of rehabilitation services. The dimensions of the stewardship framework, were: Defining the vision for health and strategies and policies to achieve better health; influencing all sectors and advocating for better health; ensuring good governance in line with prevailing values; ensuring the alignment of system design with health system goals; improving existing legal and regulatory instruments; and compiling, disseminating, and applying information. Scott’s four criteria were used to assess the authenticity, credibility, representativeness, and meaning of the documents. Those that did not meet even one of the Scott’s criteria were excluded from content analysis.FindingsA total of 16 documents were identified, all of which met Scott’s criteria and none were excluded from the study. A total of six themes and 56 subthemes were extracted. The contents of all the documents were extracted under six themes of Veillard et al.‘s health system stewardship framework. Overall, the results show that national documents place greater emphasis on the development of preventive healthcare and health promotion. Documents often focus on engaging NGOs and the families of people with disabilities and on intersectoral collaboration for knowledge production and the development of intersectoral knowledge networks. In terms of health system governance in line with prevailing values, documents are mainly focused on health system stewardship by the Ministry of Health and on evidence-based decision-making with the participation of target groups. Also, documents place more emphasis on upgrading the national infrastructure and increasing access to rehabilitation services.ConclusionIn some areas of rehabilitation services, there is a gap between national documents, which reflects differences in priorities, approaches, resources, and instruments available to strengthen rehabilitation services at the national and international levels.

6.I. Round table: Strengthening preparedness for public health emergencies: lessons learned and future perspectives

Abstract In the face of intensifying global health threats, robust health security measures in Europe and worldwide have never been more pressing. The COVID-19 pandemic has underscored the critical need for coordinated action, adaptive strategies, and robust collaborative mechanisms to effectively respond to emerging infectious diseases and other public health emergencies. This workshop serves as a platform to examine the multifaceted landscape of health security actors, focusing on collaborative initiatives and lessons learned from recent crises. By convening experts and stakeholders from across Europe, the workshop aims to achieve several key objectives: i) To provide an overview of collaborative initiatives established to strengthen European and international health security. By showcasing successful models of cooperation, participants will gain insights into effective strategies for fostering collaboration among diverse stakeholders. ii) Emphasize the role of European and international institutions, such as the European Centre for Disease Prevention and Control (ECDC) and the World Health Organization (WHO), in supporting states both in coordinating regional response efforts and in developing the necessary health workforce competencies and capabilities to respond to health emergencies. iii) Drawing on experiences from recent health emergencies, including outbreaks of high-risk pathogens, such as Ebola, the workshop will facilitate a critical examination of lessons learned. Through interactive discussions, participants will identify challenges, best practices, and opportunities for enhancing preparedness and response capacity. iv) By interactive presentations and panel discussions, the workshop will provide a platform for knowledge exchange and networking among participants. By sharing experiences, expertise, and innovative approaches, participants will contribute to a collective understanding of the challenges and opportunities in strengthening health security. This workshop seeks to illuminate key strategies, capacity-building efforts, and real-world lessons learnt that contribute to enhancing response capabilities to public health emergencies. Participants will gain a deeper understanding of emergency participation mechanisms, essential skills required, and available training resources to enhance preparedness. Key messages • Collaboration and adaptive strategies are essential for strengthening international health security in the face of emerging infectious diseases and other public health emergencies. • Lessons learned from recent crises provide valuable insights into effective response strategies and opportunities for enhancing preparedness and response capacity.

Architectural styles of curiosity in global Wikipedia mobile app readership.

Intrinsically motivated information seeking is an expression of curiosity believed to be central to human nature. However, most curiosity research relies on small, Western convenience samples. Here, we analyze a naturalistic population of 482,760 readers using Wikipedia's mobile app in 14 languages from 50 countries or territories. By measuring the structure of knowledge networks constructed by readers weaving a thread through articles in Wikipedia, we replicate two styles of curiosity previously identified in laboratory studies: the nomadic "busybody" and the targeted "hunter." Further, we find evidence for another style-the "dancer"-which was previously predicted by a historico-philosophical examination of texts over two millennia and is characterized by creative modes of knowledge production. We identify associations, globally, between the structure of knowledge networks and population-level indicators of spatial navigation, education, mood, well-being, and inequality. These results advance our understanding of Wikipedia's global readership and demonstrate how cultural and geographical properties of the digital environment relate to different styles of curiosity.

Traditional Chinese Medicine treatment for postoperative axial symptoms of cervical spondylotic myelopathy: a systematic review

BackgroundAxial symptoms (AS) represent one of the primary complications after cervical spondylotic myelopathy (CSM) surgery. Traditional Chinese Medicine (TCM), as a complementary and alternative therapy, is widely used in the...

Connectivism: A Navigation in the Network of Knowledge

In the web-based pedagogical technology, learning does not simply happen within an individual, but within and across the networks. Knowledge is distributed and resides in the brain and also in connections with electronic equipments. Learning consists of the ability to construct and traverse the networks that help learners acquire viewpoints and diversity of opinions. It is a process of plugging into the world of constant information flow and drawing meaning from it. As the world continues to grow and evolve, the knowledge needed for tomorrow is more essential than the knowledge needed for today

Interplay between Network Position and Knowledge Production of Cities in China Based on Patent Measurement

The urban knowledge network in China has undergone in-depth development in recent decades, intimately connecting the position characteristics of cities in the knowledge network to their knowledge production performance. While existing research focuses predominantly on the unidirectional relationship between network position and the knowledge production of cities, there is a notable dearth of studies exploring the bidirectional relationship between the two constructs. By proposing a conceptual framework, this paper empirically examines the interplay between network position and knowledge production of cities through simultaneous equation models. The results revealed a mutually reinforcing relationship between network position and knowledge production, and this relationship exhibits heterogeneous characteristics and spillover effects. Specifically, cities in the periphery block and the central-western region benefit more from the effect of network position on knowledge production, while cities in the core block and the eastern region benefit more from the effect of knowledge production on network position. Moreover, the interactive effect between network position and knowledge production of cities is significantly affected by the network position characteristics and knowledge production performance of their neighboring cities in geographically adjacent regions and relationally adjacent regions. These findings enhance the understanding of urban network externalities and the connotations of the knowledge production function.

Association of sugar consumption with risk of depression and anxiety: a systematic review and meta-analysis.

Sugar consumption has increased dramatically around the world, and at the same time, the prevalence of mental illnesses such as depression and anxiety continues to increase. While previous research has explored the impact of various dietary factors on mental health, the specific impact of dietary sugar consumption on the risk of depression and anxiety disorders remains elusive. This study aimed to comprehensively assess this relationship through a systematic review and meta-analysis. PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Network (CNKI), and WangFang were systematically searched for studies of the association between total dietary sugar intake and risk of depression and/or anxiety. The articles that meet the criteria are screened and included in the systematic review, and the data are extracted after assessing their quality. Stata 18.0 software was used for the meta-analysis. Forty studies with 1,212,107 participants were included in the analysis. Results showed that sugar intake increased the risk of depression by 21% (OR = 1.21, 95% CI: 1.14, 1.27), while the overall association between sugar intake and anxiety risk was not statistically significant (OR = 1.11, 95% CI: 0.93, 1.28). Despite high heterogeneity (I 2 = 99.7%), the results were statistically significant (p < 0.000). Subgroup analyses showed that the association between sugar consumption and depression risk remains consistent across different study designs (cross-sectional, cohort, and case-control studies) and different sample sizes (<5,000, 5,000-10,000, >10,000). Women have a higher risk of depression than men (OR = 1.19, 95% CI: 1.04, 1.35). Among the different exposure measures, the Food Frequency Questionnaire (FFQ) showed the most significant effect (OR = 1.32, 95% CI: 1.08, 1.67, I 2 = 99.7%, p < 0.000). The measuring tool of subgroup analysis showed that there was a significant correlation between sugar intake and risk of depression, PHQ-9 (OR = 1.29, 95% CI: 1.17, 1.42, I2 = 86.5%, p < 0.000), and CES-D (OR = 1.28, 95% CI: 1.14, 1.44, I 2 = 71.3%, p < 0.000). High-quality cross-sectional and cohort studies showed a significant association between sugar intake and depression risk, with most results being robust. While the overall analysis of sugar intake and anxiety risk was not significant, some subgroups approached significance, particularly in studies with a sample size of <5,000 (OR = 1.14, 95% CI: 0.89, 1.46) and studies using the FFQ questionnaire (OR = 1.31, 95% CI: 0.90, 1.89). Total dietary sugar consumption was significantly associated with increased risk of depression in the general population, whereas the association with risk of anxiety was not significant. Further high-quality studies are needed to verify these associations and ensure their reliability. This study highlights the impact of dietary sugar intake on mental health, identifies potentially high-risk groups through subgroup analysis, and provides new insights into the prevention of depression and anxiety. CRD42024540548.

The evolution of transnational municipal knowledge networks

AbstractThe recent growth of transnational municipal networks requires a better understanding of their evolution. For some actors, this growth has resulted in arbitrary or top‐down decisions on network membership followed by low commitment and inefficient use of time and financial resources. By reinterpreting secondary data through an evolutionary approach, this paper argues that the overall systemic nature of the networks is shaped not only by their institutional settings and the composition of actors but also by a set of specific qualities (coherence, boundedness and unified function) that may change over time. Based on the network perspective and system approach, the paper advances our understanding of transnational knowledge networks and the maximising of their effectiveness. Using exemplars, it suggests a conceptual framework for the evolution of transnational municipal knowledge networks.