Newcastle-Ottawa Scale Research Articles

Exploring the role of angiogenesis in fibrosis and malignant transformation in oral submucous fibrosis: a systematic review and meta-analysis.

Angiogenesis is a crucial molecular driver of fibrosis in various inflammatory lesions. Oral submucous fibrosis (OSMF) is a chronic inflammatory fibrotic disorder with malignant potential. The angiogenetic pathways in OSMF remain obscure due to limited research, necessitating an in-depth review. This review aimed to illuminate the cryptic pathogenetic mechanisms of angiogenesis in the disease progression/fibrosis of OSMF and its malignant transformation, providing insights for improved treatment. Extensive literature searches were conducted across an array of databases until October 2023. Original research articles on angiogenesis in OSMF were included, and the risk of bias was assessed using the modified Newcastle-Ottawa scale. RevMan ver. 5.4 (Cochrane Collaboration) was used for data analysis. Thirty-four articles were included for qualitative synthesis and seven for quantitative analysis. Findings revealed that angiogenesis was significantly increased in early-stage OSMF but decreased as the disease advanced. It was also associated with the severity of epithelial dysplasia and malignant transformation. A random-effects model confirmed the upregulation of angiogenesis as a significant risk factor in early-stage fibrosis and malignant transformation. The mounting evidence reinforces that angiogenesis plays a crucial role in the progression of early-stage fibrosis of OSMF and its malignant transformation, opening avenues for diagnostic and therapeutic interventions.

Neuroplasticity Alterations Induced by Isotretinoin use in RARA Gene Polymorphism is Associated with Increased Risk of Depression and Suicidal Ideation in Patients with Vitamin D Deficiency: A Systematic Review and Meta-Analysis

Rationale: Isotretinoin is widely used for severe acne treatment, but concerns have emerged regarding its potential association with depression and suicidal ideation. Previous studies have produced mixed findings, necessitating a comprehensive evaluation of the evidence. This systematic review and meta-analysis aim to clarify the association between isotretinoin use and the onset of depression or suicidal ideation, focusing on genetic predispositions, particularly in patients with vitamin D deficiency. Objectives: This review assesses the risk of depression and suicidal ideation in patients treated with isotretinoin for severe acne compared to those not using isotretinoin. A secondary focus is placed on identifying specific genetic factors, such as polymorphisms in the RARA and LEP genes, that may predispose patients to these psychiatric side effects. Eligibility Criteria: Randomized controlled trials (RCTs), cohort studies, and case-control studies comparing isotretinoin users to non-users were included. Exclusion criteria included studies that lacked a comparator group or did not report psychiatric outcomes (depression or suicidal ideation). Outcomes: The primary outcome was the incidence of depression or suicidal ideation among isotretinoin users compared to non-users. Secondary outcomes examined the influence of genetic polymorphisms, specifically in the RARA and LEP genes, on the risk of developing psychiatric side effects. Risk of Bias: Risk of bias was assessed using the Cochrane Risk of Bias tool for randomized trials and the Newcastle-Ottawa Scale for observational studies. The overall quality of the included studies was moderate to high. Synthesis Methods: A random-effects meta-analysis was performed to pool odds ratios (ORs) with 95% confidence intervals (CIs). Heterogeneity was assessed using the I² statistic, and sensitivity analyses were conducted to ensure the robustness of the findings. Included Studies: Fifteen studies were included, comprising 3 randomized controlled trials, 7 cohort studies, and 5 case-control studies, with a total of 8,000 isotretinoin users and 10,000 non-users. The studies were conducted in diverse clinical settings with a follow-up range of 6 months to 5 years. Synthesis of Results: The pooled analysis demonstrated a significant association between isotretinoin use and an increased risk of depression (OR: 1.3, 95% CI: 1.1–1.5, p < 0.05). Specific genetic polymorphisms, particularly in the RARA and LEP genes, were identified as potential risk factors for developing depression among isotretinoin users, particularly in patients with concurrent vitamin D deficiency. Conclusions: Isotretinoin use is associated with an increased risk of depression, particularly in individuals with specific genetic polymorphisms such as RARA and LEP. Clinicians should consider conduct precision medicine genetic testing testing for these polymorphisms before initiating isotretinoin treatment and closely monitor patients for psychiatric alterations, mood changes, especially those with with vitamin D deficiency or genetic predisposition to depression

Prevention of Overhead Shoulder Injuries in Throwing Athletes: A Systematic Review

(1) Background: Shoulder pathologies are mostly found in overhead sports. Many risk factors have been identified, in particular a deficit in the kinetic chain. The aim of this review was to find out whether prevention by strengthening the kinetic chain can have an impact on the rate of shoulder injury in overhead pitching athletes. (2) Methods: A systematic review of the literature was carried out, including studies on the role of the kinetic chain in the prevention of overhead athletes. The studies used were works published over the last 10 years searched on PubMed, Cochrane Library, PEDro and Science Direct. They were also analyzed by methodological quality scales: the PEDro scale and the Newcastle–Ottawa scale. (3) Results: Eight studies met the inclusion criteria. The studies analyzed revealed a significant correlation between the use of the kinetic chain and the prevention of shoulder injuries, associating factors such as muscle strength, physical performance in tests (CMJ, FMS), static and dynamic balance and the ability to transfer energy from the lower to the upper body. (4) Conclusions: It is important to integrate core stability work and lower limb strengthening to minimize excessive stress on the shoulder complex, while optimizing force production and performance.

Silent Struggles Within: Alexithymia Unveiled in Irritable Bowel Syndrome: A Systematic Review and Meta-analysis.

In recent years, the presence of alexithymia in patients with irritable bowel syndrome (IBS) has gained more attention, and several studies have evaluated this relationship. However, no clear conclusion has been reported yet. Therefore, we conducted a systematic review and meta-analysis to better understand the association between IBS and alexithymia. We performed a systematic search on the medical databases PubMed, EMBASE, and Scopus using predefined keywords to identify observational studies assessing the association between IBS and alexithymia. The included studies diagnosed IBS using the Rome criteria, and alexithymia was evaluated using the 20-item Toronto Alexithymia Scale (TAS-20) score. We used The Newcastle-Ottawa Scale to evaluate the quality of included studies. The primary summary outcome was the mean difference in TAS-20 scores. We included 7 studies involving 1,513 individuals in our qualitative analysis, with 6 of them included in our quantitative analysis. All studies were considered to be of satisfactory quality according to the Newcastle-Ottawa Scale criteria. We found significantly higher TAS-20 scores in IBS patients compared to controls (8.063 [95% CI, 2.554-13.572]). However, no significant mean difference in TAS-20 scores was observed in IBS vs inflammatory bowel disease patients (0.884 [95% CI -2.536-4.304]). We demonstrated that IBS is associated with an increased risk of developing alexithymia. However, our study did not show a significant difference in TAS-20 scores between patients with IBS compared to inflammatory bowel disease.

Bone Mineral Density, Bone Biomarkers, and Joints in Acute, Post, and Long COVID-19: A Systematic Review

SARS-CoV-2 is highly transmissible and affects the respiratory system. People with COVID-19 are at higher risk of physical and mental health conditions, which could impact bone health. The aim of this review was to explore the effects of COVID-19 on BMD, BTMs, and joints. An electronic search of the PubMed, Web of Science, Scopus, and Ovid Medline databases considered studies published between 1 January 2020 and 1 November 2023. The search was limited to English, original studies in adult humans. The title and abstract of the identified papers were screened, followed by a full-text review using inclusion and exclusion criteria. The data extracted included the study and participant characteristics, BTMs, BMD, and joint abnormalities. The Newcastle–Ottawa scale quality assessment tool was used to assess the risk of bias. Five studies involving 305 out of 495 infected individuals observed a reduced BMD after COVID-19, with the most significant reduction occurring a year later. Both bone resorption and bone formation markers decreased, while regulatory markers showed higher levels in infected patients. COVID-19 may harm bone health by increasing bone regulatory markers and reducing bone formation and absorption, leading to a lower BMD. Elderly, frail, and osteopenic or osteoporotic individuals are at higher risk and should be regularly monitored for bone loss if they have long COVID.

Biomarkers of rheumatoid arthritis-associated interstitial lung disease: a systematic review and meta-analysis

BackgroundInterstitial Lung Disease (ILD) represents the most common extra-articular manifestation of Rheumatoid Arthritis (RA) and is a major cause of mortality. This study aims to identify and evaluate biomarkers associated with Rheumatoid Arthritis-Associated Interstitial Lung Disease (RA-ILD).MethodsWe searched PubMed, Cochrane Library, EMBASE, and Web of Science databases for studies related to biomarkers of RA-ILD up until October 7, 2023. The Newcastle-Ottawa Scale (NOS) and standards recommended by the Agency for Healthcare Research and Quality (AHRQ) were used for quality assessment, and meta-analysis was conducted using Stata18.0 software.ResultsA total of 98 articles were assessed for quality, 48 of which were included in the meta-analysis. 83 studies were of high quality, and 15 were of moderate quality. The meta-analysis showed significant differences in biomarkers such as C-Reactive Protein (CRP), Erythrocyte Sedimentation Rate (ESR), Anti-Cyclic Citrullinated Peptide (anti-CCP) antibody, Rheumatoid Factor (RF), Krebs von den Lungen-6 (KL-6), Surfactant Protein D (SP-D), Carcinoembryonic Antigen (CEA), Carbohydrate Antigen 19-9 (CA19-9), Matrix Metalloproteinase-7 (MMP-7), C-X-C Motif Chemokine Ligand 10 (CXCL-10), and Neutrophil-to-Lymphocyte Ratio (NLR) between RA-ILD patients and RA patients. However, Platelet-to-Lymphocyte Ratio [Platelet-to-Lymphocyte Ratio (PLR)], Cancer Antigen 125 [Cancer Antigen 125 (CA-125)], and Cancer Antigen 153 [Cancer Antigen 153 (CA-153)] did not show significant differences between the two groups. KL-6, MMP-7, and Human Epididymis Protein 4 (HE4) are negatively correlated with lung function, and KL-6 is associated with the prognosis of RA-ILD.ConclusionsBiomarkers hold promising clinical value for prediction, diagnosis, severity assessment, and prognosis evaluation in RA-ILD. However, these findings need to be validated through multicenter, large-sample, prospective cohort studies.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42023448372.

Assessing the Efficacy and Challenges of Tofacitinib in the Management of COVID-19: A Systematic Review and Meta-analysis of Cohort Studies

Objectives: Global healthcare faces challenges in combating COVID-19, with rising cases despite widespread vaccination. Severe COVID-19 cases, marked by acute respiratory distress and cytokine release syndrome, highlight the importance of managing cytokine storms. Janus kinase (JAK) inhibitors, such as tofacitinib, show promise in this regard. While tofacitinib is recommended for severe cases, challenges include adverse effects, conflicting studies, and the need for further investigation of new virus strains. Overcoming these hurdles is crucial for developing an effective treatment protocol and reducing COVID-19 mortality. Methods: This study conducted a comprehensive search across PubMed, Scopus, and ISI Web of Science for observational studies on tofacitinib treatment in human adults with COVID-19. The search covered a specified period up to 2024. Data extraction, including study characteristics and quality assessment, employed the Newcastle Ottawa Scale and a modified Cochrane tool. Statistical analysis, conducted with Comprehensive Meta-Analysis Software, assessed heterogeneity and significance levels. Results: The meta-analysis of the three studies showed a significant reduction in mortality (Risk Ratio: 0.372, 95% CI: 0.213–0.649, P-value = 0.001) with low heterogeneity (Cochrane P-value = 0.793), while no significant reduction in the need for mechanical ventilation was observed (Cochrane P-value = 0.194). Conclusion: Tofacitinib administration shows a significant reduction in COVID-19 mortality. However, the limited studies on its efficacy highlight the need for cautious interpretation in clinical assessments.

Association of sleep duration with obesity in older adults: A systematic review and meta-analysis.

Research on sleep duration and obesity is extensive in children and young individuals but limited and inconsistent for older adults. Our study aims to clarify the current status of this association in the elderly population. We searched six English and four Chinese databases up to January 25, 2024, for observational studies on sleep duration and obesity in older adults. Two researchers independently conducted the literature search and data extraction. Study quality was assessed using the Newcastle-Ottawa Scale for cohort studies and the Agency for Healthcare Research and Quality for cross-sectional studies. Meta-analyses were performed using Stata 15.0 software, using both random-effects and fixed-effects models to calculate pooled odds ratios with 95% confidence intervals (CIs). The meta-analysis of 15 studies found a correlation between short sleep duration and obesity in older individuals (pooled odds ratio, 1.40 [95% CI: 1.12-1.73]; P = 0.003). However, no significant correlation was found between long sleep duration and obesity among the elderly (pooled odds ratio, 1.04 [95% CI, 0.95-1.13]; P = 0.426). Short sleep duration in the elderly was associated with obesity. More prospective studies need to be included in the future to improve the reliability of the conclusions. Geriatr Gerontol Int ••; ••: ••-•• Geriatr Gerontol Int 2024; ••: ••-••.

Perinatal depression and adverse child growth outcomes in low-income and middle-income countries (LMICs): A systematic review and meta-analysis.

Perinatal depression (PND), which encompasses the antepartum and postpartum depression (APD and PPD), is a neglected crisis in low-income and middle-income countries (LMICs). We aimed to systematically search and meta-analyze existing evidence to determine whether a mother's PND affects adverse growth outcomes in children in LMICs (PROSPERO protocol: CRD42021246803). We conducted searches, including nine databases (PubMed, EMBASE, Web of Science, CINAHL Plus, Global Health Database, Google Scholar, WHO Regional Databases, PsycINFO, and LILACS) from January 2000 to September 2023. We restricted studies that assessed PND using validated screening tools or clinical interviews during pregnancy or within 12 months postpartum. We included studies that reported four types of adverse child growth outcomes (stunting, wasting, underweight, and overweight/obesity) in children younger than 5 years. We assessed the quality using the Newcastle Ottawa Scale and pooled risk ratios (RRs) and odds ratios (ORs) between PND and each adverse growth outcome using random-effects models. In total, 27 studies met the inclusion criteria for systematic review, with 24 eligible for meta-analysis, spanning data from 15 countries and 26,261 mother-baby pairs. Based on the studies that reported ORs, children below the age of 3 years with mothers experiencing PND had higher odds for stunting (OR 1.63, 95% CI 1.32, 2.02, I2 = 56.0%) and underweight (OR 2.65, 95% CI 1.90, 3.68, I2 = 34.5%) compared to children of mothers without PND. The pooled RRs for stunting and underweight did not show significant differences between mothers with and without PND. Studies on wasting (n = 5) and overweight/obesity (n = 2) were limited, demonstrating inconsistent results across studies. The association between PND and adverse growth outcomes varied according to the measure of association, region, country, PND type, outcome timepoint, and study design. There were limited studies in diverse LMICs, particularly on wasting, or overweight/obesity as an outcome.

The effect of outdoor air pollution on Alzheimer’s disease: a systematic review

Abstract Air pollution is one of the largest global environmental risks to public health. Over recent years, neuroimaging techniques have started to uncover the detrimental impact air pollution has had on brain health, including the development of Alzheimer’s Diseases (AD). We systematically reviewed the literature to evaluate the effects of long-term exposure (months to years) to outdoor air pollutants on the development of AD-like neurology. This review was registered on PROSPERO (CRD42023482979) and followed PRISMA guidelines. Four large databases (MEDLINE, Embase, Scopus, and CINAHL) were searched in November 2023 using terms associated with air pollution, neuroimaging, and AD. Only peer-reviewed primary research articles using neuroimaging data to examine AD-like pathology after long-term exposure to air pollutants (Particulate Matter (PM2.5, PM10), SO2, NO2, O3, and/or CO) were included. Titles, abstracts and full-texts were screened, and included articles were quality assessed using the Newcastle Ottawa Scale. A narrative synthesis was conducted to analyse the studies. Our search yielded 397 results, of which eight articles met our inclusion criteria. Articles focused on changes to white matter (n = 5), cortical thickness (n = 6), and grey matter (n = 2). Exposure to PM2.5 was commonly associated with white matter reductions, and PM10 and NO2 exposure was associated with reduced cortical thickness. The effect of exposure to different outdoor pollution on grey matter was inconclusive, with both increases and decreases in grey matter volume observed. This review highlighted how PM2.5, PM10 and NO2 exposure was associated with neurological changes commonly seen in AD. These findings can be used by policymakers and researchers to identify specific pollutants that need greater restrictions and regulations to improve population health. Key messages • PM2.5, PM10 and NO2 exposure are associated with neurological changes commonly seen in AD. • Greater restrictions and regulations are needed on specific pollutants to improve population health.

Echocardiographic evaluation of right ventricle to pulmonary artery coupling in patients undergoing transcatheter aortic valve implantation: a systematic review and meta-analysis

Abstract Background Right Ventricle to Pulmonary Artery (RV/PA) uncoupling, which depicts the inability of RV contractility to match the increasing RV afterload, has recently gained recognition as a simple echocardiography parameter to aid prognosis judgment in patients with RV dysfunction. In Aortic Stenosis (AS) patients, the extent of RV dysfunction and Pulmonary Hypertension (PH) has been linked with poor outcomes, but the prognostic value of RV/PA uncoupling in AS patients undergoing TAVI has not been well-defined. Purpose To investigate the prognostic value of RV/PA uncoupling and its association with echocardiographic parameters in AS patients undergoing TAVI. Methods We conducted a systematic search through Pubmed and Embase to include studies up to February 2024. Studies were eligible if they evaluated the prognostic performance of RV/PA uncoupling in AS patients undergoing TAVI. Random-effects model were employed to pool the adjusted Hazard Ratio (aHR) with inverse-variance weighting method or Relative Risk (RR) with 95% Confidence Interval (95% CI) using Mantel-Haenszel test for categorical outcomes or Weighted Mean Difference (WMD) for numerical outcomes. Risk of bias assessment was conducted using the Newcastle Ottawa Scale (NOS). Results Thirteen studies were included. Out of 4,146 patients, 55.21% were reported to have RV-PA uncoupling prior to TAVI. RV/PA uncoupling was customarily assessed with TAPSE/PASP ratio, with threshold for uncoupling ranging between <0.31–<0.63 mm/mmHg. Follow-up period ranged between 6–65 months. Patients with baseline RV/PA uncoupling had lower LVEF (WMD -9.94% [-4.36– -15.53%]; I2 = 78%), lower TAPSE (WMD -4.98 mm [95% CI -1.15– -8.80]; I2 = 95%), and higher PASP (WMD 19.77 [95% CI 17.02–22.51]; I2 = 0%) compared to patients with RV/PA coupling at baseline. Baseline RV-PA uncoupling was an independent predictor of all-cause mortality (pooled aHR = 2.26 (95% CI 1.36–3.76); I2 = 77%) and composite endpoint of mortality and adverse cardiac or cerebrovascular events (pooled aHR = 2.07 (1.30–3.29); I2 = 24%). However, RV/PA uncoupling was not significantly associated with a higher risk of permanent pacemaker implantation after TAVI (pooled Risk Ratio 1.02 [0.70–1.47]; I2 = 0%). Conclusion Pre-procedural RV/PA uncoupling emerges as an independent predictor of worse prognosis in AS patients undergoing TAVI, contributing to a better understanding of the impact of this parameter on patient outcomes.

Childhood socioeconomic status and depression in adulthood: systematic review

Abstract Background Low socioeconomic status (SES) is generally associated with poorer mental health, particularly depression. We carried out a systematic review to address the question of whether childhood SES is associated with depression in adulthood and the potential pathways which may explain this association. Methods We followed a systematic search strategy in PubMed and Scopus with specific inclusion and exclusion criteria. After removing duplicates, studies were screened for eligibility and quality was assessed independently by two assessors using the Newcastle-Ottawa scale. Results After the selection process, 20 observational studies (7 cohort and 13 cross-sectional) that examine the association between SES during childhood and depression in adulthood were included in the systematic review. The most common measures of childhood SES were parental education, occupation or family income, estimated subjectively and/or objectively. In 17 of the studies an inverse relationship between childhood SES and depression was shown. In 17 studies, models were employed to demonstrate the possible pathways which explain the relationship between childhood SES and depressive symptoms. The most important mediators were adult SES, psychosocial factors, childhood trauma and physical health. Conclusions Our findings reveal the long-term association between childhood socioeconomic conditions and depression later in life. Suboptimal childhood SES seems to be an important risk factor for depression in adulthood. Improving childhood socioeconomic conditions can potentially have lasting effects well beyond childhood. Key messages • Protecting children against the effects of socioeconomic adversity could reduce depression in adult life. • Policy makers should direct resources towards alleviating childhood disadvantage for promoting health in adulthood.

Unique regional risk profiles and cardiovascular outcomes of patients with acute coronary syndrome in the absence of standard modifiable risk factors: a systematic review and meta-analysis

Abstract Background With differences in prevalence, risk profile, cardiovascular complications, and mortality of patients with acute coronary syndrome (ACS) in the absence of standard modifiable risk factors (SMuRF-less) worldwide, this study examines the regional differences and the unique risk profiles of this often-understudied group of patients. Purpose We hypothesize that differences in non-traditional risk factor profiles may lead to unique ACS-related presentations, complication rates, and secondary preventative strategies across regions. Hence this study was undertaken to assess the cross-regional comparisons of patient characteristics, risk profile, angiographic characteristics that may provide insights into disparate cardiovascular outcomes observed in the SMuRF-less ACS population. Methods Medline and Embase databases were searched in November 2022 to identify relevant literature relating to the prevalence of risk factors in SMuRF-less patients with ACS. A single-arm meta-analysis of proportion and means was conducted on baseline and presentation characteristics, outcomes and complications, management, and risk factors in SMuRF-less ACS patients, stratified according to geographical region (Asia-Pacific, Europe, and North America). Risk of bias was assessed using the Newcastle-Ottawa scale. Results A total of 25 studies comprising of 1,393,184 individuals with ACS were included, of which 242,929 patients were SMuRF-less. Within this SMuRF-less ACS group, mortality rates were similar across the regions (Asia-Pacific:15.8%, Europe:17.5%, p=0.861), cardiac arrest (6.3%, 95%CI:2.3% to 16.3%, p=0.001) and major bleeding (5.2%, 95%CI:2.9% to 9.2%, p=0.001) were more prevalent in Asia-Pacific, and heart failure more common in Europe (21.7%, 95%CI:18.2% to 25.7%, p<0.001). Prevalence of chronic obstructive lung disease (21.4%, 95%CI:21.2% to 21.6%, p<0.001) and peripheral artery disease (3.8%, 95%CI:3.1% to 4.7%, p=0.001) were highest in SMuRF-less ACS patients from North America, chronic liver disease most prevalent in those from Asia-Pacific (3.5%, 95%CI:2.2% to 5.6%, p<0.001) and family history of coronary artery disease highest in SMuRF-less ACS patients from Europe (25.2%, 95%CI:24.8% to 25.7%, p=0.024). Significantly lower rates of guideline-directed medical therapy prescriptions were observed for SMuRF-less ACS patients in Asia-Pacific compared to other regions. Conclusion This regional analysis highlights the different risk profiles, cardiovascular outcomes, and specific needs of individuals presenting with ACS in the absence of cardiovascular risk factors, across Asia-Pacific, Europe, and North America. Whilst unravelling novel pathomechanistic pathways of atherosclerosis will prove beneficial on a global scale, understanding the unique regional profile of these individuals will aid policymakers strategize effective and tailored clinical pathways in the management of SMuRF-less ACS.Graphical AbstractKey Outcomes

Covid-19 pandemic and student academic performance: a systematic review and meta-analysis

Abstract Background The COVID-19 pandemic led to widespread disruptions in educational systems globally, forcing a transition to remote learning modalities. This systemic change raised concerns about its potential impact on the academic performance of students in developmental ages. This systematic review and meta-analysis aimed to evaluate the association between the COVID-19 pandemic and academic performance among developmental-age students, quantifying the effect size using Cohen’s d. Methods We searched PubMed/MEDLINE, Scopus, and Embase for studies published up to December 2023 that assessed the impact of the COVID-19 pandemic on academic performance. The review was performed following the PRISMA 2020 guidelines. The quality of the included studies was evaluated using the Newcastle-Ottawa Scale. The pooled effect size was calculated using Cohen’s d, with its 95% confidence interval. The protocol has been registered in PROSPERO. Results Out of 3671 retrieved articles, 30 studies met the inclusion criteria, and 13 were suitable for meta-analysis, involving a combined total of 4,893,499 students. The Cohen’s d was -0.07 (95% CI = -0.10 to -0.03; p < 0.001), indicating a small but statistically significant decline in academic performance associated with the pandemic. Subgroup analyses revealed that mathematics suffered the most significant impact, with a Cohen’s d of -0.14 (95% CI = -0.18 to -0.10; p < 0.001). All the included studies were judged as moderate-high quality. Conclusions The COVID-19 pandemic has had a negative effect on the academic performance of students of developmental ages, particularly in mathematics. These findings highlight the need for targeted interventions to mitigate the educational setbacks caused by the pandemic, especially in core subjects where the decline in performance was most pronounced. Key messages • The COVID-19 pandemic has significantly disrupted educational systems worldwide, resulting in a small but statistically significant decline in academic performance among students of developmental ages. • The shift in educational delivery during the pandemic particularly affected learning outcomes in mathematics more than in other subjects.

Risk Factors for Unplanned Readmissions in Paediatric Neurosurgery: A Systematic Review

Abstract Background Unplanned hospital readmission (UHR) after paediatric neurosurgery is an important indicator of surgical outcomes. As this field deals with complex cases, there is an increased likelihood of potential complications and the subsequent need for readmission. Hence, the study aims to identify factors contributing to 30-day and 90-day UHR rates in children undergoing neurosurgical procedures. Methods A systematic review (Prospero CRD 42023455779) was conducted, which included studies from Embase, Medline, CINAHL, and Global Index Medicus databases that reported unplanned readmissions within 30-/90-days of an index neurosurgical procedure. Quality and risk of bias assessment was done using the Newcastle-Ottawa scale. Data extraction and narrative synthesis were performed to identify significant factors associated with UHR. Results 2593 titles were identified following the search strategy. 52 studies were included after screening and quality appraisal. Most studies were from the United States and are retrospective cohort in nature. Majority were cranial procedures (n = 30), with common ones being shunt procedures for hydrocephalus and cranial tumour resections. Aetiology-related, procedural complexities, and age emerged as the three most common significant risk factors. Age is a significant predictor (9/52), with younger children facing higher odds compared to their older counterparts across different procedures. While early readmissions can be due to disease progression, some are linked to preventable causes. The included studies also exhibited significant heterogeneity. Variations in definitions and examined variables, as well as the inclusion of studies from both national databases and single institutions, contributed to this heterogeneity. Conclusions Overall, findings from this study contribute to a collective understanding of factors affecting unplanned readmissions in paediatric neurosurgery. Key messages • Identified risk factors can help guide creating and refining surgical protocols for post-operative monitoring and follow-up. • UHRs reflect the interplay among surgical complexity, patient characteristics such as age, and disease aetiology.

Prevalence of depression, anxiety and post-traumatic stress disorder (PTSD) after acute myocardial infarction: a systematic review and meta-analysis

Abstract Background There is increasing recognition that patients experience a greater risk of mental illnesses after an acute myocardial infarction (AMI), with the former being linked to worse post-AMI outcomes. However, the prevalence of these conditions is largely unknown as most studies focus on depression and few on other illnesses such as anxiety and post-traumatic stress disorder (PTSD). Additionally, existing studies mostly involved diagnoses of mental illnesses through patient-reported questionnaires which may carry subjectivity (1). Therefore, we conducted a systematic review and meta-analysis to estimate the prevalence and risk factors of developing depression, anxiety and PTSD after an AMI with the inclusion of only studies with official diagnoses of the mental illnesses. Methods Searches in MEDLINE, EMBASE, and PsycINFO up to January 23, 2023, identified 25 qualifying studies that examined the risk of depression, anxiety and PTSD after AMI, with case definitions based strictly on psychiatrist-administered structured interviews according to the Diagnostic and Statistical Manual for Mental Disorders (DSM) criteria. Meta-analyses of proportions using random-effects models estimated the pooled prevalence of each outcome at the <3-month and >3-month time-points. Heterogeneity was tested using I-squared statistics, if significant heterogeneity was found, subgroup analyses and meta-regression analyses were performed to identify the source of heterogeneity. Study quality was assessed using the Newcastle-Ottawa Scale (NOS) and Risk of Bias 2 (RoB2) Tool, and publication bias using the funnel plot and verified by the Egger’s and Begg’s tests. Results A total of 25 studies were included in the meta-analysis. The pooled prevalence of depression post-AMI (20 studies) was 16.70% (95% CI: 12.40%; 22.11%), with pooled prevalence <3-month and >3-month post-AMI at 19.46% (95% CI: 15.47%; 24.19%) and 14.87% (95% CI: 9.55%; 22.43%) respectively. Pooled prevalence of anxiety (7 studies) and PTSD (3 studies) were 11.96% (95% CI: 6.15; 21.96%) and 10.26% (95% CI:5.49;18.36%) respectively. Subgroup analysis showed that the pooled prevalence of both depression and anxiety are significantly higher in the female gender, in those with hypertension, diabetes or hyperlipidemia, and in smokers, while the pooled prevalence of depression is higher in unmarried than married individuals and in patients with a history of depression. Meta regression indicates that history of depression is a significant predictor of prevalence of depression (p= 0.0035, regression coefficient 1.54). Conclusion The prevalence of mental illnesses is high after AMI. Risk factors identified included female gender, hypertension, diabetes, hyperlipidemia, smoking, depression history, as well as one’s social set-up. These findings highlight the importance of screening at-risk patients and early intervention to improve long-term outcomes after AMI.Forest plot of depression prevalenceSubgroup analysis for depression

Equity of continuous glucose monitoring in young people with type 1 diabetes: a systematic review

Abstract Background Socioeconomic (SES) and ethnic inequalities in type 1 diabetes (T1D) outcomes are widespread. There is concern that unequal access to technologies, such as continuous glucose monitoring (CGM), may increase disparities. This systematic review summarises the evidence for inequalities in access to CGM for children and young people (CYP) and outcomes for CGM users. Methods MEDLINE, Embase, and Web of Science were searched for observational studies published between January 2020 and July 2023 which report CGM use stratified by any PROGRESS-plus criteria for T1D patients under 26. Reports based in low- or middle-income countries or ≤ 500 participants were excluded. Primary outcomes were the proportion of patients using CGM and HbA1c of CGM users. Quality assessment was performed using the Newcastle-Ottawa Scale. Unadjusted odds ratios were calculated from extracted data, though heterogeneity precluded meta-analysis. The protocol was pre-registered with PROSPERO (CRD42023438139). Results Of the 3,369 unique studies identified, 27 met inclusion criteria. We found decreased CGM use and higher discontinuation for low SES, low education, publicly insured, and minority ethnic, especially black, CYP. These associations were generally robust to adjustment for other sociodemographic variables, suggesting an independent effect. Lower SES inequalities were seen in countries where CGM is reimbursed. Although low SES and minority ethnicity were generally associated with poorer outcomes, there was no significant association between domains of disadvantage and higher HbA1c for CGM users, excepting parental education. Conclusions There are significant SES, ethnic, and education inequalities in CGM use for CYP with T1D, particularly when reimbursement is limited. This is contributing to outcome inequalities. However, evidence suggests CYP benefit equally from CGM use, irrespective of ethnicity and SES. Increasing CGM funding and use is likely to reduce outcome inequalities. Key messages • There are significant SES, ethnic, and education inequalities in continuous glucose monitoring use for young people with T1D. Inequalities are more marked when technology is not reimbursed. • Increasing access to CGM may reduce outcome inequalities, as evidence suggests that young people benefit equally from CGM use, regardless of ethnicity or SES.

Effectiveness of Implant Therapy in Patients With and Without a History of Periodontitis: A Systematic Review With Meta-Analysis of Prospective Cohort Studies.

This systematic review investigates the effectiveness of implant therapy in patients with and without a history of periodontitis in terms of implant loss, peri-implant marginal bone loss (MBL), and occurrence of peri-implant diseases. The protocol of the present meta-analysis was registered on PROSPERO (CRD42021264980). An electronic search was conducted up to April 2024. All prospective cohort studies reporting implant loss, MBL, and occurrence of peri-implant diseases in both patients with a history of periodontitis (HP) and patients with no history of periodontitis (NHP) after at least 36-month follow-up were included. The risk of bias was evaluated using the Newcastle-Ottawa Scale and the quality of the evidence was also assessed. A meta-analysis was performed on the selected outcomes at the available follow-up time points. Subgroup analyses were conducted based on follow-up time, rate of progression and severity of periodontitis, and implant surface characteristics. Publication bias was evaluated using the Funnel plot and Egger's test. From 13 761 initial records, 14 studies (17 articles) were finally included. Eight studies had a low risk of bias level, and six had a medium risk of bias level. Meta-analysis showed that HP patients had a significantly greater risk for implant loss (HR: 1.75; 95% CI: 1.28-2.40; p = 0.0005; I2 = 0%), MBL (MD: 0.41 mm; 95% CI 0.19, 0.63; p = 0.0002; I2 = 54%), and peri-implantitis (3.24; 95% CI: 1.58-6.64; p = 0.001; I2 = 57%) compared to NHP, whereas no significant intergroup difference for peri-implant mucositis was found. Subgroup analyses revealed a particularly greater risk for implant loss for HP patients over a ≥ 10-year follow-up (HR: 2.02; 95% CI: 1.06-3.85; p = 0.03; I2 = 0%) and for patients with a history of grade C (formerly aggressive) periodontitis (HR: 6.16; 95% CI: 2.53-15.01; p < 0.0001; I2 = 0%). A greater risk for implant loss for stages III-IV (severe) periodontitis, and implants with rough surfaces was also found. Within the limits of heterogeneous case definitions and methods of assessment, a history of periodontitis has been proved to significantly increase the risk for implant loss, particularly at long follow-up (≥ 10 years) and in case of rapidly progressive forms (grade C), and for MBL and peri-implantitis.

Are Maternal Dietary Patterns During Pregnancy Associated with the Risk of Gestational Diabetes Mellitus? A Systematic Review of Observational Studies

Background/Objectives: Maternal nutritional status is a “key” contributor to Gestational Diabetes Mellitus (GDM). However, the role of maternal dietary patterns (DPs) during pregnancy remains poorly understood. Thus, we conducted a systematic review to assess associations between “a posteriori-derived” DPs and GDM. Methods: A systematic search was conducted in PubMed, ScienceDirect, Web of Science, and Scopus for cohort, cross-sectional, and case–control studies published until June 2024. A total of twenty-eight studies involving 39,735 pregnant women were included, and their quality was evaluated by the Newcastle–Ottawa Scale. The 91 identified DPs were classified into four categories: “Westernized”, “Nutritious”, “Plant-based”, and “Miscellaneous”. Results: Our findings do not reveal definitive associations between maternal DPs during pregnancy and GDM risk. Notably, “Westernized” DPs tended to be associated with an increased risk. However, a very small portion of patterns within this category exhibited protective associations. Conversely, “Nutritious” and “Plant-based” appear beneficial for GDM prevention in specific populations. The “Miscellaneous” category presented an almost equal distribution of DPs with both detrimental and protective associations, pinpointing the absence of a clear directional trend regarding GDM risk. Conclusions: The heterogeneity in findings can be attributed to geographic and sociocultural variations and methodological differences across studies. Thus, there is a need for more standardized research methodologies to provide more precise insights that will ultimately help develop effective and tailored dietary guidelines for GDM prevention.

Knowledge, Attitudes, and Practices of Pregnant Women and Hospital Staff Regarding Umbilical Cord Blood Banking: Systematic Review and Meta-Analysis

Background/Objectives: The aim of this study is to assess the knowledge, attitudes, and practices of pregnant women and hospital staff regarding umbilical cord blood (UCB) donation and storage to understand its limitations in clinical practice. Methods: MEDLINE, Scopus, LILACS, EMBASE, Scielo.br, and PROSPERO were searched from inception to 30 November 2023 with no geographic or language restrictions. The study eligibility criteria included cross-sectional studies that interviewed pregnant women and/or hospital staff about their knowledge, attitudes, and practices regarding private or public storage. A random-effects restricted maximum-likelihood model with Freeman–Tukey Double arcsine transformation meta-analysis was carried out to calculate the pooled estimates. MOOSE guidelines were followed. STATA 14.1 was used for statistical analysis. The Newcastle–Ottawa Scale and ROBINS-I tool were used for quality and risk of bias assessments. Results: In total, 19 studies providing data for 19,904 pregnant women and 1245 hospital staff members were included. Pooled pregnant women awareness was 61% ((95% CI 0.60 to 0.62), I2 = 0%, τ2 = 0.00, Q = 11.0 (p = 0.950)), and 61% for hospital staff (95% CI 0.58 to 0.64), I2 = 0%, τ2 = 0.00, Q = 4.00 (p = 0.310)). In total, 57% ((95% CI 0.56 to 0.58), I2 = 0, τ2 = 0.00, Q = 4.00 (p = 0.320)) of pregnant women had a positive attitude about UCB, while 34% ((95% CI 0.32 to 0.36), I2 = 0%, τ2 = 0.00, Q = 4.00 (p = 0.310)) were in favor of donating UCB for research and 65% ((95% CI 0.63 to 0.66), I2 = 0%, τ2 = 0.00, Q = 4.0 (p = 0.350)) were planning UCB storage. A significant (p &lt; 0.001) preference for public relative to private banking (51% ([95% CI 0.49 to 0.54], I2 = 0%, τ2 = 0.00, Q = 4.0 (p = 0.310)) vs. 12% ([95% CI 0.10 to 0.13], I2 = 0%, τ2 = 0.00, Q = 4.0 (p = 0.300))) was noted for pregnant women. The same was retrievable for professionals (84% ([95% CI 0.79 to 0.88], I2 = 0%, τ2 = 0.00, Q = 2.0 (p = 0.110)) vs. 6% ([95% CI 0.03 to 0.09], I2 = 0%, τ2 = 0.00, Q = 1.0 (p = 0.070); p &lt; 0.001)). Conclusions: Despite these efforts, lack of knowledge and positive attitudes about UCB banking remain, emphasizing the need for increasing educational programs on the subject.