Original Study Research Articles

Contributions of Health Literacy for Patient Safety in Primary Care: A Scoping Review

Introduction: This study provides unprecedented scientific evidence for the expansion of health literacy as a tool capable of increasing patient safety through effective communication between health care professionals and their patients, especially in primary health care. Objective: To map the evidence available regarding the impact of health literacy on care safety for adult patients in primary health care. Materials and methods: This is a scoping review in line with the Joanna Briggs Institute method, which covers care, techniques, protocols, or health literacy methods used to improve primary health care. The Medline (PubMed), Web of Science, Scientific Electronic Library Online (SciELO), Virtual Health Library, Scopus, Cinahl, and Google Scholar databases were used for the gray literature search. Original studies available in full and published until January 2023, in all languages covering the topic, were included. Two reviewers screened them by title and abstract, and three reviewers read the full texts and extracted data from the selected articles presented in flowcharts, tables, and descriptive narratives. Results: A total of 3749 studies were found, of which 23 were selected. From these, the following categories emerged: ‘The impact of health literacy on the engagement and health outcomes of primary health care users;’ ‘Interventions that contribute to health literacy in primary health care;’ and ‘Evaluation of users’ and professionals’ perspectives on health literacy.’ Conclusions: Health literacy interventions focused on primary care should be encouraged within health care services to promote care, prevent illnesses, and inspire the population’s transformation process, with a direct impact on patient safety.

Associations between humiliation, shame, self-harm and suicidality among adolescents and young adults: A systematic review.

Suicide is the second leading cause of death among young people worldwide. Research indicates that negative social contexts involving familial and peer relationships have far-reaching influences on levels of suicidality in later life. While previous systematic reviews have focused on evaluating associations between negative life events such as abuse and bullying in childhood and subsequent suicidality, this systematic review examines the prevalence of, and association between the processes of humiliation and shame in later self-harm, suicidal ideation, and suicide among adolescents and young adults. A systematic literature search of databases including MEDLINE, Web of Science Core Collection, CINAHL, PsycINFO, and Embase was conducted to identify potential studies. ProQuest was searched to identify relevant grey literature research. A combination of MESH terms and keywords was used. All original quantitative studies published in English that examined the prevalence, or association between humiliation or shame and suicidal behaviours and/or death by suicide were included. Studies were assessed for methodological quality using Joanna Briggs Institute critical appraisal tools. The protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) [CRD42022289843]. Narrative synthesis was performed. A total of 33 studies reporting the prevalence of, or association between humiliation (n = 10) or shame (n = 23) and suicidal thoughts/behaviours were included. The prevalence of humiliation among those with any suicidality ranged from 18% to 28.1%, excluding an outlier (67.1%), with two studies presenting a significant association between humiliation and self-harm in their fully adjusted analyses. The studies that outlined humiliation and suicidal thinking (intent/suicide plan) had no association after adjustment for confounders. For shame, half of the studies found an association in adjusted models (n = 10), and this was evident for both suicidal ideation and self-harm. To our knowledge, this is the first study to attempt a systematic review on this topic. The dearth of research in this field of enquiry is reflective of unique challenges associated with assessments of humiliation and shame in various clinical settings amongst adolescent and young adult populations. Nonetheless, given the importance and relevance of the psychological imprint of humiliation in youth morbidity and mortality in the field of mental health, it is timely to attempt such a systematic review. In light of the associated role of humiliation and shame in self-harm and suicidality among young people, we recommend that these processes need to be explored further via prospective studies and assessed as part of a comprehensive bio-psycho-social assessment when focusing on life stressors for adolescent and young adults presenting with suicidality to emergency departments and mental health services.

The Family Game to support parents with intellectual disability in managing challenging behaviours: A replication.

Although many parents with intellectual disability (ID) demonstrate good parenting practices, some parents experience difficulties in managing challenging behaviours. One potential solution to this issue involves using The Family Game, a program designed to teach parents with ID how to manage challenging behaviours in their child. The purpose of our study was to conduct an independent replication of an investigation that had been performed by the developer of the program. We used a multiple baseline design to examine the effects of The Family Game on the behaviour of two parents with ID who had a 3-year-old child. Similarly to the original study, our results indicate that The Family Game improved the use of effective parenting strategies during role play, but that these gains failed to generalise to real-life settings. The study further supports the necessity of adding novel strategies to the game to better promote generalisation.

The State of Artificial Intelligence in Skin Cancer Publications.

Artificial intelligence (AI) in skin cancer is a promising research field to assist physicians and to provide support to patients remotely. Physicians' awareness to new developments in AI research is important to define the best practices and scope of integrating AI-enabled technologies within a clinical setting. To analyze the characteristics and trends of AI skin cancer publications from dermatology journals. AI skin cancer publications were retrieved in June 2022 from the Web of Science. Publications were screened by title, abstract, and keywords to assess eligibility. Publications were fully reviewed. Publications were divided between nonmelanoma skin cancer (NMSC), melanoma, and skin cancer studies. The primary measured outcome was the number of citations. The secondary measured outcomes were articles' general characteristics and features related to AI. A total of 168 articles were included: 25 on NMSC, 77 on melanoma, and 66 on skin cancer. The most common types of skin cancers were melanoma (134, 79.8%), basal cell carcinoma (61, 36.3%), and squamous cell carcinoma (45, 26.9%). All articles were published between 2000 and 2022, with 49 (29.2%) of them being published in 2021. Original studies that developed or assessed an algorithm predominantly used supervised learning (66, 97.0%) and deep neural networks (42, 67.7%). The most used imaging modalities were standard dermoscopy (76, 45.2%) and clinical images (39, 23.2%). Most publications focused on developing or assessing screening technologies with mainly deep neural network algorithms. This indicates the eminent need for dermatologists to label or annotate images used by novel AI systems.

Reossification of Bone Defects After Surgical Correction of Nonsyndromic Craniosynostosis: A Review and An Original Study.

Surgical correction of nonsyndromic craniosynostosis (NSC) aims to restore cranial shape. Reossification of bone defects is paramount for the best aesthetic prognosis. However, the literature on the quantitative evaluation of bone defects after NSC surgery is scarce. This study aimed to quantify and analyze the surface area of bone defects after NSC surgery and establish a threshold value for predicting persistent defects. We conducted a systematic review and a prospective study of 28 children undergoing surgical treatment for NSC. We analyzed 426 defects on the first computed tomography scan (1 year postoperative) and 132 defects on the second computed tomography scan (4.6 years postoperative). Statistical analysis was performed using Spearman's rank correlation coefficient, Mann-Whitney-Wilcoxon rank-sum test, and Youden's J statistic. Our systematic review identified three studies reporting on bone defects' surface area and reossification rate. In our study, we found no statistically significant differences in the number or size of defects between sex or type of NSC. The threshold value for the surface area of bone defects above which there was a higher probability of persistent defects was 0.19 cm2 (Youden point), with an 89.47 % probability of persistence. Defects with a surface area below 0.19 cm2 had a considerably lower probability, only 15.07%, of persistence over time. Our study provides valuable quantitative data for managing bone defects after NSC surgery. Defects with a surface area above 0.19 cm2 should be monitored with radiological imaging because of the risk of persistence. Our findings highlight the importance of developing robust and reproducible methods for the quantitative analysis of bone defects after NSC surgery.

Validation of genetic risk scores for hypertension in the Central Russian population

Aim. To validate and evaluate the accuracy of 4 genetic risk scores (GRSs) for hypertension (HTN), previously created on European samples, on a population sample of the Ivanovo Oblast.Material and methods. For genetic analysis, targeted next-generation sequencing was used on a sample of the Central Russia (n=1682) based on the biobank collection. Four GRSs associated with HTN, previously developed for the European population, were selected for validation. The coefficient of determination and the area under the ROC curve were used as quality metrics for regression models. Additional validation was carried out to include all nucleotide sequence variants, regardless of linkage disequilibrium level. A combined GRS was compiled based on coefficients from individual GRSs using the clumping + thresholding (C+T) method.Results. The study demonstrated that the predictive value of previously developed GRSs when used for Central Russian population is lower than in the original studies. The proportion of explained variance was 0,5-0,8%. The best predictive ability (proportion of explained variance — 2,5%) was demonstrated using previously developed GRSs (Evangelou E, et al., 2018), which includes the largest number of nucleotide sequence variants (n=852).Conclusion. GRSs for HTN, developed on European samples, is not recommended for Russian population without preliminary validation. To create original GRSs, combining statistical parameters (β-coefficients and p-value) from different GRS is not recommended.

Exploring beyond Common Cell Death Pathways in Oral Cancer: A Systematic Review.

Oral squamous cell carcinoma (OSCC) is the most common and lethal type of head and neck cancer in the world. Variable response and acquisition of resistance to traditional therapies show that it is essential to develop novel strategies that can provide better outcomes for the patient. Understanding of cellular and molecular mechanisms of cell death control has increased rapidly in recent years. Activation of cell death pathways, such as the emerging forms of non-apoptotic programmed cell death, including ferroptosis, pyroptosis, necroptosis, NETosis, parthanatos, mitoptosis and paraptosis, may represent clinically relevant novel therapeutic opportunities. This systematic review summarizes the recently described forms of cell death in OSCC, highlighting their potential for informing diagnosis, prognosis and treatment. Original studies that explored any of the selected cell deaths in OSCC were included. Electronic search, study selection, data collection and risk of bias assessment tools were realized. The literature search was carried out in four databases, and the extracted data from 79 articles were categorized and grouped by type of cell death. Ferroptosis, pyroptosis, and necroptosis represented the main forms of cell death in the selected studies, with links to cancer immunity and inflammatory responses, progression and prognosis of OSCC. Harnessing the potential of these pathways may be useful in patient-specific prognosis and individualized therapy. We provide perspectives on how these different cell death types can be integrated to develop decision tools for diagnosis, prognosis, and treatment of OSCC.

Racial and ethnic disparities in genomic testing among lung cancer patients: a systematic review.

Racial and ethnic disparities in genomic testing could exacerbate disparities in access to precision cancer therapies and survival-particularly in the context of lung cancer, where genomic testing has been recommended for the past decade. However, prior studies assessing disparities in genomic testing have yielded mixed results. We conducted a systemic review to examine racial and ethnic disparities in the use of genomic testing among lung cancer patients in the U.S. Two comprehensive searches in PubMed, Embase, and Scopus were conducted (September 2022, May 2023). Original studies that assessed rates of genomic testing by race or ethnicity were included. Findings were narratively synthesized by outcome. The search yielded 2,739 unique records, resulting in 18 included studies. All but one study was limited to patients diagnosed with non-small cell lung cancer. Diagnosis years ranged from 2007-2022. Eleven of 18 studies found statistically significant differences in the likelihood of genomic testing by race or ethnicity; in seven of these studies, testing was lower among Black patients compared to White or Asian patients. However, many studies lacked adjustment for key covariates and included patients with unclear eligibility for testing. A majority of studies, though not all, observed racial and ethnic disparities in the use of genomic testing among patients with lung cancer. Heterogeneity of study results throughout a period of changing clinical guidelines suggests that minoritized populations-Black patients in particular-have faced additional barriers to genomic testing, even if not universally observed at all institutions.

Current Updates on Involvement of Artificial Intelligence and Machine Learning in Semen Analysis.

Background and Objectives: Infertility rates and the number of couples undergoing reproductive care have both increased substantially during the last few decades. Semen analysis is a crucial step in both the diagnosis and the treatment of male infertility. The accuracy of semen analysis results remains quite poor despite years of practice and advancements. Artificial intelligence (AI) algorithms, which can analyze and synthesize large amounts of data, can address the unique challenges involved in semen analysis due to the high objectivity of current methodologies. This review addresses recent AI advancements in semen analysis. Materials and Methods: A systematic literature search was performed in the PubMed database. Non-English articles and studies not related to humans were excluded. We extracted data related to AI algorithms or models used to evaluate semen parameters from the original studies, excluding abstracts, case reports, and meeting reports. Results: Of the 306 articles identified, 225 articles were rejected in the preliminary screening. The evaluation of the full texts of the remaining 81 publications resulted in the exclusion of another 48 articles, with a final inclusion of 33 original articles in this review. Conclusions: AI and machine learning are becoming increasingly popular in biomedical applications. The examination and selection of sperm by andrologists and embryologists may benefit greatly from using these algorithms. Furthermore, when bigger and more reliable datasets become accessible for training, these algorithms may improve over time.

CONSTRUCTION OF AN ALGORITHM OF CONDUCT OF SIGNS AND SYMPTOMS IN MALIGNANT NEOPLASTIC WOUNDS IN ADULTS

Objective: To build an algorithm of conducts to control signs and symptoms of malignant neoplastic wounds in adults. Method: Methodological research, of an exploratory nature, for the construction-production of a clinical algorithm based on the scoping review. Results: A total of 107 studies was found in the databases, nine of which were included in this review. Four studies are randomized experimental studies, four are case studies and one is retrospective documentary observational study. Odor was the most addressed sign, followed by exudate, bleeding, infection, moisture-associated dermatitis, and pain. Conclusion: Gaps were observed, such as the need for more original and experimental studies, in addition to the lack of a specific descriptor for malignant neoplastic wound. However, it was possible to build an algorithm that offers conducts that are based on the literature for greater theoretical support and nursing safety in relation to cancer patients.

What are the learning objectives in surgical training – a systematic literature review of the surgical competence framework

ObjectiveTo map the landscape of contemporary surgical education through a competence framework by conducting a systematic literature review on learning outcomes of surgical education and the instructional methods applied to attain the outcomes.BackgroundSurgical education has seen a paradigm shift towards competence-based training. However, a gap remains in the literature regarding the specific components of competency taught and the instructional methods employed to achieve these outcomes. This paper aims to bridge this gap by conducting a systematic review on the learning outcomes of surgical education within a competence framework and the instructional methods applied. The primary outcome measure was to elucidate the components of competency emphasized by modern surgical curricula. The secondary outcome measure was to discern the instructional methods proven effective in achieving these competencies.MethodsA search was conducted across PubMed, Medline, ProQuest Eric, and Cochrane databases, adhering to PRISMA guidelines, limited to 2017–2021. Keywords included terms related to surgical education and training. Inclusion criteria mandated original empirical studies that described learning outcomes and methods, and targeted both medical students and surgical residents.ResultsOut of 42 studies involving 2097 participants, most concentrated on technical skills within competency-based training, with a lesser emphasis on non-technical competencies. The effect on clinical outcomes was infrequently explored.ConclusionThe shift towards competency in surgical training is evident. However, further studies on its ramifications on clinical outcomes are needed. The transition from technical to clinical competence and the creation of validated assessments are crucial for establishing a foundation for lifelong surgical learning.

Integrating Artificial Intelligence and PET Imaging for Drug Discovery: A Paradigm Shift in Immunotherapy.

The integration of artificial intelligence (AI) and positron emission tomography (PET) imaging has the potential to become a powerful tool in drug discovery. This review aims to provide an overview of the current state of research and highlight the potential for this alliance to advance pharmaceutical innovation by accelerating the development and deployment of novel therapeutics. We previously performed a scoping review of three databases (Embase, MEDLINE, and CENTRAL), identifying 87 studies published between 2018 and 2022 relevant to medical imaging (e.g., CT, PET, MRI), immunotherapy, artificial intelligence, and radiomics. Herein, we reexamine the previously identified studies, performing a subgroup analysis on articles specifically utilizing AI and PET imaging for drug discovery purposes in immunotherapy-treated oncology patients. Of the 87 original studies identified, 15 met our updated search criteria. In these studies, radiomics features were primarily extracted from PET/CT images in combination (n = 9, 60.0%) rather than PET imaging alone (n = 6, 40.0%), and patient cohorts were mostly recruited retrospectively and from single institutions (n = 10, 66.7%). AI models were used primarily for prognostication (n = 6, 40.0%) or for assisting in tumor phenotyping (n = 4, 26.7%). About half of the studies stress-tested their models using validation sets (n = 4, 26.7%) or both validation sets and test sets (n = 4, 26.7%), while the remaining six studies (40.0%) either performed no validation at all or used less stringent methods such as cross-validation on the training set. Overall, the integration of AI and PET imaging represents a paradigm shift in drug discovery, offering new avenues for more efficient development of therapeutics. By leveraging AI algorithms and PET imaging analysis, researchers could gain deeper insights into disease mechanisms, identify new drug targets, or optimize treatment regimens. However, further research is needed to validate these findings and address challenges such as data standardization and algorithm robustness.

The global prevalence of depression, anxiety, and sleep disorder among patients coping with Post COVID-19 syndrome (long COVID): a systematic review and meta-analysis

BackgroundPost COVID-19 syndrome, also known as "Long COVID," is a complex and multifaceted condition that affects individuals who have recovered from SARS-CoV-2 infection. This systematic review and meta-analysis aim to comprehensively assess the global prevalence of depression, anxiety, and sleep disorder in individuals coping with Post COVID-19 syndrome.MethodsA rigorous search of electronic databases was conducted to identify original studies until 24 January 2023. The inclusion criteria comprised studies employing previously validated assessment tools for depression, anxiety, and sleep disorders, reporting prevalence rates, and encompassing patients of all age groups and geographical regions for subgroup analysis Random effects model was utilized for the meta-analysis. Meta-regression analysis was done.ResultsThe pooled prevalence of depression and anxiety among patients coping with Post COVID-19 syndrome was estimated to be 23% (95% CI: 20%—26%; I2 = 99.9%) based on data from 143 studies with 7,782,124 participants and 132 studies with 9,320,687 participants, respectively. The pooled prevalence of sleep disorder among these patients, derived from 27 studies with 15,362 participants, was estimated to be 45% (95% CI: 37%—53%; I2 = 98.7%). Subgroup analyses based on geographical regions and assessment scales revealed significant variations in prevalence rates. Meta-regression analysis showed significant correlations between the prevalence and total sample size of studies, the age of participants, and the percentage of male participants. Publication bias was assessed using Doi plot visualization and the Peters test, revealing a potential source of publication bias for depression (p = 0.0085) and sleep disorder (p = 0.02). However, no evidence of publication bias was found for anxiety (p = 0.11).ConclusionThis systematic review and meta-analysis demonstrate a considerable burden of mental health issues, including depression, anxiety, and sleep disorders, among individuals recovering from COVID-19. The findings emphasize the need for comprehensive mental health support and tailored interventions for patients experiencing persistent symptoms after COVID-19 recovery.

Are Cognitive Symptoms Part of the Phenotypic Spectrum of Idiopathic Adult-Onset Dystonia? Summary of Evidence from Controlled Studies.

Cognitive dysfunction has been reported in idiopathic adult-onset dystonia (IAOD), but whether this is a primary or secondary component of the disorder remains uncertain. Here, we aimed to analyze the key domains of abnormal cognitive performance in IAOD and whether this is associated with motor or mood changes. Article selection for our critical review was guided by PRISMA guidelines (mesh terms "dystonia" and "cognitive," publication period: 2000-2022). Only peer-reviewed, English-language original case-control studies involving patients with IAOD who were not exposed to dopamine- or acetylcholine-modulating agents and validated cognitive assessments were included. Abstract screening ultimately yielded 22 articles for full-text review and data extraction. A greater proportion of studies (17 of 22, 82%) reported abnormal cognitive performance in IAOD. Most of these studies focused on blepharospasm (BSP) and cervical dystonia (10 and 14, respectively). Most studies reporting cognitive impairment (11 of 17) identified multidomain impairment in cognition. Executive functions were the domain most frequently explored (14 of 22 studies), 79% of which detected worse performance in people with dystonia. Results related to other domains were inconclusive. Cognitive abnormalities were independent of motor symptoms in most studies (7 of 12) that explored this relationship and independent of mood status in all 8 that investigated this. Within IAOD, cognitive dysfunction (in particular, executive dysfunction) has been documented mainly in BSP and cervical dystonia. More comprehensive testing is warranted to assess abnormalities in other domains and in other forms of IAOD, as well as to evaluate longitudinal progression of cognitive disturbances in this condition.

Maslach Burnout Inventory – General Survey

Abstract: This study sought to investigate the measurement properties of a “gold standard” instrument for measuring burnout, the Maslach Burnout Inventory – General Survey (MBI-GS), with a systematic literature review and meta-analysis of studies that had as the primary aim its psychometric validation. The search spanned from January 1996 to December 2022 using the following databases: Web of Science, Scopus, PubMed, APA PsychINFO, ScienceDirect, and ProQuest Dissertations and Theses Global. Our search identified 35 eligible studies for inclusion in the systematic review. Of these, 17 were included in the meta-analysis. The meta-analysis of the original 16-item version studies supported a three-dimensional representation of burnout with modest internal consistencies. However, similar to the narrative findings, it also indicated the viability of a two-factor solution. Consequently, the structural validity of the MBI-GS remains unclear, and so does its cross-cultural validity. The criterion validity of the cynicism and personal efficacy scales also raised a few questions. Overall, the findings provided some support for the adequacy of the measurement properties of the MBI-GS as a research tool measuring exhaustion, cynicism, and professional efficacy. However, we also identified challenges and practices of which researchers should be cognisant and that they should consider in future burnout projects.

Use of Surface Electromyography to Evaluate Effects of Therapeutic Methods on Masticatory Muscle Activity in Patients with Temporomandibular Disorders: A Narrative Review

The presented narrative review aims to present the impact of therapeutic methods on the masticatory muscle activity measured using surface electromyography (sEMG) in patients with temporomandibular disorders (TMDs). Original interventional studies with baseline data for diagnosed TMD groups with full-text articles in English published in scientific journals in the last ten years were included in the evaluation process. The following narrative review considered only clinical, controlled, and randomized studies. Articles that included the following parameters were qualified for this review: adult participants, diagnosis of temporomandibular disorder, the presence of a musculoskeletal dysfunction, no other severe comorbidities, use of therapeutic interventions, and sEMG measurement before and after the intervention. Ten papers were accepted and analyzed for the final evaluation in the presented review. Several studies using surface electromyographic examination prove the effectiveness of various therapies to normalize the bioelectrical activity of the masticatory muscles, either reduction during rest or increase during a functional task in patients diagnosed with temporomandibular disorders. This narrative review shows the influence of manual and physical treatments on electromyographic masticatory muscle activity, including soft tissue mobilization, transcutaneous electrical nerve stimulation, low-level laser therapy, and moist heat therapy. Changes in masticatory muscle activity coincided with changes in TMD-associated pain and range of mandibular mobility.

Comparison and positioning of NGOs aimed at children from the perspective of social marketing on Twitter

The role of Non-Governmental Organizations (NGOs) in disseminating and protecting children’s rights is fundamental by increasing society’s knowledge about the reality that children face, thus mobilizing citizen attention. In this paper, we present an original study on social media data, specifically Twitter, to analyze childhood NGOs, evaluating the success of their content (through the likes obtained by publications) from the perspective of social marketing and prospective theory. In addition, it examines the positioning of organizations concerning the types of messages identified. The methodological approach is based on data mining, content analysis, and simple correspondence analysis through which the typology of the messages and positioning map are determined. The results suggest that these organizations generate predictable communication by publishing on specific topics and only increasing the number of tweets in emergencies when they are requiring urgent help. Some tweets show an immediate risk to which children are exposed if they do not receive help, which aligns with one of the premises of the Prospect Theory. Furthermore, a more significant number of posts does not necessarily imply a greater number of likes. Three types of messages have been determined: informative tweets that point out risks (type 1), impartial dialogue tweets (type 2), and action tweets that highlight benefits (type 3), confirmed through the Kruskal-Wallis test to have a relationship with impact. The positioning map shows that type 3 messages, which World Vision Spain opts for, are the most popular, followed by type 1, which Educo leans towards. Finally, there are those of type 2, with which UNICEF Spain is associated. The main implication is that our analysis validates the use of social media such as Twitter to analyze NGOs and proposes these social media platforms to be an important tool in mobilizing the community. In addition, this study offers parameters when constructing the messages for use in social marketing campaigns according to decisions that involve risk or certainty.

What are the barriers and facilitators to participation of people with Down syndrome? A scoping review.

To determine the barriers and facilitators of active community participation of children, adolescents, and adults with Down syndrome. Searches were completed in five electronic databases to identify original studies about participation of children, adolescents (ages < 18 years), and adults (ages 18-59 years) with Down syndrome. Barriers and facilitators to participation were categorized into four factors: personal, social, environmental, and policy and programme. Findings were analysed and validated by a young adult with Down syndrome and a family member, using the public and patient involvement strategy. Fourteen studies were included: eight with children and adolescents and six with adults. Of the 14 studies, 10 were qualitative and four quantitative. Most studies (n = 9) investigated participation in physical activities, while only a few examined participation in community/social activities (n = 3), daily activities (n = 2), and leisure activities (n = 1). The most commonly cited barriers and facilitators were the availability of programmes and specialized professionals, transportation, as well as attitudes and behaviours. Physical and psychological characteristics of people with Down syndrome and facilities were also frequently mentioned as barriers. On the other hand, the desire to stay active and personal interest in the activity were among the most frequently reported facilitators. The participation of people with Down syndrome is mainly influenced by physical or psychological factors, the support and attitudes of parents/caregivers, and the availability of specialized programmes. Given the scarcity of research investigating the participation of people with Down syndrome in community activities, daily activities, and leisure, especially in adults, more studies are still needed.

Efficacy, safety, and feasibility of the treatment of intrauterine pathologies with the mini-resectoscope: A systematic review.

Hysteroscopy represents the gold standard for the diagnosis and treatment of intrauterine pathologies. The advent of the mini-resectoscope heralded a new era in intrauterine surgery, both in inpatient and outpatient settings. To evaluate the effectiveness, safety, and feasibility of the mini-resectoscope for the treatment of intrauterine pathologies. Electronic databases were searched for English-language trials describing surgical procedures for uterine pathologies performed with a mini-resectoscope until 30 April 2023. Retrospective or prospective original studies reporting the treatment of uterine pathologies with mini-resectoscope were deemed eligible for the inclusion. Data about study features, characteristics of included populations, surgical procedures, complications, and results/outcomes were collected. Seven papers that met the inclusion criteria were included in this systematic review. Quantitative analysis was not possible due to data heterogeneity. A descriptive synthesis of the results was provided accordingly to the pathology hysteroscopically removed/corrected: polyps and myomas, uterine septum, intrauterine synechiae, and isthmocele. The mini-resectoscope is poised to play a leading role in hysteroscopic surgery for many pathologies, both in inpatient and outpatient settings. Since some applications of the mini-resectoscope have not yet been thoroughly investigated, future studies should address current knowledge gaps, designing high-quality comparative trials on specific applications.

USE OF ATHEROGENIC INDICES AS ASSESSMENT METHODS FOR CLINICAL ATHEROSCLEROTIC DISEASES

Accurate assessment of clinical atherosclerotic diseases is essential to guide effective therapeutic interventions, and atherogenic indices have emerged as valuable methods in this setting. The complexity of these pathologies demands approaches that go beyond the simple measurement of total cholesterol, requiring tools that consider the interaction between different lipoproteins and other risk factors. In this context, the use of atherogenic indices appears as a promising approach, providing a more comprehensive and refined assessment of atherosclerotic conditions. Objective: To comprehensively analyze scientific studies published in the last 10 years that investigated the use of atherogenic indices as methods of evaluating clinical atherosclerotic diseases. The review seeks to consolidate the available evidence by examining the effectiveness of these indices in early identification, risk stratification and monitoring the progress of atherosclerotic diseases. Methodology: The systematic review was conducted following the PRISMA guidelines. The PubMed, Scielo and Web of Science databases were consulted to identify relevant studies published in the last 10 years. The descriptors used were "atherogenic indices", "atherosclerotic diseases", "clinical assessment", "lipoproteins" and "cardiovascular risk factors". Inclusion criteria considered original studies that investigated the use of atherogenic indices in clinical populations, while exclusion criteria involved studies with unrepresentative samples and inadequate atherosclerotic assessment methods. Results: The results of the review highlight the diversity of available atherogenic indices and their usefulness in evaluating different aspects of atherosclerotic diseases, including prediction of cardiovascular events, risk stratification and treatment monitoring. The analysis identified indices that proved to be particularly sensitive and specific in different clinical contexts. Conclusion: In summary, the systematic review highlights the relevance of atherogenic indices as valuable tools in the assessment of clinical atherosclerotic diseases. The diversity of these indices and their ability to provide comprehensive information highlights their importance in clinical practice, contributing to a more refined and personalized approach to the management of these conditions.