ABSTRACT The number of individuals undergoing cosmetic surgery has increased rapidly in recent years. Considering the negative and positive impacts of these procedures, it is imperative to explore the possible influencing factors. According to the tripartite influence model and objectification theory, social media, as a form of new media, may relate to the intention of users to undergo cosmetic surgery (i.e. cosmetic surgery consideration [CSC]). Therefore, a three-level meta-analytic model was applied to quantitatively synthesize relevant studies to clarify the relationship between social media use (SMU) and CSC and to identify potential moderators. This study synthesized 24 articles with 96 effect sizes (N = 10,445) and reported an overall effect size of r = 0.21, 95% CI [0.13, 0.26]. Type of SMU significantly moderated the correlation between SMU and CSC, with appearance-focused SMU being associated with higher willingness to undergo cosmetic surgery than general SMU. However, the correlation was not moderated by age, sex, BMI, country grouping, social media platforms, and study quality. These findings highlight that measures should be implemented to mitigate the negative impact of idealized content on social media and the need to prevent the blind pursuit of idealized appearances seen on social media.

Food insecurity remains a persistent public health challenge in the United States, affecting greater than 10% of households for the past 20 years. Although a variety of interventions have been implemented to address food insecurity, no prior review appears to have synthesized evidence exclusively from randomized controlled trials (RCTs). The effectiveness of food insecurity interventions in the United States, focusing exclusively on evidence from RCTs, was examined in this systematic review. The strengths and limitations of the existing evidence were assessed, and recommendations are provided for future research, practice, and policy. A comprehensive search was conducted across the PubMed, Embase, Web of Science, and ProQuest Central databases. Randomized controlled trials conducted in the United States that evaluated food security outcomes were included. Twenty-five studies met inclusion criteria. Two reviewers independently screened abstracts and full texts. Data were extracted by a primary reviewer and verified by a second reviewer. Study quality was assessed using the Cochrane Risk of Bias tool. The reviewed studies used a wide range of interventions across diverse settings. Findings were mixed, with 44% of included studies (n = 11) reporting significant improvements in food security compared with control groups. The evidence does not support any single intervention as consistently effective and reveals significant gaps in geographic and population coverage. Key limitations across studies included short intervention and follow-up periods and limited assessment of intervention utilization. Future RCTs should prioritize long-term follow-up, inclusion of underserved regions and populations, and more rigorous evaluation of intervention uptake. OSF registration no. 49jcs.

Mental health disorders contribute significantly to the global disease burden. Integrating mental health services into primary health care (PHC) systems is a promising solution, with nurses playing a critical yet under-explored role due to their proximity to communities and holistic care approach. This study aimed to systematically review and synthesize qualitative and mixed-methods evidence. A systematic review and meta-synthesis were conducted, adhering to PRISMA 2020 and ENTREQ guidelines. Six databases (PubMed/MEDLINE, Scopus, Web of Science, CINAHL, PsycINFO, Embase) were searched from inception to June 2025, supplemented by grey literature searches. Inclusion criteria, guided by the SPIDER framework, focused on qualitative and mixed-methods studies exploring nurses' roles in PHC mental health care. Study quality was assessed using the CASP Qualitative Checklist, and data were synthesized using thematic meta-synthesis, facilitated by NVivo 14. 34 studies from 18 countries were included, revealing four overarching themes: (1) Nurses' mitigation of multilevel stigma through empathy, education, and advocacy; (2) Challenges in navigating structural barriers, including resource scarcity, training gaps, workload pressures, and access inequities; (3) Adaptive psychosocial intervention practices using holistic assessments, empowerment strategies, technology, and cultural adaptations; and (4) Leadership in interprofessional patient-centered care through collaboration, trust-building, recovery-oriented frameworks, and systemic advocacy. Nurses are instrumental in advancing mental health equity in PHC systems by addressing stigma, overcoming barriers, delivering tailored interventions, and leading collaborative care. Enhancing their impact requires mandatory mental health training, resource allocation, interprofessional frameworks, and further research in diverse global contexts.

Machine learning (ML) applied to diffusion tensor imaging (DTI) has emerged as a promising tool for detecting microstructural brain alterations in movement disorders. However, existing studies vary widely in design, sample size, imaging pipelines, and analytic rigor, resulting in high methodological heterogeneity that limits quantitative comparability. This exploratory meta-analysis and narrative synthesis aimed to characterize performance trends, methodological diversity, and sources of variability among ML models trained on DTI data for classifying movement disorders, rather than to infer a single pooled diagnostic effect. This was designated exploratory because extreme heterogeneity prevented confirmatory pooled effect inference, so the analysis focused on describing performance distributions and methodological patterns rather than estimating a unified diagnostic effect. A systematic search of PubMed, Web of Science, and Scopus identified human studies applying ML algorithms to DTI for diagnostic or classification purposes. Accuracy, sensitivity, specificity, and the area under the curve (AUC) were extracted, with multiple imputation used for incomplete metrics with missingness rates below 40%. Random-effects modeling was employed to provide descriptive summaries, and subgroup analyses were conducted to explore trends across disorders, model architectures, and imaging modalities. Study qualities were assessed with JBI tools. Forty-six studies (2016-2024) were included, spanning Parkinson's disease, Tourette syndrome, and essential tremor. Reported performance was generally high (median AUC ≈ 0.91), but between-study heterogeneity was extreme (I2 = 94.7%), indicating that studies were estimating distinct effects. Disorder-specific subgroup AUCs varied markedly: Essential Tremor (0.95), Parkinson's (0.90), Tourette's (0.88), and Other (0.79). Deep learning and radiomics-based models have reported higher accuracies, but they were often trained on small, single-center cohorts (37-139 participants), which limits their external validity. Pooled statistics were presented descriptively to illustrate performance ranges despite high heterogeneity, and were not interpreted as confirmatory effect sizes. ML models using DTI demonstrate high internal performance across studies, although generalizability remains limited across multiple movement disorders; however, current evidence remains exploratory due to small sample sizes, methodological fragmentation, and a lack of standardized imaging pipelines. Rather than confirmatory inference, these findings provide a descriptive map of emerging trends in ML-DTI diagnostics. Future progress will depend on data harmonization initiatives, multicenter collaborations, and federated learning frameworks that can support reproducible, generalizable, and clinically interpretable models.

Prostate cancer (PC) is the second most common cancer in men. Although many studies have assessed its economic burden, no recent reviews have focused on studies conducted under current clinical guidelines. This study systematically reviews recent cost-of-illness studies evaluating direct and indirect costs associated with PC. A systematic search was conducted using the PICOS framework and a combination of free-text and MeSH terms in PubMed and the Cochrane Library, and only free-text terms in EconLit. The search included articles published between January 2015 and October 2025. Data on total, direct, and indirect costs were extracted and synthesized. All costs were converted to 2025 USD, and quality of studies was assessed with a simplified version of the CHEERS checklist. Ninety-five studies met the inclusion criteria. Direct medical costs for non-metastatic prostate cancer (nmPC) varied widely by disease stage, treatment, and country, ranging from approximately US$1200 to US$280,000 per patient-year, with higher costs observed in advanced stages and in patients experiencing treatment-related adverse events (AEs). Progression to metastatic disease was associated with a marked cost escalation, with annual costs largely driven by systemic therapies and skeletal-related events. Indirect costs ranged from US$666 to US$12,900 per patient-year and accounted for up to 30% of total PC-related costs, primarily due to productivity losses from premature mortality. PC imposes a substantial economic burden on healthcare systems and society, particularly in advanced stages. Policy promoting early detection, risk-adapted treatment, and equitable therapy access may help contain costs. Further research should address the economic impact of emerging diagnostics and minimally invasive interventions.

This meta-analysis aims to determine the clinical manifestations, prevalence, and risk factors of asthenopia across diverse populations. We systematically searched PubMed up to April 2024 for studies published within the last five years on asthenopia, without language or design restrictions. Reference lists were also reviewed. The study quality was evaluated using the Newcastle-Ottawa Scale. A random-effects meta-analysis was conducted to calculate proportions, prevalence rates, odds ratios (ORs) and their 95% confidence intervals (CIs). Overall, 63 studies were included. The pooled prevalence of asthenopia detected via questionnaires or symptom report was 51% (95% CI = 50%, 52%). Subgroup analyses showed high prevalence among digital device users (90%) and computer workers (77%). During the COVID-19 pandemic, prevalence rose among adults (39%-45%), university students (36%-57%), and school-aged children (45%-64%). The most frequent ocular symptoms were eye tiredness (65%, 95% CI = 46%, 84%), eye strain (47%, 95% CI = 37%, 58%), and burning/irritation (43%, 95% CI = 35%, 51%). Musculoskeletal symptoms, including neck pain (45%, 95% CI = 28%, 62%) and shoulder pain (30%, 95% CI = 12%, 48%) were also prevalent. Neuropsychological symptoms included headache (50%, 95% CI = 41%, 59%) and difficulty concentrating (44%, 95% CI = 32%, 56%). Risk factors included short sleep duration (OR = 1.28; 95% CI = 1.04, 1.57), prior eye disease (OR = 2.59; 95% CI = 1.43, 4.69), prolonged screen time (OR = 1.15; 95% CI = 1.09, 1.21), and ambient conditions like air conditioning use (OR = 23.02; 95% CI = 4.94, 107.18). Protective measures included anti-glare filters (OR = 0.34; 95% CI = 0.19, 0.64), regular breaks (OR = 0.21; 95% CI = 0.09, 0.51), and computer use knowledge (OR = 0.20; 95% CI = 0.13, 0.30). Asthenopia is prevalent across diverse populations, characterised by a wide range of symptoms and influenced by modifiable risk factors. Our findings support a unified definition to improve clinical recognition and offer preliminary evidence to help shape future research on preventive strategies. PROSPERO: CRD42024536841.

Background Copeptin, the C-terminal fragment of provasopressin, has emerged as a potential prognostic biomarker in sepsis. However, its predictive accuracy for mortality in adult patients with sepsis remains uncertain. We conducted a systematic review and meta-analysis to evaluate the diagnostic performance of elevated blood copeptin levels for mortality prediction in this population. Methods We systematically searched PubMed, Embase, Web of Science, Wanfang Data, and CNKI from inception to 22 May 2025, for observational studies assessing copeptin levels at admission or within 48 h in adults with sepsis. Pooled sensitivity, specificity, likelihood ratios, diagnostic odds ratio (DOR), and area under the summary receiver operating characteristic curve (AUC) were calculated using a random-effects model. Study quality was assessed using QUADAS-2. Results Ten prospective studies involving 1,637 patients were included. Pooled sensitivity and specificity of elevated copeptin for predicting mortality were 0.77 (95% CI: 0.70–0.83; I 2 = 52%) and 0.76 (95% CI: 0.67–0.83; I 2 = 86%), respectively. The pooled positive and negative likelihood ratios were 3.16 (95% CI: 2.33–4.29) and 0.30 (95% CI: 0.23–0.40), with a DOR of 10.40 (95% CI: 6.62–16.33). The summary AUC was 0.83 (95% CI: 0.79–0.86), indicating good overall prognostic accuracy. Subgroup analysis according to the cutoffs of copeptin did not significantly affect the results. No significant publication bias was detected ( p = 0.58). Conclusion Elevated blood copeptin levels within 48 h of sepsis diagnosis show good prognostic accuracy for short-term mortality in adult patients with sepsis. These findings support the potential clinical utility of copeptin as a risk stratification tool in sepsis management. Systematic review registration https://www.crd.york.ac.uk/prospero/ , identifier CRD42024587540.

Background: Women’s rugby sevens is rapidly expanding, yet injury patterns remain poorly understood, limiting prevention strategies. This systematic review aimed to describe injury incidence, severity, burden, and risk factors across competitive levels. Methods: Original studies on senior or U19 women’s rugby sevens reporting ≥ 2 epidemiological variables were included; studies on men, mixed samples without disaggregation, 15-a-side rugby, other sports, or players below U19 were excluded. Searches were conducted in PubMed, Google Scholar, ScienceDirect, SpringerLink, and Scielo (last searched September 2024), supplemented by gray literature and hand searching. Risk of bias was assessed with ROBINS-I, and study quality was assessed with STROBE. Results were tabulated and synthesized narratively due to heterogeneity. Results: Fifteen studies were included. Injury incidence ranged from 40.5 to 153.6 per 1000 match h at the elite level and 26.5–46.3 at the community level. Severity was higher in elite players (45.6–124 days) than in community players (29.6–58.4 days). Lower-limb joint/ligament injuries predominated, contact (especially tackling) was the main mechanism, and injuries often occurred in the second half. Conclusions: Evidence was limited by small samples, inconsistent reporting, and a moderate risk of bias. Injuries are frequent and severe, especially in elite players, highlighting the need for targeted prevention and improved surveillance.

Chronic hyponatremia is a common electrolyte disturbance associated with adverse outcomes. The optimal rate of correction remains uncertain, with current guidelines emphasizing avoidance of overcorrection. This systematic review and meta-analysis aimed to synthesize the existing evidence on patient and healthcare utilization outcomes associated with overcorrection in adults with chronic hyponatremia. This study followed a pre-registered protocol (PROSPERO CRD42024606516). Medline and EMBASE were searched from inception to May 2024. Eligible studies included original experimental or observational research. Included studies reported outcomes for adult patients with chronic hyponatremia who experienced overcorrection, and those who did not. The outcomes of interest were neurologic complications, acute care utilization (hospital and intensive care unit length of stay, re-admission) and mortality. Study quality was assessed using the Newcastle-Ottawa Quality Assessment Scale. Meta-analyses were performed using the Hartung-Knapp-Sidik-Jonkman random effects models when data allowed; otherwise, outcomes were synthesized narratively. Forty-three studies were included. Overcorrection of hyponatremia was associated with an increased odds of neurologic complications (OR 4.23, 95% CI 2.93 - 6.11, I2 = 0%) but lower odds of mortality (OR of 0.67, 95% CI 0.47 - 0.97, I2 = 82.3%). In sensitivity analyses restricted to studies at low risk of bias, the association between overcorrection and neurologic complications was no longer statistically significant (OR 3.22, 95% CI 0.40-25.83, I2 = 25.4%). Given the observational nature of included studies, indirect evidence, and high risk of bias across studies, the certainty of evidence is very low. While sodium overcorrection appears to be associated with increased risk of neurologic complications but lower risk of mortality, the limitations of the current literature warrant cautious application of these findings. Given the potential risks of under- and overcorrection, a reframing of practice to achieve adequate correction, rather than focusing on overcorrection avoidance alone may be warranted.

Background: Gliomas frequently arise in eloquent cortical regions, where achieving maximal resection while preserving neurological function poses a major challenge. Awake craniotomy (AC) with intraoperative mapping is increasingly employed for this purpose, but its comparative effectiveness against general anesthesia (GA) remains unclear. Methods: This systematic review conducted under Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered in PROSPERO, searched PubMed, Embase, Cochrane Library, and Scopus for English-language studies published from 2015 to 2025. Eligible studies compared AC and GA in adults with supratentorial gliomas and reported outcomes on extent of resection, neurological preservation, survival, safety, quality of life, or cost-effectiveness. Data extraction was performed independently by three reviewers, and study quality was assessed with Risk of Bias 2, Newcastle-Ottawa Scale, or AMSTAR 2. Due to heterogeneity, findings were synthesized narratively. Results: Six studies were included (4 primary, 2 reviews); only two directly compared approaches. Extent of resection ( P = 0.657, P = 0.17), overall survival (adjusted hazard ratio [HR] 0.84, P = 0.48), and progression-free survival (adjusted HR 0.9, P = 0.66) showed no significant differences. AC cost $2,175 more per case ( P < 0.001). Neurocognitive function was generally preserved; psychomotor speed declined most. Conclusion: Neither approach demonstrated superiority. AC enables functional monitoring but offers no survival benefit and increases costs. Surgical decisions should be individualized. High-quality randomized trials are needed.

In recent years, forest bathing has gained popularity worldwide due to its many positive effects on health. In the face of increasing urbanization and limited access to natural forests, digital forest bathing is a promising alternative. Digital forest bathing could also be an option for people with restricted mobility, which could be a way to make the health-promoting effects of forests more accessible. This systematic review examines the current state of research on digital forest bathing, considers the associated effects, and highlights the technical possibilities and thereby consolidates the currently limited evidence base in this emerging field. For literature identification, the databases APA, PsycInfo, PubMed, PubPsych, Scopus, and Google Scholar were searched. A total of four studies were included. The results indicate that digital forest bathing could have positive effects on relaxation and well-being that could be comparable to real-life forest bathing, and summarize how interventions were technically implemented across the included studies. As there are still a few studies on digital forest bathing, the implementation of the research varies greatly, and some studies have risks of bias; the results presented here should be interpreted with caution. In addition to a critical examination of the study designs and quality, suggestions for further research in this area are given, and key methodological constraints relevant for interpreting early effects are outlined.

Concerns about the health and well-being effects of high after-hours availability expectations and work-related connectivity have prompted calls for organizational and national disconnection measures, such as the right-to-disconnect legislation. However, the effectiveness of such measures remains unclear. This is the first systematic review that aims to evaluate interventions and policies designed to limit availability expectations and after-hours work connectivity. We searched Embase, Medline, PsycINFO, and Web of Science for studies published (2004-2024) for peer-reviewed empirical studies. Two reviewers independently screened records extracted data and assessed study quality using the Effective Public Health Practice Project tool. The review was registered in PROSPERO (CRD42024599491). Effectiveness was assessed using a structured qualitative approach that accounted for various study design and methodological rigor across intervention types. Twelve studies (N=2306) were included: one national policy, three organizational disconnection guidelines, one supervisor-targeted program, and seven employee-focused programs. Half of the quantitative studies were randomized controlled trials; overall methodological quality was rated as weak. Most organizational and national-level policies showed limited or no effects, with benefits contingent on the person-environment fit and implementation quality. Supervisor-targeted and multi-component programs, particularly those allowing for flexibility and combining boundary management with other elements, showed significant modest effects on detachment, boundary control, and work-life balance, though effect sizes were generally small. The evidence base is small, heterogenous, and methodologically limited. Policies alone are unlikely to reduce harmful connectivity without active organizational implementation and cultural change. Developing and testing rigorous, multi-level interventions that address norms and supervisory practices, as well as individual boundary preferences, are urgently needed.

This systematic review evaluates the accuracy, reliability, and clinical utility of jaw motion tracking (JMT) systems compared to traditional occlusal assessment methods, providing an overview of current evidence supporting their integration in dental practice. The review followed PRISMA guidelines (PROSPERO Registration: CRD42024567619). A comprehensive search was conducted in PubMed, Scopus, Web of Science, and the Cochrane Library (January 2005- December 2025) using predefined keywords related to JMT systems and digital occlusal analysis. Studies were included if they assessed JMT device performance in clinical, experimental, or in vitro settings, comparing them to conventional mechanical articulators or manual occlusal techniques. The QUADAS-2 tool evaluated study quality, focusing on bias, patient selection, and applicability concerns. Twenty studies met inclusion criteria, ranging from single-patient case studies to larger clinical trials. Optical tracking systems demonstrated higher precision and accuracy in recording mandibular movements compared to traditional methods. JMT systems showed potential in reducing chair time and improving prosthetic outcomes. The risk of bias was high, mainly due to small sample sizes and the lack of long-term evaluations. Digital JMT technologies improve occlusal assessment and treatment planning, particularly in prosthodontics and TMJ diagnostics. However, further research is needed to standardize protocols, validate these systems across diverse populations, and ensure clinical applicability. Despite the potential benefits, methodological inconsistencies highlight the need for more rigorously designed studies.

Objective This study aimed to conduct a systematic review of the expression levels of matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) in cerebral amyloid angiopathy (CAA). Methods This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The PubMed, Embase, and Web of Science databases were searched to identify relevant studies. Two researchers independently screened the literature, extracted data, and assessed the study quality. Results Five studies evaluating a total of 442 participants were included. The findings revealed dysregulation of the MMP/TIMP system in the cerebral blood vessels of patients with CAA. Specifically, in comparison with patients without CAA, those with CAA showed significantly upregulated expression of TIMP-3 and TIMP-4 in the cerebral blood vessels, and TIMP-4 levels were positively correlated with the severity of CAA. MMP-9 expression in patients with CAA-related intracerebral hemorrhage (CAA-ICH) was significantly higher than in those without hemorrhage, while TIMP-3 expression was lower in patients with CAA-ICH; these findings suggest that an imbalance between MMP-9 and TIMP-3 may increase the risk of hemorrhage. Cerebrospinal fluid (CSF) and serum biomarker studies showed that patients with CAA had decreased TIMP-4 levels in the CSF and significantly lower serum MMP-2 levels. Conclusion The findings of this study indicated an imbalance in the MMP/TIMP system in CAA, which may be involved in its vascular pathological mechanism. However, the existing evidence is insufficient to support the use of MMPs/TIMPs as reliable biomarkers for CAA. Therefore, further evaluation of their diagnostic and therapeutic value is required in future studies. Systematic review registration This systematic review was registered in PROSPERO (Unique Identifier: CRD420251230405). The protocol can be accessed at: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251230405 , CRD420251230405.

Rare diseases (i.e., incidence of <1/2000) are individually uncommon, but collectively these 10,000 conditions affect an estimated 473 million people globally, and approximately 70% of rare diseases manifest in childhood. Despite this global impact, 90% of rare diseases lack effective treatment. Treatments for rare diseases are often identified through clinical trials. Identifying parents' knowledge needs and preferences regarding pediatric rare disease clinical trials is an important aspect of empowering parents, improving clinical research practices, and potentially improving recruitment to these vital trials. The aim of the scoping review is to determine the extent, range, and characteristics of the evidence on the knowledge needs and preferences of parents regarding pediatric rare disease clinical trials. A scoping review will be conducted to identify sources of literature on the topic. A systematic search strategy co-developed with a research librarian will be conducted in six databases (Medline, EMBASE, CINAHL, Scopus, Web of Science, and PsycINFO). Gray literature will be searched via Google, Perplexity AI, the ProQuest Dissertations & Theses Global database, and relevant rare disease organizational websites. Abstract and full-text screening will be conducted by two reviewers independently. Studies in English will be included regardless of study design, date of publication, or location of study/publication. Study quality will be appraised using the Mixed Methods Appraisal Tool. Data will be extracted including study characteristics, population, phenomena under investigation, and knowledge needs and preferences identified. Analysis will involve a descriptive numerical summary and qualitative content analysis. Findings will be presented in evidence tables, and patterns, themes, and gaps across the data will be reported using a narrative approach. This review will provide an overview of the existing literature regarding parents' knowledge needs and preferences about pediatric rare disease clinical trials. The findings of this review will inform future research and the development of knowledge translation resources for parents of children with rare diseases. This protocol has been registered in Open Science Framework (registration: https://doi.org/10.17605/OSF.IO/QXR8G).

To quantify the extent of musculoskeletal injuries in Olympic Athletics (track and field) disciplines by synthesising the current evidence on the prevalence of injured athletes, injury event incidence rates and injury characteristics. Systematic review and meta-analysis. MEDLINE, Web of Science, EMBASE, SPORTDiscus, CINAHL and Cochrane were searched from inception to 28 January 2025. Studies reporting athletics-related musculoskeletal injuries in Olympic Athletics disciplines. From 18 319 identified references, 216 studies were included; 38% of these studies were classified as having low study quality. Data synthesis was performed on 88 studies reporting on all injuries across all Athletics disciplines (21.6% with high study quality). The synthesised prevalence of injured athletes was 11.7% (95% CI 2.0% to 26.9%) for prospective studies only including championship/competition data, and 69.7% (95% CI 52.4% to 84.5%) for prospective studies combining training and competition data. The synthesised injury event incidence rates were 68.8 injuries per 1000 registered athletes (95% CI 39.4 to 120.2) for prospective studies only including championship/competition data, and 4.2 injuries per 1000 athlete-exposures (95% CI 2.1 to 7.7) and 3.8 injuries per 1000 hours of Athletics (95% CI 1.7 to 8.3) for prospective studies combining training and competition data. The Grading of Recommendations, Assessment, Development and Evaluation certainty of evidence was 'very low' for all outcomes, and 'low' for the injury event incidence rate per 1000 registered athletes for prospective studies conducted in championship/competition settings. Injuries were mainly located at the thigh, followed by the lower leg, foot and ankle. The main tissue type affected was the muscle, followed by tendon, ligament, skin, bone and joint. This systematic review with meta-analysis quantified the extent of musculoskeletal injuries in Athletics. Our findings inform future research and healthcare service planning and support targeted injury risk reduction strategies at all levels in Athletics.

Amid increasing global concerns regarding antimicrobial resistance, the routine use of prophylactic antibiotics in anorectal surgery has been questioned. In practice, prescribing practices vary widely among surgeons, highlighting the need for stronger evidence-based guidance. The aim of this study is to perform a systematic, critical assessment of the current literature to determine the role of prophylactic antibiotics in elective anorectal surgery. A comprehensive search of studies published between January 1980 and June 2025 was performed using PubMed, Embase, and Cochrane Library. The primary outcome was surgical site infection (SSI); secondary outcomes included systemic infection, wound dehiscence, abscess formation, bleeding, and recurrence. Study quality was assessed using the Cochrane RoB 2.0 tool for randomized controlled trials (RCTs) and the ROBINS-I tool for observational studies. The certainty of evidence was evaluated using the GRADE approach. Nine studies including 2317 participants were included, and five were eligible for meta-analysis. Overall, prophylactic antibiotics were not associated with a significant reduction in postoperative infectious or wound-related complications in RCTs (RR 0.76, 95% CI 0.43-1.33, and p=0.66, moderate GRADE certainty of evidence) or observational studies (RR 0.60 (95% CI 0.01-48.4) and p=0.53, very low certainty). All studies concluded that routine antibiotic prophylaxis may be unnecessary in anorectal surgery. Current evidence does not support the routine use of prophylactic antibiotics in uncomplicated anorectal procedures. However, the certainty of evidence is limited by small sample sizes, methodological heterogeneity, and limited number of available studies. Large-scale randomized trials are required to strengthen this evidence base. The review protocol was registered in the PROSPERO database CRD420251159850.

Background: Liver fibrosis drives mortality in chronic liver disease, with effective and approved targeted therapies being an urgent unmet medical need. Natural polysaccharides are promising multitarget candidates, but a critical appraisal of the preclinical evidence for their translatability is lacking. Objective: This review systematically synthesizes the evidence on the efficacy, mechanisms, and methodological quality of preclinical studies investigating the antifibrotic potential of natural polysaccharides. Methods: Six databases were searched (inception to February 2025) for studies in experimental liver fibrosis models. The review followed PRISMA guidelines. Risk of bias and reporting quality were assessed using the SYRCLE (Systematic Review Centre for Laboratory Animal Experimentation) and ARRIVE (Animal Research: Reporting of In Vivo Experiments) guidelines, respectively. Results: Eighty-eight studies on 44 polysaccharides were included. A major limitation was the predominant use of the carbon tetrachloride (CCl4) rat model (54.5%). Despite this, polysaccharides showed consistent efficacy: collagen deposition was suppressed in 92.0% of studies, and serum alanine/aspartate aminotransferase (ALT/AST) were reduced in 100%. Mechanistically, inhibition of the transforming growth factor-beta (TGF-β)/Smad pathway (implicated in 60.2% of studies) and modulation of the toll-like receptor 4 (TLR4)/nuclear factor kappa B (NF-κB) pathway (15.9%) were the most common findings. However, methodological quality was low, with unclear allocation concealment (92.0%) and absent blinding (86.4%) being pervasive issues. Conclusions: This review confirms that natural polysaccharides consistently attenuate experimental fibrosis by modulating key pathways like TGF-β/Smad. Our key contribution is highlighting a critical disconnect: demonstrated efficacy is undermined by poor methodological rigor and the use of simplistic models. This gap represents a major barrier to clinical translation. Advancing these promising agents requires prioritizing chemical standardization, employing more relevant disease models, and adhering to rigorous reporting standards.

Hypertensive disorders of pregnancy (HDP) remain a major contributor to maternal and perinatal morbidity and mortality in low- and middle-income countries (LMICs). While clinical risk factors are well-described, non-biological determinants including environmental, psychosocial, and health-system factors play a critical but underexplored role. This systematic review synthesizes evidence on these determinants, with particular focus on Kano State Northern Nigeria and sub-Saharan Africa. A systematic review was conducted following PRISMA 2020 guidelines. Key electronic databases were searched, including PubMed, Scopus, and Web of Science, along with grey literature sources such as WHO, ACOG, and the Nigerian Federal Ministry of Health, for studies published between 2000 and 2025. Observational and mixed-methods studies reporting on hypertensive disorders of pregnancy (HDP) and non-biological determinants in low- and middle-income countries (LMICs) were included. Data on study characteristics, HDP prevalence, maternal and neonatal outcomes, and environmental, psychosocial, and health-system exposures were extracted. Study quality was assessed using standardized checklists appropriate for observational studies, and findings were synthesized narratively and, where feasible, quantitatively. Forty-eight studies involving over 138 women met the inclusion criteria. In Nigeria, HDP prevalence ranged from 6% to 17%, with preeclampsia at 4–8% and eclampsia at 1–2%. Key non-biological determinants included psychosocial stressors (chronic stress, domestic violence, low social support), socioeconomic disadvantage (low education, poverty), environmental exposures (ambient heat, household air pollution), and health-system constraints (limited antenatal care, delayed booking, inadequate monitoring, insufficient referral systems). These factors were linked to delayed diagnosis, severe maternal complications (eclampsia, HELLP syndrome, renal impairment). This study highlights a critical and underexplored dimension of hypertensive disorders of pregnancy (HDP) by examining non-biological determinants in low- and middle-income countries (LMICs). By synthesizing evidence on psychosocial, environmental, and health-system factors, it broadens the understanding of HDP beyond traditional clinical risk factors. The focus on Kano State Northern Nigeria and sub-Saharan Africa provides context-specific insights for regions with high maternal morbidity and mortality. These findings are valuable for researchers, clinicians, and policymakers, informing the design of targeted interventions, the strengthening of antenatal care services, and the implementation of community-based strategies. Ultimately, this work contributes to improving maternal and neonatal health outcomes and advancing Sustainable Development Goal 3 by 2030.

Digital technologies provide a convenient and scalable approach to dietary assessment and personalised feedback, facilitating behaviour change. This is essential for reducing the prevalence of non-communicable diseases at a population level. However, the evaluation of the acceptability and feasibility of dietary feedback delivered via online platforms has not been thoroughly investigated. By utilising the term 'system architecture' to describe the essential components of the digital approach to capturing dietary feedback, this systematic review outlines the platform, dietary assessment methodology, reference values for assessing dietary intake, and elements of personalised dietary feedback. When reported, the acceptability and feasibility of personalised feedback were captured. OVID Medline, OVID Embase, Scopus via Elsevier, and Cinahl Plus via EBSCO identified 5,839 studies. Search terms included dietary assessment, feedback, and digital technologies. In total, 28 studies involving 301,271 participants were included. Food frequency questionnaires were the most commonly used dietary assessment method, accessed via web-based platforms. Dietary intake was commonly assessed using a diet quality index, and feedback was provided on food groups, often combined with a diet quality score or macronutrient analysis. While participant acceptance of personalised dietary feedback was generally high, the overall completion rates for acceptability questionnaires were low, and feasibility was seldom reported. Methods used to measure acceptability and feasibility varied, preventing comparisons across studies. Study quality was high; however, future research would benefit from the involvement of stakeholders and end-users in designing feedback messages.