Quality Assessment Tool Research Articles

Accuracy of pulse wave velocity for screening coronary artery disease: a systematic review and meta-analysis

Abstract Coronary artery disease (CAD) is the leading cause of cardiovascular events and showed high prevalence and healthcare costs in 2019. However, CAD screening for cardiovascular event prevention is invasive and expensive. This study aims to estimate the ability of a noninvasive method, pulse wave velocity (PWV), to detect the presence or absence of coronary artery disease in patients with suspected CAD. A systematic review and meta-analysis of the available evidence was conducted, comparing PWV with the gold standard diagnostic method, angiography. The literature search was systematically performed in the PubMed, Scopus and Web of Science databases from inception to August 2024. Study quality assessment was performed using the Diagnostic Accuracy Study Quality Assessment Tool (QUADAS-2). Publication bias was assessed using the method proposed by Deeks. Statistical analyses were performed with the STATA SE software, version 15. The eight included studies had a cross-sectional design, in which the presence of CAD was measured simultaneously by PWV and angiography. To assess the accuracy of the tests, the overall sensitivity and specificity were combined into a single value, the diagnostic odds ratio (dOR), which provided a value of 3.61, indicating a high probability of detecting CAD by PWV. The implementation of PWV as a screening technique in healthcare centers could bring great benefits to patients with suspected CAD and increase efficiency in the use of healthcare resources.

A practical approach to the spatial-domain calculation of nonprewhitening model observers in computed tomography.

Modern reconstruction algorithms for computed tomography (CT) can exhibit nonlinear properties, including non-stationarity of noise and contrast dependence of both noise and spatial resolution. Model observers have been recommended as a tool for the task-based assessment of image quality (Samei E etal., Med Phys. 2019; 46(11): e735-e756), but the common Fourier domain approach to their calculation assumes quasi-stationarity. A practical spatial-domain approach is proposed for the calculation of the nonprewhitening (NPW) family of model observers in CT, avoiding the disadvantages of the Fourier domain. The methodology avoids explicit estimation of a noise covariance matrix. A formula is also provided for the uncertainty on estimates of detectability index, for a given number of slices and repeat scans. The purpose of this work is to demonstrate the method and provide comparisons to the conventional Fourier approach for both iterative reconstruction (IR) and a deep Learning-based reconstruction (DLR) algorithm. Acquisitions were made on a Revolution CT scanner (GE Healthcare, Waukesha, Wisconsin, USA) and reconstructed using the vendor's IR and DLR algorithms (ASiR-V and TrueFidelity). Several reconstruction kernels were investigated (Standard, Lung, and Bone for IR and Standard for DLR). An in-house developed phantom with two flat contrast levels (2 and 8 mgI/mL) and varying feature size (1-10mm diameter) was used. Two single-energy protocols (80 and 120kV) were investigated with two dose levels (CTDIvol=5 and 13 mGy). The spatial domain calculations relied on repeated scanning, region-of-interest placement and simple operations with image matrices. No more repeat scans were utilized than required for Fourier domain estimations. Fourier domain calculations were made using techniques described in a previous publication (Thor D etal., Med Phys. 2023;50(5):2775-2786). Differences between the calculations in the two domains were assessed using the normalized root-mean-square discrepancy (NMRSD). Fourier domain calculations agreed closely with those in the spatial domain for all zero-strength IR reconstructions, which most closely resemble traditional filtered backprojection. The Fourier-based calculations, however, displayed higher detectability compared to those in the spatial domain for IR with strong iterative strength and for the DLR algorithm. The NRMSD remained within 10% for the NPW model observer without eye filter, but reached larger values when an eye filter was included. The formula for the uncertainty on the detectability index was validated by bootstrap estimates. A practical methodology was demonstrated for calculating NPW observers in the spatial domain. In addition to being a valuable tool for verifying the applicability of typical Fourier-based methodologies, it lends itself to routine calculations for features embedded in a phantom. Higher estimates of detectability were observed when adopting the Fourier domain methodology for IR and for a DLR algorithm, demonstrating that use of the Fourier domain can indicate greater benefit to noise suppression than suggested by spatial domain calculations. This is consistent with the results of previous authors for the Fourier domain, who have compared to human and other model observers, but not, as in this study, to the NPW model observer calculated in the spatial domain.

A systematic review of pre-pandemic resilience factors and mental health outcomes in adolescents and young adults during the COVID-19 pandemic.

Adolescence and young adulthood are sensitive developmental periods to environmental influences. Investigating pre-emptive measures against stressors, such as those associated with the COVID-19 pandemic, on mental health is crucial. We aimed to synthesize evidence on pre-pandemic resilience factors shaping youth mental health outcomes during this period. For this pre-registered systematic review, we searched seven databases for longitudinal studies of youth populations affected by the COVID-19 pandemic, assessing a priori defined resilience factors at the individual, family, or community level before the pandemic. Studies required validated mental health or wellbeing measures collected both before and during the pandemic. Study quality was assessed using the corresponding NIH Quality Assessment Tool. From 4,419 unique records, 32 studies across 12 countries were included, using 46 distinct resilience measures. Due to the heterogeneity of study designs, we applied a narrative synthesis approach, finding that resilience factors were generally associated with better mental health outcomes both prior to and during the pandemic. However, most factors did not mitigate pandemic-related mental health effects. Nonetheless, family-level resilience factors emerged as promising under specific conditions. Study quality was generally fair, with concerns in resilience assessment and sampling quality. Future research should prioritize rigorous study designs and comprehensive resilience assessments.

Voice Meets Swallowing: A Scoping Review of Therapeutic Connections.

This scoping review aimed to explore the use of volitional voice tasks in assessing swallowing-related outcomes and to evaluate their therapeutic impact on swallowing disorders, including their effects on swallowing biomechanics. This scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. A literature search was performed across multiple databases (PubMed, Web of Science, and Scopus), and additional records were identified through manual searches. After screening and eligibility assessment, 36 studies were included for data extraction and analysis. The Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies was employed to evaluate the quality of the included studies. The review identified various volitional voice tasks, such as maximum phonation time and pitch glides, as potential assessment tools for predicting swallowing-related outcomes. Additionally, voice tasks targeting pitch modulation, increased vocal loudness, and squeezed voice quality showed promising therapeutic benefits for swallowing disorders across different populations, especially individuals with neurological conditions and head and neck cancer. While methodological limitations were found in current literature, volitional voice tasks demonstrate potential as complementary tools for assessing and treating swallowing disorders, leveraging their interconnected neurological and biomechanical mechanisms underlying functions. Further research with more robust methodologies is needed to establish the efficacy of these integrated interventions, facilitate their translation into clinical practice, and test new possibilities.

FAMILY PLANNING EFFECTS ON MATERNAL AND CHILD HEALTH IN PAKISTAN- A NARRATIVE REVIEW

Background: Family planning is a cornerstone of reproductive health, contributing significantly to improved maternal and child health outcomes. In Pakistan, where high population growth, limited healthcare infrastructure, and socio-cultural barriers persist, the role of family planning is pivotal in reducing maternal and infant mortality, enhancing birth spacing, and improving overall health indicators. Despite its importance, challenges such as gender inequality, socio-religious norms, and inadequate healthcare services limit its adoption and effectiveness. Objective: To evaluate the impact of family planning on maternal and child health outcomes in Pakistan, including contraceptive use, maternal and infant mortality, birth spacing, and childhood illnesses. Methods: A narrative review was conducted using electronic databases, including PubMed, Embase, Web of Science, and Scopus, alongside manual reference searches. Studies conducted in Pakistan, published in English, and focusing on family planning's impact on maternal and child health outcomes were included. Data extraction encompassed study characteristics, family planning interventions, maternal and child health outcomes, and key findings. Quality assessment tools such as the Newcastle-Ottawa Scale and Cochrane Risk of Bias Tool were employed to evaluate methodological rigor. Data synthesis was performed narratively, and meta-analysis was conducted where feasible to summarize quantitative findings. Results: Family planning interventions demonstrated significant benefits, including reductions in maternal and infant mortality, healthier birth spacing, and lower rates of childhood illnesses. Contraceptive use improved maternal health outcomes by preventing high-risk pregnancies and reducing complications. However, socio-cultural barriers, limited healthcare access, and unmet contraceptive needs were identified as persistent challenges. Conclusion: Family planning has a transformative impact on maternal and child health outcomes in Pakistan. Addressing socio-cultural and healthcare system barriers through integrated strategies and evidence-based policies can enhance its adoption, contributing to improved health and well-being for families nationwide.

The mental health impact of climate change on Pacific Islanders: A systematic review focused on sea level rise and extreme weather events

Objective This systematic review investigates the impact of climate change on the mental health of Pacific Island Nations (PINs), with a focus on identifying culturally tailored interventions and appropriate research methodologies to address these impacts. Method A systematic review of peer-reviewed literature up to May 18, 2024, was conducted using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) protocol and the Population, Interest Area, and Context (PICo) framework. Empirical studies on the impact of climate change on mental health in PINs were evaluated by using the Quality Assessment Tool for Studies with Diverse Designs (QATSDD). Results Six studies from the Solomon Islands, Cook Islands, and Tuvalu were identified, indicating significant mental health impacts from sea level rise (SLR) and extreme weather events with compounding and mitigating effects across diverse groups. The Skills for Life Adjustment and Resilience (SOLAR) program was highlighted as a promising culturally adapted intervention. Conclusion Climate change significantly impacts mental health, particularly in PIN communities facing SLR and Extreme Weather Events (EWE). Culturally sensitive interventions, local knowledge, and further research are vital to mitigate these effects and support well-being.

Dietary sodium intake restriction in patients with heart failure: an overview of systematic reviews.

This study aimed to identify, assess, and summarize systematic reviews on dietary sodium intake restrictions for patients with heart failure. Literature searches were conducted on Pubmed, CINAHL, ScienceDirect, Cochrane Library, China National Knowledge Infrastructure, and the Wanfang Database up to January 2024. The methodological quality of the included reviews was assessed using the quality assessment tool from the Australian JBI Center for Evidence-Based Healthcare (2016). The results of systematic reviews and meta-analyses were synthesized and presented according to different outcome indicators. Nine systematic reviews were included in this study. The current evidence does not support the fact that dietary sodium intake restrictions for patients with heart failure have a positive impact on mortality rates, rehospitalization rates, and quality of life. Conversely, strict dietary sodium intake restrictions (≤ 2000mg/day) may increase the risk of death, rehospitalization, and symptom exacerbation. Dietary sodium intake restriction may not have a positive impact on clinical outcomes in patients with heart failure. Nevertheless, more evidence is required to explore the differences in the impact of various levels of dietary sodium restriction on the outcomes and symptom management indicators of patients with heart failure.

Organ-specific malperfusion in acute type A aortic dissection: epidemiological meta-analysis of incidence rates.

Acute type A aortic dissection is a life-threatening clinical emergency that necessitates immediate surgical intervention with an estimated mortality rate of approximately 1-2% per hour. When complicated by malperfusion, the perioperative mortality rate is reported to be increased by up to 39%. Malperfusion can affect many vascular beds with varying incidence and severity, resulting in coronary, cerebral, visceral, peripheral, renal or spinal malperfusion. The primary aim of this systematic review and meta-analysis is to investigate the epidemiology of specific types of organ malperfusion in acute type A aortic dissection and to analyse the impact on the survival outcomes associated with each malperfusion type. Electronic databases PubMed, MEDLINE and Embase were searched through to September 2024 to identify original studies that presented data on the incidence and the survival outcome of organ malperfusion in association with acute type A aortic dissection. The extracted data included patient characteristics and incidence of organ-specific malperfusion. Primary outcomes were the respective in-hospital mortality rate associated with each organ-specific malperfusion and a proportional meta-analysis was conducted to pool results. Quality assessment was performed using the modified National Institutes of Health quality assessment tool for single-arm observational studies. A total of 40 studies met the inclusion criteria, including a total of 35 361 patients. Peripheral limb malperfusion was the most prevalent with a pooled incidence of 12% (95% c.i. 10 to 14). This was followed by lower limb or iliofemoral with 11% (95% c.i. 9 to 14). Spinal malperfusion was the lowest with 1% (95% c.i. 1 to 2). The pooled mortality rate with organ malperfusion varied between 18 and 36%. Within this population the highest mortality rate was associated with mesenteric malperfusion with 36% (95% c.i. 28 to 45). Following this the highest mortality rate was found with coronary at 33% (95% c.i. 26 to 40) and cerebral at 28% (95% c.i. 24 to 33) malperfusion. Survival during hospital admission after acute type A aortic dissection can vary depending on the presence and type of malperfusion, with mesenteric, coronary and cerebral malperfusion being associated with the highest in-hospital mortality rates. Organ-specific malperfusion syndromes should be considered when assessing the perioperative risk and surgical planning of patients undergoing surgical repair for acute type A aortic dissection.

Effectiveness of Birthing Ball Exercises Therapy in Improving Labor Pain and Labor Outcomes: A Systematic Review

Objective: We must treat every woman with respect and compassion during her childbirth, allowing her to choose how she wants to remember the experience. Midwives and nurses use birthing balls to reduce labor pain and enhance maternal comfort without an epidural. The aim of this systematic review was to critically evaluate the available evidences on the effect of birthing balls on labor pain and labour outcomes. Materials and methods: Studies identified through PubMed, Semantic Scholar, and Mendeley electronic databases to gather evidences with selected keywords. This review incorporated randomised controlled trials and quasi-experimental research studies that met specific, predefined inclusion criteria. The search generated 441 titles and abstracts, which were further filtered down to 29 publications that were possibly relevant. Out of those, eight studies met the inclusion criteria. Performed a quality assessment of the articles using the JBI quality assessment tool. Results: All of the included studies show labor pain on a 10-cm Visual Analogue Scale (VAS), and interventional groups reported significantly less labor pain in delivery compared to the control group without birth ball exercise. On labour outcome findings, the intervention group had a higher mean score of cervical dilation in 2 studies, quicker head descent in 3 studies, lower labor time in 4 studies, mother satisfaction throughout labor in 2 studies, and a preference for vaginal delivery in 2 studies. Conclusion: Clinical implementation of a birthing ball exercise during the process of labor is an effective intervention to reduce labor pain and improve labor outcomes.

The Diet Quality of Athletes as Measured by Diet Quality Indices: A Scoping Review.

The goals of sports nutrition are to support athletic performance. However, the diet quality of athletes remains poorly understood. This scoping review aims to synthesise the existing body of literature, evaluating the diet quality of adult athletes. The scoping review was conducted in accordance with guidance from the Joanna Briggs Institute. Database searches were conducted in Medline, Scopus, SPORTDiscus, Web of Science, and EMBASE. Eligible studies were observational, utilised a validated dietary quality assessment tool (diet quality index), and assessed athletes aged 18 to 65 years. Screening was performed independently by two researchers, with any conflicts resolved by a third researcher. The search yielded 1142 articles, of which 18 met the inclusion criteria. Basketball athletes and gymnasts were the most frequently examined groups. Studies were dominated by one gender (n = 7 all males studies, n = 4 only female). Eleven diet quality tools were used, including variations of the Healthy Eating Index (n = 7). Overall diet quality was rated as poor (n = 3 studies), needs improvement (n = 12), or adequate (n = 3). Food groups where intake was suboptimal included wholegrains (n = 8), fruit (n = 5), and dairy intake (n = 3). The intake of protein-rich foods was adequate in n = 9 studies, whilst fat intake was excessive in 4 studies. These findings suggested that the diet quality of athletes is suboptimal and needs improvement in the areas of wholegrain, fruit, and dairy/alternatives intake. The inadequate intake of these food groups and the consumption of excessive fat intake may increase the long-term risk of developing non-communicable diseases and impair short-term performance and recovery. Further exploration is warranted to develop targeted nutrition education and interventions that address these inadequacies.

Prevalence of detransition in persons seeking gender-affirming hormonal treatments: a systematic review.

Despite recent evidence of the benefits of gender-affirming medical procedures, data in the literature indicate emerging demands of detransition and regrets while suggesting potential sources of bias in different datasets, including a nonconsensual definition of detransition. The present systematic review aims to summarize the existing research regarding the prevalence of detransition in transgender persons who requested or started receiving gonadotrophin-releasing hormone analogs (GnRHa) and/or gender-affirming hormonal therapy (GAHT). A systematic literature search (CINAHL Plus, Cochrane Library, Google Scholar, MEDLINE, Web of Science, Sage Journals, Science Direct, Scopus) for quantitative studies was conducted up to May 2024. All eligible studies were assessed using the Strengthening the Reporting of Observational Studies in Epidemiology statement. The risk of bias was assessed using the National Institute of Health quality assessment tool. The present analysis follows the PRISMA statement for systematic review articles and the synthesis without meta-analysis recommendations. The primary outcome was the point-prevalence proportion of detransition events as a percentage in the population of transgender persons who were considered eligible for treatment or had initiated GnRHa and/or GAHT. Fifteen observational studies involving 3804 children and adolescents and 3270 adult participants were included in the 3212 screened studies. Five studies reported a change in request before starting GnRHa, five studies reported GnRHa discontinuation, and nine studies reported GAHT discontinuation. The point-prevalence proportions of shifts in requests before any treatment ranged from 0.8-7.4%. The point-prevalence proportions of GnRHa discontinuation ranged from 1-7.6%. The point-prevalence proportions of GAHT discontinuation ranged from 1.6-9.8%. All of the included studies were heterogeneous regarding definitions of detransition used and the study design: their numbers were too small to be statistically relevant, their time frame was insufficient, they did not use patient-level data, or they did not consider confounding factors. Quality measurement tools are needed, as are monitoring standards, and both are important for health outcomes and guarantee the attention of health care providers and policy-makers. The unique features of this analysis are its restrictive inclusion criteria compared with those of previous reviews, such as a strict definition of detransition and a focus on empirical studies only. However, most of the studies were retrospective and unblinded, and most were not sufficiently powered to detect detransition rates. Taken together, the results of the present analysis show that detransition in persons undergoing gender-affirming treatment has been insufficiently investigated, highlighting the need for long-term follow-up studies.

Association between food insecurity and overweight: Protocol for a systematic review based on intersectionality of gender and race/color.

Food insecurity violates the right to regular access to quality food, affecting population groups unequally. In Brazil, FI is associated with both malnutrition and increased obesity and is intertwined with racial and gender inequalities, perpetuating cycles of poverty and social exclusion. This protocol aims to select observational studies that evaluate the association between food insecurity and overweight and their intersectional discussions (gender and race/color). The PRISMA checklist guidelines will be applied, and the PROSPERO platform will be used for registration. Searched in the Virtual Health Library (Lilacs-BVS), Medline PubMed, Web of Science, and Embase Elsevier databases. The stages of article selection and information extraction will be carried out by independent researchers who will identify articles that meet the established inclusion criteria, removing duplicate publications and excluding those that do not meet the requirements. The quality of eligible articles will be assessed using the Quality Assessment Tool For Quantitative Studies (QATFQS), which is recommended for observational studies. This study is not needed for ethical approval, as it is a systematic review based on secondary data. They will disseminate their conclusions from the original articles. PROSPERO registration number: CRD42023427239.

Incidence of cancer-related lymphoedema: a protocol for a living systematic review with meta-analysis

IntroductionGiven the projected rise in the incidence of cancer treatment-related conditions, such as lymphoedema, and the limited research on lymphoedema in cancers with poor prognoses, there is a need for...

A systematic review of parent-child communication in pediatric asthma.

Parent-child communication is integral to pediatric asthma management. This review evaluates parent-child communication among youth with asthma and their caregivers. It aims to characterize the type of communication according to a unifying framework (Murphy, L. K., Murray, C. B., & Compas, B. E., Guest Editors: Cynthia A. Gerhardt, Cynthia A. Berg, Deborah J. Wiebe and Grayson N. Holmbeck (2017). Topical review: Integrating findings on direct observation of family communication in studies comparing pediatric chronic illness and typically developing samples. Journal of Pediatric Psychology, 42, 85-94. https://doi.org/10.1093/jpepsy/jsw051), assess sociodemographic factors associated with communication, and examine the relationship between parent-child communication and youth psychosocial and health-related outcomes. A systematic literature search was conducted using PubMed, PsycINFO, CINAHL, Web of Science, Cochrane Library, and Embase databases (June 2021; updated May 2024). Included studies reported original, peer-reviewed research on the relationship between parent-child communication and youth psychosocial or health outcomes among pediatric patients (mean age <18 years) with asthma and their primary caregiver(s). Study quality was evaluated using the Study Quality Assessment Tools of the NHLBI. Sixty-six articles were included with data from 5,373 youth with asthma. Studies assessed both positive (warm and structured) and negative (hostile/intrusive and withdrawn) communication. Most studies used questionnaires and cross-sectional designs. Associations between sociodemographic and communication variables were largely nonsignificant. Greater positive and less negative communication was associated with better youth psychosocial and asthma outcomes overall. Parent-child communication may be an important target for interventions aimed at improving youth outcomes. More research is needed to develop communication-focused interventions that aim to enhance parents' and youths' communication skills (i.e., increase their use of positive communication approaches and/or reduce their use of negative communication approaches) and evaluate their impact on youth outcomes. Future research should also use more discussion tasks and longitudinal designs.

Ideal animal models according to multifaceted mechanisms and peculiarities in neurological disorders: present and challenges.

Neurological disorders, encompassing conditions such as Alzheimer's disease (AD), Parkinson's disease (PD), Huntington's disease (HD), and amyotrophic lateral sclerosis (ALS), pose a significant global health challenge, affecting millions worldwide. With an aging population and increased life expectancy, the prevalence of these disorders is escalating rapidly, leading to substantial economic burdens exceeding trillions of dollars annually. Animal models play a crucial role in understanding the underlying mechanisms of these disorders and developing effective treatments. Various species, including rodents, non-human primates, and fruit flies, are utilized to replicate specific aspects of human neurological conditions. However, selecting the ideal animal model requires careful consideration of its proximity to human disease conditions and its ability to mimic disease pathobiology and pharmacological responses. An Animal Model Quality Assessment (AMQA) tool has been developed to facilitate this selection process, focusing on assessing models based on their similarity to human conditions and disease pathobiology. Therefore, integrating intrinsic and extrinsic factors linked to the disease into the study's objectives aids in constructing a biological information matrix for comparing disease progression between the animal model and human disease. Ultimately, selecting an ideal animal disease model depends on its predictive, face, and construct validity, ensuring relevance and reliability in translational research efforts.

A Novel Methodology for Classifying Wikipedia Articles: Insights into Digital Forensics and Content Integrity

Well-written articles shape readers interaction with information, as top-ranked articles are more likely to be seen than those further down the ranks. We present a new approach to classifying Wikipedia articles across various quality dimensions, harnessing knowledge gained from expert assessments. The study also includes an attempt to develop a solid framework that meets the evaluation of the quality of an article for the sole purpose to ensure the integrity of the content in the multipoint structure of the Internet, and to have input for the applications of Digital Forensics. The suggested method: the article details is gathered using the Wikipedia API and a set of metrics is well-defined to store and analyze this information. The methodology then explores the relationship between independent variables (metrics of the articles) and the dependent variable (quality level as rated by the experts). Three machine learning algorithms (RF, J48, and NB) are then used to classify the articles. The classification is dragged along with the expert reviews to determine whether quality level of Wikipedia articles. The empirical evidence illustrates the effectiveness of the proposed approach, with average accuracies greater than 70% for the J48 algorithm. The precision, recall and F-measure values corresponding to the classification models’ accuracy exceed 0.7, representing a strong performance model. Overall, these findings indicate that the method uses reliable criteria, which classifies Wikipedia articles in accordance with experts' opinions, making it a reliable tool for quality assessment. In addition, the study underscores the significance of the combined focus on precision and recall for assessing the quality of a model, thereby demonstrating how useful this method is in ensuring that content can be trusted and as part of digital forensics.

A critical review on the toxicological and epidemiological evidence integration for assessing human health risks to environmental chemical exposures.

Toxicology and epidemiology are the two traditional public health scientific disciplines which can contribute to investigate harmful health effects of exposure to toxic substances. Several frameworks for integrating different lines of evidence were proposed since 2011, evolving based of the emergence of new methodologies and approaches. Through the comparison of various theoretical frameworks for evidence integration, we examined similarities, differences, strengths, and weaknesses to provide insights into potential directions for future research. We identified several key challenges of the integration approach to be applied to risk assessment. More specifically, collaboration within a multidisciplinary team of scientists, toxicologists, epidemiologists, and risk assessors, is strongly recommended to be aligned with key regulatory objectives and promote a harmonized approach. Moreover, literature search transparency and systematicity have to be ensured by following validated guidelines, developing parallel protocols for collecting epidemiological and toxicological evidence from various sources, including human, animal, and new approach methodologies (NAMs). Also, the adoption of tailored quality assessment tools is essential to grade the certainty in evidence. Lastly, we recommend the use of the Adverse Outcome Pathway framework to provide a structured understanding of toxicity mechanisms and allow the integration of human, animal, and NAMs data within a single framework.

Meta-analysis of global distribution of root-caries prevalence in middle-aged and elderly.

Root caries (RC) remains a global health problem leading to negative impacts on an elderly person's well-being causing oral health-related quality of life issues, as inadequate nutrition and detrimental oral functionality. The present systematic review with meta-analysis is designed to synthesize existing research findings on the prevalence and experience of root caries globally over the past 30 years. It aims to describe its distribution by country and explore its links with various socioeconomic indicators. Selection criteria: Three electronic databases (PubMed, Embase and Scopus) were screened for observational epidemiological studies (cross-sectional and cohort studies) reporting the prevalence of RC and/or mean RC experience between 1990 and 2023. No language were applied. Study selection, data extraction and quality assessment were done in duplicate. . risk of bias was graded with customized quality assessment tools (Study Quality Assessment Tools NHLBI, NIH). studies reporting on (1) root caries experience (mean and SD) and (2) on root caries prevalence (%), were used synthesize the results. It was assessed as decayed, missing, and filled teeth (RDMFT) Results: A total of 91 publications were included in the descriptive analysis; the estimated overall pooled mean RC was 2.87 teeth and the global estimated random-effects pooled RC prevalence was 41%. Low gross national income (GNI) countries reported a low mean number of RC (1.35 GNI<$5000), while high GNI countries reported a higher mean number of RC (3.45 GNI $10000- $19999). Countries of higher inequalities (Gini index) reported lower means medium RC (1.98 teeth) than countries with no inequalities (4.90 teeth). This study highlights the high caries burden among adult population globally by estimating overall trends and comparing against factors including area, GNI and Gini-index. The large magnitude of these inequities indicates that oral health equity can only be achieved taking into account socioeconomic factors on a global scale. The lack of uniform data collecting among studies as well as knowledge gap regarding the incidence and experience of RC in different countries.

Evaluating the Success Rate of Dental Implants in Diabetic Patients: A Systematic Review of Clinical Outcomes and Risk Factors

Diabetes mellitus is a chronic condition that poses significant challenges for dental health, particularly in the context of dental implants, where effective osseointegration and healing are crucial for success. Diabetic patients may experience delayed wound healing and increased susceptibility to infections, potentially impacting the success rate of dental implants. This systematic review aims to evaluate the success rates of dental implants in diabetic patients compared to non-diabetic individuals and to identify key clinical outcomes and risk factors influencing implant success. A comprehensive literature search will be conducted across major databases, including PubMed, Cochrane Library, and Embase, for studies published from 2016 onwards. Studies assessing implant success rates, complications, and relevant factors such as glycemic control and diabetes type will be included. Data will be extracted systematically, and quality assessment tools will be applied to evaluate the risk of bias. Findings from this review are expected to clarify the impact of diabetes on implant outcomes, provide evidence-based recommendations for managing diabetic patients undergoing implant procedures, and highlight areas for further research.

A quality assessment tool for focused abdominal sonography for trauma examinations using artificial intelligence.

Current tools to review focused abdominal sonography for trauma (FAST) images for quality have poorly defined grading criteria or are developed to grade the skills of the sonographer and not the examination. The purpose of this study is to establish a grading system with substantial agreement among coders, thereby enabling the development of an automated assessment tool for FAST examinations using artificial intelligence (AI). Five coders labeled a set of FAST clips. Each coder was responsible for a different subset of clips (10% of the clips were labeled in triplicate to evaluate intercoder reliability). The clips were labeled with a quality score from 1 (lowest quality) to 5 (highest quality). Clips of 3 or greater were considered passing. An AI training model was developed to score the quality of the FAST examination. The clips were split into a training set, a validation set, and a test set. The predicted scores were rounded to the nearest quality level to distinguish passing from failing clips. A total of 1,514 qualified clips (1,399 passing and 115 failing clips) were evaluated in the final data set. This final data set had a 94% agreement between pairs of coders on the pass/fail prediction, and the set had a Krippendorff α of 66%. The decision threshold can be tuned to achieve the desired tradeoff between precision and sensitivity. Without using the AI model, a reviewer would, on average, examine roughly 25 clips for every 1 failing clip identified. In contrast, using our model with a decision threshold of 0.015, a reviewer would examine roughly five clips for every one failing clip - a fivefold reduction in clips reviewed while still correctly identifying 85% of passing clips. Integration of AI holds significant promise in improving the accurate evaluation of FAST images while simultaneously alleviating the workload burden on expert physicians. Diagnostic Test/Criteria; Level II.