Search

Background: Diabetic autonomic neuropathy is a common complication of type 2 diabetes mellitus (T2DM), especially in patients with long-term, poorly controlled diabetes. This study investigates the effects of exercise on autonomic nervous system activity in T2DM patients over time. Methods: A literature review using MEDLINE, Embase, Cochrane Library, Scopus, and PubMed identified studies assessed via heart rate variability. Papers were categorized into three groups: immediate effects (within 60 min), short-term effects (2–3 months), and long-term effects (over 4 months). Results: Nine articles with 161 T2DM patients were included in the meta-analysis. RMSSD changes after exercise were −4.3 (p = 0.227), 8.14 (p < 0.001), and 4.17 (p = 0.002) for the immediate, short-term, and long-term groups, respectively. LF/HF ratio changes were 0.21 (p = 0.264), −3.04 (p = 0.102), and −0.05 (p = 0.006) for the respective groups. Meta-regression indicated age, male gender, and exercise duration were associated with increased RMSSD, with coefficients of 2.36 (p = 0.001), 13.76 (p = 0.008), and 1.50 (p = 0.007), respectively. Age positively correlated with the LF/HF ratio, with a coefficient of 0.049 (p = 0.048). Conclusions: Regular exercise (≥3 times per week) for over 2 months increases parasympathetic activity in T2DM patients, while sympathetic activity decreases significantly after 4 months. Further study is needed to validate these findings. [ABSTRACT FROM AUTHOR]

Background: Delirium is a common disorder affecting patients' psychiatric illness, characterized by a high rate of underdiagnosis, misdiagnosis, and high risks. However, previous studies frequently excluded patients with psychiatric illness, leading to limited knowledge about risk factors and optimal assessment tools for delirium in psychiatric settings. Objectives: The scoping review was carried out to (1) identify the risk factors associated with delirium in patients with psychiatric illness; (2) synthesize the performance of assessment tools for detecting delirium in patients with psychiatric illness in psychiatric settings. Design: Scoping review. Data sources: PubMed, Web of Science, and Embase were searched to identify primary studies on delirium in psychiatric settings from inception to Dec 2023 inclusive. Two independent reviewers screened eligible studies against inclusion criteria. A narrative synthesis of the included studies was conducted. Results: A final set of 36 articles meeting the inclusion criteria, two main themes were extracted: risk factors associated with delirium in patients with psychiatric illness and assessment tools for detecting delirium in psychiatric settings. The risk factors associated with delirium primarily included advanced age, physical comorbid, types of psychiatric illness, antipsychotics, anticholinergic drug, Electroconvulsive therapy, and the combination of lithium and Electroconvulsive therapy. Delirium Rating Scale-Revised-98, Memorial Delirium Assessment Scale, and Delirium Diagnostic Tool-Provisional might be valuable for delirium assessment in patients with psychiatric illness in psychiatric settings. Conclusions: Delirium diagnosis in psychiatric settings is complex due to the overlapping clinical manifestations between psychiatric illness and delirium, as well as their potential co-occurrence. It is imperative to understand the risk factors and assessment methods related to delirium in this population to address diagnostic delays, establish effective prevention and screening strategies. Future research should focus on designing, implementing, and evaluating interventions that target modifiable risk factors, to prevent and manage delirium in patients with psychiatric illness. What is already known about the topic?: • Delirium is common among individuals living in psychiatric settings and remains clinically under-detected, and it is associated with the length of hospital stay and poor prognoses. • Dementia with behavioral and psychological symptoms of dementia (BPSD) and other psychiatric illnesses has been shown to make delirium more likely. However, despite extensive research on factors associated with delirium, there is a notable lack of studies conducted in psychiatric settings. • Early detection and identification of delirium are crucial in psychiatric settings; however, literature regarding the assessment and identification of delirium has not been synthesized, particularly in the context of comorbid psychiatric illness. What this paper adds?: • Risk factors associated with delirium in patients with psychiatric illness primarily include advanced age, physical comorbid, types of psychiatric illness, antipsychotics, anticholinergic drug, Electroconvulsive therapy (ECT), and the combination of lithium and ECT. • Delirium Rating Scale-Revised-98, Memorial Delirium Assessment Scale, and Delirium Diagnostic Tool-Provisional might hold promising value as assessment tools for delirium in patients with psychiatric illness in psychiatric settings. [ABSTRACT FROM AUTHOR]

Background: Meaningful involvement of adolescents in health research is their fundamental human right and has many benefits. A lack of awareness among researchers on how to meaningfully involve adolescents in health research has been linked to adolescent under involvement in health research. To address this barrier, studies have reported the need for more guidance. To inform the development of better guidelines on adolescent involvement, there is a need to first consolidate the currently available guidance on adolescent involvement in health research and to identify the gaps in these guidelines. This review aims to systematically identify all the currently available guidelines on adolescent involvement in health research and evaluate their scope, content, context, and quality. Methods: This rapid review was pre‐registered with PROSPERO #CRD42021293586. It included documents that incorporated tangible recommendations on the involvement of adolescents in health research. We searched six databases for peer‐reviewed literature: MEDLINE, CINAHL, Embase, Scopus, Web of Science, and ERIC. We conducted a grey literature search in Google Scholar, Google, websites of 472 relevant organisations and sought expert input. The quality of the guidelines was assessed using the Appraisal of Guidelines for REsearch & Evaluation (AGREE‐II) Instrument. Data was analysed using descriptive analyses and narrative synthesis. Results: We found that the current guidelines on adolescent involvement in health research are often narrow in scope, targeting specific users and populations while focusing on limited research areas. The guidelines individually fail to provide comprehensive coverage of recommendations across all topics related to adolescent research involvement, that are collectively addressed across all included guidelines. Furthermore, these guidelines tend to be context‐specific and are generally of low quality, often due to inadequate stakeholder involvement and a lack of rigorous development methods. Conclusion: This review provides a consolidated list of guidelines on adolescent involvement in health research along with their quality scores as a resource for researchers to select the guidelines suitable for their research topic, context, and scope for adolescent involvement. There is a need to develop a set of guidelines on adolescent involvement in research, which are comprehensive in scope, cover all key aspects of adolescent involvement in health research, can be adapted for different contexts, and which are based on rigorous and systematic methods. Patient and Public Involvement: Adolescent co‐researchers D. B. and C. W. were involved at different stages of the review process. D. B. screened 25% of the peer‐reviewed articles at the title and abstract screening stage and 10% at full‐text screening stage. C. W. extracted data from 10% of the included guidelines. Both co‐researchers reviewed and shared their feedback on the article and are co‐authors on this paper. They will also be invited to contribute to further dissemination of the findings from this review. [ABSTRACT FROM AUTHOR]

Simple Summary: Oral cancer is among the twenty most common cancers worldwide. Finding and treating this cancer early improves survival rates. Screening the whole population to check for oral cancer is unlikely to be an efficient use of resources; however, screening only individuals at higher risk has been shown to reduce oral cancer deaths and be cost-effective for healthcare services. Mathematical models have previously been developed to identify these high-risk groups; however, it is not known whether any of these would be suitable for use in clinical practice. In this study, we identified and compared previously published models. We found several that had potential, but only two had been tested outside the original study population. We suggest that future research should focus on (a) testing how well the models identify those at high risk within potential screening populations and (b) assessing how the models might be included within the healthcare systems. In the last 30 years, there has been an increasing incidence of oral cancer worldwide. Earlier detection of oral cancer has been shown to improve survival rates. However, given the relatively low prevalence of this disease, population-wide screening is likely to be inefficient. Risk prediction models could be used to target screening to those at highest risk or to select individuals for preventative interventions. This review (a) systematically identified published models that predict the development of oral cancer and are suitable for use in the general population and (b) described and compared the identified models, focusing on their development, including risk factors, performance and applicability to risk-stratified screening. A search was carried out in November 2022 in the Medline, Embase and Cochrane Library databases to identify primary research papers that report the development or validation of models predicting the risk of developing oral cancer (cancers of the oral cavity or oropharynx). The PROBAST tool was used to evaluate the risk of bias in the identified studies and the applicability of the models they describe. The search identified 11,222 articles, of which 14 studies (describing 23 models), satisfied the eligibility criteria of this review. The most commonly included risk factors were age (n = 20), alcohol consumption (n = 18) and smoking (n = 17). Six of the included models incorporated genetic information and three used biomarkers as predictors. Including information on human papillomavirus status was shown to improve model performance; however, this was only included in a small number of models. Most of the identified models (n = 13) showed good or excellent discrimination (AUROC > 0.7). Only fourteen models had been validated and only two of these validations were carried out in populations distinct from the model development population (external validation). Conclusions: Several risk prediction models have been identified that could be used to identify individuals at the highest risk of oral cancer within the context of screening programmes. However, external validation of these models in the target population is required, and, subsequently, an assessment of the feasibility of implementation with a risk-stratified screening programme for oral cancer. [ABSTRACT FROM AUTHOR]

Background: In current years, the increase in older population has led to creating one of the main public health challenges, worldwide. Because of the special characteristics of older adults, this age group is exposed to possible problems, such as mental and physical disorders, that usually affect their functional independence. The study aimed to determine the psychosocial determinants (e.g., depression, social support, and self-efficacy) affecting functional independence among older population. Methods: Our search was conducted on three international databases (Web of Sciences, PubMed/Medline, and Scopus) for all the observational studies (cross-sectional, cohort or longitudinal designs) on the social and psychological determinants of functional independence among older adults. Papers published in English without limitation of time were reviewed from inception to 26 August 2023. The quality assessment tool was the Newcastle-Ottawa Scale (NOS). The I2 index was used to quantify the degree of heterogeneity among the studies. In the case of heterogeneity higher than 50%, the random effects model has been used for overall estimation of the effects; otherwise, the fixed effects model was used. The pooled associations were expressed as odds ratio (OR) and 95% confidence intervals (CIs). Stata version 14 software (StataCorp LP) was used for data analysis. The significance level was considered at 0.05. Results: In the initial search, 6978 articles were retrieved, and finally, considering the inclusion criteria, 46 articles were examined. Finally, 18 articles were eligible for meta-analysis. The findings indicated that among all the determinants affecting functional independence among older adults, depression could lead to a 76% increase in functional dependence. Conclusion: The findings provide a statistically significant relationship between psychosocial factors and functional independence. Depression was the strongest determinant of functional dependence among older adults. [ABSTRACT FROM AUTHOR]

Background: Delayed discharge is problematic. It is financially costly and can create barriers to delivering best patient care, by preventing return to usual functioning and delaying admissions of others in need. This systematic review aimed to collate existing evidence on delayed discharge in psychiatric inpatient settings and to develop understanding of factors and outcomes of delays in these services. Methods: A search of relevant literature published between 2002 and 2022 was conducted on Pubmed, PsycInfo and Embase. Studies of any design, which published data on delayed discharge from psychiatric inpatient care in high income countries were included. Studies examining child and adolescent, general medical or forensic settings were excluded. A narrative synthesis method was utilised. Quality of research was appraised using the Mixed Methods Appraisal Tool (MMAT). Results: Eighteen studies from England, Canada, Australia, Ireland, and Norway met the inclusion criteria. Six main reasons for delayed discharge were identified: (1) accommodation needs, (2) challenges securing community or rehabilitation support, (3) funding difficulties, (4) family/carer factors, (5) forensic considerations and (6) person being out of area. Some demographic and clinical factors were also found to relate to delays, such as having a diagnosis of schizophrenia or other psychotic disorder, cognitive impairment, and increased service input prior to admission. Being unemployed and socially isolated were also linked to delays. Only one study commented on consequences of delays for patients, finding they experienced feelings of lack of choice and control. Four studies examined consequences on services, identifying high financial costs. Conclusion: Overall, the findings suggest there are multiple interlinked factors relevant in delayed discharge that should be considered in practice and policy. Suggestions for future research are discussed, including investigating delayed discharge in other high-income countries, examining delayed discharge from child and forensic psychiatric settings, and exploring consequences of delays on patients and staff. We suggest that future research be consistent in terms used to define delayed discharge, to enhance the clarity of the evidence base. Review registration number on PROSPERO: 292515. Date of registration: 9th December 2021. [ABSTRACT FROM AUTHOR]

The World Health Organisation advocates Digital Health Technologies (DHTs) for advancing population health, yet concerns about inequitable outcomes persist. Differences in access and use of DHTs across different demographic groups can contribute to inequities. Academics and policy makers have acknowledged this issue and called for inclusive digital health strategies. This systematic review synthesizes literature on these strategies and assesses facilitators and barriers to their implementation. We searched four large databases for qualitative studies using terms relevant to digital technology, health inequities, and socio-demographic factors associated with digital exclusion summarised by the CLEARS framework (Culture, Limiting conditions, Education, Age, Residence, Socioeconomic status). Following the PRISMA guidelines, 10,401 articles were screened independently by two reviewers, with ten articles meeting our inclusion criteria. Strategies were grouped into either outreach programmes or co-design approaches. Narrative synthesis of these strategies highlighted three key themes: firstly, using user-friendly designs, which included software and website interfaces that were easy to navigate and compatible with existing devices, culturally appropriate content, and engaging features. Secondly, providing supportive infrastructure to users, which included devices, free connectivity, and non-digital options to help access healthcare. Thirdly, providing educational support from family, friends, or professionals to help individuals develop their digital literacy skills to support the use of DHTs. Recommendations for advancing digital health equity include adopting a collaborative working approach to meet users' needs, and using effective advertising to raise awareness of the available support. Further research is needed to assess the feasibility and impact of these recommendations in practice. [ABSTRACT FROM AUTHOR]

(1) Receiving an oncological diagnosis involves countless physical and mental challenges for those who become ill. In addition to this, developmental activities are put on hold when a parent becomes ill, significantly impairing children's normal growth and development. The purpose of this review is to highlight the psychological impact of cancer on children, with particular attention to differences based on the age of the child and the stage of the parent's disease. (2) Articles published on PubMed up until October 2023 were searched. Qualitative and quantitative studies were included in this review after an evaluation of the full text. The study selection process was undertaken by two researchers, and articles for which there was unanimous agreement between researchers were included in the review. (3) Children's psycho-emotional responses differ based on their age and the disease stage. In general, good communication and a supportive family environment that understands everyone's needs seem to constitute important protective factors that favor the adaptation of the entire family to the disease. (4) The family, as an evolutionary system, finds itself facing phases typical of development. Knowing the variables that intervene in the process of adaptation to the disease will allow us to design specific and differentiated clinical interventions based on the needs of not only the patient but also the entire family. [ABSTRACT FROM AUTHOR]

This is the protocol for a Campbell systematic review. The objectives are as follows. The aim of the present review is to synthesize evidence on the effectiveness of interventions for at‐risk families aimed at preventing the out‐of‐home placement of children or increasing the likelihood that children are reunited with their birth families following temporary care arrangements. The review has two objectives: (1) To assess the effectiveness of interventions for at‐risk families with children aged between 0 and 17 years old on measures of out‐of‐home placement and on secondary outcomes. (2) To identify factors that modify intervention effectiveness (e.g., prior placements, parental risk factors such as substance abuse, mental health issues, age, minority status, child risk factors such as disabilities, age, and gender). [ABSTRACT FROM AUTHOR]

Simple Summary: Pancreatic neuroendocrine tumors (PanNETs) and lung NETs (LNETs) have garnered increased attention in recent years due to their diverse clinical manifestations and challenging management. Although the vast majority of both PanNETs and LNETs are sporadic, they can also occur in the context of inherited syndromes that necessitate a high index of suspicion as the course of the disease is different and there are additional clinical implications for other family members. Our systematic review encompasses studies conducted over the past decade, focusing on the incidence, diagnosis, and treatment of PanNETs and/or LNETs encountered in hereditary syndromes such as Multiple Endocrine Neoplasia type 1 (MEN1), MEN4, von Hippel–Lindau (VHL), Tuberous Sclerosis Complex (TSC), and Neurofibromatosis type 1 (NF1). We discuss the importance of early detection and tailored management strategies, emphasizing the need for multidisciplinary collaboration among relevant healthcare professionals to optimize patients' outcomes. Moreover, we highlight the importance of active surveillance strategies for early tumor detection in high-risk individuals and the evolving landscape of personalized medicine for targeted intervention. Pancreatic neuroendocrine tumors (PanNETs) and lung NETs (LNETs) represent a rare but clinically significant subgroup of neoplasms. While the majority is sporadic, approximately 17% of PanNETs and a subset of LNETs develop in the context of monogenic familial tumor syndromes, especially multiple endocrine neoplasia type 1 (MEN1) syndrome. Other inherited syndromes associated with PanNETs include MEN4, von Hippel–Lindau (VHL) syndrome, neurofibromatosis type 1 (NF1), and tuberous sclerosis complex (TSC). These syndromes are highly penetrant and their clinical manifestations may vary even among members of the same family. They are attributed to genetic mutations involving key molecular pathways regulating cell growth, differentiation, and angiogenesis. Pancreatic NETs in hereditary syndromes are often multiple, develop at a younger age compared to sporadic tumors, and are associated with endocrine and nonendocrine tumors derived from multiple organs. Lung NETs are not as common as PanNETs and are mostly encountered in MEN1 syndrome and include typical and atypical lung carcinoids. Early detection of PanNETs and LNETs related to inherited syndromes is crucial, and specific follow-up protocols need to be employed to optimize diagnosis and management. Genetic screening is recommended in childhood, and diagnostic screening starts often in adolescence, even in asymptomatic mutation carriers. Optimal management and therapeutic decisions should be made in the context of a multidisciplinary team in specialized centers, whereas specific biomarkers aiming to identify patients denoted to follow a more aggressive course need to be developed. [ABSTRACT FROM AUTHOR]

(1) Background: Social isolation, which has numerous adverse effects on health status, is prevalent among cancer patients. This review proposes to identify the influencing factors of social isolation among cancer patients. (2) Methods: Articles published in English or Chinese from six electronic databases before December 2023 were identified via a systematic search. A manual search was also performed. (3) Results: Twenty-eight studies were identified in this systematic review. The factors associated with social isolation can be summarized into the following categories: demographic characteristics, having cancer, health status, coping, social support and social interaction. Despite the heterogeneity, 20 factors were significantly associated with social isolation, including age, gender, comorbidity burden, education level, residence, medical insurance, occupation status, personality, race, smoking status, having children, not living alone, household income level, marital status, the role of primary caregiver, physical health status, mental health status, social health status, coping styles, and the level of social support and social interaction. (4) Conclusions: The systematic review showed that cancer patients' social isolation was influenced by their demographic characteristics, cancer-related factors, physical condition, psychological status, social health status, coping styles, and level of social support and social interaction. In addition, future group intervention could be considered to improve social isolation. [ABSTRACT FROM AUTHOR]

Background: Maximal strength may contribute to soccer players' performance. Several resistance training modalities offer the potential to improve maximal strength. During recent years, a large number of plyometric jump training (PJT) studies showed evidence for maximal strength improvements in soccer players. However, a comprehensive summary of the available data is lacking. Objective: To examine the effects of PJT compared with active, passive or intervention controls on the maximal strength of soccer players, irrespective of age, sex or competitive level. Methods: To perform a systematic review with meta-analysis following PRISMA 2020. Three electronic databases (PubMed, Web of Science, and SCOPUS) were systematically searched. Studies published from inception until March 2023 were included. A PICOS approach was used to rate studies for eligibility. The PEDro scale was used to assess risk of bias. Meta-analyses were performed using the DerSimonian and Laird random-effects model if ≥ 3 studies were available. Moderator and sensitivity analyses were performed, and meta-regression was conducted when ≥ 10 studies were available for a given comparison. We rated the certainty of evidence using GRADE. Results: The search identified 13,029 documents, and from these 30 studies were eligible for the systematic review, and 27 for the meta-analyses. Overall, 1,274 soccer players aged 10.7–25.0 years participated in the included studies. Only one study recruited females. The PJT interventions lasted between 5 and 40 weeks (median = 8 weeks), with 1–3 weekly sessions. Compared to controls, PJT improved maximal dynamic strength (18 studies, 632 participants [7 females], aged 12.7–24.5 y; effect size [ES] = 0.43, 95% confidence interval [CI] = 0.08–0.78, p = 0.017, impact of statistical heterogeneity [I2] = 77.9%), isometric strength (7 studies; 245 participants, males, aged 11.1–22.5 y; ES = 0.58, 95% CI = 0.28–0.87, p < 0.001, I2 = 17.7%), and isokinetic peak torque (5 studies; 183 participants, males, aged 12.6–25.0 y; ES = 0.51, 95% CI = 0.22–0.80, p = 0.001, I2 = 0.0%). The PJT-induced maximal dynamic strength changes were independent of participants' age (median = 18.0 y), weeks of intervention (median = 8 weeks), and total number of training sessions (median = 16 sessions). The certainty of evidence was considered low to very low for the main analyses. Conclusions: Interventions involving PJT are more effective to improve maximal strength in soccer players compared to control conditions involving traditional sport-specific training. Trial Registration The trial registration protocol was published on the Open Science Framework (OSF) platform in December 2022, with the following links to the project (https://osf.io/rpxjk) and to the registration (https://osf.io/3ruyj). Key Points: Plyometric jump training is an easy-to-administer training regime that can be performed on the soccer pitch and may have the potential to improve maximal strength in soccer players. Findings from this meta-analysis including 1274 soccer players indicate maximal strength improvements after plyometric jump training, with similar effects for youth and adult players, and with < 8 vs. ≥ 8 weeks or < 16 vs. ≥ 16 sessions [ABSTRACT FROM AUTHOR]

Endoscopy-related musculoskeletal injuries (ERIs) are frequent among gastrointestinal, pulmonary, nasal, and urologic endoscopists, impacting the healthcare system. The present review aims to compare the ERI rates, risk factors, and ergonomic recommendations in the different endoscopic fields. A review was conducted using PubMed and Cochrane Library for articles based on surveys and published until 10 January 2024. Demographic, work, and ERI data from 46 publications were included, covering 10,539 responders. The ERI incidence ranged between 14% and 97%, highlighting the need of intervention independent of the specialties. The neck, back, and shoulder were the most frequent ERI locations, while gender, age, years of experience, and procedure volume the most common risk factors. Ergonomic recommendations suggest concentrating on endoscope design changes, especially in gastrointestinal endoscopy, to increase the comfort, adaptability of the equipment in the operating room, and workflow/institutional policy changes. The inclusion of an ergonomic timeout guarantees the correct equipment positioning, the neutralisation of the endoscopist's posture, and an indirect break between procedures. Ergonomic training to increase awareness and best practice should be promoted, also using new technologies. Future research should concentrate on intervention and comparative studies to evaluate to which extent prevention measures and newly designed equipment could reduce ERI incidence. [ABSTRACT FROM AUTHOR]

Background: Calcitonin gene-related peptide (CGRP) is the most promising candidate to become the first migraine biomarker. However, literature shows clashing results and suggests a methodological source for such discrepancies. We aimed to investigate some of these methodological factors to evaluate the actual role of CGRP as biomarker. Methods: Previous to the experimental part, we performed a literature review of articles measuring CGRP in migraine patients. Using our 399 bio-bank sera samples, we performed a series of experiments to test the validity of different ELISA kits employed, time of sample processing, long-term storage, sampling in rest or after moderate exercise. Analysis of in-house data was performed to analyse average levels of the peptide and the effect of sex and age. Results: Literature review shows the high variability in terms of study design, determination methods, results and conclusions obtained by studies including CGRP determinations in migraine patients. CGRP measurements depends on the method and specific kit employed, also on the isoform detected, showing completely different ranges of concentrations. Alpha-CGRP and beta-CGRP had median with IQR levels of 37.5 (28.2–54.4) and 4.6 (2.4–6.4)pg/mL, respectively. CGRP content is preserved in serum within the 24 first hours when samples are stored at 4°C after clotting and immediate centrifugation. Storages at -80°C of more than 6 months result in a decrease in CGRP levels. Moderate exercise prior to blood extraction does not modulate the concentration of the peptide. Age positively correlates with beta-CGRP content and men have higher alpha-CGRP levels than women. Conclusions: We present valuable information for CGRP measurements in serum. ELISA kit suitability should be tested prior to the experiments. Alpha and beta-CGRP levels should be analysed separately as they can show different behaviours even within the same condition. Samples can be processed in a 24-h window if they have been kept in 4°C and should not be stored for more than 6 months at -80°C before assayed. Patients do not need to rest before the blood extraction unless they have performed a high-endurance exercise. For comparative studies, sex and age should be accounted for as these parameters can impact CGRP concentrations. [ABSTRACT FROM AUTHOR]

Background: Conservative management is recommended as the first therapeutic step in chronic low back pain (LBP), but there is no available evidence regarding the possible effect of patients' baseline characteristics on the therapeutic outcomes. A systematic review of the literature was performed to investigate this point. Methods: In February 2024, all the level I studies investigating the role of pharmacological management for chronic LBP were accessed. Data concerning the patient demographic at baseline were collected: number of patients and related mean BMI and age, duration of the symptoms, duration of the follow-up, percentage of females, Numeric Rating Scale (NRS), the Roland Morris Disability Questionnaire (RMQ), Oswestry Disability Index (ODI). The outcomes at the last follow-up were evaluated through NRS, RMQ, and ODI. A multiple linear model regression diagnostic through the Pearson Product-Moment Correlation Coefficient (r) was used. Results: Data from 47 articles (9007 patients) were obtained. The analysis yielded the following significant associations: age at baseline and NRS at follow-up (r = − 0.22; P = 0.04), NRS at baseline with NRS (r = 0.26; P = 0.03) and RMQ (r = − 0.58; P = 0.02) at follow-up, RMQ at baseline and the same at follow-up (r = 0.69; P = 0.0001). Conclusion: Older age, higher BMI, presence of comorbidities, higher ODI and a long history of symptoms or surgical treatments do not reduce the efficacy of pharmacological management of chronic LBP. However, pharmacological therapy is not an effective option for patients with high baseline RMQ. Level of evidence: I systematic review of RCTs. [ABSTRACT FROM AUTHOR]

This study aimed to identify the individual, organizational, and environmental factors which contributed to COVID-19-related outcomes in long-term care facilities (LTCFs). A systematic review was conducted to summarize and synthesize empirical studies using a multi-level analysis approach to address the identified influential factors. Five databases were searched on 23 May 2023. To be included in the review, studies had to be published in peer-reviewed journals or as grey literature containing relevant statistical data. The Joanna Briggs Institute critical appraisal tool was employed to assess the methodological quality of each article included in this study. Of 2137 citations identified after exclusions, 99 records met the inclusion criteria. The predominant individual, organizational, and environmental factors that were most frequently found associated with the COVID-19 outbreak comprised older age, higher dependency level; lower staffing levels and lower star and subset domain ratings for the facility; and occupancy metrics and co-occurrences of outbreaks in counties and communities where the LTCFs were located, respectively. The primary individual, organizational, and environmental factors frequently linked to COVID-19-related deaths comprised age, and male sex; higher percentages of racial and ethnic minorities in LTCFs, as well as ownership types (including private, for-profit, and chain membership); and higher occupancy metrics and LTCF's size and bed capacity, respectively. Unfolding the risk factors collectively may mitigate the risk of outbreaks and pandemic-related mortality in LTCFs during future endemic and pandemics through developing and improving interventions that address those significant factors. [ABSTRACT FROM AUTHOR]

The purpose of the meta‐analysis was to evaluate and compare the risk factors for neurosurgical surgical site infection (SSI) after craniotomy. Using dichotomous or contentious random or fixed effect models, the odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CIs) were computed based on the examination of the meta‐analysis results. Eighteen analyses, covering 11 068 craniotomies between 2001 and 2023, were included in the current meta‐analysis. Subjects with SSIs had a significantly younger age (MD, −2.49; 95% CI, −2.95 to −2.04, p < 0.001), longer operation duration (MD, 10.21; 95% CI, 6.49–13.94, p < 0.001) and longer length of postoperative hospital stay (MD, 1.52; 95% CI, 0.45–2.60, p = 0.006) compared to subjects with no SSI with craniotomy. However, no significant difference was found between craniotomy subjects with SSIs and with no SSI in gender (OR, 0.90; 95% CI, 0.76–1.07, p = 0.23), and combination with other infection (OR, 3.93; 95% CI, 0.28–56.01, p = 0.31). The data that were looked at showed that younger age, longer operation duration and longer length of postoperative hospital stay can be considered as risk factors of SSI in subjects with craniotomy; however, gender and combination with other infections are not. Nonetheless, consideration should be given to their values because several studies only involved a small number of patients, and there are not many studies available for some comparisons. [ABSTRACT FROM AUTHOR]

Background: In recent years, new technologies such as the introduction of the smartphone and the tablet in everyday life and habits have often made adolescents sedentary. It is becoming a serious problem in society. It is important to propose, as soon as possible, proper and feasible programs to modify this trend. A solution should be to increase physical activity, reducing sedentary behaviors. Adopting dogs and walking and playing with them could be a solution, and the population should be sensitized about this aspect. Consequently, the objective of this scoping revision of the literature is to analyze the association between physical activity in adolescents and the presence of a dog in the family. Methods: Three electronic databases were screened until 21 February 2024. The detected articles were screened against the eligibility criteria. The results were narratively discussed. Results: After the screening process, a total of four studies were included. The studies presented heterogeneity in the physical activity assessment. This made it hard to synthesize the results. Indicatively, there is a positive association between physical activity and dog ownership. Conclusions: walking and playing with the dog increase the physical activity level of adolescents. Therefore, a sensibilization campaign should highlight the importance of having dogs in families, especially in adolescence. It is fundamental to daily walk and play with them. [ABSTRACT FROM AUTHOR]

Simple Summary: In a comprehensive analysis of phase 3 clinical trials, including the two FLAIR sub-studies, ECOG1912, and the CLL13 trials, we assessed the impact of first-line treatments with targeted agents (TAs), or fludarabine, cyclophosphamide, and rituximab (FCR)-based chemo-immunotherapy (CIT), on overall survival (OS) compared to age- and sex-matched individuals in the general population. TAs demonstrated a higher 5-year restricted mean survival time (RMST) (58.1 months; 95% CI: 57.4 to 58.8) compared to CIT (5-year RMST, 56.9 months; 95% CI: 56.7–58.2). Moreover, the comparison with age- and gender-matched general populations (AGMGP) suggested that TAs may mitigate CLL's impact on OS during the first five years post-treatment initiation. In contrast, CLL patients treated with FCR exhibited sustained OS differences compared to both the Italian and US AGMGP cohorts. These results support TAs as the preferred first-line treatment for younger/fit CLL patients but imply the need for a careful interpretation due to variations in patient selection criteria and clinical profiles across trials. Longer follow-up is essential to assess the survival improvement of younger CLL patients treated with TAs relative to the AGMGP. To assess the impact of first-line treatment with targeted agents (TAs) or fludarabine, cyclophosphamide, and rituximab (FCR)-based chemo-immunotherapy (CIT) on overall survival (OS) compared to age- and sex-matched individuals in the general population, we conducted an aggregated analysis of phase 3 clinical trials, including the two FLAIR sub-studies, ECOG1912, and CLL13 trials. The restricted mean survival time (RMST), an alternative measure in outcome analyses capturing OS changes over the entire history of the disease, was used to minimize biases associated with the short follow-up time of trials. Patients treated with TAs demonstrated a higher 5-year RMST (58.1 months; 95% CI: 57.4 to 58.8) compared to those treated with CIT (5-year RMST, 56.9 months; 95% CI: 56.7–58.2). Furthermore, the OS comparison of treatment groups with the AGMGP suggests that TAs may mitigate the impact of CLL on OS during the first five years post-treatment initiation. In summary, the 5-year RMST difference was −0.4 months (95% CI: −0.8 to 0.2; p = 0.10) when comparing CLL patients treated with TAs to the Italian age- and gender-matched general population (AGMGP). A similar trend was observed when CLL patients treated with TAs were compared to the US AGMGP (5-year RMST difference, 0.3 months; 95% CI: −0.1 to 0.9; p = 0.12). In contrast, CLL patients treated with FCR exhibited sustained OS differences when compared to both the Italian cohort (5-year RMST difference: −1.6 months; 95% CI: −2.4 to −0.9; p < 0.0001) and the US AGMGP cohort (5-year RMST difference: −0.9 months; 95% CI: −1.7 to −0.2; p = 0.015). Although these results support TAs as the preferred first-line treatment for younger CLL patients, it is crucial to acknowledge that variations in patient selection criteria and clinical profiles across clinical trials necessitate a cautious interpretation of these findings that should be viewed as directional and hypothesis-generating. A longer follow-up is needed to assess the survival improvement of younger CLL patients treated with TAs relative to the AGMGP. [ABSTRACT FROM AUTHOR]

(1) Background: The aim of this study was to review the scope of the existing scientific literature on creating safe and inclusive healthcare environments for transgender people and provide an overview of the resources and nursing skills required to do so. (2) Methods: With the research question in mind, an exploratory search of six databases was conducted to identify all relevant primary studies. After screening and selection of articles based on the inclusion and exclusion criteria, a total of 41 articles were included and reviewed. (3) Results: The results were classified under four headings: the training of health professionals, the creation of safe spaces, the nurse as facilitator, and best care practice. Most of the evidence indicates that it is essential for nurses and other healthcare staff to be trained in specific skills to provide comprehensive, high-quality care to transgender people; however, there is a lack of material and human resources to do so. (4) Conclusions: The trans-inclusive care competent nurse should use neutral language that respects the person's preferred name and pronouns in a safe healthcare environment that offers and ensures warmth, respect, and inclusivity in the care provided. This study was registered with the Open Science Framework (OSF) on 9 January 2024 (osf.io/rpj6a). [ABSTRACT FROM AUTHOR]

Delayed discharge for non-clinical reasons is defined as a period of stay that continues after a patient has been deemed medically fit to leave the hospital but is unable to do so for non-medical reasons. This circumstance overburdens the healthcare system and constitutes a major problem for healthcare systems and the patients themselves in this situation. The aim of this study was to evaluate the delay in effective discharge for non-medical reasons for patients admitted to acute care hospitals in Spain. A scoping review followed the Joanna Briggs Institute methodology guidelines to search for and synthesize studies published between 2019 and 2022. To identify potentially relevant documents, the following bibliographic databases were searched: EMBASE, CINAHL and MEDLINE. For the search, we used free terms («delayed discharges», «discharge delays», «bed-blocking», «timely discharge», «unnecessary days» and «inappropriate stays»). Quantitative or qualitative studies published in scientific journals on delayed effective discharge for non-medical reasons for patients admitted to a hospital for any health issue of medical or surgical origin were selected. Information collection of the documents was performed using a structured datasheet specifically developed by the authors. The initial search strategy identified a total of 124 references, which were successively screened to a final selection of 13 studies. To conclude, delayed discharge from a hospital for non-clinical reasons is a multifactorial problem. This may be due to factors internal or external to the hospital, as well as personal factors. The main causes of the delay were similar among the studies found, as were the clinical characteristics of the patients, most of whom were elderly, frail and more dependent due to declining functional capacities. Further studies addressing the socio-familial characteristics of the patients and the perspective of the patient and families would be necessary. [ABSTRACT FROM AUTHOR]

This systematic review was conducted with the objective of understanding the efficacy and safety of proton pump inhibitors (PPIs) in the pediatric population. We used PubMed to identify randomized controlled trials (RCTs) published between 1 June 2010 and 30 June 2023, performed in patients from birth to 18 years old with gastroesophageal reflux disease (GERD) who received treatment with any PPI. This literature search yielded 76 articles and 13 of these met the inclusion criteria. For infants, PPIs were equal to placebos in reducing GERD symptoms in four articles. In one article, the numbers of GER episodes and esophageal acid exposures were lower in infants who received PPIs in the left lateral position, but there was generally no significant improvement in symptoms. In another publication, the combination of PPIs and feeding modifications (FMs) was not more effective than PPIs alone. For children and adolescents, PPIs were effective in improving symptoms and achieving endoscopic healing, which was subsequently maintained. To conclude, PPIs are not effective in reducing the symptoms related to GERD in infants but are effective in older children, where histological remission can be seen. Generally, PPIs are well tolerated, but it is important to remember the possible adverse events (AEs), especially if PPIs are used for an extended period. [ABSTRACT FROM AUTHOR]

Introduction. Cancer screening programmes for cervical, breast, and colorectal cancer have successfully reduced mortality rates among target groups. However, a large proportion of women and men are unscreened. Aim. This review aims to provide an overview of the literature regarding the determinants of cancer screening participation among target groups in Queensland. Methods. Electronic databases were searched for studies on determinants of cancer screening participation in Queensland. Retrieved studies were screened, and eligible articles were selected for data extraction. Both peer-reviewed and grey literature studies were included. The determinants of cancer screening participation were classified according to the I-Change model. Results. Sixteen out of 75 articles were selected and analysed. Information factors, such as the lack of tailored strategies, determined cancer screening participation. Age, gender, cultural beliefs, fear and past experiences were the most reported predisposing factors to cancer screening participation. Lack of knowledge, misconceptions, low awareness, timely access to service, privacy and confidentiality were mainly reported awareness and motivation factors. Encouragement from health professionals, providing more information and interactions with communities would result in different effects on cancer screening participation among the target groups. Discussion. The I-Change model is a valuable tool in mapping the current determinants of cancer screening participation programs. Further research may be needed to fully understand the barriers and facilitators of cancer screening programs. [ABSTRACT FROM AUTHOR]

Background: Heart failure (HF) is a prevalent condition worldwide. HF self-care is a set of behaviors necessary for improving patient outcomes. This study aims to review and summarize the individual and system-related factors associated with HF self-care published in the last seven years (Jan 2015 – Dec 2021) using the Socioecological Model as a review framework. Methods: An experienced nursing librarian assisted authors in literature searches of CINAHL Plus with Full Text, Ovid Nursing, PsychINFO, and PubMed databases for peer-reviewed descriptive studies. Inclusion criteria were HF sample with self-care as the outcome variable, and a quantitative descriptive design describing individual and/or system-level factors associated with self-care. Exclusion criteria were interventional or qualitative studies, reviews, published before 2015, non-English, and only one self-care behavior as the outcome variable. The search yielded 1,649 articles. Duplicates were removed, 710 articles were screened, and 90 were included in the full-text review. Results: A subset of 52 articles met inclusion and exclusion criteria. Study quality was evaluated using modified STROBE criteria. Study findings were quantitated and displayed based on socioecological levels. Self-care confidence, HF knowledge, education level, health literacy, social support, age, depressive symptoms, and cognitive dysfunction were the most frequently cited variables associated with self-care. Most factors measured were at the individual level of the Socioecological Model. There were some factors measured at the microsystem level and none measured at the exosystem or macrosystem level. Conclusion: Researchers need to balance the investigation of individual behaviors that are associated with HF self-care with system-level factors that may be associated with self-care to better address health disparities and inequity. [ABSTRACT FROM AUTHOR]

Objectives: To examine the impact of displacement experiences on 0- to 6-year-old children's social-emotional and cognitive development, as well as influencing factors on reported outcomes. Study design: We systematically searched MEDline, Psyndex, Cochrane Library, Web of Science, Elsevier, TandF, Oxford Journal of Refugee Studies, Journal of Immigrant & Refugee Studies, and Canada's Journal on Refugees for existing literature regarding social-emotional and cognitive outcomes in children directly exposed to forced displacement due to political violence. Results were synthesized in the discussion and displayed using harvest plots. Results: Our search generated 9,791 articles of which 32 were selected for review and evaluation according to NICE criteria. Included studies provided results for 6,878 forcibly displaced children. Measured outcomes were diverse and included areas such as peer relations, prosocial behavior, family functioning, play, intelligence, learning performance, and language development. Repeated exposure to adverse experiences, separation from parents, parental distress, as well as duration and quality of resettlement in the host country were reported as influencing factors in the reviewed studies. Conclusion: As protective factors like secure and stable living conditions help to promote children's development, we call for policies that enhance participation in the welcoming society for refugee families. Early integration with low-threshold access to health and educational facilities can help to mitigate the wide-ranging negative consequences of forced displacement on young children's development. [ABSTRACT FROM AUTHOR]

Background: Hospital-acquired pressure injuries are a major patient safety concern in intensive care units that are considered largely preventable adverse events by adherence to nursing standards of care. The hypothesis of this research was to investigate the prevalence of hospital-acquired pressure injuries in intensive care units (ICUs) of the Eastern Mediterranean Region. Methods: This study was designed as a systematic review and meta-analysis. All articles published on Pressure ulcer prevalence in the ICUs of hospitals in Eastern Mediterranean Region countries, identified by searching PubMed through MEDLINE, Web of Science, Scopus, and Google Scholar from January 1, 2011, until September 22, 2023. The reference lists of these articles were checked for additional relevant studies. Data were analyzed using the Comprehensive Meta-Analysis Software (v.2.2.064). Results: A total of 15 articles met the inclusion criteria. Based on the random-effects model, the overall Pressure ulcer prevalence rate was 16.6% (95% CI (8.6-29.6)). Both the highest and lowest prevalence was observed in Jordan in 2011 at 83.1% (95% CI (71.2- 90.7)) and in 2012 at 0.9% (95% CI (0.5- 1.5)), respectively. The results showed that publication year, average age, and sample size were the main causes of heterogeneity between the reviewed studies (p < 0.05). Conclusion: This systematic review and meta-analysis of the pertinent peer-reviewed literature revealed a high prevalence of hospital-acquired pressure injuries of 16% in intensive care units of Eastern Mediterranean region. Therefore, it is necessary for health policymakers and managers in Eastern Mediterranean Region to take necessary measures to prevent the incidence of Pressure ulcers in hospitals, especially in ICUs. [ABSTRACT FROM AUTHOR]

Simple Summary: With ageing, the number of pancreaticoduodenectomies (PD) for benign or malignant disease is expected to increase in elderly patients. The aim of the present meta-analysis is to compare the surgical outcomes of MIPD in elderly versus younger patients. The results of our analysis disclose no considerable differences in terms of technical and post-operative outcomes between the two groups. However, slightly higher, but acceptable, major complication and mortality rates were recorded in the elderly cohort. Although the real additional value of minimally invasive surgery in this frailty subset of patients needs to be further investigated, our findings reveal that MIPD seems to be relatively safe and feasible in elderly patients. (1) Background: With ageing, the number of pancreaticoduodenectomies (PD) for benign or malignant disease is expected to increase in elderly patients. However, whether minimally invasive pancreaticoduodenectomy (MIPD) should be performed in the elderly is not clear yet and it is still debated. (2) Materials and Methods: A systematic review and meta-analysis was conducted including seven published articles comparing the technical and post-operative outcomes of MIPD in elderly versus younger patients up to December 2022. (3) Results: In total, 1378 patients were included in the meta-analysis. In term of overall and Clavien–Dindo I/II complication rates, post-operative pancreatic fistula (POPF) grade > A rates and biliary leakage, abdominal collection, post-operative bleeding and delayed gastric emptying rates, no differences emerged between the two groups. However, this study showed slightly higher intraoperative blood loss [MD 43.41, (95%CI 14.45, 72.38) p = 0.003], Clavien–Dindo ≥ III complication rates [OR 1.87, (95%CI 1.13, 3.11) p = 0.02] and mortality rates [OR 2.61, (95%CI 1.20, 5.68) p = 0.02] in the elderly compared with the younger group. Interestingly, as a minor endpoint, no differences in terms of the mean number of harvested lymphnode and of R0 resection rates were found. (4) Conclusion: MIPD seems to be relatively safe; however, there are slightly higher major morbidity, lung complication and mortality rates in elderly patients, who potentially represent the individuals that may benefit the most from the minimally invasive approach. [ABSTRACT FROM AUTHOR]

Background: Despite the increasing number of research studies examining the effects of age on the control of posture, the number of annual fall-related injuries and deaths continues to increase. A better understanding of how old age affects the neural mechanisms of postural control and how countermeasures such as balance training could improve the neural control of posture to reduce falls in older individuals is therefore necessary. The aim of this review is to determine the effects of age on the neural correlates of balance skill learning measured during static (standing) and dynamic (walking) balance tasks in healthy individuals. Methods: We determined the effects of acute (1–3 sessions) and chronic (> 3 sessions) balance skill training on balance in the trained and in untrained, transfer balance tasks through a systematic review and quantified these effects by robust variance estimation meta-analysis in combination with meta-regression. We systematically searched PubMed, Web of Science, and Cochrane databases. Balance performance and neural plasticity outcomes were extracted and included in the systematic synthesis and meta-analysis. Results: Forty-two studies (n = 622 young, n = 699 older individuals) were included in the systematic synthesis. Seventeen studies with 508 in-analysis participants were eligible for a meta-analysis. The overall analysis revealed that acute and chronic balance training had a large effect on the neural correlates of balance skill learning in the two age groups combined (g = 0.79, p < 0.01). Both age groups similarly improved balance skill performance in 1–3 training sessions and showed little further improvements with additional sessions. Improvements in balance performance mainly occurred in the trained and less so in the non-trained (i.e., transfer) balance tasks. The systematic synthesis and meta-analysis suggested little correspondence between improved balance skills and changes in spinal, cortical, and corticospinal excitability measures in the two age groups and between the time courses of changes in balance skills and neural correlates. Conclusions: Balance skill learning and the accompanying neural adaptations occur rapidly and independently of age with little to no training dose-dependence or correspondence between behavioral and neural adaptations. Of the five types of neural correlates examined, changes in only spinal excitability seemed to differ between age groups. However, age or training dose in terms of duration did not moderate the effects of balance training on the changes in any of the neural correlates. The behavioral and neural mechanisms of strong task-specificity and the time course of skill retention remain unclear and require further studies in young and older individuals. Registration: PROSPERO registration number: CRD42022349573. Key Points: We examined the effects of balance training on balance performance, and its neural correlates in healthy younger (n = 21 studies) and older individuals (n = 18 studies) Balance training improves the trained balance skill rapidly, i.e., 30–40 min Balance training improves the non-trained balance skills (i.e., transfer tasks) much less or not at all Balance training improves neural measures independently of age and training dose Age and training duration do not moderate the training-induced changes in the neural correlates of balance learning There is little-to-no temporal correspondence between improvements in balance skills and the neural correlates examined [ABSTRACT FROM AUTHOR]

Aim: To describe current scientific knowledge on cognitive impairment and emotional disturbances (anxiety and depression) in younger adult patients after ischemic stroke. Design: A scoping review. Methods: For the search, the following scientific databases were utilized: Web of Science, MEDLINE (Ovid), ScienceDirect (Elsevier), PsycInfo (EBSCO), Scopus (Elsevier), and ProQuest. Relevant studies were identified by searching publications from 2000 to July 2023. Results: A total of eight studies were ultimately included in the review. Cognitive impairment occurred in a range between 39.4% and 40%. This encompassed various aspects of cognitive function, such as working memory, processing speed, global cognitive function, immediate and delayed memory, attention, and executive functioning. Depression had an incidence rate ranging from 10.8% to 16.8%. Several risk factors were associated with a higher likelihood of developing generalized anxiety. These included younger age, more depressive symptoms, lower education, unemployment, a history of depression, and alcohol use. In the context of depressive symptoms, a higher risk was linked to lower education and unemployment. Conclusion: The included studies highlighted the need to assess these issues not only at the time of patient discharge but, more importantly, during the stage of further recovery. This can contribute to the creation of tailored interventions for these individuals. [ABSTRACT FROM AUTHOR]

Background. ADHD is a neurodevelopmental disorder that is accompanied by executive challenges. Objectives. To obtain evidence of the usefulness of the BRIEF-P and to analyze the possible ceiling and floor effect of its scores in the assessment of executive function in preschoolers with signs compatible with a possible diagnosis of ADHD. Method. A search was performed in Science Direct, NCBI (PubMed), and ProQuest Education Journals during the period 2012–2022. We included studies that evaluated samples of individuals with symptomatology compatible with ADHD, with an age range between 2 and 6 years, published in English or Spanish. Of a total of 2538 articles, only seven met the inclusion criteria. The risk of bias was assessed using the QUADAS-2 questionnaire. The main variables were age and executive functioning. Conclusions. Executive deficits in early-age individuals with symptoms compatible with ADHD are more extensive than just deficits in working memory. A floor effect has been found in tests associated with hot executive functions and a ceiling effect in cold executive functions. This makes it necessary to use different tests to assess executive performance in preschoolers with ADHD-compatible symptomatology and to design intervention proposals accordingly. The BRIEF-P is an instrument that facilitates obtaining a sensitive and discriminative executive profile, although it should be used in combination with other neuropsychological performance tests. [ABSTRACT FROM AUTHOR]