Pub Date : 2025-12-19DOI: 10.1002/14651858.CD015458
Daniel Dümmler, Stefanie Eck, Alexander Hapfelmeier, Alexey Fomenko, Zekeriya Aktürk, Clara Teusen, Victoria von Schrottenberg, Sarah Dawson, Klaus Linde, Antonius Schneider
<p><strong>Background: </strong>Anxiety disorders are highly prevalent mental health conditions, yet frequently remain undiagnosed. The State-Trait Anxiety Inventory (STAI) is one of the most widely used self-report questionnaires for assessing both momentary (state) and general (trait) anxiety severity. As it has also been considered for screening, it is essential to evaluate its accuracy in identifying undiagnosed anxiety disorders.</p><p><strong>Objectives: </strong>To assess the diagnostic test accuracy (DTA) of the State-Trait Anxiety Inventory (STAI) for detecting anxiety disorders in adults. We specifically aimed to determine accuracy estimates for the full range of sum score cut-offs and grouped our analyses by the STAI's two subscales, State Anxiety subscale (STAI-S) and Trait Anxiety subscale (STAI-T), assessing the target condition category 'any anxiety disorder' (AAD) as well as 'generalised anxiety disorder' (GAD) as one of its specific conditions.</p><p><strong>Search methods: </strong>We conducted a comprehensive search in Ovid Embase, MEDLINE, PubMed-not-MEDLINE, and PsycINFO (1990 to 15 May 2024). We also screened reference lists of included studies and relevant systematic reviews.</p><p><strong>Selection criteria: </strong>We included studies of adults that administered the STAI irrespective of mode, with no limitations on the language or number of participants. We excluded studies on adults seeking help in mental health settings or participants who were recruited specifically due to mental health symptoms in other settings. Eligible studies administered the STAI as the index test and used a structured or semi-structured diagnostic interview as the reference standard, allowing the creation of 2 x 2 contingency tables. We excluded studies following a case-control design and studies with a time lag of more than four weeks between the STAI and the reference standard.</p><p><strong>Data collection and analysis: </strong>At least two review authors independently assessed the eligibility of articles, extracted data, and evaluated the methodological quality using the Quality Assessment of Diagnostic Accuracy Studies tool, version 2 (QUADAS-2). We applied the multiple thresholds model to obtain summary sensitivity and specificity with 95% confidence intervals (CIs) across all cut-offs (from ≥ 20 to 80). Using the multiple-threshold summary receiver operating characteristic (SROC) curve, we calculated the area under the curve (AUC) as an overall measure of accuracy.</p><p><strong>Main results: </strong>We included 12 studies from 11 countries with a total of 2525 participants, of whom 475 had an anxiety disorder. Of these, 11 studies assessed the state anxiety subscale, STAI-S (2042 participants) and eight studies assessed the trait anxiety subscale, STAI-T (1906 participants). The diagnoses made by the reference standards were all ultimately based on criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (
背景：焦虑症是一种非常普遍的精神健康状况，但往往仍未得到诊断。状态-特质焦虑量表（state - trait Anxiety Inventory，简称STAI）是一种应用最广泛的自我报告问卷，用于评估瞬时（状态）焦虑和一般（特质）焦虑的严重程度。由于它也被考虑用于筛查，因此评估其在识别未确诊焦虑症方面的准确性至关重要。目的：评价状态-特质焦虑量表（STAI）对成人焦虑障碍的诊断准确性。我们特别旨在确定全范围的总分数截断值的准确性估计，并通过STAI的两个子量表，状态焦虑子量表（STAI- s）和特质焦虑子量表（STAI- t）对我们的分析进行分组，评估目标条件类别“任何焦虑症”（AAD）以及“广泛性焦虑症”（GAD）作为其特定条件之一。检索方法：我们对Ovid Embase、MEDLINE、PubMed-not-MEDLINE和PsycINFO（1990 - 2024年5月15日）进行了综合检索。我们还筛选了纳入研究的参考文献和相关的系统综述。选择标准：我们纳入了使用STAI的成人研究，不考虑模式，没有语言或参与者数量的限制。我们排除了在心理健康机构寻求帮助的成年人的研究或在其他环境中因心理健康症状而被招募的参与者。符合条件的研究使用STAI作为索引测试，并使用结构化或半结构化诊断访谈作为参考标准，允许创建2 × 2列联表。我们排除了遵循病例对照设计的研究以及STAI与参考标准之间的时间滞后超过四周的研究。数据收集和分析：至少两名综述作者独立评估文章的合格性，提取数据，并使用诊断准确性研究质量评估工具，版本2 （QUADAS-2）评估方法学质量。我们应用多阈值模型获得所有截止值（≥20至80）的95%置信区间（ci）的总灵敏度和特异性。使用多阈值汇总接收者工作特征（SROC）曲线，我们计算曲线下面积（AUC）作为准确度的总体衡量标准。主要结果：我们纳入了来自11个国家的12项研究，共有2525名参与者，其中475人患有焦虑症。其中，有11项研究评估了状态焦虑量表（STAI-S）（2042名参与者），8项研究评估了特质焦虑量表（STAI-T）（1906名参与者）。参考标准的诊断最终均基于《精神疾病诊断与统计手册》第四版（DSM- iv）的标准，其中7项研究采用迷你国际神经精神病学访谈（MINI）， 5项研究采用DSM结构化临床访谈（SCID）。11项研究在临床环境中针对各种特定情况（如癫痫、怀孕）进行，而一项研究包括癌症患者的伴侣。大多数研究表明，在参与者选择方面存在较高或不明确的偏倚风险和适用性问题。在检测AAD时，从SROC曲线中获得所有截断点的总结检验准确度估计值，STAI-S的AUC为0.78 （95% CI 0.75至0.82；11项研究，2042名受试者），STAI-T的AUC为0.78 （95% CI 0.75至0.81；8项研究，1906名受试者）。在STAI-S常用的临界值≥40时，总敏感性为0.83 (95% CI 0.77 ~ 0.88)，特异性为0.55 （95% CI 0.45 ~ 0.65）。同样，对于STAI-T，截止值≥44时，总敏感性为0.81 (95% CI 0.75至0.86)，特异性为0.60 （95% CI 0.44至0.74）。由于研究数量较少，对STAI检测GAD准确性的分析受到限制（STAI- s: 4项研究，1182名受试者；STAI- t: 3项研究，988名受试者）。对于截止值≥40的STAI-S，总敏感性为0.86 (95% CI 0.74 ~ 0.93)，特异性为0.53 （95% CI 0.37 ~ 0.69）。AUC为0.80 （95% CI 0.74 ~ 0.86）。对于cut-off≥44的stat - t，敏感性为0.86 (95% CI 0.72 ~ 0.94)，特异性为0.57 （95% CI 0.36 ~ 0.75）。AUC为0.81 （95% CI 0.79 ~ 0.82）。作者的结论是：目前可获得的证据并不能对STAI在筛查焦虑症方面的准确性做出自信的判断。研究结果来自数量有限的研究，大多数具有较高或不明确的偏倚风险，并且几乎完全是在具有各种潜在健康状况的个体的专业临床环境中进行的，因此限制了通用性。基于对AUC的常见解释，在所有截止点上，STAI-S和STAI-T子量表的总体准确性是中等的，与其他焦虑问卷大致相当。
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Pub Date : 2025-12-18DOI: 10.1002/14651858.CD016062
Juan Va Franco, Yang Guo, Brenda Bongaerts, Maria-Inti Metzendorf, Jan Hindemit, Zakariya Aqra, Murad Alhalahla, Karina Tapinova, Esteban Villegas Arbelaez, Omolola T Alade, Mauricio Medina Rodriguez, Karen Rees, Lena Al-Khudairy, Gabriel Torbahn, Louisa J Ells
<p><strong>Rationale: </strong>Adolescent obesity is a global public health problem with multiple causes. The mainstay approach for managing obesity includes interventions targeting changes in health-related behaviours (diet, physical activity, and behaviour). However, previous research highlighted uncertainty about the sustainability and long-term results of these approaches.</p><p><strong>Objectives: </strong>To assess the effects of multimodal health behaviour-changing interventions for adolescents aged 10 to 19 living with obesity.</p><p><strong>Search methods: </strong>We used CENTRAL, MEDLINE, three other databases, and two trial registers, together with reference checking and contact with study authors, to identify studies included in the review. The latest search date was 28 February 2024.</p><p><strong>Eligibility criteria: </strong>We included randomised controlled trials (RCTs) in adolescents aged 10 to 19 living with obesity that compared interventions involving a minimum of two health-related behaviour components (modifications in diet, physical activity, or behavioural change) to control (including no treatment, usual care, or waiting-list control) with a minimum of one year of follow-up.</p><p><strong>Outcomes: </strong>Critical outcomes included physical well-being, mental well-being, physical activity, health-related quality of life (HRQoL), obesity-associated disability, adverse events, and anthropometry (body mass index (BMI) z-score).</p><p><strong>Risk of bias: </strong>We used the original version of the Cochrane Collaboration's tool for assessing risk of bias (RoB 1).</p><p><strong>Synthesis methods: </strong>We synthesised results for each outcome using meta-analysis, where possible, with a random-effects model. Where this was not possible, we described the results narratively. We used GRADE to assess the certainty of evidence for critical outcomes included in two key summary of findings tables. For continuous outcomes, we calculated mean differences (MDs) or standardised mean differences (SMD).</p><p><strong>Included studies: </strong>We included 33 RCTs with 5949 participants aged 10 to 19, primarily from high-income countries. We included 13 community-based interventions in schools, churches, and community centres, and 20 healthcare-based interventions implemented in primary care and hospitals. Intervention components included sessions on dietary modification, physical activity, and behavioural change. Of the 33 included studies, one targeted parents only, one involved only adolescents, and the remainder used family-based approaches, primarily through individual or group sessions.</p><p><strong>Synthesis of results: </strong>Healthcare-based multimodal interventions versus control Healthcare-based multimodal interventions may result in little to no difference in physical well-being at 12 months of follow-up (multiple scales: SMD 0.13, 95% CI -0.13 to 0.39; I² = 67%; 4 studies, 1006 participants; low-certainty evidence).
理由：青少年肥胖是一个全球性的公共卫生问题，有多种原因。管理肥胖的主要方法包括针对改变健康相关行为（饮食、身体活动和行为）的干预措施。然而，先前的研究强调了这些方法的可持续性和长期结果的不确定性。目的：评估多模式健康行为改变干预措施对10至19岁肥胖青少年的影响。检索方法：我们使用CENTRAL、MEDLINE、其他三个数据库和两个试验注册库，结合参考文献检查和与研究作者的联系，确定纳入综述的研究。最近一次搜索日期是2024年2月28日。入选标准：我们纳入了10 - 19岁肥胖青少年的随机对照试验（RCTs），这些试验比较了至少涉及两种健康相关行为成分（饮食改变、身体活动或行为改变）的干预措施与至少1年随访的对照组（包括不治疗、常规护理或等候名单对照）。结果：关键结果包括身体健康、精神健康、身体活动、健康相关生活质量（HRQoL）、肥胖相关残疾、不良事件和人体测量（体重指数（BMI） z-score）。偏倚风险：我们使用Cochrane协作的原始版本工具来评估偏倚风险（RoB 1）。综合方法：在可能的情况下，我们使用随机效应模型使用meta分析综合了每个结果的结果。如果这是不可能的，我们叙述的结果。我们使用GRADE来评估两个关键结果总结表中关键结局证据的确定性。对于连续结果，我们计算平均差异（MDs）或标准化平均差异（SMD）。纳入的研究：我们纳入了33项随机对照试验，5949名10至19岁的参与者，主要来自高收入国家。我们纳入了在学校、教堂和社区中心实施的13项基于社区的干预措施，以及在初级保健和医院实施的20项基于医疗保健的干预措施。干预内容包括饮食调整、身体活动和行为改变。在纳入的33项研究中，一项仅针对父母，一项仅涉及青少年，其余的采用以家庭为基础的方法，主要是通过个人或小组会议。基于医疗保健的多模式干预与对照组相比，在12个月的随访中，基于医疗保健的多模式干预可能导致身体健康几乎没有差异（多尺度：SMD 0.13, 95% CI -0.13至0.39;I²= 67%；4项研究，1006名参与者；低确定性证据）。在12至18个月的随访中，他们的心理健康状况可能几乎没有差异（多重量表：SMD 0.09, 95% CI -0.07至0.24;I²= 0%；4项研究，693名参与者；低确定性证据）。证据非常不确定这些干预措施对12个月时自我报告的身体活动（最终得分）的影响（多量表：SMD 0.51, 95% CI -0.07至1.10;I²= 93%；4项研究，964名参与者；非常低确定性的证据），当以基线变化得分测量时，这些干预措施可能导致自我报告的身体活动几乎没有差异(多量表：SMD 0.02, 95% CI -0.29至0.34;I²= 0%；2项研究，156名参与者；确定性的证据)。这些干预措施可能在12个月时略微改善HRQoL（多重量表：SMD 0.13, 95% CI 0.02至0.24;I²= 4%；7项研究，1454名参与者；低确定性证据）。基于医疗保健的多模式干预措施对不良事件的影响的证据非常不确定（0个事件；1项研究，46名参与者；非常低确定性的证据）。这些干预措施可能导致BMI z-score在12至18个月（MD为-0.11,95% CI为-0.19至-0.02;I²= 78%；17项研究，2666名受试者；低确定性证据）和24个月（MD为0.50,95% CI为-0.35至1.35；I²不适用；1项研究，33名受试者；低确定性证据）时的差异很小或没有差异。纳入的研究均未报告肥胖相关的残疾。基于社区的多模式干预与对照组相比，基于社区的多模式干预可能在12个月的随访中改善身体健康（青少年生活质量工具-权重模块：MD 13.50, 95% CI 4.99至22.01；I²不适用；1项研究，136名参与者；低确定性证据）。这些干预措施可能导致12个月时的心理健康状况几乎没有差异（优势和困难问卷：MD 1.20, 95% CI -0.46至2.86；I²不适用；1项研究，208名参与者；低确定性证据）。这些干预措施可能导致24个月时自我报告的身体活动几乎没有差异（全球身体活动问卷：系数= -0.04,95% CI -0.3至0.2;P = 0）。 76年;确定性的证据)。基于社区的多模式干预可能导致12个月时HRQoL的差异很小或没有差异（多尺度：SMD 0.06, 95% CI -0.11至0.24;I²= 19%；4项研究，666名受试者；中等确定性证据），并且可能导致24个月时HRQoL的差异很小或没有差异（儿科生活质量调查：SMD -0.03, 95% CI -0.33至0.27；I²不适用；1项研究，188名受试者；低确定性证据）。这些干预措施可能导致12个月时BMI z-score的差异很小或没有差异（MD -0.07, 95% CI -0.21至0.08;I²= 85%；5项研究，585名参与者；低确定性证据），并且可能在24个月的随访中略有降低BMI z-score （MD -0.47, 95% CI -0.96至0.02;I²= 98%；3项研究，430名参与者；低确定性证据）。纳入的研究均未报告肥胖相关残疾或不良事件的数据。作者的结论是：多模式健康行为改变干预可能导致12个月时身体健康状况和12个月时社区分娩时BMI z-score的小幅改善，以及12个月时医疗机构分娩时HRQoL的小幅改善。它们可能对其他预先定义的关键结果几乎没有影响，包括心理健康和身体活动。未来的研究应该考虑创新的方法来照顾患有肥胖症的青少年，并涉及不同的人群，因为我们发现在弱势和文化/种族不同的人群以及其他低资源环境中进行的研究有限。供资：世界卫生组织（WHO）注册：议定书（2024）：PROSPERO CRD42023468867。
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Pub Date : 2025-12-18DOI: 10.1002/14651858.CD016075
Dominik Lawniczak, Sarah Rubin, Derick Yates, Ben A Marson
Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of interventions for treating tibial shaft fractures in children.
目的：这是Cochrane综述（干预）的一个方案。目的如下：评估干预治疗儿童胫骨干骨折的效果。
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Pub Date : 2025-12-18DOI: 10.1002/14651858.CD016194
Jenifer A Otieno, Lisa Malesi Were, Vittoria Lutje, Katie Scandrett, Yemisi Takwoingi, Eleanor A Ochodo
<p><strong>Rationale: </strong>The World Health Organization (WHO) recommends rapid nucleic acid amplification tests (NAATs), such as Xpert MTB/RIF Ultra, as the initial diagnostic test for tuberculosis (TB). However, the effect of these tests on key health outcomes is not well-established.</p><p><strong>Objectives: </strong>To assess the effects of three classes of rapid NAATs-low-complexity automated (LC-aNAATs), low-complexity manual (LC-mNAATs) and moderate-complexity automated (MC-aNAATs)-compared with smear microscopy or bacterial culture on patient outcomes in people investigated for TB, irrespective of age or disease severity. Our secondary objective was to assess the effects of the three classes of rapid NAATs in vulnerable populations such as children and people living with HIV, to inform health equity considerations.</p><p><strong>Search methods: </strong>We searched Cochrane CENTRAL, MEDLINE, Embase, five other electronic bibliographic databases, and two trial registries, from 1900 up to 21 January 2025. We also checked reference lists of included articles and relevant systematic reviews to identify additional studies. We contacted manufacturers, researchers, and experts working on new diagnostic tests for TB through a WHO public call for data, which lasted from 30 November 2023 to 15 February 2024.</p><p><strong>Eligibility criteria: </strong>We included randomised controlled trials (RCTs) that involved children and adults of any age who were suspected to have TB (i.e. 'presumptive TB'). We included both individually randomised and cluster-randomised designs. In terms of the intervention, we considered "design-locked, marketed test technologies" (i.e. testing technologies with designs that have been finalised and are currently being sold or promoted in the healthcare market) by class and tests provided by the WHO: LC-aNAATs (e.g. Xpert MTB/RIF Ultra, Truenat MTB Plus, Truenat MTB-RIF Dx); LC-mNAATs (e.g. TB-LAMP); and MC-aNAATs (e.g. FluoroType XDR-TB). We restricted comparative strategies to smear microscopy and bacterial culture methods. We excluded studies on standard Xpert MTB/RIF, which has been superseded by the Xpert MTB/RIF Ultra test.</p><p><strong>Outcomes: </strong>Our critical outcomes were all-cause mortality from the time of the first diagnostic test to the end of the trial follow-up, and cure rates among people with bacteriologically-confirmed TB at the beginning of treatment and who completed treatment with no evidence of failure. Our important outcomes were the proportion of participants lost to follow-up, time to TB diagnosis, and time to treatment initiation.</p><p><strong>Risk of bias: </strong>Two review authors independently assessed the risk of bias for all reported outcomes in the included studies using the revised Cochrane risk of bias tool (RoB 2). Disagreements were resolved through discussion or by consulting a senior review author as needed.</p><p><strong>Synthesis methods: </strong>We could not combine t
{"title":"Impact of rapid nucleic acid amplification tests for tuberculosis on patient outcomes.","authors":"Jenifer A Otieno, Lisa Malesi Were, Vittoria Lutje, Katie Scandrett, Yemisi Takwoingi, Eleanor A Ochodo","doi":"10.1002/14651858.CD016194","DOIUrl":"10.1002/14651858.CD016194","url":null,"abstract":"<p><strong>Rationale: </strong>The World Health Organization (WHO) recommends rapid nucleic acid amplification tests (NAATs), such as Xpert MTB/RIF Ultra, as the initial diagnostic test for tuberculosis (TB). However, the effect of these tests on key health outcomes is not well-established.</p><p><strong>Objectives: </strong>To assess the effects of three classes of rapid NAATs-low-complexity automated (LC-aNAATs), low-complexity manual (LC-mNAATs) and moderate-complexity automated (MC-aNAATs)-compared with smear microscopy or bacterial culture on patient outcomes in people investigated for TB, irrespective of age or disease severity. Our secondary objective was to assess the effects of the three classes of rapid NAATs in vulnerable populations such as children and people living with HIV, to inform health equity considerations.</p><p><strong>Search methods: </strong>We searched Cochrane CENTRAL, MEDLINE, Embase, five other electronic bibliographic databases, and two trial registries, from 1900 up to 21 January 2025. We also checked reference lists of included articles and relevant systematic reviews to identify additional studies. We contacted manufacturers, researchers, and experts working on new diagnostic tests for TB through a WHO public call for data, which lasted from 30 November 2023 to 15 February 2024.</p><p><strong>Eligibility criteria: </strong>We included randomised controlled trials (RCTs) that involved children and adults of any age who were suspected to have TB (i.e. 'presumptive TB'). We included both individually randomised and cluster-randomised designs. In terms of the intervention, we considered \"design-locked, marketed test technologies\" (i.e. testing technologies with designs that have been finalised and are currently being sold or promoted in the healthcare market) by class and tests provided by the WHO: LC-aNAATs (e.g. Xpert MTB/RIF Ultra, Truenat MTB Plus, Truenat MTB-RIF Dx); LC-mNAATs (e.g. TB-LAMP); and MC-aNAATs (e.g. FluoroType XDR-TB). We restricted comparative strategies to smear microscopy and bacterial culture methods. We excluded studies on standard Xpert MTB/RIF, which has been superseded by the Xpert MTB/RIF Ultra test.</p><p><strong>Outcomes: </strong>Our critical outcomes were all-cause mortality from the time of the first diagnostic test to the end of the trial follow-up, and cure rates among people with bacteriologically-confirmed TB at the beginning of treatment and who completed treatment with no evidence of failure. Our important outcomes were the proportion of participants lost to follow-up, time to TB diagnosis, and time to treatment initiation.</p><p><strong>Risk of bias: </strong>Two review authors independently assessed the risk of bias for all reported outcomes in the included studies using the revised Cochrane risk of bias tool (RoB 2). Disagreements were resolved through discussion or by consulting a senior review author as needed.</p><p><strong>Synthesis methods: </strong>We could not combine t","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"12 ","pages":"CD016194"},"PeriodicalIF":8.8,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12713157/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145773614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-16DOI: 10.1002/14651858.CD016063
Juan Va Franco, Yang Guo, Brenda Bongaerts, Maria-Inti Metzendorf, Jan Hindemit, Zakariya Aqra, Murad Alhalahla, Karina Tapinova, Esteban Villegas Arbelaez, Omolola T Alade, Mauricio Medina Rodriguez, Karen Rees, Lena Al-Khudairy, Gabriel Torbahn, Louisa J Ells
<p><strong>Rationale: </strong>Childhood obesity is a global public health problem with multiple causes. First-line obesity interventions target changes in health-related behaviours (diet, physical activity, behaviour). However, the sustainability and long-term results of these interventions are uncertain.</p><p><strong>Objectives: </strong>To assess the effects of multimodal health behaviour-changing interventions for children under 10 years living with obesity and their parents.</p><p><strong>Search methods: </strong>We used CENTRAL, MEDLINE, three other databases, and two trial registers, together with reference checking and contact with study authors, to identify studies included in the review. The latest search date was 28 February 2024.</p><p><strong>Eligibility criteria: </strong>We included randomised controlled trials in children under 10 with obesity (and their parents) that tested multimodal health behaviour interventions (diet, physical activity, and/or behaviour change) versus control (no treatment, usual care, or waiting list), with at least one year of follow-up.</p><p><strong>Outcomes: </strong>Critical outcomes were physical well-being, mental well-being, physical activity, health-related quality of life (HRQoL), obesity-associated disability, adverse events, and anthropometry (body mass index (BMI) z-score).</p><p><strong>Risk of bias: </strong>We used the original version of the Cochrane Collaboration's tool for assessing risk of bias (RoB 1).</p><p><strong>Synthesis methods: </strong>We synthesised outcomes using random-effects meta-analysis where possible, otherwise narratively. For continuous outcomes on the same scale, we calculated mean differences (MDs) with 95% confidence intervals (CIs). We calculated standardised mean differences (SMDs) with 95% CIs when studies used different instruments for the same outcome or when applying a generic minimally important difference. We assessed certainty of evidence for critical outcomes with GRADE.</p><p><strong>Included studies: </strong>We included 34 RCTs involving 6849 participants, aged four to nine, conducted in high-income countries. We identified 23 healthcare-based interventions implemented in primary care and hospitals, and 11 community-based interventions implemented in schools and community centres. The intervention components included sessions on dietary modification, physical activity, and behavioural change. Three studies targeted parents directly, and the remainder used family-based approaches, primarily through individual or group sessions.</p><p><strong>Synthesis of results: </strong>Healthcare-based multimodal interventions versus control Healthcare-based multimodal interventions likely result in little to no difference in physical well-being at 12 months of follow-up (Pediatric Quality of Life Inventory (PedsQL) physical score, final value: SMD 0.05, 95% CI -0.09 to 0.19; I² = 0%; 2 studies, 757 participants; moderate-certainty evidence). When measured on the Peds
{"title":"Multimodal health behaviour-changing interventions for children living with obesity and their parents.","authors":"Juan Va Franco, Yang Guo, Brenda Bongaerts, Maria-Inti Metzendorf, Jan Hindemit, Zakariya Aqra, Murad Alhalahla, Karina Tapinova, Esteban Villegas Arbelaez, Omolola T Alade, Mauricio Medina Rodriguez, Karen Rees, Lena Al-Khudairy, Gabriel Torbahn, Louisa J Ells","doi":"10.1002/14651858.CD016063","DOIUrl":"10.1002/14651858.CD016063","url":null,"abstract":"<p><strong>Rationale: </strong>Childhood obesity is a global public health problem with multiple causes. First-line obesity interventions target changes in health-related behaviours (diet, physical activity, behaviour). However, the sustainability and long-term results of these interventions are uncertain.</p><p><strong>Objectives: </strong>To assess the effects of multimodal health behaviour-changing interventions for children under 10 years living with obesity and their parents.</p><p><strong>Search methods: </strong>We used CENTRAL, MEDLINE, three other databases, and two trial registers, together with reference checking and contact with study authors, to identify studies included in the review. The latest search date was 28 February 2024.</p><p><strong>Eligibility criteria: </strong>We included randomised controlled trials in children under 10 with obesity (and their parents) that tested multimodal health behaviour interventions (diet, physical activity, and/or behaviour change) versus control (no treatment, usual care, or waiting list), with at least one year of follow-up.</p><p><strong>Outcomes: </strong>Critical outcomes were physical well-being, mental well-being, physical activity, health-related quality of life (HRQoL), obesity-associated disability, adverse events, and anthropometry (body mass index (BMI) z-score).</p><p><strong>Risk of bias: </strong>We used the original version of the Cochrane Collaboration's tool for assessing risk of bias (RoB 1).</p><p><strong>Synthesis methods: </strong>We synthesised outcomes using random-effects meta-analysis where possible, otherwise narratively. For continuous outcomes on the same scale, we calculated mean differences (MDs) with 95% confidence intervals (CIs). We calculated standardised mean differences (SMDs) with 95% CIs when studies used different instruments for the same outcome or when applying a generic minimally important difference. We assessed certainty of evidence for critical outcomes with GRADE.</p><p><strong>Included studies: </strong>We included 34 RCTs involving 6849 participants, aged four to nine, conducted in high-income countries. We identified 23 healthcare-based interventions implemented in primary care and hospitals, and 11 community-based interventions implemented in schools and community centres. The intervention components included sessions on dietary modification, physical activity, and behavioural change. Three studies targeted parents directly, and the remainder used family-based approaches, primarily through individual or group sessions.</p><p><strong>Synthesis of results: </strong>Healthcare-based multimodal interventions versus control Healthcare-based multimodal interventions likely result in little to no difference in physical well-being at 12 months of follow-up (Pediatric Quality of Life Inventory (PedsQL) physical score, final value: SMD 0.05, 95% CI -0.09 to 0.19; I² = 0%; 2 studies, 757 participants; moderate-certainty evidence). When measured on the Peds","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"12 ","pages":"CD016063"},"PeriodicalIF":8.8,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12706831/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145762406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-15DOI: 10.1002/14651858.CD015338.pub2
Katharine Scrivener, Louise Ada, Joanne V Glinsky, Simone Dorsch, Serena Jamieson, Sarah M Brighton-Hall, Laura McCredie, Ashleigh Hanekom, Natasha A Lannin
<p><strong>Rationale: </strong>Muscle weakness is a common impairment after stroke. Electrical stimulation that contracts muscles strongly (cyclical electrical stimulation (CES)) may improve voluntary strength, and electrical stimulation during the practice of an activity (functional electrical stimulation (FES)) may improve the performance of that activity.</p><p><strong>Objectives: </strong>To evaluate the benefits and harms of electrical stimulation of the motor system for adults with stroke. Specifically, the objectives were to evaluate whether: • CES is effective at increasing voluntary strength compared with nothing/sham intervention, and if this carries over to the performance of an activity; • CES is effective at increasing voluntary strength compared with another strengthening intervention, and if this carries over to the performance of an activity; • FES is effective at improving activity compared with nothing/sham; • FES is effective at improving activity compared with practice of the same activity without stimulation. For each comparison, we also wanted to examine the effects on participation and quality of life, and to describe potential harms (e.g. adverse events).</p><p><strong>Search methods: </strong>We searched CENTRAL, MEDLINE, Embase, four other databases, and two trial registries, plus reference checking to identify trials for inclusion in the review. The latest search date was December 2024.</p><p><strong>Eligibility criteria: </strong>We included randomised controlled trials (RCTs) and randomised cross-over trials that compared CES versus nothing/sham or another strengthening intervention, or FES versus nothing/sham or practice of the same activity without stimulation, in adults with stroke.</p><p><strong>Outcomes: </strong>Our critical outcome of interest was voluntary strength (i.e. without electrical stimulation) for CES, and activity trained (i.e. without electrical stimulation) for FES. Our important outcomes were participation restrictions, quality of life, and adverse events.</p><p><strong>Risk of bias: </strong>We assessed risk of bias in the included studies using the Cochrane RoB 1 tool.</p><p><strong>Synthesis methods: </strong>We synthesised results for each outcome using meta-analysis, where possible, by calculating standardised mean differences (SMD) with 95% confidence intervals (CI) for continuous outcomes. Where this was precluded by the nature of the data, we summarised the results narratively. We used the GRADE approach to assess the certainty of the evidence.</p><p><strong>Included studies: </strong>We included 83 RCTs and 6 randomised cross-over trials involving a total of 2905 participants. Thirty-four trials investigated CES (1176 participants), and 55 trials investigated FES (1729 participants). Most trials were small, with only nine enrolling more than 50 participants. The risk of bias for most items was low; however, many were unclear (especially regarding allocation concealment and selective repor
理由：肌肉无力是中风后常见的损害。强烈收缩肌肉的电刺激（周期性电刺激（CES））可以改善自愿力量，在活动练习期间的电刺激（功能性电刺激（FES））可以改善该活动的表现。目的：评价电刺激成人脑卒中患者运动系统的利与弊。具体而言，目的是评估：•与无干预/虚假干预相比，CES在增加自愿力量方面是否有效，以及这是否会延续到活动的表现；•与其他强化干预相比，CES在增加自愿力量方面是有效的，如果这延续到一项活动的表现；•与什么都不做/假手术相比，FES在改善活动方面有效；•与没有刺激的相同活动练习相比，FES在改善活动方面有效。对于每个比较，我们还想检查对参与和生活质量的影响，并描述潜在的危害（例如不良事件）。检索方法：我们检索了CENTRAL、MEDLINE、Embase、其他四个数据库和两个试验注册库，并进行了参考资料检查，以确定纳入综述的试验。最近一次搜索日期是2024年12月。入选标准：我们纳入了随机对照试验（RCTs）和随机交叉试验，这些试验比较了成人中风患者的CES与无/假手术或其他强化干预，或FES与无/假手术或无刺激相同活动的实践。结果：我们感兴趣的关键结果是CES的自主力量（即无电刺激）和FES的活动训练（即无电刺激）。我们的重要结局是参与限制、生活质量和不良事件。偏倚风险：我们使用Cochrane RoB 1工具评估纳入研究的偏倚风险。综合方法：在可能的情况下，通过计算连续结果的95%置信区间（CI）的标准化平均差异（SMD），我们使用荟萃分析综合了每个结果的结果。由于数据的性质，这是不可能的，我们用叙述的方式总结了结果。我们使用GRADE方法来评估证据的确定性。纳入的研究：我们纳入83项随机对照试验和6项随机交叉试验，共涉及2905名受试者。34项试验调查CES（1176名受试者），55项试验调查FES（1729名受试者）。大多数试验规模都很小，只有9项试验的参与者超过了50人。大多数项目的偏倚风险很低；然而，许多结果并不明确（特别是关于分配隐瞒和选择性报告），值得注意的是，许多试验没有使用盲法评估。综合结果：与无干预/假手术相比，无干预/假手术对干预后立即的强度（SMD 0.47, 95% CI 0.32至0.61；23项试验，741名受试者；高确定性证据）和活动（SMD 0.50, 95% CI 0.34至0.65；20项试验，662名受试者；高确定性证据）有中等影响。在干预之后，这些影响可能在强度（SMD 0.48, 95% CI 0.28至0.69；11项试验，384名受试者；中等确定性证据）和活性（SMD 0.57, 95% CI 0.37至0.78；11项试验，385名受试者；中等确定性证据）方面保持不变。我们没有发现参与或生活质量结果的可用数据。与另一项强化干预相比，CES对干预后立即（SMD -0.07, 95% CI -0.70至0.57；1项试验，38名受试者；极低确定性证据）和干预后（SMD 0.23, 95% CI -0.41至0.87；1项试验，38名受试者；极低确定性证据）强度的影响的证据非常不确定。证据也非常不确定CES对干预后立即活动的影响（SMD 0.47, 95% CI -0.18至1.11；1项试验，38名参与者；极低确定性证据）和干预后（SMD 0.49, 95% CI -0.16至1.14；1项试验，38名参与者；极低确定性证据）。与无/假FES相比，FES对干预后立即的活动可能有中等影响（SMD 0.42, 95% CI 0.16至0.68；12项试验，235名参与者；中等确定性证据），并且可能在干预后产生较大影响（SMD 0.87, 95% CI 0.29至1.44；3项试验，53名参与者；低确定性证据）。我们没有发现参与或生活质量结果的可用数据。FES与相同活动的实践相比，FES对干预后立即活动的影响很小（SMD为0.22,95% CI为0.11至0.34；35项试验，1193名参与者；高确定性证据）。 在干预之后，FES可能比相同活动的练习更有效，但该结果的CI包括无效果的可能性（SMD为0.22,95% CI为-0.02至0.46；9项试验，268名参与者；中等确定性证据）。FES对参与（SMD 0.20, 95% CI -0.68至1.08；1项试验，20名受试者；极低确定性证据）和生活质量（SMD 0.06, 95% CI -0.03至0.43；1项试验，119名受试者；低确定性证据）的影响证据不确定。在CES和FES的试验中，不良事件的报道并不普遍，与电刺激相关的总体事件很少，也没有描述严重事件（低到中等确定性证据）。作者的结论：高确定性的证据表明，与没有/虚假相比，CES对强度有中等影响，并且这种影响会延续到活动上。有中等确定性的证据表明，与什么都不做/不做相比，FES可能对活动有中等程度的影响，而高确定性的证据表明，与相同活动的练习相比，FES的影响很小。因此，CES可用于增强中风后身体虚弱者的力量。然而，与其他增加强度的干预措施相比，关于CES效果的决策证据有限。当中风后的人恢复运动并可以尝试日常活动时，在活动期间增加电刺激只有很小的好处。经费：无须申报。注册：协议可在doi.org/10.1002/14651858.CD015338获得。
{"title":"Electrical stimulation of the motor system after stroke.","authors":"Katharine Scrivener, Louise Ada, Joanne V Glinsky, Simone Dorsch, Serena Jamieson, Sarah M Brighton-Hall, Laura McCredie, Ashleigh Hanekom, Natasha A Lannin","doi":"10.1002/14651858.CD015338.pub2","DOIUrl":"10.1002/14651858.CD015338.pub2","url":null,"abstract":"<p><strong>Rationale: </strong>Muscle weakness is a common impairment after stroke. Electrical stimulation that contracts muscles strongly (cyclical electrical stimulation (CES)) may improve voluntary strength, and electrical stimulation during the practice of an activity (functional electrical stimulation (FES)) may improve the performance of that activity.</p><p><strong>Objectives: </strong>To evaluate the benefits and harms of electrical stimulation of the motor system for adults with stroke. Specifically, the objectives were to evaluate whether: • CES is effective at increasing voluntary strength compared with nothing/sham intervention, and if this carries over to the performance of an activity; • CES is effective at increasing voluntary strength compared with another strengthening intervention, and if this carries over to the performance of an activity; • FES is effective at improving activity compared with nothing/sham; • FES is effective at improving activity compared with practice of the same activity without stimulation. For each comparison, we also wanted to examine the effects on participation and quality of life, and to describe potential harms (e.g. adverse events).</p><p><strong>Search methods: </strong>We searched CENTRAL, MEDLINE, Embase, four other databases, and two trial registries, plus reference checking to identify trials for inclusion in the review. The latest search date was December 2024.</p><p><strong>Eligibility criteria: </strong>We included randomised controlled trials (RCTs) and randomised cross-over trials that compared CES versus nothing/sham or another strengthening intervention, or FES versus nothing/sham or practice of the same activity without stimulation, in adults with stroke.</p><p><strong>Outcomes: </strong>Our critical outcome of interest was voluntary strength (i.e. without electrical stimulation) for CES, and activity trained (i.e. without electrical stimulation) for FES. Our important outcomes were participation restrictions, quality of life, and adverse events.</p><p><strong>Risk of bias: </strong>We assessed risk of bias in the included studies using the Cochrane RoB 1 tool.</p><p><strong>Synthesis methods: </strong>We synthesised results for each outcome using meta-analysis, where possible, by calculating standardised mean differences (SMD) with 95% confidence intervals (CI) for continuous outcomes. Where this was precluded by the nature of the data, we summarised the results narratively. We used the GRADE approach to assess the certainty of the evidence.</p><p><strong>Included studies: </strong>We included 83 RCTs and 6 randomised cross-over trials involving a total of 2905 participants. Thirty-four trials investigated CES (1176 participants), and 55 trials investigated FES (1729 participants). Most trials were small, with only nine enrolling more than 50 participants. The risk of bias for most items was low; however, many were unclear (especially regarding allocation concealment and selective repor","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"12 ","pages":"CD015338"},"PeriodicalIF":8.8,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12703829/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145755296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-12DOI: 10.1002/14651858.CD015457
Stefanie Eck, Daniel Dümmler, Zekeriya Aktürk, Maxim Korman, Sarah Dawson, Antonius Schneider, Alexander Hapfelmeier, Klaus Linde, Alexey Fomenko
<p><strong>Background: </strong>Despite being highly prevalent mental health conditions, anxiety disorders frequently go undiagnosed. The Beck Anxiety Inventory (BAI) is a widely used self-report scale for measuring the severity of anxiety, which has also been used for anxiety screening.</p><p><strong>Objectives: </strong>To assess the test accuracy of the Beck Anxiety Inventory (BAI) in adults against structured or semi-structured diagnostic interviews for the following target conditions: any anxiety disorder (AAD), generalised anxiety disorder (GAD), and panic disorder (PD).</p><p><strong>Secondary objectives: </strong>- To explore sources of heterogeneity according to setting, the prevalence of anxiety disorders, the reference standard and the risk of bias. - To investigate how test accuracy changes with the test threshold.</p><p><strong>Search methods: </strong>We searched Embase, MEDLINE, PubMed-not-MEDLINE subset and PsycINFO from 1990 to 12 July 2024. We checked the reference lists of included studies and review articles. We searched for errata or retractions of included studies via PubMed or Embase. We also checked relevant journal publishers' websites and conducted a search on the Retraction Watch database (retractiondatabase.org).</p><p><strong>Selection criteria: </strong>Studies that included adults presenting with reasons unrelated to mental distress were eligible for this review. These studies involved the administration of the BAI alongside structured or semi-structured diagnostic interviews, allowing for the generation of 2 x 2 tables. We excluded case-control studies and studies with a time gap exceeding four weeks between administering the index test and the reference standard.</p><p><strong>Data collection and analysis: </strong>At least two reviewers independently decided on the eligibility of the articles, extracted the data and assessed the methodological quality of the included studies using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. For each target condition, we present the sensitivity and specificity of each study along with 95% confidence intervals (CIs). We used the multiple thresholds model to obtain the summary test accuracy estimates of all available cut-offs.</p><p><strong>Main results: </strong>We identified 14 studies encompassing data from 6232 participants that were available for the analyses. Ten studies contributed to the analysis of the BAI for detecting AAD, eight for GAD, and four for PD. The median prevalence of AAD, GAD and PD was 0.27, 0.12 and 0.10, respectively. Nine studies were conducted in diverse specialised clinical settings, two in non-clinical, and three in mixed settings. A considerable number of studies showed a high or unclear risk of bias in the domains of patient selection (n = 7), index test (n = 8) and flow and timing (n = 8). A major applicability concern was the presence of prediagnosed anxiety prior to undergoing BAI or the fact that this information may not
背景：尽管焦虑症是一种非常普遍的精神健康状况，但它经常未被诊断出来。贝克焦虑量表（BAI）是一种广泛使用的自我报告量表，用于测量焦虑的严重程度，也被用于焦虑筛查。目的：评估成人贝克焦虑量表（BAI）对以下目标条件的结构化或半结构化诊断访谈的测试准确性：任何焦虑症（AAD），广泛性焦虑症（GAD）和恐慌症（PD）。次要目标：-根据环境、焦虑障碍的患病率、参考标准和偏倚风险探索异质性的来源。-调查测试精度随测试阈值的变化情况。检索方法：检索1990年至2024年7月12日的Embase、MEDLINE、PubMed-not-MEDLINE子集和PsycINFO。我们检查了纳入研究和综述文章的参考文献列表。我们通过PubMed或Embase检索纳入研究的勘误表或撤稿。我们还检查了相关期刊出版商的网站，并在撤稿观察数据库（retractiondatabase.org）中进行了搜索。选择标准：包括与精神困扰无关的成年人的研究符合本综述的条件。这些研究包括BAI的管理以及结构化或半结构化的诊断访谈，允许生成2 x 2表。我们排除了病例对照研究和实施指标试验与参考标准之间时间间隔超过四周的研究。数据收集和分析：至少有两名审稿人独立决定文章的合格性，提取数据并使用诊断准确性研究质量评估（QUADAS-2）工具评估纳入研究的方法学质量。对于每个目标条件，我们给出了每个研究的敏感性和特异性以及95%置信区间（ci）。我们使用多阈值模型来获得所有可用截止值的汇总测试精度估计。主要结果：我们确定了14项研究，包括来自6232名参与者的数据，可用于分析。10项研究分析了BAI检测AAD， 8项研究分析了GAD， 4项研究分析了PD。AAD、GAD和PD的中位患病率分别为0.27、0.12和0.10。9项研究在不同的专业临床环境中进行，2项在非临床环境中进行，3项在混合环境中进行。相当多的研究显示，在患者选择（n = 7）、指标检验（n = 8）和血流与时机（n = 8）方面存在较高或不明确的偏倚风险。一个主要的适用性问题是在进行BAI之前是否存在预先诊断的焦虑，或者这些信息可能尚未收集。根据多阈值模型，在临界值≥16时，BAI检测AAD的总灵敏度为0.54 (95% CI 0.43 ~ 0.64)，特异性为0.87 （95% CI 0.78 ~ 0.92）。检测GAD的总敏感性为0.72 (95% CI 0.65 ~ 0.78)，特异性为0.80 (95% CI 0.71 ~ 0.87)；检测PD的总敏感性为0.72 (95% CI 0.50 ~ 0.87)，特异性为0.77 （95% CI 0.55 ~ 0.90）。检测AAD的多阈值综合受试者工作特征（mtsROC）曲线下面积（AUC）为0.76 (95% CI 0.72至0.80)，检测GAD的面积为0.83 (95% CI 0.80至0.86)，检测PD的面积为0.80 （95% CI 0.74至0.87）。由于纳入的研究数量有限，对异质性进行正式调查是不可行的。作者结论：由于临床异质性以及纳入研究的质量和数量有限，从本综述中可以得出的结论受到限制。此外，异质性的来源仍未完全了解。鉴于这些限制和较短的问卷调查表的存在（特别是为了筛选目的），BAI在检测焦虑症方面的效用目前尚不确定。资助：本Cochrane综述由德国联邦教育与研究部资助（资助号：01KG2105）。注册：协议（2022）：doi.org/10.1002/14651858.CD015292。
{"title":"Beck Anxiety Inventory (BAI) for detecting anxiety disorders in adults.","authors":"Stefanie Eck, Daniel Dümmler, Zekeriya Aktürk, Maxim Korman, Sarah Dawson, Antonius Schneider, Alexander Hapfelmeier, Klaus Linde, Alexey Fomenko","doi":"10.1002/14651858.CD015457","DOIUrl":"10.1002/14651858.CD015457","url":null,"abstract":"<p><strong>Background: </strong>Despite being highly prevalent mental health conditions, anxiety disorders frequently go undiagnosed. The Beck Anxiety Inventory (BAI) is a widely used self-report scale for measuring the severity of anxiety, which has also been used for anxiety screening.</p><p><strong>Objectives: </strong>To assess the test accuracy of the Beck Anxiety Inventory (BAI) in adults against structured or semi-structured diagnostic interviews for the following target conditions: any anxiety disorder (AAD), generalised anxiety disorder (GAD), and panic disorder (PD).</p><p><strong>Secondary objectives: </strong>- To explore sources of heterogeneity according to setting, the prevalence of anxiety disorders, the reference standard and the risk of bias. - To investigate how test accuracy changes with the test threshold.</p><p><strong>Search methods: </strong>We searched Embase, MEDLINE, PubMed-not-MEDLINE subset and PsycINFO from 1990 to 12 July 2024. We checked the reference lists of included studies and review articles. We searched for errata or retractions of included studies via PubMed or Embase. We also checked relevant journal publishers' websites and conducted a search on the Retraction Watch database (retractiondatabase.org).</p><p><strong>Selection criteria: </strong>Studies that included adults presenting with reasons unrelated to mental distress were eligible for this review. These studies involved the administration of the BAI alongside structured or semi-structured diagnostic interviews, allowing for the generation of 2 x 2 tables. We excluded case-control studies and studies with a time gap exceeding four weeks between administering the index test and the reference standard.</p><p><strong>Data collection and analysis: </strong>At least two reviewers independently decided on the eligibility of the articles, extracted the data and assessed the methodological quality of the included studies using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. For each target condition, we present the sensitivity and specificity of each study along with 95% confidence intervals (CIs). We used the multiple thresholds model to obtain the summary test accuracy estimates of all available cut-offs.</p><p><strong>Main results: </strong>We identified 14 studies encompassing data from 6232 participants that were available for the analyses. Ten studies contributed to the analysis of the BAI for detecting AAD, eight for GAD, and four for PD. The median prevalence of AAD, GAD and PD was 0.27, 0.12 and 0.10, respectively. Nine studies were conducted in diverse specialised clinical settings, two in non-clinical, and three in mixed settings. A considerable number of studies showed a high or unclear risk of bias in the domains of patient selection (n = 7), index test (n = 8) and flow and timing (n = 8). A major applicability concern was the presence of prediagnosed anxiety prior to undergoing BAI or the fact that this information may not","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"12 ","pages":"CD015457"},"PeriodicalIF":8.8,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12699516/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145741551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-11DOI: 10.1002/14651858.CD016162
Dennis Vaidakis, Anastasia Bagiasta, Vasileios Sioulas, Dimitrios Giannakidis, Athanasios Saitis, Melina Nikolakea, Angeliki C Syristatidi, Michail Papapanou
Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of pelvic floor muscle therapy for sexual dysfunction in gynaecological cancer survivors.
{"title":"Pelvic floor muscle therapy for sexual dysfunction in gynaecological cancer survivors.","authors":"Dennis Vaidakis, Anastasia Bagiasta, Vasileios Sioulas, Dimitrios Giannakidis, Athanasios Saitis, Melina Nikolakea, Angeliki C Syristatidi, Michail Papapanou","doi":"10.1002/14651858.CD016162","DOIUrl":"10.1002/14651858.CD016162","url":null,"abstract":"<p><strong>Objectives: </strong>This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of pelvic floor muscle therapy for sexual dysfunction in gynaecological cancer survivors.</p>","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"12 ","pages":"CD016162"},"PeriodicalIF":8.8,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12696796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145721376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-11DOI: 10.1002/14651858.CD000512.pub3
Chad Andersen, Michael J Stark, Tara Crawford, Robin K Whyte, Axel R Franz, Roger F Soll, Haresh Kirpalani
<p><strong>Background: </strong>Infants of very low birthweight frequently receive red blood cell transfusions during their primary hospital stay. Generally, this is guided by predetermined haemoglobin or haematocrit thresholds according to a protocol or as prompted by clinical situations, including critical illness or surgery. Recommendations advocate maintaining higher thresholds in the early weeks when the risk of major morbidity is highest, while permitting lower thresholds after this time. In truth, clinicians worry about the potential effect of chronic anaemia on neurodevelopmental outcomes, as well as the risk of transfusion-related complications in the immature host. Clinical trials have reflected this practice by comparing haemoglobin levels adjusted for critical illness, comparing transfusion algorithms that use fixed differences between haemoglobin thresholds, with both thresholds progressively lowered across postnatal age. This is an update of a review first published in 2011.</p><p><strong>Objectives: </strong>To evaluate the effect of lower (restrictive) compared with higher (liberal) haemoglobin thresholds for transfusion, with or without adjustment for age and critical illness with either fixed or variable transfusion volume, on mortality or later neurodevelopmental outcomes assessed in later infancy at approximately two years postmenstrual age, or the number of transfusions in very low birthweight infants.</p><p><strong>Search methods: </strong>Searches were conducted in January 2024 in CENTRAL, MEDLINE, Embase, CINAHL, Epistemonikos, and trial registries. We searched the reference lists of related systematic reviews and trials.</p><p><strong>Selection criteria: </strong>We selected randomised controlled trials (RCTs) of lower or restrictive haemoglobin/haematocrit thresholds compared with liberal or higher haemoglobin/haematocrit thresholds for transfusion in low birthweight infants within three days of birth.</p><p><strong>Data collection and analysis: </strong>We used standard Cochrane methods. Our main outcomes were a combined outcome of death or neurodevelopmental impairment, all-cause mortality, and the number of transfusions per infant. We expressed our results using mean difference (MD), standardised mean difference (SMD), risk ratio (RR), and risk difference (RD) with 95% confidence intervals (CIs). We used GRADE to assess the certainty of evidence.</p><p><strong>Main results: </strong>Six trials, enrolling 3451 infants, compared transfusion strategies utilising a lower (restrictive) haemoglobin threshold compared to a higher (liberal) haemoglobin threshold. The transfusion thresholds used in these trials reflected prevailing clinical practice at the time of study design. For comparative purposes, they have been labelled as 'restrictive' and 'liberal'. The trials were similar in design, although each used slightly different transfusion algorithms and intervention thresholds. The three larger trials also conducted later n
背景：出生体重极低的婴儿在初级住院期间经常接受红细胞输注。一般来说，这是由预先确定的血红蛋白或红细胞压积阈值根据协议或提示临床情况，包括危重疾病或手术。建议主张在主要发病风险最高的最初几周保持较高的阈值，而在此之后允许降低阈值。事实上，临床医生担心慢性贫血对神经发育结果的潜在影响，以及未成熟宿主输注相关并发症的风险。临床试验反映了这种做法，通过比较针对危重疾病调整的血红蛋白水平，比较使用血红蛋白阈值固定差异的输血算法，两种阈值随着出生年龄逐渐降低。这是对2011年首次发表的一篇综述的更新。目的：评价输血时较低（限制性）血红蛋白阈值与较高（自由）血红蛋白阈值的影响，无论是否调整年龄和固定或可变输血量的危重疾病，对大约2岁后婴儿的死亡率或后期神经发育结局评估，或对极低出生体重婴儿的输血次数评估。检索方法：检索于2024年1月在CENTRAL、MEDLINE、Embase、CINAHL、Epistemonikos和试验注册中心进行。我们检索了相关系统综述和试验的参考文献列表。选择标准：我们选择了低出生体重婴儿出生3天内输血时较低或限制性血红蛋白/红细胞压积阈值与自由或较高血红蛋白/红细胞压积阈值的随机对照试验（rct）。资料收集与分析：采用标准Cochrane方法。我们的主要结局是死亡或神经发育障碍、全因死亡率和每个婴儿输血次数的综合结局。我们使用95%置信区间（ci）的平均差（MD）、标准化平均差（SMD）、风险比（RR）和风险差（RD）来表达我们的结果。我们使用GRADE来评估证据的确定性。主要结果：6项试验，纳入3451名婴儿，比较了使用较低（限制性）血红蛋白阈值与较高（自由）血红蛋白阈值的输血策略。这些试验中使用的输血阈值反映了研究设计时的主流临床实践。出于比较的目的，他们被贴上了“限制性”和“自由”的标签。这些试验在设计上是相似的，尽管每个试验使用的输血算法和干预阈值略有不同。三个更大的试验还进行了后来的神经感觉评估。纳入结果计算的婴儿数量因住院与出院后结果、评估方法和排除标准而异，我们的分析使用了原始出版物中报告的分母。总的来说，使用较低的血红蛋白输血阈值与较高的血红蛋白输血阈值相比，在月经后18至26个月的死亡或神经发育障碍的综合结局方面几乎没有差异（RR 1.02, 95% CI 0.95至1.09;I2 = 55%; RD 0.01, 95% CI -0.03至0.04；3项研究，3041名婴儿；高确定性证据）。18至26个月的死亡率也无差异（RR 0.99, 95% CI 0.83至1.17;I2 = 0%; RD -0.00, 95% CI -0.03至0.02;I2 = 0%； 3项研究，3186名婴儿；高确定性证据）。分配到限制性阈值的婴儿可能在初级住院期间接受较少的输血（每个婴儿输血次数的平均差异为-1.05,95% CI为-1.26至-0.84;I2 = 84%； 6项研究，3451名婴儿；低确定性证据）。作者的结论是：比较输血时较低或限制性血红蛋白阈值与较高或自由血红蛋白阈值的试验显示，出院时和后来神经发育随访时的重要结果几乎没有差异。在这些试验中，与自由输血相比，在极低出生体重婴儿中使用限制性血红蛋白或红细胞压度输血阈值可导致输血暴露和血红蛋白水平的适度降低。血红蛋白水平低于这些下限的安全性尚未得到评估，仅应在随机对照试验的背景下考虑。
{"title":"Low versus high haemoglobin concentration threshold for blood transfusion for preventing morbidity and mortality in very low birthweight infants.","authors":"Chad Andersen, Michael J Stark, Tara Crawford, Robin K Whyte, Axel R Franz, Roger F Soll, Haresh Kirpalani","doi":"10.1002/14651858.CD000512.pub3","DOIUrl":"10.1002/14651858.CD000512.pub3","url":null,"abstract":"<p><strong>Background: </strong>Infants of very low birthweight frequently receive red blood cell transfusions during their primary hospital stay. Generally, this is guided by predetermined haemoglobin or haematocrit thresholds according to a protocol or as prompted by clinical situations, including critical illness or surgery. Recommendations advocate maintaining higher thresholds in the early weeks when the risk of major morbidity is highest, while permitting lower thresholds after this time. In truth, clinicians worry about the potential effect of chronic anaemia on neurodevelopmental outcomes, as well as the risk of transfusion-related complications in the immature host. Clinical trials have reflected this practice by comparing haemoglobin levels adjusted for critical illness, comparing transfusion algorithms that use fixed differences between haemoglobin thresholds, with both thresholds progressively lowered across postnatal age. This is an update of a review first published in 2011.</p><p><strong>Objectives: </strong>To evaluate the effect of lower (restrictive) compared with higher (liberal) haemoglobin thresholds for transfusion, with or without adjustment for age and critical illness with either fixed or variable transfusion volume, on mortality or later neurodevelopmental outcomes assessed in later infancy at approximately two years postmenstrual age, or the number of transfusions in very low birthweight infants.</p><p><strong>Search methods: </strong>Searches were conducted in January 2024 in CENTRAL, MEDLINE, Embase, CINAHL, Epistemonikos, and trial registries. We searched the reference lists of related systematic reviews and trials.</p><p><strong>Selection criteria: </strong>We selected randomised controlled trials (RCTs) of lower or restrictive haemoglobin/haematocrit thresholds compared with liberal or higher haemoglobin/haematocrit thresholds for transfusion in low birthweight infants within three days of birth.</p><p><strong>Data collection and analysis: </strong>We used standard Cochrane methods. Our main outcomes were a combined outcome of death or neurodevelopmental impairment, all-cause mortality, and the number of transfusions per infant. We expressed our results using mean difference (MD), standardised mean difference (SMD), risk ratio (RR), and risk difference (RD) with 95% confidence intervals (CIs). We used GRADE to assess the certainty of evidence.</p><p><strong>Main results: </strong>Six trials, enrolling 3451 infants, compared transfusion strategies utilising a lower (restrictive) haemoglobin threshold compared to a higher (liberal) haemoglobin threshold. The transfusion thresholds used in these trials reflected prevailing clinical practice at the time of study design. For comparative purposes, they have been labelled as 'restrictive' and 'liberal'. The trials were similar in design, although each used slightly different transfusion algorithms and intervention thresholds. The three larger trials also conducted later n","PeriodicalId":10473,"journal":{"name":"Cochrane Database of Systematic Reviews","volume":"12 ","pages":"CD000512"},"PeriodicalIF":8.8,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12696806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145721321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-11DOI: 10.1002/14651858.CD014794.pub2
Elizabeth Kristjansson, Michael Dignam, Anita Rizvi, Muna Osman, Olivia Magwood, Deborah Olarte, Juliana Fw Cohen, Julia Krasevec, Tanya Grover, Patrick R Labelle, Jennifer A Garner, Laura Janzen, Sydney Rossiter, Omar Dewidar, Beverley Shea, Vivian Welch, George A Wells
<p><strong>Rationale: </strong>School feeding aims to alleviate hunger and enhance child outcomes. Since the first Cochrane systematic review of school meals, there has been a marked increase in studies and reviews of school feeding programs. However, most systematic reviews are geographically limited and use qualitative analysis. We reviewed worldwide papers and performed several meta-analyses, providing a more comprehensive picture of the effectiveness of school feeding.</p><p><strong>Objectives: </strong>1. To assess effectiveness of school feeding programs for improving the physical and psychological health of children experiencing socioeconomic disadvantage worldwide. 2. To assess effectiveness of school feeding programs for improving the health of children experiencing socioeconomic disadvantage compared with children who are more advantaged.</p><p><strong>Search methods: </strong>We searched 17 subject-specific and multidisciplinary databases and registries up to November 2023. In November 2024, two Information Specialists ran a top-up search for randomized controlled trials (RCTs). We handsearched references of included studies and relevant reviews.</p><p><strong>Eligibility criteria: </strong>We included individually randomized, cluster-randomized, and cross-over trials, as well as longitudinal non-randomized studies of interventions (NRSIs). Studies had to compare the provision of free or reduced-price food in schools versus no school feeding, focusing on socioeconomically disadvantaged children. The food had to contain at least 3% of the daily energy requirement and at least 10% of the daily protein requirement for the specified age group(s). Eligible participants were primary or secondary school students aged five to 19 years.</p><p><strong>Outcomes: </strong>Our critical outcomes were change in: math achievement, reading achievement, attendance, enrollment, height-for-age z-score (HAZ), weight-for-age z-score (WAZ), and overweight/obesity. Our important outcomes were change in: overall academic achievement, fluid intelligence, working memory, behavioral/emotional outcomes, height, weight, and anemia. We planned to study changes between baseline and final outcomes. In one study with extreme contamination, we used the first follow-up.</p><p><strong>Risk of bias: </strong>We assessed the risk of bias for RCTs by outcome using the appropriate version of the Cochrane risk of bias tool (RoB 2): RoB 2 for individually randomized trials, for cluster-RCTs, and for cross-over trials. We evaluated the quality of NRSIs using the School-based Measurement & Assessment of Results Tool (SMART), which is adapted from the Newcastle Ottawa Scale.</p><p><strong>Synthesis methods: </strong>We used standardized mean differences (SMDs) with 95% confidence intervals (CIs) for educational and cognitive outcomes. We used mean differences (MDs), odds ratios (ORs), or incidence rate ratios (IRRs) for others. All meta-analyses used random-effects generic inverse
理由：学校供餐旨在减轻饥饿和提高儿童的学业成绩。自从Cochrane首次对学校膳食进行系统评估以来，对学校供餐计划的研究和评估显著增加。然而，大多数系统综述在地理上是有限的，并且使用定性分析。我们回顾了世界各地的论文，并进行了几项荟萃分析，为学校供餐的有效性提供了更全面的图景。目的:1。评估学校供餐计划在改善全球处于社会经济劣势的儿童身心健康方面的有效性。2. 评估学校供餐计划在改善社会经济劣势儿童与社会经济优势儿童健康方面的有效性。检索方法：我们检索了截至2023年11月的17个特定学科和多学科数据库和注册库。2024年11月，两位信息专家对随机对照试验（rct）进行了补充搜索。我们手工检索了纳入研究的参考文献和相关综述。入选标准：我们纳入了单独随机、集群随机和交叉试验，以及纵向非随机干预研究（NRSIs）。研究必须比较学校提供免费或减价食品与不提供学校供餐的情况，重点关注社会经济上处于不利地位的儿童。食物必须含有指定年龄组每日所需能量的至少3%及每日所需蛋白质的至少10%。合资格的参与者为5至19岁的小学生或中学生。结果：我们的关键结果是：数学成绩、阅读成绩、出勤、入学、身高年龄z分数（HAZ）、体重年龄z分数（WAZ）和超重/肥胖的变化。我们的重要结果是：总体学业成绩、流体智力、工作记忆、行为/情绪结果、身高、体重和贫血。我们计划研究基线和最终结果之间的变化。在一项严重污染的研究中，我们使用了第一次随访。偏倚风险：我们使用适当版本的Cochrane偏倚风险工具（RoB 2）通过结果评估rct的偏倚风险：单独随机试验、集群rct和交叉试验的RoB 2。我们使用基于学校的结果测量和评估工具（SMART）来评估nsis的质量，该工具改编自纽卡斯尔渥太华量表。综合方法：我们使用标准化平均差异（SMDs）和95%置信区间（ci）来衡量教育和认知结果。我们使用平均差异（md）、优势比（ORs）或发病率比（IRRs）来分析其他指标。所有荟萃分析均采用随机效应一般逆方差。我们按性别和社会经济地位进行了公平亚组分析。我们使用GRADE来评估我们对随机对照试验中报告的关键结局证据的信心。纳入的研究：我们纳入了40项研究和83份报告。共有13项随机对照试验（12项集群随机试验和1项单独随机试验）和27项nrsi。大多数研究（34项）来自低收入和中等收入国家。总共有超过91,885名学生（有四项研究没有报告样本量）。其中一项研究涉及59,613名学生，而其他研究涉及60至6038名学生。这些研究包括48个结果；我们荟萃分析或报道了14例。结果综合：低收入和中等收入国家（LMICs）学校供餐与没有学校供餐相比，数学成绩略有提高（SMD 0.14, 95% CI 0.06至0.23;P = 0.001; I²= 68%；6个集群rct， 5587名参与者；高确定性证据），但对阅读成绩可能几乎没有影响（SMD 0.02, 95% CI -0.06至0.11;P = 0.61; I2 = 54%； 3个集群rct， 3417名参与者；低确定性证据）。学校供餐计划导致入学率略有增加（MD增加3.44%,95% CI 0.83至6.04;P = 0.01; I²= 0%；2组随机对照试验，5200名参与者，高确定性证据），但可能对出勤率几乎没有影响（MD 0.17%, 95% CI -2.64%至2.97%;P = 0.91; I2 = 81%； 3组随机对照试验，3566名参与者，低确定性证据）。学校供餐计划可能导致HAZ （MD 0.06, 95% CI 0.03至0.09;P < 0.001; I2 = 0%； 2组随机对照试验，3678名参与者；中等确定性证据）和WAZ （MD 0.08, 95% CI 0.05至0.12;P < 0.001; I2 = 0%； 3组随机对照试验，2132名参与者；中等确定性证据）略有增加。两组随机对照试验评估了肥胖/超重的变化。一项为期10个月的研究发现，与对照组青少年相比，接受校餐的青少年超重/肥胖的几率低53% （OR 0.47, 95% CI 0.30至0.72）。另一项研究发现，在干预前后没有超重/肥胖病例。这些发现的确定性很低。 一些研究人员遇到了他们无法控制的实施问题，包括冲突、延误和官僚决策。背景、结果、儿童群体和统计数据的异质性是本综述的局限性。高收入国家（HICs）一个NRSI发现了非常不确定的证据，即与对照组的儿童相比，被分配到早餐俱乐部的儿童平均出勤率提高了1.6%以上。性别和社会经济地位的公平性（亚组）分析均不显著。每个亚组分析中只有两项研究；他们可能动力不足。作者的结论是：在中低收入国家，学校供餐计划导致数学成绩略有提高，但可能对阅读成绩几乎没有影响。学校供餐计划导致入学人数略有增加，但可能对出勤率几乎没有影响。他们可能会导致HAZ和WAZ的轻微增加。学校供餐和超重/肥胖之间可能几乎没有联系，但证据非常不确定。我们建议研究人员和决策者将研究视为实施过程的一个组成部分。为了减少结果的异质性，我们建议加强研究的协调，研究人员和利益相关者共同努力确定一组核心结果。资助：作者要感谢以下捐助方的慷慨支持，使本次审查成为可能：迪拜关怀，世界粮食计划署的学校膳食和社会保护服务，以及学校健康和营养研究联盟。注册：议定书（2022）：https://doi.org/10.1002/14651858.CD014794原始审查（2007）：https://doi.org/10.1002/14651858.CD004676.pub2原始坎贝尔议定书（2006）：doi.org/10.1002/CL2.12。
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