Systematic Reviews最新文献

Background: Dietary adherence is a critical component of managing chronic kidney disease (CKD) and its associated complications. However, patients with CKD often struggle to adhere to dietary recommendations due to various barriers and facilitators that influence their behavior. Existing reviews on this topic have been limited in scope or have not used a theoretical framework to guide the analysis. This systematic review aims to identify and synthesize the evidence on barriers and facilitators to dietary adherence in CKD patients using the Theoretical Domains Framework (TDF) to categorize the identified factors. Using a PICo framework: Population-adults with chronic kidney disease (all stages); Phenomena of Interest-barriers and facilitators to dietary adherence; Context-any healthcare setting globally; Outcomes-TDF-categorized factors influencing dietary adherence and their associations with adherence measures.

Methods: We will conduct a comprehensive search of electronic databases (PubMed, Web of Science, Embase, CINAHL, MEDLINE, The Cochrane Library, PsycINFO, and Scopus), grey literature, and reference lists of included studies to identify quantitative, qualitative, and mixed-methods studies that report on barriers and facilitators to dietary adherence in adult CKD patients. Two independent reviewers will screen studies for inclusion, extract data, and assess the risk of bias using established tools (NOS, CASP, MMAT, RoB 2). We will use a narrative synthesis approach guided by the TDF to categorize and synthesize the findings. If appropriate, meta-analyses will be conducted for specific outcomes or associations. Potential meta-analyses may examine associations between specific barriers/facilitators and dietary adherence measures, biochemical outcomes (e.g., serum phosphorus, potassium levels), or clinical outcomes where sufficient homogeneous data are available. The GRADE and GRADE-CERQual approaches will be used to assess the overall quality of evidence.

Discussion: This systematic review will provide a comprehensive and theoretically informed synthesis of the barriers and facilitators to dietary adherence in CKD patients. The findings will inform the development of targeted interventions, patient education strategies, and future research priorities in the field of CKD dietary management. By using the TDF to guide the analysis, we will provide a structured understanding of the complex factors influencing dietary adherence, which can inform the design of theory-based interventions to improve patient outcomes.

Systematic review registration: PROSPERO CRD42024571389.

Heterogeneity is a defining and expected feature of prevalence studies and their systematic reviews, yet it is frequently interpreted using conceptual and statistical frameworks developed for intervention research. Unlike treatment effects, prevalence estimates do not represent a single underlying biological parameter but are inherently determined by case definitions, population characteristics, measurement strategies, and contextual factors. Consequently, heterogeneity in prevalence meta-analyses often reflects structural incompatibility between studies rather than random statistical variation around a common effect. This article explains why conventional heterogeneity metrics, particularly the I² statistic, are poorly suited to prevalence data and may be misleading when used as decision rules for pooling. We clarify the conceptual distinction between structural heterogeneity and statistical heterogeneity and demonstrate why only the latter can be meaningfully addressed through quantitative synthesis. Building on epidemiological principles and current methodological guidance, we propose a pragmatic, clinically oriented framework to support the interpretation of heterogeneity and to guide decisions regarding pooling, stratification, or alternative synthesis approaches. The aim is to promote more rigorous, transparent, and conceptually coherent synthesis of prevalence evidence, improving its interpretability and usefulness for clinicians, epidemiologists, statisticians, and health policy researchers.

Background: The prevalence of non-communicable diseases has increased in part due to a shift in food environments with more processed foods and low food skills among adults and children. Developing food literacy from early childhood is essential since food-related knowledge and skills develop throughout one's life and are related to improved dietary intake. Food literacy is a multidimensional construct including food-related knowledge, skills, and self-efficacy used to access, prepare, and eat food. Given its multidimensionality, food literacy is shaped by a range of influences at various levels of the socio-ecological model for health (i.e., individual, household/interpersonal, community, and organizational). Therefore, we conducted a systematic scoping review to identify potential influences on children's food literacy at the individual, household/interpersonal, community, and organizational levels.

Methods: MEDLINE, Web of Science, and CINAHL databases were comprehensively searched. This scoping review was conducted in accordance with the PRISMA extension for Scoping Reviews and informed by Arksey and O'Malley's framework.

Results: Of 3082 titles and abstracts, 139 studies, i.e., randomized controlled trials, quasi/cluster-randomized trials, non-randomized controlled trials, qualitative, longitudinal and cross-sectional studies, were included in the scoping review. Findings show that most influences on child food literacy exist at individual (children's individual characteristics), household (parents' demographics, knowledge, and involvement) and organizational levels (school-based interventions, school environment) and highlight the lack of research examining influences at the community (community-based interventions, media campaigns, geographical locations) level. The representation of our results across the different levels of the socio-ecological model may be a starting point for interdisciplinary mapping to inform future research and help guide policy and program efforts to improve children's food literacy.

Systematic scoping review registration: OSF Registries (September 19, 2023) [https://osf.io/9p7n5].

Background: Psychosocial hazards are increasingly recognised as critical factors affecting employee health, safety, and well-being, arising from how work is designed, organised, and managed. In the European Union, employers are legally obliged to address these hazards as part of workplace risk assessment. While much is known about what constitutes a psychosocial hazard, the core risk management steps-assessment, mitigation, and control-are addressed only scarcely and inconsistently across studies and practices. This limits current understanding of how these steps contribute to reducing the risk of psychosocial hazards, hindering efforts to evaluate effectiveness and guide future research. This scoping review aims to map current knowledge related to these three foundational steps and explore their role in overall risk management.

Methods: Guided by the Joanna Briggs Institute and PRISMA-ScR recommendations, this scoping review will be divided into three sub-reviews, each focusing on one step in psychosocial risk management: assessment, mitigation, and control. Comprehensive searches will be conducted in Scopus, Web of Science, PubMed, PSYNDEX, and APA PsycINFO for peer-reviewed publications since 2000 aligning with the EU legal framework. Grey literature sources will also be explored. Two independent reviewers will perform a multi-stage screening of titles, abstracts, and full texts using predefined inclusion and exclusion criteria. Data extraction will capture study characteristics, methods, and findings related to the three risk management steps. Narrative synthesis and tabular summaries will be used to present results, delineate knowledge gaps, and inform research and practice.

Discussion: This review will provide a comprehensive overview of current knowledge on the assessment, mitigation, and control of psychosocial hazards, while identifying key research gaps. Its findings aim to inform policymakers, practitioners, and researchers on strategies to enhance worker well-being and support cohesive risk management. Although the EU focus enables an in-depth look at regulation-driven approaches, it may limit generalisability to non-EU contexts. Additionally, the scoping methodology, which prioritizes breadth over depth, will not allow for full evaluation of methodological quality or effectiveness. Nonetheless, the review will serve as a foundational map of the current state of psychosocial risk assessment and management, fostering dialogue and guiding future global research efforts.

Systematic review registration: OSF number osf.io/t5cnu. https://doi.org/10.17605/OSF.IO/GNAMH.

Objective: To accurately predict neurological outcomes among survivors after cardiac arrest (CA), we aim to analyze the experimental data of epileptiform electroencephalography (EEG) in CA survivors to explore the value of predictors of epileptiform EEG. We also aim to refine the timeline of EEG examination, thus providing a foundation for the prediction of the neurological outcomes of CA survivors in clinical practice.

Methods: The PubMed, Embase, Web of Science, and Cochrane Library databases will be searched from 2010 to 2025 to identify relevant literature based on previously established search terms. We will include observational studies that reported epileptiform EEG patterns and neurological outcomes in comatose survivors of CA. Studies involving patients under 18 years of age or with a prior history of epilepsy will be excluded. Methodological quality was assessed using quality assessment of diagnostic accuracy studies 2 (QUADAS-2). The GRADE framework will be used to assess the quality of evidence of the included studies. Meta-analysis will be performed using Stata 18 software.

Discussion: EEG is widely used to predict neurological recovery after CA, yet the prognostic value of epileptiform patterns remains debated regarding its time dependency and optimal use in multimodal approaches. This meta-analysis will address these gaps by assessing how predictive accuracy varies across EEG recording time windows (≤ 24, 24-48, > 48 h) to define optimal timing, and by synthesizing data on multiple EEG markers to inform multimodal prognostication. Our findings aim to refine outcome prediction for CA survivors.

Systemic review registration: PROSPERO 2023 CRD42023468222. Available from https://www.crd.york.ac.uk/prospero/display_record.php? ID = CRD42023468222.

Background: Maternal and perinatal quality collaboratives (M/PQCs) across nearly all U.S. states focus on improving health care and outcomes for birth parents and their infants. In the context of increases in maternal morbidity (MM) and severe maternal mortality (SMM) in the USA, M/PQCs increasingly focus on addressing maternal care and disparities in care that are partly driving observed increases in SMM and MM. To date, quality care or safety bundles and other programming from state-based M/PQCs have been implemented by hospitals and other collaborating partners, while various studies have assessed their impact. However, no extant reviews synthesize the findings of this literature. The aim of this review is to synthesize the current evidence on implementation approaches of M/PQCs at the health system level in the USA and their impact on maternal health outcomes.

Methods: We will conduct a scoping review of the literature of studies or reports that qualitatively and/or quantitatively assess the implementation of "toolkits" or "bundles" through state M/PQCs. We will include studies and reports on the implementation of state M/PQC initiatives in health systems/birth facilities or the impact of these on births, maternal and infant health outcomes and clinical care in the USA published after January 1, 2000. We will exclude studies that examine single-site quality improvement initiatives or initiatives outside of state M/PQCs, or studies that do not report on implementation, births, maternal and infant health, nor care outcomes. The information sources will include MEDLINE, Embase, CINAHL, and the Maternity and Infant Care Database, as well as a targeted search using Google Advanced for grey literature to capture information produced outside of academic publishing channels such as government and academics. Each record will be assessed independently by two reviewers at the title/abstract level and then at the full-text level. Included records will be subject to single reviewer data abstraction. We will assess study quality using the Mixed Methods Appraisal Tool (MMAT).

Results: Findings will be reported in the form of a narrative review and mapping outcomes in tabular form.

Discussion: This review will identify where additional evidence is needed to understand the relationship between M/PQCs and maternal health care and outcomes, as well as understanding key implementation processes. We will note key limitations of the included studies and general implications for the broader findings.

Systematic review registration: Open Science Framework-Embargoed/anonymized until August 30, 2025 https://osf.io/bnmpk/?view_only=9e1f754cc2d947cba6ea889e5ae58f19.

Introduction: Network meta-analysis (NMA) is a key tool for comparing multiple treatments. However, its reliability can be compromised by inconsistencies in methodology and reporting. We conducted this meta-research study to assess the characteristics and quality of NMAs published between 2019 and 2023 in BMJ, Lancet, JAMA, NEJM, and Annals of Internal Medicine, to identify limitations and propose improvement strategies.

Methods: We sampled and evaluated NMAs from the target journals using a 36-item checklist. Reviewers independently extracted data and assessed methodological and reporting quality. We compared our sample's compliance with NMAs from specific domains (Anesthesia, Cancer, Acupuncture, and Cochrane reviews) using odds ratios (ORs) with 95% confidence intervals (CIs) to identify field-specific variations.

Results: Of the 43 included NMAs, the majority originated from Canada (n = 12, 27.91%), China (n = 9, 20.93%), and the UK (n = 9, 20.93%), with 70% published in The BMJ. Overall compliance was high (> 95%) for conducting risk-of-bias assessments, providing a full search strategy, and evaluating inconsistency. However, several key methodological aspects showed suboptimal adherence: statistician involvement (55.81%), transitivity assessment (53.49%), performance of subgroup analyses (53.49%), and meta-regression (44.19%) all had compliance below 60%. Stratified analyses indicated that both the involvement of statistician involvement and the type of intervention significantly influenced methodological and reporting quality. Comparative analyses quantified differences: top medical journals' NMAs were more likely to employ random-effects models than Anesthesia NMAs [OR = 5.49, 95%CI (1.90-15.84)], Cancer NMAs [OR = 10.86, 95%CI (3.95-29.88)], and Cochrane NMAs [OR = 12.35, 95%CI (4.02-37.90)]. They were also more likely to assess consistency compared with Anesthesia NMAs [OR = 47.79, 95%CI (6.18-369.38)], Cancer NMAs [OR = 144.26, 95%CI (18.82-1105.91)], and Cochrane NMAs [OR = 84.00, 95%CI (10.45-675.31)]. Compared with Anesthesia, Acupuncture, and Cochrane NMAs, top medical journal NMAs demonstrated superior methodological rigor and reporting quality, particularly in items related to data collection, presentation of network geometry, and reporting of additional analyses.

Conclusions: Future NMAs should incorporate rational living-update mechanisms and statistical expertise to ensure methodological rigor. Transitivity must be evaluated to confirm study homogeneity, while sensitivity analyses, subgroup analyses, and meta-regression should be systematically conducted to explore heterogeneity. Certainty-of-evidence assessments using standardized frameworks are essential to enhance transparency and to guide evidence-based clinical decision-making and guideline development.

Introduction: Thalassemia, a hereditary blood disorder characterized by abnormal hemoglobin production, is prevalent in malaria-endemic regions, particularly among individuals of African descent. This hemoglobinopathy is believed to confer protection against malaria, reducing the severity of the disease and its associated complications. This systematic review and meta-analysis aimed to evaluate the protective effects of thalassemia against malaria, drawing insights from studies conducted in Africa between 2013 and 2025.

Methods: This review adhered to the PRISMA guidelines and has been registered on PROSPERO. A comprehensive literature search was conducted via PubMed, Scopus, Cochrane Library, Embase and Google Scholar, supplemented by manual reference checks. Boolean search terms such as "thalassemia," "malaria," and "Africa" were used. The meta-analysis was conducted via R version 4.4.1, and a random effects model was used to calculate pooled odds ratios (ORs). Heterogeneity was assessed via the I2 statistic, and publication bias was evaluated via funnel plots and Egger's test.

Results: Among the 4,957 screened articles, 15 studies met the inclusion criteria, with eight providing sufficient data for meta-analysis. The meta-analysis indicated that thalassemic individuals had lower odds (OR: 0.856) of developing malaria than non-thalassemic individuals. Mechanistically, alpha thalassemia has been shown to reduce cytoadhesion and rosette formation and enhance immune clearance, with favorable interactions observed with the haptoglobin phenotype (Hp2-1).

Conclusion: Although the pooled estimate suggested a protective trend, the association was not statistically significant and was characterized by substantial heterogeneity across studies. While these findings underscore the evolutionary link between hemoglobinopathies and malaria resistance, further research is needed to elucidate molecular pathways and broader implications of thalassemia.

Systematic review registration: PROSPERO CRD420261294712.

Background: Sub-Saharan Africa (SSA) has been witnessing a persistent increase in the burden of cardiovascular diseases (CVD), such as stroke and heart disease, over several decades. A key driver of this burden has been the poor adoption of healthy lifestyles such as physical activity. The goal of this systematic review was to critically appraise and synthesize evidence on the barriers and facilitators to adopting healthy lifestyles for CVD prevention in SSA.

Methods: We searched PubMed, African Journals Online, Google Scholar, Medline, and Web of Science from January to March 2024 for both quantitative and qualitative studies that assessed barriers and/or facilitators to the adoption of at least one preventative measure for CVD prevention. The socioecological model was used to categorize barriers and facilitators into four levels: intrapersonal, interpersonal, institutional, and community. The Critical Appraisal Skills Program (CASP) checklist was used to determine the quality of qualitative studies, while the AXIS checklist was used to assess the quality of cross-sectional studies. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach was used to estimate the certainty of the evidence.

Results: There were a total of 25 studies included in this review. At the intrapersonal level, barriers included perceived self-efficacy, limited knowledge and awareness, personal attitudes and behaviours, and poverty, while health literacy and awareness served as facilitators. At the interpersonal level, social norms and limited social support were the main barriers, while social support and having positive role models were facilitators. At the institutional level, accessibility and affordability of preventive healthcare services, as well as healthcare provider characteristics, were barriers, while trust in healthcare providers, affordability of care, reputation, and approachability of healthcare providers, quality of patient-provider relationships, and quantity and quality of patient education were facilitators. Lastly, at the community level, the physical, social, and economic characteristics of the community acted as either facilitators or barriers.

Conclusions: A complex interplay of multiple barriers and facilitators influences the adoption of healthy lifestyles in SSA. While individual factors, such as knowledge and motivation, are crucial, they are often overshadowed by deeply rooted socioeconomic disparities, limited access to healthcare and resources, and cultural norms. A multi-sectoral approach that empowers individuals, strengthens community support systems, improves access to affordable, healthy options, and implements supportive policies could address these barriers.

Background/objectives: Cardiovascular diseases (CVDs), particularly myocardial infarction (MI) and heart failure (HF), remain global causes of morbidity and mortality, despite the current treatment options. Stem cell therapy (SCT) has emerged as a promising intervention aimed at halting disease progression and promoting cardiac repair. Nonetheless, the clinical efficacy, optimal cell type, delivery method, and safety profile of SCT remain inadequately defined.

Methods: This systematic review and meta-analysis aimed to evaluate the efficacy and safety of SCT in patients diagnosed with ischemic heart disease (IHD) and HF. PubMed, Web of Science, Embase, Scopus, and Science Direct were searched to retrieve randomized controlled trials (RCTs) investigating SCT in patients with MI or HF. Primary outcomes encompassed changes in left ventricular ejection fraction (LVEF), end-diastolic and end-systolic volumes (LVEDV, LVESV), infarct size, functional status, and quality of life measures. Risk ratios were calculated for safety outcomes. Subgroup analyses were executed based on follow-up duration, delivery method, and type of stem cell utilized.

Results: This review included 35 RCTs comprising 3345 patients (1875 in the SCT group and 1488 in the control group). The SCT indicated that significantly enhanced LVEF at 3, 6, and 12 months (mean difference [MD] = 1.43; 95% CI 0.92 to 1.95; p < 0.00001), while simultaneously reducing LVEDV (MD = - 5.23; 95% CI - 7.55 to - 2.91; p < 0.0001) and LVESV (MD = - 6.91; 95% CI - 9.01 to - 4.82; p < 0.00001). Additionally, infarct size demonstrated significant reductions at 6 and 12 months. Patients undergoing SCT exhibited improvements in functional status and quality of life. The safety profile of SCT indicated that it was well tolerated.

Conclusions: SCT appears to be a safe and modestly effective adjunctive therapy for patients with IHD and HF. The standardization of treatment protocols and the conduct of longer-term studies are critical to validate its clinical utility and optimize therapeutic outcomes.

Systematic review registration: PROSPERO CRD42024582716.