Systematic Reviews最新文献

Background: Arbovirus infection outbreaks are becoming more widely reported in Africa. However, it is still difficult and crucial to better understand arbovirus transmission patterns, disease trends, and burdens. The epidemiology of these infections-dengue virus (DENV), Zika virus (ZIKV), chikungunya virus (CHIKV), West Nile virus (WNV), Rift Valley fever virus (RVFV), and yellow fever virus (YFV)-is unfortunately not well understood. This review provides an epidemiological inventory of DENV, ZIKV, CHIKV, WNV, RVFV, and YFV infections in Africa, with helpful results for risk mapping and upcoming prevention and control initiatives.

Methods: This systematic review protocol implements the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and an expert-evaluated design, laboratory assay and reporting evaluation (DARE) concept. Two independent reviewers conducted preliminary literature searches in PubMed in May 2023 to improve search keywords, strategy, and inclusion criteria while considering the context and scientific significance. The final search will be conducted using PubMed, ScienceDirect (SCOPUS), Web of Science Core Collection, African Journal Online, and Google Scholar. Two reviewers will simultaneously and independently conduct searches, screen studies, and extract data. Quality assessment will be performed by two independent epidemiology experts, and discrepancies will be handled by consensus or by consulting a third reviewer. Meta-analysis will be performed to determine the pooled estimate of arboviruses circulation and transmission patterns in Africa.

Discussion: With this review, we want to present an epidemiological inventory with information that will be relevant for risk assessment, future arbovirus infection outbreak prevention, and arbovirus infection outbreak control in Africa. This will include estimating the patterns, trends, and burden of arboviral infection across Africa, as well as identifying the regions with the highest risk of transmission. This will be crucial for developing well-informed policies for epidemic prevention.

Systematic review registration: PROSPERO CRD42023434939.

Background: The process of developing and updating an evidence gap map (EGM) is based on the principles of systematic reviews and requires extensive time and financial resources. Artificial intelligence (AI) tools, like prioritisation screening (PS), integrated into programmes such as EPPI-Reviewer (ER) and Copilot 365, can potentially mimic human performance in systematic review processes. ER is a subscription-based web application employed by systematic review groups, while Copilot 365, integrated into Microsoft 365, offers real-time assistance. Although ER shows promise in speeding up screening, the optimal threshold for accuracy remains unclear. Additionally, there is no evidence on the effectiveness of any version of Copilot in systematic review and EGM processes.

Objectives: Assess the accuracy and efficiency of Copilot 365 and PS integrated into ER at different stages of an EGM update, comparing it to human performance.

Methods: We will conduct both manual and automated screening of references, full-text screening, data extraction, and critical appraisal. Two reviewers will independently screen studies for inclusion, extract data, and appraise included studies, resolving conflicts through discussion. We will assess the accuracy and efficiency of Copilot 365 and ER at different EGM update stages, comparing them to human performance. To evaluate the PS accuracy, we will use 20% and 40% manual screening thresholds, calculating the proportion of relevant references prioritised by PS and the total relevant citations missed. We will compare Copilot 365's full-text screening accuracy to reviewers' decisions and assess consistency using Cohen's Kappa. For automated data extraction and appraisal, we will manually inspect 20% of Copilot 365's outputs, comparing them to reviewers' results, measuring consistency with Cohen's Kappa, and evaluating time savings by comparing the time taken for manual extraction versus using Copilot 365.

Discussion: This study will offer insights into ER's accuracy in screening small samples of citations and potentially guide future applications in this context. Additionally, by evaluating Copilot 365, which shares similar features with other AI tools, we will gain a broader understanding of its applicability and limitations in evidence synthesis, making the results relevant to other AI applications in this field.

Systematic review registration: Registered at Open Science Framework: https://doi.org/10.17605/OSF.IO/49BX8.

Background: Childhood multimorbidity, defined as the co-occurrence of two or more chronic conditions, is an emerging yet underexplored global health concern. Unlike adult multimorbidity, which is predominantly linked to ageing, childhood multimorbidity affects critical developmental phases, impacting physical, cognitive, and emotional well-being. Despite increasing recognition, its prevalence, correlates, and long-term implications remain inadequately understood.

Objectives: This systematic review aims to synthesize existing evidence on the prevalence, correlates, and outcomes of childhood multimorbidity in the general paediatric population.

Methods: A comprehensive search was conducted across PubMed, EMBASE, Web of Science, and CINAHL (EBSCO) to identify observational studies published up to May 31, 2024. Studies were included if they reported multimorbidity prevalence among children aged 0-18 years. Owing to high heterogeneity across studies, a meta-analysis was not performed, and the results were synthesized narratively.

Results: Nine studies, covering diverse paediatric populations, met the inclusion criteria. The individual study prevalence varied widely, ranging from 1.26% to 17.04%, reflecting differences in chronic conditions, multimorbidity definitions, study designs, and data sources. The key correlates included socioeconomic disadvantage, early-life factors (e.g., preterm birth), and poly-victimization. The co-occurrence of physical and mental health conditions commonly affects health-related quality of life (HRQOL), healthcare utilization, and educational performance.

Conclusions: Childhood multimorbidity poses significant health and social challenges, necessitating integrated care approaches and standardized definitions for cross-study comparability. Preventive strategies targeting social determinants and early-life interventions are crucial to mitigate its long-term burden. Future research should focus on longitudinal studies to explore progression and inform targeted interventions.

Systematic review registration: PROSPERO CRD42024601137.

Introduction: Despite significant efforts to manage and prevent HIV, knowledge gaps persist regarding mother-to-child transmission of HIV among women of reproductive age. Previous studies, limited in scope and producing inconsistent findings, have hindered the development of effective policies and interventions. This study aims to provide updated information on MTCT knowledge among women of reproductive age and identify associated factors globally.

Method: A systematic search was conducted across four databases (PubMed, Scopus, Web of Science, and Cochrane Central Library). The quality of the included studies was assessed using the JBI tool. Extracted data characteristics were presented in tables and forest plots. The random effects model was applied, and statistical heterogeneity was assessed using Higgins I² statistics. Subgroup and sensitivity analyses were performed to examine variation in estimates and the impact of individual studies on the pooled result. Publication bias was evaluated using a funnel plot and Egger's regression test.

Result: A total of 37 studies meeting the eligibility criteria were included in this systematic review and meta-analysis. The pooled knowledge of women regarding mother-to-child transmission of HIV was 52% (45%, 59%). Subgroup analysis by study year showed lower knowledge in studies conducted before 2015 compared to those after. Egger's test indicated no publication bias and sensitivity analysis confirmed no single study impact on the pooled estimate. Significant factors associated with knowledge included place of residence, education, wealth status, media exposure, antenatal visits, and HIV testing history.

Conclusion: Knowledge of mother-to-child transmission of HIV among reproductive-age women globally remains insufficient. Our findings show that urban residence, higher education, wealth status, media exposure, antenatal care visits, and HIV testing are significantly linked to better knowledge. Targeted interventions for rural, uneducated, and socioeconomically disadvantaged women are needed to improve awareness and prevent MTCT of HIV.

Systematic review registration: PROSPERO CRD42024620895.

Background: Hearing loss is increasingly prevalent among older adults and significantly impacts their ability and motivation to communicate. This often results in reduced social participation, increased feelings of loneliness, and a higher risk of social isolation. This review aims to evaluate the effectiveness of interventions designed to improve social participation, reduce loneliness, and mitigate social isolation in older adults with hearing loss.

Methods: This review followed PRISMA guidelines. Keyword and subject heading searches were conducted within MEDLINE, EMBASE, PsycINFO, AgeLine, CINAHL, and ProQuest Sociology. Articles were selected based on pre-defined inclusion and exclusion criteria. Quality assessment was conducted with the Cochrane Risk of Bias and the Risk of Bias in Non-randomised Studies of Interventions tools.

Results: The search identified 746 records, of which 11 met inclusion criteria. Two studies employed pilot randomized controlled trial designs, while the remaining studies used prospective pre-post observational designs. Interventions included hearing aids, cochlear implants, assistive listening technologies, and Group Auditory Rehabilitation (GAR). Across study designs, interventions targeting hearing loss were consistently showed improvements in loneliness and social participation, with the strongest and most consistent evidence observed for GAR combined with hearing device uptake. In contrast, social isolation was less frequently measured, limiting conclusions for this outcome relative to loneliness and social participation.

Conclusions: The best available evidence across diverse study designs suggests that hearing interventions, including hearing devices and Group Auditory Rehabilitation, can support improvements in loneliness and social participation in older adults with hearing loss. Although fewer studies have directly examined social isolation, available findings indicate potential benefit. Future research should further evaluate social isolation outcomes, long-term sustainability, and mechanisms of change.

Systematic review registration: PROSPERO database (reference number CRD42024529695).

Background: Praziquantel is the drug of choice for parasitic diseases such as opisthorchiasis, schistosomiasis, and taeniasis. The U.S. Food and Drug Administration and World Health Organization (WHO) advise administering praziquantel with food to increase absorption and decrease side effects. However, there is a scarcity of evidence on the impact of food, and different types of food, on treatment outcomes. This review aims to address this knowledge gap by (i) examining how pre-treatment food intake is reported in humans, and characterising the types of food provided, if any, and (ii) assessing whether the presence and/or type of food impacts four key treatment outcomes in humans: absorption, metabolism, treatment-associated side effects, and drug efficacy.

Methods: We will search the following databases: Embase (via Ovid), MEDLINE (via PubMed), Web of Science Core Collection, Cochrane Central Register of Controlled Trials (CENTRAL), and African Index Medicus (via Global Index Medicus), and trial registries including clinicaltrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP). Additionally, we will perform citation and grey literature searching and will contact researchers to obtain information on ongoing and unpublished relevant research. The search strategy is constructed using two core concepts: (i) praziquantel, and (ii) the outcomes of interest (pharmacokinetics, treatment-associated side effects, and drug efficacy). In Covidence, two review authors will independently screen the retrieved studies based on pre-defined inclusion/exclusion criteria and extract data using a standardised form. Risk of bias will be assessed using the Risk of Bias 2 (RoB 2) tool for randomised controlled trials and the Risk of Bias In Non-randomised Studies of Interventions (ROBINS-I) tool for non-randomised studies. Data will be synthesised narratively, and random-effects meta-analyses will be conducted to estimate the effect of food on the outcomes of interest, where appropriate. The certainty of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.

Discussion: This review has the potential to enhance treatment outcomes for individuals and communities living in endemic regions for schistosomiasis and other parasitic diseases treated with praziquantel. Our findings will be of direct relevance for WHO guidelines and, therefore, can help improve the design and impact of future targeted treatment and mass drug administration (MDA) programmes.

Systematic review registration: PROSPERO CRD420251024296.

Background: Chronic obstructive pulmonary disease (COPD) symptoms of dyspnea and chest tightness overlap with some symptoms of panic attacks, the hallmark feature of panic disorder (PD). Our objective was to quantify PD prevalence in COPD from a systematic review and meta-analysis.

Methods: A database search from inception to January 2025 was performed using five electronic databases. Eligible studies utilized structured clinical psychiatric interviews to identify PD in adult populations with COPD derived from inpatient, outpatient, or general population sampling.

Results: Twenty-one studies met inclusion criteria, with most from Asia (k = 9), reporting data from 1847 persons with COPD, 860 healthy controls, and 450 persons with comorbidities other than COPD. The prevalence of PD in persons with COPD was 12.5% (95% confidence interval [CI] 8.2-18.7, I² = 90%), revised to 8.1% (95% CI 5.7-11.6, I² = 73%) after the exclusion of k = 5 outliers. In case-control studies, PD was more prevalent in COPD patients (k = 9, 9.7%; 95% CI 5.9-15.4, I² = 69%) than healthy controls (k = 6, 2.8%; 95% CI 1.7-4.6, I² = 0%). There was no evidence to suggest a higher PD prevalence than in other medical conditions (k = 5, 4.8%; 95% CI 1.8-12.0, I² = 47%).

Conclusions: The pooled estimates of PD in COPD were higher than the general population but markedly lower than suggested by prior narrative reviews. Further research needs to elucidate whether the characteristic symptoms of panic in COPD are similar to PD in non-COPD populations and, secondly, whether they lead to differential healthcare resource utilization and portend a higher risk for adverse outcomes.

Systematic review registration: CRD42024559743.

Background: The burden of type 2 diabetes mellitus (T2DM) is rising rapidly in low- and middle-income countries (LMICs). Diabetic cardiomyopathy (DbCM), defined as myocardial dysfunction occurring independently of coronary artery disease, hypertension, or significant valvular disease, is an important complication of T2DM and may progress to overt heart failure if undiagnosed. While well characterised in high-income settings, DbCM prevalence and distribution in LMICs remain poorly defined. This systematic review aims to estimate the pooled prevalence of DbCM among adults with T2DM in LMICs.

Methods: This protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines and the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis. A comprehensive search will be conducted in PubMed, Scopus, Web of Science, Embase, AJOL, and EBSCOhost, supplemented by regional databases and grey literature sources. Observational studies conducted in LMICs that report the prevalence of DbCM among adults with T2DM will be considered. DbCM must be diagnosed using objective cardiac imaging after exclusion of alternative causes of myocardial dysfunction. Two reviewers will independently screen, extract data, and assess risk of bias using a tool adapted for prevalence studies.

Data synthesis and analysis: Where data are sufficiently comparable, pooled prevalence estimates will be calculated using random-effects meta-analysis. Prevalence proportions will be modelled using generalised linear mixed models with a logit link function to account for within- and between-study variability. Statistical heterogeneity will be assessed using the I² statistic and explored through subgroup analyses by demographic, clinical, and regional characteristics. Where meta-analysis is not appropriate, findings will be synthesised using a structured narrative approach.

Expected outcomes: This review is expected to report pooled prevalence estimates of DbCM across LMICs and to describe regional variation. Differences in diagnostic approaches, glycaemic control, diabetes duration, age, sex, and geographical region are anticipated to contribute to heterogeneity and will be explored where data permit.

Conclusion: By synthesising available evidence on the prevalence of DbCM in LMICs, this review will clarify the burden of disease and provide evidence to inform health system planning and guide future research and prevention efforts aimed at reducing diabetes-related heart failure.

Background: Acute respiratory distress syndrome (ARDS) and acute lung injury (ALI) are life-threatening conditions with limited effective pharmacological interventions. Sivelestat sodium, a selective neutrophil elastase inhibitor, has been extensively investigated in ARDS/ALI treatment due to its significant anti-inflammatory properties; however, its therapeutic efficacy remains controversial. As a drug developed and first approved in Japan, most previous meta-analyses have failed to incorporate Japanese literature, potentially introducing substantial language bias. Additionally, Japanese clinical practices may employ different treatment protocols that could offer novel perspectives on sivelestat sodium's application. This systematic review aims to comprehensively evaluate sivelestat sodium's efficacy in ARDS/ALI patients by simultaneously including both English and Japanese clinical literature.

Methods: We will systematically search English databases (Cochrane Library, EMBASE, PubMed) and Japanese databases (Ichushi Web, J-STAGE) for randomized controlled trials comparing sivelestat sodium with placebo or standard therapy in adult ARDS/ALI patients. Two independent reviewers will screen studies, extract data, and assess risk of bias. Primary outcomes include duration of mechanical ventilation and all-cause mortality (28-30 days, ICU, and in-hospital). If sufficient eligible studies are identified, a random-effects model will be employed for meta-analysis. Between-study heterogeneity will be assessed using the I² statistic, and the certainty of evidence will be evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework.

Discussion: This protocol outlines a systematic approach for evaluating sivelestat sodium's efficacy in ARDS/ALI through the integration of English and Japanese literature. Methodological rigor will ensure high-quality evidence synthesis despite challenges in integrating diverse studies. This research addresses a significant gap, as meta-analyses incorporating Japanese publications have been absent for over a decade. The findings will provide evidence-based guidance for clinical practice, inform individualized treatment strategies, optimize sivelestat administration protocols, and identify directions for future research.

Systematic review registration: PROSPERO CRD420251067146.

Background: Sickle cell disease (SCD) is a genetic blood disorder associated with chronic cardiovascular and pulmonary complications, including pulmonary hypertension (PHT), venous thromboembolism (VTE), and cardiac involvement (CI), all of which contribute significantly to premature mortality. Despite their clinical importance, the burden of these conditions in adolescents and adults with SCD remains poorly characterized.

Methods: We conducted a systematic review and meta-analysis to evaluate the prevalence and impact of these complications in SCD patients aged ≥ 10 years. Following PRISMA guidelines, we searched MEDLINE/PubMed, Web of Science, and Scopus for observational studies reporting prevalence or incidence. We did not apply any date or time restrictions to the literature search. Pooled estimates were calculated using random-effects meta-analysis.

Results: The studies yielded from the search were published between January 1, 1974, and October 12, 2023. Seventy-nine studies met the inclusion criteria, of which fifty-nine were included in the meta-analysis. The pooled prevalence estimates were as follows: PHT 30% (95% CI 26-34), VTE 13% (9-18), and CI 24% (17-33), with substantial heterogeneity (I² > 90%) among the studies. PHT was primarily diagnosed via Doppler echocardiography, while VTE was identified through ultrasonography or CT angiography. CI manifestations included diastolic dysfunction and structural abnormalities. These complications were strongly associated with increased mortality and functional impairment.

Conclusion: Chronic cardiovascular and pulmonary complications are highly prevalent in adolescents and adults with SCD, leading to significant morbidity and mortality. Routine screening and early intervention are essential to mitigate disease progression and improve outcomes. Future research should focus on standardized diagnostic criteria and targeted therapies to reduce the burden of these conditions in SCD.

Systematic review registration: PROSPERO CRD42023474623.