Systematic Reviews最新文献

Background: Socioeconomic determinants of health (SDoH) have a significant impact on healthcare, health outcomes, and resulting health inequalities. A wealth of research relating to the adult population exists, including those with long-term health conditions. However, research is lacking on the impact of these SDoH on children and young people with long-term health conditions. Children and young people are also often forgotten when it comes to policies, legislation, and funding to reduce health inequalities. This scoping review aims to explore the extent and quality of research, legislation, and policies in the United Kingdom, in relation to SDoH and the resulting health inequalities in children and young people with long-term health conditions.

Methods and design: A flexible, iterative approach to this scoping review will enhance our ability to explore the impact of SDoH on children and young people with long-term health conditions. This will involve six steps: (1) defining the research question; (2) identifying relevant articles; (3) study selection; (4) charting the data; (5) collating, summarising, and reporting the results; and (6) consultation exercise with key stakeholders. A search of EMBASE, EMCARE, Medline, CINAHL, Cochrane Library, Web of Science Core Collection, Scopus, Sociological Abstracts, and APA PsycINFO will be conducted from 2010 to present to evaluate the published literature following the Equality Act (2010), which set out the legal framework, and the Marmot Review (2010), a strategic review of health inequalities. Manual searching of national and international conferences, government white papers, published reports, and research summaries searched via the Health Research Authority website, and grey literature will be included.

Discussion: This review will inform concurrent work being undertaken at Great Ormond Street Hospital, which aims to develop and implement targeted, evidence-based interventions to reduce the impact of these SDoH and the resulting health inequalities. As such, this review is focused on UK-specific evidence relevant to our healthcare systems and patient population. The inclusion of UK policy and legislative literature will also ensure a real-world perspective and identify current gaps in policy that need to be addressed.

Systematic review registration: This review protocol has been registered within the Open Science Framework database ( osf.io/5ut9x ).

Background: Artificial intelligence (AI) can greatly enhance efficiency in systematic literature reviews and meta-analyses, but its accuracy in screening titles/abstracts and full-text articles is uncertain.

Objectives: This study evaluated the performance metrics (sensitivity, specificity) of a GPT-4 AI program, Review Copilot, against human decisions (gold standard) in screening titles/abstracts and full-text articles from four published systematic reviews/meta-analyses.

Research design: Participant data from four already-published systematic literature reviews were used for this validation study. This was a study comparing Review Copilot to human decision-making (gold standard) in screening titles/abstracts and full-text articles for systematic reviews/meta-analyses. The four studies that were used in this study included observational studies and randomized control trials. Review Copilot operates on the OpenAI, GPT-4 server. We examined the performance metrics of Review Copilot to include and exclude titles/abstracts and full-text articles as compared to human decisions in four systematic reviews/meta-analyses. Sensitivity, specificity, and balanced accuracy of title/abstract and full-text screening were compared between Review Copilot and human decisions.

Results: Review Copilot's sensitivity and specificity for title/abstract screening were 99.2% and 83.6%, respectively, and 97.6% and 47.4% for full-text screening. The average agreement between two runs was 95.4%, with a kappa statistic of 0.83. Review Copilot screened in one-quarter of the time compared to humans.

Conclusions: AI use in systematic reviews and meta-analyses is inevitable. Health researchers must understand these technologies' strengths and limitations to ethically leverage them for research efficiency and evidence-based decision-making in health.

Background: University students are an at-risk population for developing mental health problems which can negatively impact their academic performance, social relationships, physical health, and future life. Among this population, the cohort of international students is more vulnerable. Chinese international students (CIS) form the largest international student group in the world, but research on their mental health is limited. Although researchers have become increasingly interested in their mental health in recent years, a comprehensive review of existing evidence is not yet available. The proposed review aims to integrate quantitative and qualitative findings concerning factors associated with CIS mental health.

Methods: The systematic review will follow the PRISMA guidelines. Nine online databases-six English language and three Chinese language-will be searched. Peer-reviewed journal articles will be examined and screened according to the inclusion and exclusion criteria. Both quantitative and qualitative data will be extracted and narratively synthesised to generate an improved understanding of factors associated with the mental health of CIS.

Discussion: Findings from this systematic review will provide researchers, education professionals, mental health workers, and universities with knowledge concerning the factors associated with CIS mental health that is necessary for practical actions and will inform further research.

Systematic review registration: PROSPERO CRD42023402503.

Background: Thalassemia is a genetic hemoglobin disorder commonly associated with iron overload and cardiac complications from repeated transfusions. Deferiprone (DFP), an oral iron chelator, has shown potential in reducing body iron and improving cardiac function. This systematic review and meta-analysis evaluates the efficacy and safety of DFP in thalassemia patients.

Methods: A systematic search of PubMed, MEDLINE, and Scopus was conducted from inception to June 8, 2025. Eligible randomized controlled trials (RCTs) enrolled thalassemia patients receiving iron chelation therapy and compared DFP (alone or in combination) with deferoxamine, deferasirox, placebo, or no chelation. Non-randomized studies, those without comparators, or lacking sufficient data were excluded. Risk of bias was assessed using the Cochrane RoB 2 tool, and certainty of evidence by GRADE. Pooled standardized mean differences (SMDs) the inclusion criteria; 18 were included in the meta-analysis. DFP significantly improved left ventricular ejection -effects model.

Results: Twenty-three RCTs (n = 1,005) met the inclusion criteria; 18 were included in the meta-analysis. DFP significantly improved left ventricular ejection fraction (SMD: 0.55) and shortening fraction (SMD: 0.37). Non-significant improvements were observed in urinary iron excretion and right ventricular ejection fraction. No significant effects were found for serum ferritin, liver iron concentration, or cardiac T2* MRI. DFP increased the risk of adverse events (RR: 1.37), but not mortality (RR: 0.30). Evidence certainty was moderate for cardiac function and adverse events, and low for other outcomes.

Conclusion: DFP improves cardiac function and iron excretion with an acceptable safety profile in thalassemia. Further high-quality RCTs are warranted to confirm its role and optimize regimens.

Systematic review registration: PROSPERO CRD420251028324.

Introduction: Maternal health remains a critically neglected issue in low-resource countries and represents a significant public health concern. Maternal mortality in these regions is ten times higher than in high-income countries. Sub-Saharan Africa bears the highest maternal mortality ratio globally. The persistently high maternal mortality rate is attributed to the myriad professional, social, and economic challenges healthcare providers face, which impede their ability to deliver optimal maternal healthcare. Given the central role of healthcare professionals in maternal health, understanding the barriers and facilitators they encounter is essential to improving maternal health outcomes. This systematic review aims to synthesise the existing literature on the challenges and enablers of providing maternal healthcare in Africa.

Method: The review will involve a comprehensive search using databases such as MEDLINE, CINAHL, Google Scholar, and PubMed, accessed through the City St. George's University library. The search strategy will be refined with input from the school librarian to ensure thoroughness. Search terms will include Medical Subject Headings (MeSH) terms like "Barriers OR challenges," "Facilitators OR Enablers," "maternal health," and "Africa," alongside relevant keywords. Boolean operators "AND" and "OR" will expand the search scope, with inclusion criteria limited to English-language articles published between 2010 and 2025 with available abstracts, studies conducted in African countries, and qualitative articles addressing barriers and/or facilitators of maternal healthcare. The SPIDER framework will guide the research question, adhering to PRISMA guidelines for systematic reviews, while STARLITE principles will report on the literature search process. The selected studies will be appraised using the Critical Appraisal Skills Programme (CASP) checklist for qualitative studies.

Result: Data will be analysed thematically following the approach outlined by Thomas and Harden (2008), presenting findings as an interpretive summary.

Conclusion: This review will enhance the existing evidence on the challenges and opportunities faced by maternal healthcare providers in delivering better services across Africa.

Ethics and dissemination: No formal ethical approval is necessary since this study does not involve collecting primary data. The findings will be shared via a peer-reviewed journal article and presented at conferences.

Systematic review registration: (PROSPERO) CRD42025634335.

Background: Work-related musculoskeletal disorders (WRMSDs) are significant health concerns among Radiographers, arising from ergonomic challenges, repetitive tasks, and the physical demands of their profession. These conditions contribute to pain, disability, and reduced productivity, emphasizing the need for targeted prevention and management strategies. Despite the growing recognition of WRMSDs, no systematic reviews or meta-analyses have comprehensively synthesized the prevalence and associated risk factors among Radiographers.

Method: This systematic review and meta-analysis will investigate the prevalence of WRMSDs and identify key risk factors in Radiographers. Six electronic databases will be searched from inception to June 2025, using predefined inclusion criteria. The methodological quality of the included studies will be assessed using the Joanna Briggs Institute (JBI) critical appraisal checklists. Pooled prevalence estimates and risk factor analyses will be performed using meta-analytic techniques, with heterogeneity assessed using Cochran's Q test and I² statistics.

Discussion: The findings of this review will give critical insights into the burden and underlying causes of WRMSDs within this occupational group, emphasizing the need for supporting evidence-based interventions and workplace modifications to enhance their health and productivity. Additionally, this review is expected to inform policy development in the healthcare sector, guiding the implementation of ergonomic equipment design, workplace health promotion strategies, and targeted training programs. By addressing these challenges, the review will support a comprehensive approach to enhance occupational health and fostering a safe, more efficient work environment for Radiographers.

Systematic review registration: PROSPERO, CRD42024565835.

Background: Physical activity is a cornerstone of lifestyle-oriented rehabilitation for community-dwelling stroke survivors. Effective physical activity is of great significance for restoring physical functions and enhancing self-care ability in stroke survivors. Although qualitative research on PA in this population is expanding, a systematic synthesis is lacking. This qualitative systematic review aims to integrate stroke survivors' experiences of PA after return to home and community settings.

Methods: This review will follow the Joanna Briggs Institute (JBI) methodology for qualitative systematic reviews. Ten electronic databases (PubMed, Embase, Web of Science, PsycINFO, CINAHL, Scopus, WanFang Data, CNKI, Chongqing VIP, and CBM) will be searched; hand-searching and gray-literature retrieval will supplement database results. Two independent reviewers will perform study selection, methodological quality appraisal (JBI Critical Appraisal Checklist), data extraction, and meta-aggregation. The ConQual approach will establish confidence in the synthesized findings.

Discussion: A rigorously conducted qualitative systematic review will provide a transparent, comprehensive account of stroke survivors' PA experiences. The findings will generate robust evidence to inform the development and implementation of effective community- and home-based PA interventions.

Systematic review registration: PROSPERO CRD42024561586.

Background: Sarcopenia is a clinical syndrome characterized by a significant reduction in muscle mass and strength, typically associated with the ageing process. In recent years, an increasing number of studies have shown that sarcopenia not only affects functional health in the elderly but may also be closely associated with the onset of cardiovascular diseases, particularly atrial fibrillation. However, the association between sarcopenia and atrial fibrillation has not yet been adequately systematically evaluated. Therefore, this study aims to investigate the relationship between sarcopenia and atrial fibrillation through a systematic review and meta-analysis.

Methods: The study will adhere to the PRISMA-P guidelines to ensure a transparent and rigorous methodology and will conduct a comprehensive literature search using databases PubMed, Embase, the Cochrane Library, and Web of Science, with the search period spanning from the establishment of the databases to 15 May 2025. Included will be clinical observational studies that meet the criteria, including prospective cohort studies, and case-control studies. The included studies must explicitly assess the association between sarcopenia and the occurrence of atrial fibrillation. We will assess the risk of bias of all included studies using the Newcastle-Ottawa Scale (NOS) and the AHRQ quality assessment tool. The data for this study will be analyzed using Stata 15. We will employ random-effects models for statistical analysis, along with subgroup analysis, to further explore the potential influence of factors such as age, gender, and disease status on the results.

Discussion: The primary objective of this study is to assess the impact of sarcopenia on atrial fibrillation and to analyze their potential association. This study is expected to reveal the potential association between sarcopenia and atrial fibrillation and provide evidence-based support for clinical prevention and treatment. The study results will help promote early identification and intervention for sarcopenia, thereby reducing the risk of atrial fibrillation and improving health outcomes for the elderly population.

Systematic review registration: Prospero CRD420251054023.

Background: Type 2 diabetes has been associated with impaired thermoregulatory responses to increased core body temperature, making patients more vulnerable to heat-related disorders. Although recent studies have investigated these diabetes-related impairments in heat loss mechanisms, our understanding of the occurring phenomena remains unclear due to the complexity of results and the various factors contributing to increased core body temperature.

Objective: To address the following Population/Exposure/Comparator/Outcome (PECO) question: what is the effect of an increase in core body temperature level (E) on the vasomotor and sudomotor responses and the physiological and molecular mechanisms that control these responses (O) within individuals with type 2 diabetes (P) compared to healthy individuals at the same level of core body temperature (between-group comparisons) and/or type 2 diabetes patients at lower or normal core body temperature level (within-group comparisons) (C)?

Methods: This protocol will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A thorough database search will be conducted in PubMed and Embase using tested and validated search algorithms. Experimental (randomized and non-randomized controlled trial) or observational studies with type 2 diabetes populations and have measured core body temperature will be included. A narrative synthesis will be conducted and if possible, meta-analysis will be performed. Risk of bias will be assessed using the Office of Health Assessment and Translation tool.

Discussion: The results from this review will expand our knowledge of the physiological mechanisms through which type 2 diabetes impairs heat loss under hyperthermic conditions and inform guidelines to mitigate heat-related risks in type 2 diabetes populations.

Systematic review registration: PROSPERO CRD42023471939.

Background: Caesarean section rates are increasing globally. Caesarean section and repeat caesarean section increase risk in the next pregnancy. Risks associated with next pregnancy after caesarean section for both the mother and fetus are well documented including placentation anomalies, uterine rupture, small for gestational age neonates and preterm birth. Interpregnancy interval may play a role in reducing risk in the next pregnancy. It is therefore important to understand the meaning of interpregnancy interval to women planning further pregnancies after caesarean section. Appreciating interpregnancy interval from women's perspective can improve the sharing of interpregnancy interval recommendations relevant to women for informing their decision making.

Methods: The review will include all studies exploring women's knowledge, understanding and decision making when planning another pregnancy after caesarean section and will follow the JBI methodology for mixed methods reviews using a convergent integrated approach, reported as per the preferred reporting items for systematic reviews and meta-analysis (PRISMA). A search strategy will be used to find published and unpublished studies in CINHAL, Medline, Embase, Psycinfo and SCOPUS. No limitation will be placed on study type, language of publication, or date range. All studies will be screened against the inclusion criteria, all data extracted critically appraised for methodological quality using JBI tools by two independent reviewers. Integrated findings will be presented as line of action statements. Confidence in the textual synthesis will be presented in a table.

Discussion: This review aims to integrate research exploring the meaning of interpregnancy interval to women after a caesarean section when planning further pregnancies. This systematic review holds implications for practice and informed decision making, for a next pregnancy after caesarean section in the context of newfound risk and reproductive life planning.

Systematic review registration: Protocol registered with PROSPERO CRD42024552081.