Systematic Reviews最新文献

Background: With growing proportions of single-person households, increasing numbers of people with dementia are living alone, challenging the still-prevalent assumption that people have an informal carer available. We aimed to characterise the research literature on people living alone with dementia and summarise what is known about their characteristics and needs.

Method: This scoping review followed Joanna Briggs Institute methodology and PRISMA-ScR reporting guidelines. Seven databases (PubMed, Web of Science, CINAHL, Ageline, EMBASE, PsycInfo, Social Policy and Practice) were searched for English-language publications on 18/01/2024, without date limits. Eligible studies reported on people with dementia living alone, using any research design; reviews, editorials, and conference abstracts were excluded. Titles, abstracts, and full texts were screened independently. Data were extracted using structured forms and summarised narratively, grouping quantitative findings descriptively and qualitative findings thematically.

Results: We included 200 articles (162 quantitative, 38 qualitative) from 161 studies. Living alone was the primary focus in 30.5% of articles, living situation was explored in secondary comparisons or sub-group analyses in 62.5%, and noted only in describing samples in 7%. Most research (80.1%) was from Europe or North America. The first study was published in 1962 and the next in 1984, since when the annual number of publications has gradually increased. Across studies, people living alone with dementia were commonly described as older, more often female, and as experiencing significant unmet need. Reports noted variation in the extent of informal support, with some people receiving little or no support. Compared with those living with others, people living alone were often described as having less timely diagnosis, lower access to formal services, higher home care costs, and greater likelihood of moving into residential care or dying outside the home. Studies commonly reported social isolation, loneliness, and difficulties with daily living in people living alone with dementia. Family members providing support at a distance were described as receiving little assistance. Few studies examined approaches to addressing these needs or improving support.

Conclusions: This review highlights living alone with dementia as a growing but neglected source of inequality. Practical steps are needed now to address this issue in policy, service provision, practice and research.

Background: Azoospermia affects ~ 1% of men and represents a major cause of severe male infertility. Intracytoplasmic sperm injection (ICSI) with surgically retrieved sperm from the testis or epididymis enables biological fatherhood in obstructive (OA) and non-obstructive azoospermia (NOA) patients. However, comparative studies versus ejaculated sperm remain fragmented, particularly for neonatal and long-term offspring outcomes. This study aims to address the existing evidence gap regarding the outcomes of ICSI cycles using surgically retrieved versus ejaculated sperm in men with azoospermia by evaluating reproductive, perinatal, long-term offspring, and paternal outcomes.

Methods: A systematic review and meta-analysis will be conducted following the PRISMA-P and PRISMA 2020 guidelines. Eligible studies will include randomized and non-randomized comparative designs of ICSI using surgically retrieved versus ejaculated sperm as single-arm studies for outcomes not applicable to ejaculated sperm. The primary outcome is live birth per oocyte pick-up or per started cycle. The secondary outcomes include reproductive, perinatal, long-term offspring, and paternal outcomes. Searches will be conducted in PubMed, Embase, Scopus, CENTRAL, Web of Science, and ProQuest, supplemented by trial registries, conference proceedings, and grey literature from 1990 onward. The risk of bias will be assessed with RoB 2 and ROBINS-I; certainty of evidence will be assessed with GRADE. Random-effects meta-analyses with restricted maximum likelihood estimation and Hartung-Knapp-Sidik-Jonkman adjustment will be applied, with rare-event models explored as sensitivity analyses.

Discussion: This protocol describes a systematic approach to evaluate the efficacy and safety of ICSI via surgically retrieved sperm compared with ejaculated sperm, with a particular focus on filling current evidence gaps in perinatal, offspring, and paternal outcomes. The results will contribute to evidence-based counseling, clinical practice, and guideline refinement.

Systematic review registration: PROSPERO CRD420251142427.

Background: Metabolic dysfunction-associated steatohepatitis (MASH), a progressive subtype of steatotic liver disease, imposes a substantial global health burden due to its association with obesity and metabolic syndrome. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) demonstrate therapeutic potential through pleiotropic mechanisms, including appetite regulation, metabolic enhancement, and anti-inflammatory activity. However, clinical evidence remains limited by methodological heterogeneity and insufficient long-term efficacy data, necessitating a rigorous systematic evaluation.

Methods: This protocol for a systematic review and meta-analysis will include randomized controlled trials (RCTs) evaluating GLP-1 RAs versus placebo in adults with biopsy-confirmed MASH. Comprehensive searches of PubMed, Web of Science, Embase, and the Cochrane Library will be conducted using predefined strategies. Two independent reviewers will perform study screening, data extraction, and risk-of-bias assessment with the Cochrane ROB 2 tool. Primary outcomes are histological: (1) MASH resolution without fibrosis worsening, and (2) fibrosis improvement without MASH deterioration. Secondary outcomes encompass physiological and biochemical parameters. Data synthesis will utilize random-effects meta-analysis, complemented by meta-regression to explore heterogeneity sources. Trial sequential analysis (TSA) will be used to control random errors (α = 0.05, power = 80%) and validate evidence sufficiency, strengthening result reliability. Sensitivity analyses will assess robustness. Statistical analyses will employ RevMan 5.4 and R 4.3.1. Evidence certainty will be evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) framework.

Ethics and dissemination: Ethical approval is not required as this study synthesizes published data. Findings will be disseminated through peer-reviewed publication and conference presentations.

Systemic review registration: PROSPERO CRD420251090801.

Background: Over the past 30 years, the global use of cesarean section (CS) has increased significantly, surpassing the recommended population-based rate of 10-15%. Increased maternal weight is a major factor for cesarean section (CS) delivery.

Objective: This systematic review and meta-analysis assessed the association between maternal overweight/obesity and CS delivery, estimating the proportion of CS deliveries attributable to excess maternal weight in Middle East and North Africa (MENA) countries.

Methods: Electronic databases (PubMed, Scopus, Embase, CINAHL, Web of Science, and Cochrane) were searched for studies published between Jan 2000 and Nov 2024 in MENA countries. Two authors reviewed studies and extracted data. Subgroup analyses examined obesity class (I-III) and CS type. Attributable risk fractions (ARFs) and population-attributable risk fractions (PARFs) were calculated. Random-effects models were used.

Results: Forty-five studies from 12 MENA countries, including 97,518 women, were analyzed. Compared to women with a normal body mass index (BMI), overweight and obese women had a 35.0% (aOR 1.35; 95% CI, 1.24-1.49) and a 77.0% (aOR 1.77; 95% CI, 1.49-2.11) elevated likelihood of CS, respectively. The likelihood of CS significantly increased with increasing obesity class by 78% for class I, 121% for class II, and 161% for class III. Overweight women were also at higher risk of emergency CS (aOR 1.34; 95% CI, 1.02-1.76). An estimated 25.9% and 43.5% of CS deliveries were attributable to maternal overweight and obesity. The highest estimated PARF for maternal overweight was in Syria (15.9%) and for obesity in Saudi Arabia (35.4%).

Limitations: Few included studies lacked standardized definitions or classifications of BMI and maternal weight, which may have affected comparability. Substantial heterogeneity was observed in subgroup analyses, requiring cautious interpretation of the pooled estimates.

Conclusions: Promoting healthy weight before and during pregnancy could reduce unnecessary and emergency CS deliveries, offering a critical intervention for improving maternal health.

Systematic review registration: PROSPERO CRD42024551878.

Background: Knee osteoarthritis (KOA) is the most common and burdensome form of osteoarthritis worldwide. Although numerous non-pharmacological interventions are recommended in clinical practice, existing evidence remains fragmented and lacks comprehensive comparative evaluation. This study aims to systematically compare the effectiveness of first- and second-line non-pharmacological interventions recommended by the American Academy of Orthopaedic Surgeons (AAOS) for symptomatic KOA using Bayesian network meta-analysis (NMA), which integrates both direct and indirect evidence from randomized controlled trials (RCTs).

Methods: We will conduct a systematic review and Bayesian NMA of randomized trials evaluating non-pharmacological interventions for symptomatic KOA. Eligible interventions include exercise, weight management, braces, and other guideline-recommended non-pharmacological therapies with strong or moderate evidence. The primary outcome is pain intensity, assessed using validated scales. Secondary outcomes include physical function, quality of life, stiffness, global assessment, and adverse events. A comprehensive search will be conducted across multiple databases without language restrictions from inception to the date of the formal search. Risk of bias will be assessed using the Cochrane RoB 2.0 tool. Bayesian NMA models will be implemented using Markov chain Monte Carlo methods. Subgroup analyses and meta-regressions will explore heterogeneity related to disease severity and treatment characteristics. Certainty of evidence will be assessed using the GRADE approach adapted for NMA.

Conclusions: This NMA will synthesize high-quality evidence on the comparative effectiveness of AAOS-recommended non-pharmacological interventions for KOA. The findings will provide clinically relevant treatment rankings, support individualized non-pharmacological management in adults, and inform future guideline updates and research priorities.

Systematic registration number: PROSPERO CRD420251045765.

Background: Indigenous Peoples face a notable absence of standardized equity indicators for non-communicable diseases. Existing measurement models are rooted in Euro-Western biomedical frameworks that overlook Indigenous worldviews, definitions of health, and relational approaches to wellness. These models remain narrow in scope-focused on disease-specific indicators and treatment pathways-and reinforce deficit-oriented perspectives rather than advancing holistic, strengths-based understandings of well-being. This scoping review aims to identify and synthesize research that utilizes, assesses, or validates measures of wellness, health, and supportive early environments in Indigenous populations.

Methods: This review will use an Indigenous-informed scoping review study methodology, which grounds each stage of the review process in Indigenous values and community guidance. A systematic search of global academic and grey literature databases will be conducted to identify relevant literature. Selected studies will include those that assess or validate the measurement of health and wellness spanning from preconception through pregnancy, infancy, and early childhood within Indigenous populations in Canada, Australia, New Zealand, and the USA. Articles will be screened and assessed for eligibility by two reviewers. From eligible articles, data including author and year of publication; source country; target population; objectives; name(s) of instrument(s); type(s) of measure(s); development/adaptation/validation process; main outcomes; community engagement; quality assessment; and other descriptive variables will be extracted. A thematic analysis approach guided by an Indigenous Community Advisory Committee will be applied to synthesize the findings.

Discussion: This scoping review aims to identify and synthesize the global literature on tools and instruments to measure health, well-being, and supportive early environments in Indigenous populations. This work aims to inform the development of Indigenous wellness indicators for the Indigenous Healthy Life Trajectories Initiative (I-HeLTI) Cohort Research Study funded by the Canadian Institutes of Health Research. Traditional population health monitoring methods, rooted in Western paradigms, have often perpetuated colonial biases and overlook unique contexts of Indigenous communities. This review seeks to bridge knowledge gaps in developing and validating Indigenous wellness indicators that align with Indigenous values and aspirations. The findings are expected to advance ethical approaches to health measurement in Indigenous populations, supporting data sovereignty and culturally inclusive wellness indicators.

Systematic review registration: Open Science Framework https://osf.io/yfv8m .

Background: Anorexia nervosa (AN) is a severe eating disorder. With a lifetime prevalence of 1.4% in women and 0.2% in men, an increasing incidence and the highest mortality rate of all mental disorders, it is recognized as a major public health threat. Although the number of available treatments is increasing worldwide, the comparative efficacy and safety of different treatment options have not been investigated systematically. In this systematic review with network meta-analysis (NMA), we aim to assess the efficacy and safety of pharmacological and non-pharmacological interventions in adolescents and adults with AN.

Methods: We will consider randomized controlled trials investigating pharmacological (e.g., antidepressants) and non-pharmacological (e.g., cognitive behavioral therapy) interventions compared to each other and to relevant control groups (e.g., no treatment, treatment as usual, waiting list) in adolescents (≥ 10 years) and/or adults (≥ 18 years) with AN. Eligible outcomes will include physiological (e.g., body weight) and psychological (e.g., depressive symptoms) outcomes prioritized by various interest-holders, including patients and healthcare professionals. Six electronic databases will be searched (Ovid MEDLINE, Scopus, WHO Global Index Medicus, Cochrane Central Register of Controlled Trials, Science Citation Index Expanded [Web of Science], Ovid APA PsycINFO). We will additionally search for grey literature and unpublished trials in further sources. Study selection, data extraction and the risk of bias assessment (Cochrane RoB 2 tool), will be performed independently by two reviewers. We will synthesize the data using a random-effects network meta-analysis and component network meta-analysis, if appropriate. We will assess inconsistency using a random-effects design-by-treatment interaction model. As effect measures, the risk ratio will be used for dichotomous outcomes, while the (standardized) mean difference will be utilized for continuous outcomes. Subgroup analyses, sensitivity analyses, and an assessment of publication bias are planned. The certainty of evidence derived from NMA will be assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.

Discussion: Our NMA will provide important findings on the efficacy and safety of (non-)pharmacological interventions, offering valuable insights to inform clinical guidelines for the treatment of AN. The findings will inform various interest-holders including patients, their families, and clinical decision-makers.

Systematic review registration: PROSPERO 2025 CRD420250654515.

Background: Sporting injuries have a psychological impact on competitive athletes, though most research focusses on the time of injury and returning to play. A greater understanding of the impact of injury rehabilitation programs on athletes is required. This scoping review synthesised the current peer-reviewed literature on the psychological and emotional experiences of competitive athletes undergoing injury rehabilitation.

Method: A systematic search of the PsycInfo, SportDiscus, MEDLINE, and Scopus electronic databases was conducted using keywords relating to psychology, rehabilitation, athletes, and injuries from January 1980 to April 2024. Studies that focussed on mental or psychological wellbeing during injury rehabilitation among competitive athletes aged ≥18 years who had suffered a musculoskeletal or soft-tissue injury were eligible for inclusion.

Results: In total, 64 studies were included, with 61% using a cross-sectional design. There was considerable variability in the definitions of injuries, competitive athletes, and injury severity in the included studies. The results highlighted the injury rehabilitation process is an emotional experience and while minimal psychological support was offered during rehabilitation, the level of social support received by athletes may positively and/or negatively impact their experience. Numerous coping strategies used during rehabilitation were identified, including goal setting.

Conclusion: The findings suggest that despite injury rehabilitation resulting in a range of emotions for athletes, minimal psychological support is offered, though positive social support can benefit experiences. Due to significant variation in definitions, including injury severity, it is difficult to draw consistent conclusions about athletes' rehabilitation experiences. Future research should explore dynamic responses to injury throughout rehabilitation where possible. This information is critical for supporting competitive athletes' mental or psychological wellbeing during injury rehabilitation.

Background: Cancer has become a major public health problem threatening human health worldwide. Affected by the disease and treatment, cancer patients bear heavy burdens, which shows a state of social isolation. Accurately assess the social isolation problem of cancer patients and formulate effective intervention measures, which are of great significance for promoting cancer patients' return to families and society and improving quality of life. This protocol aims to evaluate scientifically the psychometric properties of social isolation assessment tools for cancer patients, which provides a reference for medical staff to select the most appropriate tool in clinical practice.

Methods: This protocol will follow the checklist of Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015. The PRISMA-COSMIN for Outcome Measures instruments (OMIs) 2024 guideline will be applied in this study to report the psychometric properties of each assessment tool. Systematic searches will be conducted for studies related to the psychometric properties of social isolation assessment tools for cancer patients in CNKI, WANFANG, VIP, CBM, PubMed, Web of Science, CINAHL and Embase. Two graduate students who have completed the study of the COSMIN guidelines will conduct studies screening, data extraction, quality evaluation, evidence classification independently, and will give recommendations.

Discussion: Although there are many types of assessment tools for social isolation of cancer patients at present, there is a lack of systematic evaluation of their psychometric properties. The findings from this review may contribute to the optimization of assessment tools and the proposal of improvement suggestions, and provide reference for medical staff when choosing appropriate assessment tools.

Systematic review registration: PROSPERO CRD420251041263.

Background: Acute malnutrition, including severe acute malnutrition (SAM) and moderate acute malnutrition (MAM), affects over 45 million children under five globally and remains a leading cause of childhood morbidity and mortality. Despite therapeutic feeding programs using ready-to-use therapeutic foods (RUTFs) and fortified blended foods (FBFs), relapse and suboptimal treatment outcomes persist. Emerging evidence links gut microbiota dysbiosis to impaired nutrient absorption and immune function in malnourished children. Probiotic supplementation has been proposed as a strategy to restore microbial balance, enhance intestinal health, and improve nutritional recovery. However, clinical trial evidence remains inconsistent, particularly for children with MAM.

Methods: This protocol outlines a systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating the effects of probiotic or probiotic-fortified product supplementation in children under five diagnosed with SAM or MAM. Databases to be searched include PubMed, Embase, CENTRAL, CINAHL, Web of Science, and Scopus, along with clinical trial registries. Eligible studies will compare probiotic interventions with placebo, standard care, or no treatment. Primary outcomes include weight gain, weight-for-height z-scores (WHZ), mid-upper arm circumference (MUAC), recovery rate, and time to nutritional recovery. Two reviewers will independently conduct study selection, data extraction, and risk of bias assessment using the Cochrane Risk of Bias 2.0 tool. Random-effects meta-analyses will be performed where appropriate. To explore potential sources of heterogeneity, we will perform subgroup analyses based on factors such as strain, dosage, and duration. Furthermore, sensitivity analyses will be used to test the robustness of the findings against various methodological assumptions and decisions. The overall certainty of the evidence for each outcome will be assessed using the GRADE approach.

Discussion: This will be the first systematic review to rigorously evaluate probiotic supplementation for both SAM and MAM populations using PRISMA 2020 guidelines and GRADE methodology. Strengths include a focus on high-quality RCTs, comprehensive search strategies, and transparent bias and evidence quality assessments. Limitations may include variability in probiotic strains, formulations, dosages, and outcome measures, as well as limited subgroup data.

Systematic review registration: PROSPERO CRD420251091133.