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In Table 2 (Study characteristics and estimated birth prevalence) and Fig. 2 (Pooled global birth prevalence of clubfoot), the estimate was noted as 3.57 (2.93–4.34) per 1000 births. However, Zhou et al. (2020) report this as per 10,000 births. The correct estimate is therefore 0.36 (0.29–0.43) per 1000 births.
Background
Worldwide, lung cancer (LC) is the second most frequent cancer and the leading cause of cancer related mortality. Low-dose CT (LDCT) screening reduced LC mortality by 20–24% in randomised trials of high-risk populations. A significant proportion of those screened have nodules detected that are found to be benign. Consequently, many individuals receive extra imaging and/or unnecessary procedures, which can have a negative physical and psychological impact, as well as placing a financial burden on health systems. Therefore, there is a need to identify individuals who need no interval CT between screening rounds.
Methods and analysis
The aim of this study is to identify risk factors predictive of LC, which are known at the time of the scan, in patients with LDCT screen-detected lung nodules. The MEDLINE and EMBASE databases will be searched and articles that are on cohorts or mention cohorts of screenees with nodules will be identified. A data extraction framework will ensure consistent extraction across studies. Individual participant data (IPD) will be collected to perform a one-stage IPD meta-analysis using hierarchical univariate models. Clustering will be accounted for by having separate intercept terms for each cohort. Where IPD is not available, the effects of risk factors will be extracted from publications, if possible. Effects from IPD cohorts and aggregate data will be reported and compared. The PROBAST (Prediction model Risk Of Bias ASsessment Tool) will be used for assessment of quality of the studies.
Ethics and dissemination
Ethical approval was not required as this study is a secondary analysis. The results will be disseminated through publication in peer-reviewed journals and presentations at relevant conferences.
PROSPERO registration number
CRD42022309515
Introduction
Non-adherence to tuberculosis (TB) treatment poses a significant challenge to effective TB management globally and is a major contributor to the emergence of multidrug-resistant TB. Although adherence to TB treatment has been widely studied, a comprehensive evaluation of the comparative levels of adherence in high- versus low-TB burden settings remains lacking. The objective of this systematic review and meta-analysis is to assess the levels of adherence to TB treatment in high-TB burden countries compared to low-burden countries. Additionally, it seeks to identify the unique facilitators and barriers to treatment adherence in these distinct settings.
Methods and analysis
This systematic review and meta-analysis will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses Protocols Statement. Using key medical subject heading terms and free-text terms related to TB treatment adherence, a systematic search of the literature will be performed in Medline, Embase, CINAHL, Scopus, Global Health and the Cochrane Databases of Systematic Reviews. A medical librarian will assist with developing the search strategy. Two independent reviewers will independently screen studies against predefined inclusion and exclusion criteria at both the title/abstract and full-text stages. Working in duplicate, the same two reviewers will independently extract relevant study and outcomes data, including study descriptors, TB burden, adherence levels and adherence measures, from eligible studies. Countries will be classified according to TB burden based on the WHO’s high-burden country list from the post-2015 era (2015–2025). The quality of the included studies will be appraised using the Cochrane Risk of Bias tool and the Newcastle-Ottawa Scale. Qualitative data will be appraised using the Critical Appraisal Skills Programme tool. Studies will be pooled using the DerSimonian-Laird random-effects meta-analysis. Additionally, a meta-synthesis of the qualitative data from the included studies may be conducted to identify emergent themes related to facilitators and barriers of TB treatment adherence in high- vs low-TB burden countries.
Ethics and dissemination
Ethics approval is not required for this study as it does not involve the recruitment or collection of data from participants. The findings from this systematic review and meta-analysis will be disseminated through publication in peer-reviewed journals, presentations at scientific conferences, and via social media channels to enhance visibility, particularly within programmatic and policy spheres.
PROSPERO registration number
CRD42021273336
Objectives
How are socioeconomic inequalities modified by, or how do they interact with, preterm birth?
Design
Narrative systematic review of quantitative observational studies of an interaction, or effect modification, between preterm birth and socioeconomic status.
Data sources
Five databases were searched for studies published between January 2000 and June 2020. Title and abstract were reviewed to identify articles for dual screening. All included studies were citation searched.
Eligibility criteria
Inclusion criteria were comparison across socioeconomic status and gestational age, interaction between the two, or stratification by either, and health or education as outcome.
Data extraction and synthesis
Data extracted included study design, sample size, outcome, interaction measure, effect and significance. Included studies were assessed for methodological quality and synthesised narratively.
Results
After searches, 52 studies were identified for full-text screening and, with supplementary citation searches, we identified 21 included studies. Eighteen studies studied interaction between gestational age or preterm birth, and socioeconomic status. Three groups of outcomes were identified: cognitive, mental health and developmental. Age at outcome measurement was divided into four categories: preschool, primary school (5–11), secondary school (11–18) and post school (18–29). Seven studies found a significant interaction between the effect of preterm birth and socioeconomic status. Six of these interactions demonstrate that the negative influence of low socioeconomic status was stronger for those born preterm (and vice versa) for cognitive and mental health outcomes, all in studies with a sample size of more than 100 000. One study found that negative effects of low socioeconomic status were reduced for those born preterm (and vice versa) for communication delay.
Conclusions
Our findings suggest that the impact of low socioeconomic status on cognitive and mental health outcomes is exacerbated by preterm birth. The remaining evidence suggests the effects are not modified; however, this is potentially due to underpowered studies. Public health action is indicated to support babies born preterm, particularly for disadvantaged families, to improve educational attainment and mental health.
PROSPERO registration number
CRD42020203613.
Objectives
This study sheds light on the available global definitions, classifications, and criteria used for rare diseases (RDs), ultrarare diseases (URDs), orphan drugs (ODs) and ultraorphan drugs (UODs) and provides insights into the rationale behind these definitions.
Design
A systematic literature review was conducted to identify existing definitions and the criteria used to define RDs, ODs and their subtypes.
Data sources
Searches were performed in the PubMed/Medline, Embase, Scopus and Web of Science (Science and Social Sciences Citation Index) databases covering articles published from 1985 to 2021.
Eligibility criteria for selecting studies
English-language studies on the general human population were included if they provided definitions or criteria for RDs, ODs and/or their subtypes without restrictions on publication year, country or jurisdiction.
Data extraction and synthesis
Two independent reviewers conducted the search, screening and data extraction. Narrative synthesis, content analysis and descriptive analyses were conducted to extract and categorise definitions and criteria from these sources. Study quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools.
Results
Online searches identified 2712 published articles. Only 93 articles met the inclusion criteria, with 209 distinct definitions extracted. Specifically, 93 of these articles pertained to 119 RDs, 11 URDs, 67 ODs and 12 UODs. These definitions varied in their reliance on prevalence based and other contextual criteria.
Conclusion
Prevalence-based criteria alone pose challenges, as disease frequencies differ by country. Establishing country-specific definitions can enhance understanding, support intercountry evaluations, improve healthcare efficiency and access to ODs, and strengthen equity and equality in healthcare. Such efforts would also promote research and development and support better outcomes for patients with complex and rare conditions.
PROSPERO registration number
CRD42021252701.
Introduction
The peripheral vascular catheter (PVC) is the most common intravenous medical device used in hospitals, given it is crucial for the delivery of intravenous therapies. Despite its widespread use, PVC complications such as occlusion, infiltration, extravasation, phlebitis, thrombophlebitis, catheter-related thrombosis and catheter-related bloodstream infection significantly affect patient safety, leading to increased morbidity and healthcare costs. One approach to maintain PVC patency and therefore device longevity is to flush the PVC. This usually involves the use of 5 to 10 mL syringes with normal saline. The evidence on PVC flushing practices is dispersed, making it difficult to draw clear conclusions about current practices and clinical implications. A scoping review is needed to explore and synthesise this evidence systematically and to systematically map the existing research on PVC flushing by assessing the scope, methodologies and outcomes of existing studies.
Methods and analysis
The review will adhere to the Joanna Briggs Institute (JBI) methodology, using a three-phase search strategy as recommended by JBI and covering the full-time range available in each database. Systematic searches will be conducted across Embase, Web of Science, PubMed, Scopus, and CINAHL; clinical trial registries; and grey literature sources to identify potentially eligible studies published up to May 2024. Following duplicate removal, 3021 records will remain for screening. Two independent reviewers will screen the records and extract data based on the review questions. The reporting will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews, with the results and discussion structured according to the Patterns, Advances, Gaps, Evidence for practice and Research recommendations framework.
Ethics and dissemination
Ethics approval is not required for this study. The findings will be shared through professional networks, presented at conferences and published in a scientific journal.
Objectives
To map the scope of available evidence on relationships between multimorbidity patterns and functioning among adults in low- and middle-income countries (LMICs), and describe methods used.
Design
Scoping review guided by a five-step methodological framework and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews reporting guidelines.
Data sources
PubMed/MEDLINE, Scopus, EBSCOhost (CINAHL) and Cochrane databases were searched from January 1976 to March 2023, plus reference lists of included studies.
Eligibility criteria for selecting studies
Peer-reviewed full-text articles or conference proceedings of any design, published in English or Afrikaans, involving adults ( >18 years) with multimorbidity living in LMICs. Studies had to refer to associations between multimorbid patterns of co-occurrence and functioning. Multimorbidity was defined as the coexistence of ≥2 diseases, including any combination of non-communicable, infectious and mental health conditions.
Data extraction and synthesis
Data were extracted independently by two reviewers using a piloted form. Findings were synthesised according to methodological approaches, multimorbidity-pattern epidemiology, evidence gaps/limitations and recommendations for future research. The International Classification of Functioning, Disability and Health framework was used to classify functional problems.
Results
Nine studies (total sample size: 62 003) were included, mainly from upper-middle-income Asian countries. Key methodological inconsistencies were identified in defining and operationalising multimorbidity, conditions included in determining patterns, statistical methods for pattern determination and functioning outcome measures. Five main multimorbidity pattern domains emerged: Cardio-Metabolic and Coronary Atherosclerotic, Musculoskeletal, Respiratory and Digestive/Visceral, Degenerative, and Mental Health-Related. Mobility limitations, instrumental activities of daily living, self-care and bowel/bladder problems were consistently linked to all pattern domains.
Conclusions
The limited and geographically skewed body of literature, along with methodological inconsistencies, hampers a comprehensive understanding of multimorbidity patterns and associations with functioning in LMICs. Future research should explore context-specific multimorbidity definitions, employ transparent methodologies, use standardised measures and incorporate diverse samples to inform tailored interventions and policies.
Objective
To synthesise the role of digital technologies in epidemic control and prevention, focussing on Ebola and COVID-19.
Design
A scoping review.
Data sources
A systematic search was done on PubMed, HINARI, Web of Science, Google Scholar and a direct Google search until 10 September 2024.
Eligibility criteria
We included all qualitative and quantitative studies, conference papers or abstracts, anonymous reports, editorial reports and viewpoints published in English.
Data extraction and synthesis
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist was used to select the included study. Data analysis was performed using Gale’s framework thematic analysis method, resulting in the identification of key themes.
Results
A total of 64 articles that examined the role of digital technology in the Ebola and COVID-19 pandemics were included in the final review. Five main themes emerged: digital epidemiological surveillance (using data visualisation tools and online sources for early disease detection), rapid case identification, community transmission prevention (via digital contact tracing and assessing interventions with mobility data), public education messages and clinical care. The identified barriers encompassed legal, ethical and privacy concerns, as well as organisational and workforce challenges.
Conclusion
Digital technologies have proven good for disease prevention and control during pandemics. While the adoption of these technologies has lagged in public health compared with other sectors, tools such as artificial intelligence, telehealth, wearable devices and data analytics offer significant potential to enhance epidemic responses. However, barriers to widespread implementation remain, and investments in digital infrastructure, training and strong data protection are needed to build trust among users. Future efforts should focus on integrating digital solutions into health systems, ensuring equitable access and addressing ethical concerns. As public health increasingly embraces digital innovations, collaboration among stakeholders will be crucial for effective pandemic preparedness and management.
Mahesarajah S, El Asmar ML, Irwin R, et al. Impact of the COVID-19 pandemic on psychotropic prescribing: a systematic review BMJ Open 2024;14:e076791. doi: 10.1136/bmjopen-2023–0 76 791
The article is updated since it was first published. The below mentioned sections have been updated:
Results- Changes in antipsychotic prescribing rates, line 21 and 22, page no. 8.
Results – Changes in antidepressant prescribing rates, line 20, page no. 8.
Discussion – Discussion of findings and implications of selected studies, line 33, page no. 9.
Table 2- Result, last paragraph.
Objectives
Kangaroo mother care (KMC) is high impact for survival of low birth weight neonates, but there are few rigorous evaluations of duration required for impact. We conducted a scoping review of KMC duration measurement methods and assessed their validation.
Design
Scoping review in accordance with Joanna Briggs Institute guidance for conducting scoping review.
Data sources
MEDLINE, Embase, Cochrane Library, PsycINFO, African Index Medicus, Latin American and Caribbean Health Sciences Literature, ClinicalTrials.gov, International Clinical Trials Registry Platform, International Standard Randomised Controlled Trial Number Registry, Medrxiv and OpenGrey were searched through November 2022.
Eligibility criteria for selecting studies
Publications with primary data on KMC duration were included. We excluded short procedural skin-to-skin care studies.
Data extraction and synthesis
Selection and data abstraction were conducted by two independent reviewers. A data charting form based on the variables of interest was used to abstract data.
Results
A total of 213 publications were included, of which 54 (25%) documented a method of measuring KMC duration. Only 20 publications (9%) provided a detailed description of the duration measurement method, and none reported validity. Most studies used caregiver reports (29, 54%) or healthcare worker observations (17, 31%). Other methods included independent observers and electronic monitoring devices.
Conclusion
Only 9% of KMC studies reporting duration documented the measurement method applied, and no studies were found with documented validation of duration measurement methods. Accurate and comparable data on the dose response of KMC will require duration measurement methods to be validated against a gold standard such as an independent observer.
Objective
To identify effective policies and non-policy interventions preventing youth vaping behaviour initiation and assess their effectiveness by the level of intrusiveness and subpopulations.
Design
This systematic rapid review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
Data sources
Searches on MEDLINE and APA-PsycINFO for studies published between January 2019 and November 2023.
Eligibility criteria
Observational, intervention or mixed-method studies and quantitative systematic reviews/meta-analyses measuring the impact of interventions on youth (6–18 years) who never vaped or who had experimentally vaped.
Data extraction and synthesis
A predesigned form was used to extract data. To classify interventions by levels of intrusiveness, we used the PLACE Research Lab Intervention Ladder Policy Analysis Framework. We applied PROGRESS-Plus (Place of residence, Race/ethnicity/culture/language, Occupation,Gender/sex, Religion, Education, Socioeconomic status, Social capital, and additional context-specific factors) for an equity analysis. Methodological quality was assessed using the Effective Public Health Practice Project Quality Assessment Tool.
Results
20 studies were included: 45% were experiments or quasiexperiments, 85% reported data from the USA, 65% were non-policy interventions and 40% and 35% measured susceptibility and attitudes and behaviours related to vaping, respectively. Considering the level of intrusiveness, 45% of the studies provided information and 25% eliminated choices. Overall, the certainty of evidence was low. The effectiveness of interventions regarding their level of intrusiveness varied by each outcome. No clear pattern was found between the level of intrusiveness and intervention effectiveness, suggesting that overall, the studied interventions positively changed youth vaping behaviours. Some interventions had positive effects on multiple outcomes. Equity-related findings suggested that younger youth may be less responsive to the interventions. Recommendations for action are provided.
Conclusions
We suggest that combining multiple interventions targeting different levels of intrusiveness and outcomes may be more effective in preventing youth vaping behaviours. Also important is to tailor programmes to younger youth to better meet their needs.
Objectives
Coronary heart disease (CHD) is the leading cause of global morbidity and mortality, yet no comprehensive evaluation of its global economic costs exists. We conducted a systematic review with meta-analysis to examine the costs of CHD treatment by region and CHD subtypes, examine whether there are cost difference by sex, and examine costing methodologies.
Design
We conducted a systematic review and meta-analysis of non-randomised studies.
Data sources
We searched Medline, Embase, CINAHL, EconLit and Google Scholar from 1 January 2000 to February 2023.
Eligibility criteria for selecting studies
We included observational studies reporting economic costs of CHD treatment and outcomes for adults that were published in English.
Data extraction and synthesis
Data extraction and quality assessment were independently undertaken by two reviewers. Costs were converted to percentage of gross domestic product (GDP) per capita of corresponding country. A random-effects model was used for meta-analysis using StataSE V.18 to calculate the pooled percentage. Heterogeneity was assessed using the I2 statistic. Meta-regression and bias assessment were performed.
Results
Out of 20 100 records identified, 37 studies (including 2 564 189 individuals) from 22 countries were included in the qualitative synthesis and the quantitative meta-analysis. In most countries, the annual cost of CHD exceeds many times the total health expenditure per capita. The pooled direct annual cost of CHD per patient varied from 4.9% to 137.8% of GDP per capita (Int$ purchasing power parity), with pooled percentage of 21.7% (95% CI 15.3, 28.1) for those with CHD. Slight difference in the annual pooled cost of CHD was observed, with a 2% of GDP per capita higher cost in men (95% CI 0.8, 3.2). Most studies applied a top-down costing approach (n=21).
Conclusions
The review illustrates the expense associated with CHD, which is varied by region and CHD subtypes. The observed cost difference by sex warrants further exploration of sex-specific factors influencing cost disparities. Exploring advanced costing methods such as time-driven activity-based costing can optimise resource allocation and identify opportunities to reduce unnecessary costs and cost disparities.
PROSPERO registration number
CRD42023412044.
Objective
We aim to assess which variables are associated with recruitment failure of obstetrical and gynaecological randomised controlled trials (RCTs), leading to an extension of the study period.
Design
Nationwide study.
Setting
A cohort of RCTs supported by the trial centre of the Dutch Consortium of Obstetrics and Gynaecology.
Population
We included 83 RCTs that recruited patients between 1 March 2003 and 1 December 2023.
Main outcome measures
Main outcome was recruitment target not achieved within 6 months after the preplanned recruitment period. Secondary outcomes were recruitment target not achieved within an extension period of at least 12 months and premature termination of the trial. In all RCTs, we collected information on variables with a potential effect on recruitment failure, recorded at five levels; patient, doctor, participating centre, study organisation and study design.
Results
In total, 46 of 83 RCTs (55%) did not achieve their targeted recruitment within the preplanned study period with a maximal extension period of 6 months. The most relevant variables for recruitment failure in multivariable risk prediction modelling were presence of a no-treatment arm (where treatment is standard clinical practice), a compensation fee of less than 200 per included patient, funding of less than 350 000, while a preceding pilot study lowered this risk.
Conclusions
We identified that the presence of a no-treatment arm, low funding and a low compensation fee per included patient were the most relevant risk factors for recruitment failure within the preplanned period, while a preceding pilot study lowered this risk. Awareness of these variables is important when designing future studies.
Introduction
The aim of this scoping review is to connect theoretical research related to stress with practical applications to supervision experiences within allied health professions. Understanding the implications of stress between clinical supervisors and allied health students will allow for better insights to improve supervisory methods within clinical training, stronger mentorship and lead to better quality patient care.
Methods and analysis
This review is conducted according to Joanna Briggs Institute (JBI) methodology for scoping reviews, which includes defining the research question, developing inclusion criteria and searching for, selecting, extracting and analysing the evidence. A literature search will be conducted in MEDLINE (PubMed), CINAHL (EBSCO), ERIC (EBSCO), PsycINFO (EBSCO) and Embase (Elsevier), as well as various grey literature resources. Studies will be included if they focus on undergraduate or graduate allied health students in a clinical setting and allied health clinical educators, and report on outcomes related to stress dynamics between these two populations. Results will pass through title/abstract and full-text screening before data are extracted using a tool developed by the reviewers. Data will be analysed and summarised descriptively and presented in both tabular and narrative formats.
Ethics and dissemination
Ethical approval is not required for this scoping review. Results will be disseminated in peer-reviewed publications and professional conferences.
Trial registration number
The protocol was registered with Open Science Framework on 2 October 2024 (https://doi.org/10.17605/OSF.IO/REK7Z).
Introduction
Individuals experiencing disadvantaged socioeconomic positions (SEPs) may be at increased risk of falls during middle and older age, and these impacts of socioeconomic factors may vary according to the duration, timing and sequencing of exposures across the life course. However, there has not been a recent systematic review of this evidence. This study, therefore, aims to synthesise existing knowledge on the association between SEP across the life course and falls within middle- and older-aged adults.
Methods and analysis
We systematically searched for literature in three academic databases from database inception to 15 March 2024: MEDLINE (Ovid), Embase (Ovid) and PsycInfo (Ovid). The search strategy combined MeSH headings and search terms related to SEP, falls, middle- and older-aged adults and observational studies. Cohort, case-control and cross-sectional studies with mean or median participant age of >40 years, which report on the association between at least one socioeconomic indicator across the life course and one fall outcome and are published in peer-reviewed academic journals were included. No language or geographic restrictions were imposed. Titles and abstracts were screened by one reviewer with 20% of titles and abstracts also screened by a second reviewer. Two reviewers independently screened full texts. Data will be extracted using a standardised Excel template. Using a modified Quality in Prognosis Studies (QUIPS) tool, the risk of bias of included studies will be assessed by one reviewer with 20% of studies also independently appraised by a second reviewer. Meta-analyses will be conducted if sufficient homogeneity between studies permits. Otherwise, a narrative synthesis of results will be undertaken.
Ethics and dissemination
As this is a review of published literature, no ethics approval is required. Findings will be disseminated through a journal article publication, conference presentations and plain-text summaries for public accessibility.
PROSPERO registration number
CRD42024534813.
Introduction
Cultural humility practices are shown to be effective when working with diverse populations in healthcare settings. Research recruitment and retention among minoritised groups are essential to address health inequities. Given the successful application to healthcare settings, cultural humility practices may hold promise for recruiting and retaining minoritised individuals. However, little is known about how these practices may be applied to health research. The objective of this scoping review is to understand the extent to which cultural humility practices are applied to health research and how they may be leveraged to optimise recruitment and retention among minoritised populations.
Methods and analysis
This scoping review will follow the Joanna Briggs Institute methodology for scoping reviews. Databases to be searched will include Medline (Ovid), CINAHL (EBSCOhost), EMBASE (Ovid), PsycINFO (Ovid) and Web of Science Core Collection. Literature from 1993 to 2024 that captures the concept of cultural humility in health research with racial and ethnic or gender and sexual minoritised populations in the USA will be considered. The identified pool of records will be imported to Covidence, an online data management software. At the first screening stage, two independent reviewers will screen for title and abstract relevance. A third reviewer will be recruited to resolve discrepancies, if any. Records achieving consensus will have their full texts screened against the eligibility criteria and included in the final pool. Two tables will be developed to guide the data extraction process. The tabular format will be piloted and agreed on by all research team members. Descriptive content analysis will outline the operationalisation of cultural humility and identify strategies found effective in improving the representation of minoritised populations.
Ethics and dissemination
Ethical approval is not required in line with the scoping review methodology. Dissemination of the findings mapping the cultural humility strategies found effective in health research will be conducted through a peer-reviewed publication.
Trial registration number
Open Science Framework https://osf.io/vra7h.
