Explore the vast range of titles available.

Iron deficiency is negatively associated with children's cognitive development. Evidence showed that iron supplementation improves cognitive development. Nearly 50% of anemia is caused by iron deficiency. Anemia affects more school-age children, at an age where their brain development continues. The aim of this systematic review and meta-analysis is to review the evidence from published randomized controlled trials to evaluate the effects of iron supplementation on cognitive development and function among school-age children. Five databases including MEDLINE, EMBASE, Scopus, Web of Science and CENTRAL were used to search for articles on April 20th, 2021. The search was reconducted on October 13th, 2022 to retrieve new records. Studies were eligible if they included school children 6-12 years of age, were randomized controlled trials, and if they tested iron supplementation and measured cognitive development. Thirteen articles were included in the systematic review. Overall, iron supplementation significantly improved intelligence (standardized mean difference, 95% confidence interval) (SMD 0.46, 95%CI: 0.19, 0.73, P<0.001), attention and concentration (SMD 0.44, 95%CI: 0.07, 0.81, P = 0.02) and memory (SMD 0.44, 95%CI: 0.21, 0.67, P <0.001) of school-age children. There was no significant effect of iron supplementation on school achievement of school-age children (SMD 0.06, 95%CI: -0.15, 0.26, P = 0.56). In a subgroup analysis, iron-supplemented children who were anemic at baseline had had better outcomes of intelligence (SMD 0.79, 95%CI: 0.41, 1.16, P = 0.001) and memory (SMD 0.47, 95%CI: 0.13, 0.81; P = 0.006). Iron supplementation has a significant positive effect on the intelligence, attention and concentration, and the memory of school-age children but there was no evidence on the effect of iron supplementation on their school achievement.

HIV/AIDS may cause malnutrition, both directly and indirectly, through common infections. This systematic review and meta-analysis aim to evaluate the effects of nutritional interventions on nutritional status, immunological status, adherence to antiretroviral treatment (ART), and food security among people living with HIV/AIDS (PLWHA) in low- and middle-income countries (LMICs). Five databases-MEDLINE, Embase, Scopus, Web of Science, and CENTRAL-were searched for articles on August 17, 2021, with an updated search conducted on September 30, 2023 to identify new records. Studies were considered eligible if they included adults living with HIV/AIDS who recently initiated ART, if they were controlled trials that provided nutritional interventions, and if they assessed the relevant nutritional, immunological and adherence outcomes. The effects of nutritional interventions were analyzed using a random-effects model. The systematic review comprised 22 articles from 12 LMICs, while the meta-analysis included 19 articles. The interventions provided lipid-based nutrient supplements, corn-soy blends, food baskets, conditional cash, prepared meals, micronutrient supplementation, and functional foods to PLWHA. Compared to controls, nutritional interventions for PLWHA significantly improved their body mass index (standardized mean difference, 95% confidence interval) (SMD 0.42; 95% CI: 0.03, 0.81; p =  0.03), fat mass (SMD 0.21; 95% CI: 0.07, 0.34; p =  0.002), fat-free mass (SMD 0.33; 95% CI: 0.19, 0.46; p <  0.0001), and CD4 (SMD 0.54; 95% CI: 0.01, 1.07; p =  0.05), but had no effect on their weight, viral load, or adherence to ART. The baseline nutritional and immunological characteristics of PLWHA, as well as the intervention characteristics, further modified these effects. Nutritional interventions improved some nutritional and immunological indicators but not ART adherence among PLWHA. Additionally, their effects were modified by some baseline characteristics and the type and duration of interventions which require consideration before its scaling up.

Background While chronic workplace stress is known to be associated with health-related outcomes like mental and cardiovascular diseases, research about day-to-day occupational stress is limited. This systematic review includes studies assessing stress exposures as work environment risk factors and stress outcomes, measured via self-perceived questionnaires and physiological stress detection. These measures needed to be assessed repeatedly or continuously via Ecological Momentary Assessment (EMA) or similar methods carried out in real-world work environments, to be included in this review. The objective was to identify work environment risk factors causing day-to-day stress. Methods The search strategies were applied in seven databases resulting in 11833 records after deduplication, of which 41 studies were included in a qualitative synthesis. Associations were evaluated by correlational analyses. Results The most commonly measured work environment risk factor was work intensity, while stress was most often framed as an affective response. Measures from these two dimensions were also most frequently correlated with each other and most of their correlation coefficients were statistically significant, making work intensity a major risk factor for day-to-day workplace stress. Conclusions This review reveals a diversity in methodological approaches in data collection and data analysis. More studies combining self-perceived stress exposures and outcomes with physiological measures are warranted.

Introduction Systematic reviews play a crucial role in informing clinical decision‐making, policy formulation, and evidence‐based practice. However, despite the existence of well‐established guidelines, inadequately executed and reported systematic reviews continue to be published. These highly cited reviews not only pose a threat to the credibility of science but also have substantial implications for medical decision‐making. This study aims to evaluate and recommend improvements to the author instructions of biomedical and health journals concerning the conducting and reporting of systematic reviews. Methods A sample of 168 journals was selected based on systematic reviews published between 2020 and 2021, taking into account their Altmetric attention score, citation impact, and mentions in Altmetric Explorer. Author instructions were downloaded, and data extraction was carried out using a standardized web form. Two reviewers independently extracted data, and discrepancies were resolved by a third reviewer. The findings were presented using descriptive statistics, and recommendations for editorial teams were formulated. The protocol is registered with the Open Science Framework Registries (osf. io/bym8d). Results One‐third of the journals lack tailored guidance for systematic reviews, as demonstrated by the absence of references to conducting or reporting guidelines, protocol registration, data sharing, and the involvement of an information specialist. Half of the author instructions do not include a dedicated section on systematic reviews, hampering the findability of tailored information. The involvement of information specialists is seldom acknowledged. Ultimately, the absence of an update date in most author instructions raises concerns about the incorporation of the most recent developments and tools for systematic reviews. Conclusion Journals that make substantial contributions to synthesizing evidence in biomedicine and health are missing an opportunity to provide clear guidance within their author instructions regarding the conducting and reporting of reliable systematic reviews. This not only fails to inform future authors but also potentially compromises the quality of this frequently published research type. Furthermore, there is a need for greater recognition of the added value of information specialists to the systematic review and publishing processes. This article provides recommendations drawn from the study's observations, aiming to help editorial teams enhance author instructions and, consequently, potentially assisting systematic reviewers in improving the quality of their reviews.

Cardiovascular diseases remain the foremost global cause of death. The COVID-19 pandemic has strained health-care systems, leading to delays in essential medical services, including treatment for cardiovascular diseases. We aimed to examine the impact of the pandemic on delayed cardiovascular care in Europe. In this systematic review, we searched PubMed, Embase, and Web of Science for peer-reviewed and published quantitative studies in English from Nov 1, 2019, to Sept 18, 2022, that addressed pandemic-induced delays in cardiovascular disease care for adult patients in Europe. Data appraisal, extraction, and quality assessment were done by two reviewers using the 14-item QualSyst tool checklist. We extracted summary patient-level data from the studies, including around 3·5 million patients. Evaluated outcomes included changes pre-March 2020 and during the COVID-19 pandemic in hospital admissions, mortality rates, medical help-seeking delays post-symptom onset, treatment initiation delays, and treatment procedure counts. The protocol is registered on PROSPERO (CRD42022354443). Of the 132 included studies (20% from the UK), all were observational retrospective, with 87% focusing on the first wave of the pandemic. Results were categorised into five disease groups: ischaemic heart diseases, cerebrovascular diseases, cardiac arrests, heart failures, and others. Hospital admissions showed significant decreases around the ranges of 12–66% for ischaemic heart diseases, 9–40% for cerebrovascular diseases, 9–66% for heart failures, 27–88% for urgent and elective cardiac procedures, and an increase between 11–56% for cardiac arrests. Mortality rates were significantly higher during the pandemic, ranging between 1–25% (vs 16–22% before the pandemic) for ischaemic heart diseases and 8–70% (vs 8–26% before the pandemic) for cerebrovascular diseases. Only one study ranked low in quality. The pandemic led to reduced acute CVD hospital admissions and increased mortality rates. Delays in seeking medical help were observed, while urgent and elective cardiac procedures decreased. Policymakers and health-care systems should work together on implementing adequate resource allocation strategies and clear guidelines on how to handle care during health crises, reducing diagnosis and treatment initiation delays, and promoting a healthy lifestyle. Future studies should evaluate the long-term impact of pandemics on delayed CVD care, and the health-economic impact of COVID-19. Belgian Science Policy Office.

Chronic obstructive pulmonary disease (COPD) is characterized by infiltration of inflammatory cells, destruction of lung parenchyma, and airway wall remodeling. Hyaluronan (HA) is a component of the extracellular matrix, and low-molecular-weight (LMW) HA fragments have proinflammatory capacities. We evaluated the presence of HA in alveolar and airway walls of C57BL/6 mice that were exposed to air or cigarette smoke (CS) for 4 weeks (subacute) or 24 weeks (chronic). We measured deposition of the extracellular matrix proteins collagen and fibronectin in airway walls and determined the molecular weight of HA purified from lung tissue. In addition, we studied the expression of HA-modulating genes by RT-PCR. HA staining in alveolar walls was significantly enhanced upon chronic CS exposure, whereas HA levels in the airway walls were already significantly higher upon subacute CS exposure and remained elevated upon chronic CS exposure. This differed from the deposition of collagen and fibronectin, which are only elevated at the chronic time point. In lungs of CS-exposed mice, the molecular weight of HA clearly shifted toward more LMW HA fragments. CS exposure significantly increased the mRNA expression of the HA synthase gene Has3 in total lung tissue, whereas the expression of Has1 was decreased. These in vivo studies in an experimental model of COPD show that CS exposure leads to enhanced deposition of (mostly LMW) HA in alveolar and bronchial walls by altering the expression of HA-modulating enzymes. This may contribute to airway wall remodeling and pulmonary inflammation in COPD.

Background Chronic obstructive pulmonary disease (COPD) is associated with abnormal inflammatory responses and structural alterations of the airways, lung parenchyma and pulmonary vasculature. Since Pentraxin-3 (PTX3) is a tuner of inflammatory responses and is produced by endothelial and inflammatory cells upon stimuli such as interleukin-1β (IL-1β), we hypothesized that PTX3 is involved in COPD pathogenesis. Methods and Results We evaluated whether cigarette smoke (CS) triggers pulmonary and systemic PTX3 expression in vivo in a murine model of COPD. Using immunohistochemical (IHC) staining, we observed PTX3 expression in endothelial cells of lung venules and veins but not in lung arteries, airways and parenchyma. Moreover, ELISA on lung homogenates and semi-quantitative scoring of IHC-stained sections revealed a significant upregulation of PTX3 upon subacute and chronic CS exposure. Interestingly, PTX3 expression was not enhanced upon subacute CS exposure in IL-1RI KO mice, suggesting that the IL-1 pathway is implicated in CS-induced expression of vascular PTX3. Serum PTX3 levels increased rapidly but transiently after acute CS exposure. To elucidate the functional role of PTX3 in CS-induced responses, we examined pulmonary inflammation, protease/antiprotease balance, emphysema and body weight changes in WT and Ptx3 KO mice. CS-induced pulmonary inflammation, peribronchial lymphoid aggregates, increase in MMP-12/TIMP-1 mRNA ratio, emphysema and failure to gain weight were not significantly different in Ptx3 KO mice compared to WT mice. In addition, Ptx3 deficiency did not affect the CS-induced alterations in the pulmonary (mRNA and protein) expression of VEGF-A and FGF-2, which are crucial regulators of angiogenesis. Conclusions CS increases pulmonary PTX3 expression in an IL-1 dependent manner. However, our results suggest that either PTX3 is not critical in CS-induced pulmonary inflammation, emphysema and body weight changes, or that its role can be fulfilled by other mediators with overlapping activities.

Background Children with serious illness suffer from symptoms at the end of life that often fail to be relieved. An overview is required of healthcare interventions improving and decreasing quality of life (QOL) for children with serious illness at the end of life. Methods A systematic review was performed in five databases, January 2000 to July 2018 without language limit. Reviewers selected quantitative studies with a healthcare intervention, for example, medication or treatment, and QOL outcomes or QOL-related measures, for example, symptoms, for children aged 1–17 years with serious illness. One author assessed outcomes with the QualSyst and GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) Framework; two authors checked a 25% sample. QOL improvement or reduction was categorized. Results Thirty-six studies met the eligibility criteria studying 20 unique interventions. Designs included 1 randomized controlled trial, 1 cross-sectional study, and 34 cohort studies. Patient-reported symptom monitoring increased QOL significantly in cancer patients in a randomized controlled trial. Dexmedetomidine, methadone, ventilation, pleurodesis, and palliative care were significantly associated with improved QOL, and chemotherapy, stem cell transplant, and hospitalization with reduced QOL, in cohort studies. Conclusions Use of patient-controlled symptom feedback, multidisciplinary palliative care teams with full-time practical support, inhalation therapy, and off-label sedative medication may improve QOL. Curative therapy may reduce QOL. Impact QOL for children at the end of life may be improved with patient-controlled symptom feedback, multidisciplinary palliative care teams with full-time practical support, inhalation therapy, and off-label sedative medication. QOL for children at the end of life may be reduced with therapy with a curative intent, such as curative chemotherapy or stem cell transplant. A comprehensive overview of current evidence to elevate currently often-failing QOL management for children at the end of life. New paradigm-level indicators for appropriate and inappropriate QOL management in children at the end of life. New hypotheses for future research, guided by the current knowledge within the field. Various healthcare interventions (as described above) could or might be employed as tools to provide relief in QOL management for children with serious illness, such as cancer, at the end of life, and therefore could be discussed in pediatrician end-of-life training to limit the often-failed QOL management in this population, cave the one-size-fits-all approach for individual cases. Multidisciplinary team efforts and 24/7 presence, especially practical support for parents, might characterize effective palliative care team interventions for children with serious illness at the end of life, suggesting a co-regulating link between well-being of the child partly to that of the parents Hypothesis-oriented research is needed, especially for children with nonmalignant disorders, such as genetic or neurological disorders at the end of life, as well as QOL outcomes for intervention research and psychosocial or spiritual outcomes.

The use of MRI in forensic age estimation has been explored extensively during the last decade. The authors of this paper synthesized the available MRI data for forensic age estimation in living children and young adults to provide a comprehensive overview that can guide age estimation practice and future research. To do so, the authors searched MEDLINE, Embase and Web of Science, along with cited and citing articles and study registers. Two authors independently selected articles, conducted data extraction, and assessed risk of bias. They considered study populations including living subjects up to 30 years old. Fifty-five studies were included in qualitative analysis and 33 in quantitative analysis. Most studies had biases including use of relatively small European (Caucasian) populations, varying MR approaches and varying staging techniques. Therefore, it was not appropriate to pool the age distribution data. The authors found that reproducibility of staging was remarkably lower in clavicles than in any other anatomical structure. Age estimation performance was in line with the gold standard, radiography, with mean absolute errors ranging from 0.85 years to 2.0 years. The proportion of correctly classified minors ranged from 65% to 91%. Multifactorial age estimation performed better than that based on a single anatomical site. The authors found that more multifactorial age estimation studies are necessary, together with studies testing whether the MRI data can safely be pooled. The current review results can guide future studies, help medical professionals to decide on the preferred approach for specific cases, and help judicial professionals to interpret the evidential value of age estimation results.

Purpose This umbrella review aims to evaluate the quality, summarize and compare the conclusions of systematic reviews investigating the impact of curative treatment options on health-related quality of life (HRQoL) in muscle-invasive bladder cancer (MIBC). Methods The Cochrane Library, MEDLINE, Embase and Web of Science were searched independently by two authors from inception until 06 January 2020. Systematic reviews and meta-analyses assessing the impact of any curative treatment option on HRQol in MIBC patients were eligible. Risk of bias was assessed using the AMSTAR 2 tool. Results Thirty-two reviews were included. Robot-assisted RC with extracorporeal urinary diversion and open RC have similar HRQoL ( n  = 10). Evidence for pelvic organ-sparing RC was too limited ( n  = 2). Patients with a neobladder showed better overall and physical HRQoL outcomes, but worse urinary function in comparison with ileal conduit ( n  = 17). Bladder-preserving radiochemotherapy showed slightly better urinary and sexual but worse gastro-intestinal HRQoL outcomes in comparison with RC patients ( n  = 6). Quality of the reviews was low in more than 50% of the available reviews and most of the studies included in the reviews were nonrandomized studies. Conclusion This umbrella review gives a comprehensive overview of the available evidence to date.