To provide comprehensive evidence on the impact of prior recurrent pregnancy loss (RPL) on obstetric, perinatal, and neonatal outcomes.

PubMed, EMBASE, and Scopus databases were screened for observational cohort, case-control, and cross-sectional studies in peer-reviewed journals. Pooled effect estimates were calculated by random-effects models and reported as an odds ratio (OR) with 95% confidence intervals (CIs).

The study included 14 papers. Most of the studies (n = 12) were retrospective. Women with previous RPL had higher risk of pre-eclampsia (OR 1.25, 95% CI: 1.04, 1.50), placental abruption (OR 2.11, 95% CI: 1.31, 3.39), and delivery through cesarean section (OR 1.41, 95% CI: 1.21, 1.65) than women with no prior pregnancy loss. Women with previous RPL also had an increased risk of still birth (OR 1.77, 95% CI: 1.19, 2.61), preterm birth (OR 1.58, 95% CI: 1.38, 1.81), child born small for gestational age (SGA) (OR 1.31, 95% CI: 1.11, 1.55) and perinatal mortality (OR 2.02, 95% CI: 1.46, 2.81). The risks of having a neonate with low birth weight (<2500 g at birth), APGAR score of less than 7 (at 5 min), and requiring neonatal intensive care unit admittance were somewhat higher in women with previous RPL. There was no significant correlation between the history of recurring miscarriage and gestational diabetes and birth defects. The certainty of evidence was "low" to "very low" for most of the outcomes considered.

RPL was associated with a higher risk of negative obstetric and neonatal outcomes, such as pre-eclampsia, placental abruption, cesarean section, stillbirth, and SGA.

Acute leukemia (AL) presents significant health challenges, particularly in children, and iron plays a critical role in cellular processes that could influence cancer development. The study was motivated by the need to clarify the potential role of iron supplementation during pregnancy in influencing the risk of developing childhood leukemia.

This meta-analysis adhered to PRISMA guidelines and systematically searched PubMed, Scopus, and Web of Science databases up to April 2024 for relevant observational studies. Inclusion criteria focused on case-control studies assessing the relationship between iron supplementation during pregnancy and leukemia risk, reporting odds ratios (ORs) with 95% confidence intervals (CIs). Data extraction and quality assessment were performed independently by two researchers using the Newcastle-Ottawa Scale (NOS). Statistical analysis involved calculating overall relative risk (RR) using a random-effects model and assessing heterogeneity through Cochran's Q test and the I2 statistic. Publication bias was evaluated using Egger's and Begg's tests.

The study analyzed data from 9 studies with 12 data sets involving a total of 4281 participants (2327 cases and 1954 controls). The findings indicated no significant association between iron supplementation during pregnancy and the overall risk of childhood leukemia (OR:1.01; 95% CI: 0.84-1.21, I2 = 63.2%). Also, no relationship was found between receiving iron supplements during pregnancy and the risk of AML (OR:1.01; 95% CI: 0.84-1.21, I2 = 56.6%) and ALL (OR:1.00; 95% CI: 0.81-1.24, I2 = 67.3%).

This study found no significant association between iron supplementation during pregnancy and AL risk among case-control studies. Further research is needed to explore the potential influence of genetic and environmental factors on this relationship.

This systematic review and meta-analysis aimed to examine the prevalence of Attention deficit hyperactivity disorder (ADHD) in homeless children and adolescents, and the factors that may influence its prevalence.

Relevant publications in Medline, Web of Science, Scopus and PsycINFO were systematically searched to identify studies on the prevalence of ADHD in homeless children and adolescents (≤19 years). The extracted data were pooled using a random-effects model.

Thirteen studies involving 2878 homeless children and adolescents were included (mean age: 12.0 years, sex F/M: 0.43). The prevalence rates of ADHD vary considerably across studies, ranging from 1.6% to 64.5%. The pooled prevalence of ADHD was 22.8% (95% CI 12.9-34.4%, I2 =98%). Meta-regression analyses indicated that age (slope = 0.046; p = .042) significantly increased ADHD prevalence. The prevalence of ADHD in studies with a mean age ≥ 12 years (43.1%, 95% CI 26.5-60.4%) was higher than those with a mean age < 12 years (13.1%, 95%CI 4.3-25.6).

Despite the high heterogeneity of the studies, we observed that ADHD could affect almost a quarter of homeless children and adolescents. Reintegrating them into care systems and ensuring access to public health interventions tailored for homeless families and youth is imperative for breaking the cycle of homelessness and improving long-term trajectories.

Background: Evidence supporting the association between posttraumatic stress disorder (PTSD) and cognitive impairment is accumulating. However, less is known about which factors influence this association.Objective: The aims of this meta-analysis were to (1) elucidate the association between PTSD and a broad spectrum of cognitive impairment, including the risk of developing neurocognitive disorder (NCD) later in life, using a multilevel meta-analytic approach, and (2) identify potential moderating factors of this association by examining the effects of age (20-39, 40-59, 60+), study design (cross-sectional or longitudinal), study population (war-exposed populations/veterans or the general population), neurocognitive outcome assessed (i.e. a diagnosis of NCD or type of cognitive domain as classified according to A Compendium of Neuropsychological tests), gender (≥50% women or <50% women), study quality (high vs low), type of PTSD measure (self-report or clinical diagnosis), as well as the presence of comorbidities such as traumatic brain injury (TBI), depression, and substance use (all coded as either present or absent).Method: Peer-reviewed studies on this topic were extracted from PubMed and Web of Science with predetermined keywords and criteria. In total, 53 articles met the criteria. Hedge's g effect sizes were calculated for each study and a three-level random effect meta-analysis conducted.Results: After accounting for publication bias, the results suggested a significant association between PTSD and cognitive impairment, g = 0.13 (95% CI: 0.10-0.17), indicating a small effect. This association was consistent across all examined moderators, including various neurocognitive outcomes, age, gender, study design, study population, study quality, type of PTSD measure, and comorbidities such as depression, substance use, and TBI.Conclusions: These findings collectively suggest that PTSD is associated with both cognitive impairment and NCD. This emphasizes the need for early intervention (including prevention strategies) of PTSD, alongside monitoring cognitive function in affected individuals.International Prospective Register of Systematic Reviews (PROSPERO) registration number: CRD42021219189, date of registration: 02.01.2021.

Competitive swimmers have a high prevalence of sports supplement (SS) consumption. However, only a few SS are scientifically proven to be safe, effective, and legal. Therefore, before incorporating supplements to enhance performance and health in competitive swimming, it is crucial to conduct an analysis and review to assess their effects. The objective of this study was to analyze the demonstrated effects of SS, as reported in published studies, on the swimming performance of competitive swimmers.

Following PRISMA guidelines, a systematic search was conducted across six databases for the selection of studies included in this review. Studies that analyzed the effects of sports supplementation compared to placebo were included and subjected to meta-analysis.

This revision included 23 studies, 16 of them (69.6%) qualified as excellent and 7 (30.4%) as good at the methodological level based on the punctuation in the PEDro scale. The systematic review included 422 swimmers (61.8% male, 38.2% female), with distances assessed ranging from 50 m to 800 m, including studies employing interval procedures. Creatine showed a significant effect (ES = -0.46; 95% CIs = -0.75 to -0.17, p = 0.002; I2 = 11%) on swimming performance, while the rest of the analyzed supplements did not show significant effects (all p > 0.05).

Creatine supplementation demonstrated ergogenic benefits for competitive swimmers, although the evidence supporting the use of this supplement is still limited. Sodium bicarbonate and β-alanine may enhance performance in distances with higher glycolytic demands, while caffeine is effective at dosages of 3-6 mg/kg administered 60 min before exercise. Further research is needed to confirm the potential ergogenic effects of other supplements, such as beetroot juice.

Systematic reviews and meta-analyses play a pivotal role in evidence-based medicine, including nephrology, by consolidating findings from multiple studies. To maximize their utility, rigorous quality assessment during peer review is essential. Challenges such as heterogeneity, bias, and methodological flaws often undermine these studies, necessitating a structured appraisal process.

This guide outlines a framework for nephrologists on appraising systematic reviews and meta-analyses. Key areas include heterogeneity assessment using the I2 statistic, interpretation of forest plots for pooled effect estimates, and the use of funnel plots with Egger's test to identify potential publication bias. Risk of bias is evaluated using RoB 2 for randomized controlled trials and ROBINS-I for non-randomized studies. Subgroup and sensitivity analyses, along with meta-regression, address heterogeneity and examine the robustness of findings.

The I2 statistic quantifies heterogeneity by estimating the proportion of variability in a meta-analysis. Funnel plots and Egger's test help detect publication bias. Major biases, such as selection, performance, detection, and publication bias, are identified using structured tools like AMSTAR 2, Cochrane RoB 2, and ROBINS-I. The GRADE framework further assesses the overall certainty of the evidence. Emphasis is placed on PRISMA compliance, protocol pre-registration, and transparent reporting of statistical analyses, subgroup, and sensitivity assessments. The inclusion of grey literature remains optional.

By focusing on key areas such as heterogeneity, risk of bias, and robust statistical methods, this guide enables nephrologists to critically appraise systematic reviews and meta-analyses, fostering better clinical decision-making and improved patient care in nephrology.

This study aims to systematically quantify the prevalence of falls in people on hemodialysis and to assess risk factors associated with falls by synthesizing emerging best evidence.

A comprehensive search was conducted across ten databases from their inception to February 27, 2025. The research team independently conducted study selection, quality assessments, data extraction, and analyses of all included studies. Meta-analysis was performed using random-effects and fixed-effects models. The PRISMA guidelines were used to report the systematic review and meta-analysis.

A total of 31 studies, comprising 191,800 individuals, were included in the analysis. The pooled prevalence of falls in people on hemodialysis was 27.1%. The meta-analysis of risk factors included 19 studies. After controlling for confounding variables, 12 risk factors were associated with falls, including older age, female gender, longer dialysis duration, diabetes mellitus, peripheral vascular disease, paralysis, antidepressant use, frailty, use of walking aids, malnutrition, intradialytic hypotension, and low hemoglobin levels.

This study provides an updated, evidence-based assessment of the prevalence and risk factors of falls in people on hemodialysis, confirming their multifactorial etiology. Screening and interventions should be implemented promptly to mitigate the adverse outcomes of falls in people on hemodialysis.

PROSPERO CRD42024525375.

To systematically evaluate and meta-analyze the performance, validity, and influencing factors of frailty risk prediction models specifically developed for patients undergoing maintenance hemodialysis in China.

China National Knowledge Infrastructure, Wanfang Database, China Science and Technology Journal Database, SinoMed, PubMed, Web of Science, Cochrane Library, CINAHL and Embase were searched from inception to October 10, 2024. Two independent reviewers conducted literature screening, data extraction, and risk of bias assessment using the Prediction Model Risk of Bias Assessment Tool (PROBAST). Meta-analysis was performed to pool the incidence rates and identify independent predictors.

Fourteen studies incorporating 16 distinct frailty risk prediction models were included. The predictive accuracy, measured by the area under the receiver operating characteristic curve (AUC), ranged from 0.819 to 0.998. Seven studies performed internal validation, one study executed external validation, and one study conducted both internal and external validation. All studies exhibited a high overall risk of bias. Pooled incidence of frailty among maintenance hemodialysis patients was 32.2% (95% CI: 26.9%-37.6%). Significant predictors of frailty included advanced age, hypoalbuminemia, poor nutritional status, female sex, comorbid conditions, and depression (p < 0.05).

The pooled incidence of frailty among maintenance hemodialysis patients was notably high at 32.2%, with advanced age, hypoalbuminemia, poor nutritional status, female sex, comorbid conditions, and depression emerging as significant predictors. Existing frailty prediction models for maintenance hemodialysis patients demonstrated robust predictive capacity but exhibited substantial methodological limitations, high bias and limited external validation. Future research should prioritize multicenter, large sample, validation studies to enhance applicability and reliability.

ABSTRACTBackground: Prevalence of posttraumatic stress disorder (PTSD) in refugees is higher compared to the general population, and barriers in accessing mental health care are often experienced. With staggering numbers of people seeking refuge around the world, and 40% being 18 years or younger, effective trauma-focused therapies for refugee children with PTSD are highly needed.Objective: A systematic review and meta-analyses were conducted to provide an overview of, and to analyse, intervention studies using PTSD measures in young refugees, assessing treatment effectiveness and addressing efforts to mitigate barriers to mental health care.Method: Eleven databases were searched for studies evaluating trauma-focused treatments (TFT) for refugee children (0-18). Meta-analyses were conducted for all included studies grouped together; and second, per intervention type, using posttreatment measures and follow-up measures. Pooled between-group effect sizes (ESs) and pre-post ESs, using a random-effects model were calculated.Results: A total of 47 studies was retrieved, with 32 included in the meta-analyses. The narrative review highlighted positive outcomes in reducing posttraumatic stress symptoms for CBT-based interventions, EMDR therapy, KIDNET, and other treatments such as art therapy. Meta-analyses revealed medium pooled pre-post ESs for CBT-based interventions (ES = -.55) and large for EMDR therapy (ES = -1.63). RCT and CT studies using follow-up measures showed promising outcomes for KIDNET (ES = -.49). High heterogeneity of the included studies limited interpretation of several other combined effects. Results should be interpreted with caution due to the generally low quality of the included studies. All studies addressed efforts to minimize treatment barriers.Conclusion: More high-quality studies are urgently needed to inform treatment recommendations. Evidence-based therapies, such as CBT-based interventions, EMDR therapy, and KIDNET, demonstrate promising findings but need further replication. Strategies to overcome barriers to treatment may be necessary to reach this population.

Background: Women report higher rates of trauma-related disorders compared to men. With women being disproportionately impacted by the consequences of natural hazards, this gender disparity may increase in their aftermath.Objective: This meta-analysis aimed at quantifying gender gaps in mental disorder prevalence following natural hazards, considering both the recent and long-term aftermath of natural hazards, the developmental status of affected countries, and type of hazard.Method: A systematic search was conducted in MEDLINE, PsycINFO, and Web of Science in February 2024. Random effects models were used to calculate odds ratios (OR) based on point prevalences. OR adjusted for covariates were also descriptively reported.Results: In total, 141 reports (N = 3,726,153 independent participants) were included. The prevalence for posttraumatic stress disorder (PTSD), major depression (MD), and generalized anxiety disorder (GAD) within the first year after the hazard were 24.95%, 8.11%, and 14.24%, respectively. More than one-year post-natural hazard the prevalence for PTSD and MD were 22.89% and 13.51%, respectively. Women had significantly higher odds for PTSD (OR = 1.85) and MD (OR = 1.52) within the first year after the hazard, as well as in later assessments (OR = 1.83 for PTSD, OR = 1.41 for MD). Only four studies reported on GAD gender differences in the recent aftermath of natural hazards, resulting in a non-significant OR of 1.85. Subgroup analyses indicated no differences between developmental status of affected countries and adjusted OR showed no systematic variations upon the inclusion of covariates. Gender differences were larger in the aftermath of earthquakes.Conclusions: Significant gender differences for mental disorders following natural hazards exist, although these differences appear similar to other contexts. Gender-sensitive disaster response plans for mental health are essential.

Our objective is to elucidate the reciprocal association between atopic dermatitis (AD) and attention deficit hyperactivity disorder (ADHD) by prespecified subgroups and determine potential modified factors.

Adhering to PRISMA 2020, we conducted a comprehensive database search up until March 11, 2024. Observational studies reporting on AD and ADHD as either exposure or outcome variables were included. A random-effects model meta-analysis was conducted to calculate pooled estimates. Subgroup and meta-regression analyses were undertaken to explore heterogeneity. Publication bias was investigated via funnel plots and Egger's test.

Overall, 49 studies were determined to meet the inclusion criteria after rigorous screening. Patients with AD were more likely to have ADHD (ORs = 1.34, 95% CI 1.25-1.44, p < 0.01; HRs = 1.42, 95% CI 1.20-1.68, p < 0.01), while patients with ADHD also had an increased risk of developing AD (ORs = 1.45, 95% CI 1.21-1.73, p < 0.01). Subgroup analyses indicated that the associations were particularly pronounced among studies that assessed patients with severe AD (ORs = 2.62, 95% CI 1.76-3.92, p < 0.01), suffered from multiple allergic conditions (ORs = 2.89, 95% CI 1.18-7.10, p < 0.01) and sleep disturbances (ORs = 2.43, 95% CI 2.14-2.76, p < 0.01) simultaneously.

This review substantiates the significant bidirectional association between AD and ADHD, indicating that they serve as mutually independent risk factors and may either exacerbate each other. These findings underscore the necessity for heightened awareness and early targeted interventions, especially in individuals with severe AD manifestations, sleep problems, and multiple allergic diseases.

The atherogenic index of plasma (AIP) has been related to an increased risk of coronary artery disease. However, previous studies evaluating the prognostic role of AIP for acute coronary syndrome (ACS) showed inconsistent results. This meta-analysis was conducted to systematically evaluate the association between AIP and the risk of major cardiovascular adverse events (MACE) of patients with ACS.

Relevant cohort studies were retrieved by searching electronic databases, including PubMed, Web of Science, and Embase. A random-effects model was used to combine the data by incorporating the influence of between-study heterogeneity.

Thirteen datasets from nine cohort studies, involving 10,861 patients with ACS were included in the meta-analysis. Of them, 1546 (14.2%) developed MACE during follow-up. Pooled results suggested that a high AIP at admission was associated with an increased risk of MACE during follow-up (risk ratio [RR]: 1.54, 95% confidence interval [CI]: 1.30-1.82, p < 0.001; I2 = 48%). Subgroup analyses suggested a stronger association between a high AIP and an increased risk of MACE in older patients (mean age ≥60 years, RR: 2.26, 95% CI: 1.78-2.87, p < 0.001; I2 = 0%) than the younger ones (mean age <60 years, RR: 1.30, 95% CI: 1.17-1.44, p < 0.001; I2 = 0%; p for subgroup difference <0.001), which fully explained the heterogeneity.

A high AIP is associated with an increased risk of MACE in patients with ACS, particularly for older patients.

Virological failure (VF) significantly threatens the efficacy of antiretroviral therapy (ART) programs in East Africa. This systematic review and meta-analysis assess the prevalence and predictors of VF among individuals living with HIV.

We searched PubMed, Web of Science, African Journals Online, and EMBASE for relevant studies. Heterogeneity was assessed using the I2 statistic, and random-effects models addressed between-study variability. Publication bias was examined through funnel plots, Egger's regression, and Begg's tests. Subgroup analyses and meta-regression explored heterogeneity sources and potential VF predictors. Analyses were conducted using MedCalc version 20.010, adhering to PRISMA 2020 guidelines.

Twenty-five records were included, with a sample size of 29,829 people living with HIV on ART. The pooled prevalence of VF in East Africa was 19.4% (95% CI: 15.2%-24.0%), with substantial heterogeneity across studies. Sociodemographic predictors of VF included male sex (30.9%, p < .001), unmarried status (28.2%, p < .001), lower educational attainment (33.0%, p < .001), non-formal employment (47.2%, p < .001), and urban residence (51.2%, p < .001). Clinical factors associated with higher VF rates were ambulatory status (44.7%, p < .001), low CD4 count (35.1%, p < .001), low haemoglobin (52.2%, p < .001), advanced HIV stage III/IV (44.2%, p < .001), HIV/TB co-infection (24.3%, p < .001), and other opportunistic infections (20.5%, p = .008). Treatment-related factors associated with VF were first-line nevirapine-based regimen (27.7%, p = .009) and poor ART adherence (41.76%, p < .001).

Sociodemographic factors, advanced HIV disease, co-morbidities, poor adherence, and specific first-line ART regimens are key predictors of virological failure. Targeted, multidisciplinary interventions focusing on routine viral load monitoring, adherence support, and addressing socioeconomic barriers are essential to improve ART outcomes in East Africa.

The adoption of game-based interventions has begun to rise as innovative methods in nursing education have gained prominence. This systematic review and meta-analysis study aimed to analyze the effects of game-based interventions on nursing students' knowledge level. We searched nine electronic databases published in English, without year limitations, until May 2024. We followed the PRISMA 2020 checklist. A random-effects model was used to determine intervention effects. The Cochrane Collaboration technique was used to evaluate potential bias. Six studies involving 718 nursing students were included in this study. We identified the use of different game-based approaches such as video games, serious games, mobile games, board games, gamified flipped classrooms, and virtual gaming simulations. Game-based intervention duration ranged from only once to once weekly throughout the study period. No significant publication bias was observed. Compared to the control group, game-based interventions improved the level of knowledge (SMD = 1.00; 95 % CI [0.26, 1.74]; p < 0.001). Game-based interventions are an effective strategy for achieving learning objectives in the cognitive domain and contribute to increasing nursing students' knowledge levels. Therefore, integrating game-based interventions into nursing education is recommended. Further research is needed to determine how game-based affect nursing students' behavioral and affective learning outcomes.

The association between diet and the onset and treatment of depression is unclear. This study aims to estimate the evidence for the prospective association between diet quality and depression.

Systematic searches in PubMed, Web of Science and Embase up to 2024/01/04 of propective studies on the potential relationship between diet quality and depression identified 21 randomized clinical trials (RCT) and 92 prospective cohorts (PC) (>700,000 participants), that were pooled in random-effects frequentist and Bayesian meta-analyses.

Treatment-RCT yielded anecdotal-to-moderately strong support for the hypothesis that dietary interventions improve depression (d = -0.80, 95 % CI = -1.46 to -0.14), though their internal validity was low. Interventional effects were observed in nonpatient samples (d = -0.17, -0.29 to -0.08). Prevention-RCT yielded strong evidence indicating no association. Data from PC showed that adherence to some dietary patterns/food groups was associated with depression, e.g., adherence to the Mediterranean-diet was associated to fewer self-reported symptoms (OR = 0.91, 95%CI = 0.88-0.96), with anecdotal-to-moderate strength of evidence but no dose-response relationship. For most dietary patterns and food-groups (e.g., fish), data supported the null-hypothesis of no effect. Effect moderation was present: associations were evident when depression was self-reported but not when diagnosed. Postpartum-depression studies yielded evidence showing dose-response associations between fish (OR = 0.84, 95%CI = 0.78-0.91) and dietary DHA/EPA/Omega3 consumption (OR = 0.84, 95%CI = 0.77-0.92) with self-reported depression-scores.

The strength of the current evidence on the hypothesis that dietary quality influences depression outcome is very low, due to reverse causation and low internal and construct validity. The clinical significance of fish/dietary DHA/EPA/Omega3 intake to reduce the risk of postpartum-depression should be further investigated.

Suicide is a leading cause of death among college students, but inconsistent data and a lack of meta-analysis make it difficult to identify and recognize the risk factors for suicidal ideation, planning, and attempts in this group. To gain a comprehensive understanding of previous research, this study summarized risk factors for suicidal ideation, planning, and attempts among college students through a review and meta-analysis.

We systematically searched six electronic databases from inception to May 18, 2024, to identify longitudinal studies of factors associated with suicidal ideation, planning, and attempts among college students. The effect sizes of the risk factors were pooled using a random effects model. Based on the results of the meta-analysis, we developed a risk prediction model for suicidal ideation among college students.

Thirty-three studies involving 193,517 college students were included. This study identified 18 risk factors, such as sexual orientation and traumatic experiences, and identified two protective factors, namely, social support and positive coping. Suicidal ideation is considered an important precursor to suicide. This study developed a predictive model for suicidal ideation with the results of the meta-analysis.

This review demonstrated the importance of several risk and protective factors for suicidal ideation, planning, and attempts among college students. A predictive model was developed based on the results of this meta-analysis, thus providing novel insights for translating evidence into clinical practice.

Antidepressants use is linked to poor response, treatment discontinuation, and treatment-resistant depression. However, evidence regarding efficacy of cranial electrotherapy stimulation (CES) in treating depression is limited. Therefore, we conducted the first meta-analysis to explore efficacy of CES in treating primary and secondary depression in adults.

PubMed, Embase, CINAHL, Web of Science, EBSCOHost, and Cochrane Library were comprehensively searched. Dersimonian-Lard random-effects model in Comprehensive Meta-Analysis 4.0 was used, presenting Hedges' g with corresponding 95 % confidence interval (CI) for depressive symptoms and Quality of life (QoL) while odds ratio (OR) for safety and acceptability of CES. Heterogeneity was examined using Cochrane's Q and I2 statistics with moderator analysis determining sources of variation.

Sixteen randomized controlled trials involving 1148 adults were included. CES significantly reduced depressive symptoms with small effect (g = -0.33 [95%CI -0.46, -0.20]) compared to non-CES treatment; it was safe (OR = 0.84 [95%CI 0.32, 2.18]) and acceptable (OR = 0.72 [95%CI 0.41, 1.27]). CES revealed non-significant effect on improving QoL (g = 0.13 [95%CI -0.05, 0.31]). Substantial improvement of CES were observed for females (β = -0.010 [95%CI -0.019, -0.0003]), secondary depression (g = -0.42 [95%CI -0.58, -0.27]), current >100 μA (g = -0.38 [95%CI -0.58, -0.18]), frequency > 100 Hz (g = -0.50 [95%CI -0.81, -0.20]), length ≤ 30 min (g = -0.39 [95%CI -0.64, -0.14]), sessions/week ≤5times (g = -0.34 [95%CI -0.49, -0.19]), and duration ≤5 weeks (g = -0.45 [95%CI -0.63, -0.27]).

CES, a safe adjunctive therapy, demonstrates small effect in the treatment of depression. Future research should explore long-term effects of CES for treating adults with depression.

International migrant workers face an elevated risk of common mental disorders (CMDs), stress, and sleep disturbances due to various individual, psychosocial, and occupational factors. This meta-analysis systematically evaluated the prevalence of CMDs, stress, and sleep disturbance among international migrant workers. Two independent reviewers systematically searched the literature on five electronic databases from inception to June 2022. Random effects meta-analyses were performed to estimate the pooled prevalence of depressive symptoms, anxiety symptoms, stress, and sleep disturbance among international migrant workers. Additionally, subgroup analyses were conducted to examine potential modifiers for the prevalence rates. Of 8461 records, 57 studies (n = 29,481) were included in this meta-analysis. The pooled prevalence rates of depressive symptoms, anxiety symptoms, stress, and sleep disturbance were 20.3 %, 17.8 %, 17.3 %, and 25.3 %, respectively. Subgroup analyses revealed that the prevalence of CMDs and stress was statistically significantly modified by country of destination and type of work, stress by gender and country of origin, and anxiety by migration type. Potential publication bias was observed only in the meta-analysis of stress. Most of the studies included were of moderate to high methodological quality. However, given that the included studies were predominantly cross-sectional and used non-probability sampling, the results should be interpreted with caution. This meta-analysis highlights that CMDs, stress, and sleep disturbances are prevalent among international migrant workers, posing a significant public health concern for host countries. These findings underscore the urgent need for tailored mental health interventions for specific subgroups within this population.

Trauma exposure is associated with dissociation, post-traumatic stress disorder (PTSD), and psychosis; however, less is known about whether dissociation is a transdiagnostic mediator between trauma exposure and the PTSD-psychosis symptom spectrum. Hence, we conducted a meta-analysis to elucidate the associations among trauma exposure, dissociation, PTSD symptoms, and psychotic symptoms. A total of 311 articles with 94,454 individuals were coded and a two-stage meta-analytical structural equation model was used to investigate the indirect effect of trauma exposure on PTSD symptoms and psychotic symptoms through dissociation. Subgroup analyses investigated the heterogeneity in indirect effects due to dissociation type (i.e., general dissociation versus traumatic dissociation), sample type, study design, study quality, and geographical differences. The indirect effect from trauma exposure to PTSD symptoms via dissociation was significant (β = 0.15, 95 % CI [0.13, 0.17]). The indirect effect from trauma exposure to psychotic symptoms via dissociation was significant (β = 0.14, 95 % CI [0.12, 0.17]). There was no statistical difference between both indirect effects. Subgroup analyses revealed larger indirect effects for traumatic dissociation, clinical samples, non-Western countries, and poor quality studies. The present meta-analytic results indicate that dissociation is a transdiagnostic mediator in the relationship between trauma exposure and the PTSD-psychosis symptom spectrum. Traumatic dissociation and clinical samples were associated with larger indirect effects. These findings inform clinical practice and future transdiagnostic research on PTSD and psychosis.

Menopause, a crucial transitioning stage for women, can significantly impact mood and wellbeing. We aimed to systematically examine the effectiveness of Mindfulness-based interventions (MBIs) on health outcomes, including menopausal symptoms, quality of life (QOL), sleep quality, anxiety, depressive symptoms, stress, mindfulness levels, and female sexual function index.

Eight databases were searched from inception to November 4, 2024 for randomized controlled trials. Two researchers independently selected, extracted, and appraised trials using the Cochrane Collaboration's 'risk of bias' tool. Meta-analysis, subgroup analysis, leave-one-out sensitivity analysis, and meta-regression were performed using Stata 18.0. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to assess the quality of evidence.

A total of 19 studies (1670 participants) published between 2011 and 2024 were identified. Of these, 18 studies were included in the meta-analysis. Compared with control group, The pooled analysis demonstrated that MBIs had statistically significant effects on menopausal symptoms (SMD, -2.10; 95 % CI, -3.49 to -0.70), QOL (SMD, -0.88; 95 % CI, -1.67 to -0.09), sleep quality (SMD, -0.92; 95 % CI, -1.65 to -0.20), anxiety (SMD, -1.03; 95 % CI, -1.42 to -0.66), depressive symptoms (SMD, -0.91; 95 % CI, -1.30 to -0.53), stress (SMD, -0.85; 95 % CI, -1.55 to -0.15), and mindfulness levels (SMD, 1.19; 95 % CI, 0.35 to 2.02). The overall quality of evidence for all pooled estimates were graded as low and moderate due to methodological limitations and small sample size. The low attrition rate (6 %) and relatively high adherence rate (79 %) highlight the acceptability of MBIs.

This systematic review and meta-analysis support using of MBIs to improve health outcomes in menopausal women. Rigorous randomized controlled trials with extended follow-up are needed to elucidate the mechanisms linking MBIs to menopausal health and strengthen evidence for clinical application.

Exposure to environmental pollutants during foetal and childhood development has been associated with neurodevelopmental disorders; however, existing evidence remains fragmented and lacks comprehensive credibility assessments.

PubMed, Embase, PsycINFO, and the Cochrane Database of Systematic Reviews were systematically searched from database inception through January 2025, supplemented by reference list searches. Eligible studies were meta-analyses of observational research examining the associations between environmental pollutant exposure and adverse neurodevelopmental outcomes, with quality assessment performed using the AMSTAR 2 tool. Summary effect estimates were re-analysed using random-effects models, accompanied by heterogeneity I² statistics, 95 % prediction intervals, and evaluations of small-study effects and excess significance bias. Evidence was graded according to established criteria as follows: convincing, highly suggestive, suggestive, weak, or not significant. Reporting adhered to PRISMA guidelines, and the study protocol was pre-registered with PROSPERO (CRD42022339292).

A total of 45 studies, comprising 256 unique meta-analyses, were included in the umbrella review. Of these, 88 meta-analyses demonstrated statistical significance; however, 62 % of these exhibited small-study effects and/or excess significance bias. According to the quantitative grading criteria, highly suggestive evidence was identified for the association between PM2.5 exposure and attention deficit hyperactivity disorder (ADHD) (odds ratio [OR] 1.82 [1.52, 2.18]), as well as for lead (Pb) exposure (OR 1.96 [1.57, 2.46]) and ADHD. Childhood fluoride exposure was also graded as highly suggestive evidence for cognitive deficit (OR 3.80 [2.42, 5.97]). Suggestive evidence included the associations between pregnancy O3 exposure and autism spectrum disorder (ASD), childhood lead exposure with decreased intelligence quotient (IQ), decreased blood magnesium (Mg) levels in children with ADHD, and first-trimester pregnancy exposure to PM2.5 and ASD. Sensitivity analyses indicated that results derived from the Restricted Likelihood Maximum (REML) estimator demonstrated greater robustness compared to the widely used DerSimonian and Laird (DL) estimator, reflecting a 13 % increase in significant associations.

Neurodevelopmental disorders associated with environmental pollutants from industrial and human activities pose a critical public health challenge. Future research necessitates cautious analytical strategies and enhanced methodological transparency to improve the credibility of findings.

Heavy metal (HM) contamination disrupts soil ecosystem functions. Microorganisms are pivotal for sustaining soil health, but accurately assessing the ecological risks of HM contamination to microorganisms remains challenging. Here, we conducted a meta-analysis synthesizing 914 datasets from 72 studies to quantify and evaluate the impacts of HMs on microorganisms. The overall effect value results indicate that HM negatively impacts most microbiological indicators, with bacterial abundance (-38 %), fungal abundance (-18 %), microbial biomass carbon (-42 %), microbial biomass nitrogen (-44 %), arylsulfatase (-45 %) and dehydrogenase activity (-66 %) were significantly reduced (p < 0.01), suggesting they can act as sensitivity indicators for assessing ecological risk of microorganisms. Compared to bacteria, fungal indicators (e.g., fungal community structure and Shannon index) are less responsive to HM contamination. At low potential ecological risk index (RI < 150), HM contamination positively impacted certain microbial indicators, such as fungal abundance, fungal Shannon index, and β-glucosidase activity. With increasing RI levels, the negative effects of HMs on microorganisms became more pronounced. Microbiological indicators in acidic soils (pH < 6.5), coarse textured soils, and mining soils were more negatively affected by HMs. Random forest and structural equation modeling analysis also identified RI levels and pH as crucial factors in determining the microbial response to HMs. Adjusted RI (adRI) were calculated using adjusted toxicity factors (adTF). The adRI demonstrated stronger correlations with microbial indicators and lower root-mean-square error (RMSE) in the random forest model than the RI, indicating that adTF is a more effective method for evaluating the effects of HMs on microorganisms. This study enhances the accuracy of quantifying and assessing HM impacts on microorganisms, offering crucial scientific basis for environmental protection and soil remediation.

Poor adherence to clinical practice guidelines among healthcare workers could have negative impacts on the effectiveness of care, patient health outcomes, and healthcare costs. Social norm feedback can be an essential means of achieving the intended intervention goals by providing information to the intervention target regarding the values, attitudes, or behaviors of the reference group or individual. However, there is a lack of consensus on the effectiveness of social norm feedback in improving adherence to clinical practice guidelines among healthcare workers. Therefore, this systematic review aimed to assess the effects of social norm feedback on adherence to clinical practice guidelines among healthcare workers and its characteristics in behavior change techniques.

Searches of PubMed, Web of Science, Cochrane Central Register of Controlled Trials (via CENTRAL), EMBASE (via OVID), MEDLINE (via OVID), and Scopus were preformed to identify peer-reviewed studies published until February 29, 2024. Randomized controlled trials reporting social norm feedback interventions (social comparison, information about others' approval, credible source, social reward, and social incentive) to support compliance with clinical practice guidelines were included. The risk of bias of individual studies was assessed using the Cochrane Risk of Bias 2.0 tool and the certainty of evidence was rated using the GRADE method. Pooled data were analyzed in Stata 17.0 using a random effects model meta-analysis.

A total of 31 articles (30 studies) were identified. Fifteen behavior change techniques were tested in the included studies. The three most commonly used behavior change techniques in clinical practice guidelines were social comparison, feedback on the outcome of behavior, and social support. A meta-analysis showed that social norm feedback appeared to be an effective strategy to improve adherence to clinical practice guidelines among healthcare workers, with a rate difference (RD) of 0.04 (95 % confidence interval [CI] 0.02-0.06). Credible source (RD 0.12, 95 % CI 0.06-0.19) and multiple social norms behavioral change techniques (RD 0.05, 95 % CI 0.04-0.06) seemed effective when combined with other behavioral change techniques, compared to the control condition. The certainty of evidence across the outcomes ranged from very low to high based on the GRADE approach.

Social norm feedback appears to be an effective method for improving adherence to clinical practice guidelines among healthcare workers. This review provides a broad understanding of how social norm feedback can be applied to improve adherence of healthcare workers to clinical practice guidelines, ultimately improving patient health and quality of care.

PROSPERO CRD42023411582.

Decision making is a critical skill for sports officials, often directly influencing the flow and fairness of a match. While this topic has received considerable interest in the literature, a synthesis of current evidence to understand the effectiveness of decision-making training interventions remains unexplored. Therefore, the aim of this study was to conduct a systematic review and meta-analysis of decision-making interventions in team sport officials.

A total of 14 studies were identified, with a random-effects meta-analysis revealing an overall moderate positive effect of decision-making training on decision-making performance outcomes (g = 0.68, p < .001) compared to control conditions. Notably, decision-making training was more effective in Soccer (g = 1.05), Rugby Union (g = 0.90), but not for Australian Football (g = 0.24). Video-based (i.e., 2-D footage) showed significant improvements, especially for objective decision-making outcomes like offside identification (g = 1.48, p < .001). However, our findings indicated that decision-making training tends to be less effective for subjective decision-making outcomes that requires higher levels of interpretation. Furthermore, shorter interventions (4-6 weeks) were found to be most effective, with performance improvements reducing as interventions increased in time.

Our findings highlight the need for further research to explore alternative technologies such as virtual reality to understand how to better replicate game scenarios and assess the transferability of decision-making training to real-world officiating contexts. Additionally, this review highlights the need to investigate sports beyond Soccer, Rugby, and Australian Rules Football to develop our understanding further into optimising decision-making training in sports officials.

The relationship between dissociation features, maladaptive regulation strategies, and emotional dysregulation is a controversial issue. This meta-analytic review provides a comprehensive and multidimensional overview of the association between aspects of dissociation and emotional (dys)regulation.

We conducted systematic research on the main databases (Psycinfo, PsycARTICLES, Pubmed, MEDLINE, Scopus), collecting the literature of the last 20 years. A total of 120 studies were included in the meta-analytic review. The analyses were based on the Pearson coefficient as a measure of the size of the effect, using the random effect model and performing moderation analysis.

Results showed significant relationships between emotion (dys)regulation and the different facets of dissociation. Overall, we observed stronger associations between deficits in emotion regulation/maladaptive regulating strategies, rather than alexithymia, and dissociation, supporting the prior involvement of emotional dimensions in dissociative experiences.

This work confirms the connection between emotion (dys)regulation and dissociation, revealing differential patterns according to the specific assessed dimensions and, thus, providing a systematization of the associations between specific aspects of the examined constructs.

Obstructive sleep apnea (OSA), a sleep disorder, is associated with cognitive decline and is potentially linked to glymphatic system dysfunction. This meta-analysis investigates glymphatic function in severe OSA (apnea-hypopnea index ≥30) using the Diffusion Tensor Imaging Analysis along the Perivascular Space (DTI-ALPS) index.

This study followed PRISMA guidelines for systematic reviews and meta-analyses. A comprehensive search of PubMed, Web of Science, Scopus, and Embase was conducted from inception to January 20, 2024. Studies investigating the ALPS index in OSA using DTI were included. Analyses included a random-effects meta-analysis, sensitivity analysis, meta-regression, publication bias evaluation (funnel plot, Egger's test, and Begg's test), and risk of bias assessment.

Systematic review identified four studies (137 patients with severe OSA and 170 healthy controls (HCs)). Pooled analysis revealed a significant reduction in the DTI-ALPS index in severe OSA patients compared to HCs (standardized mean difference: -0.95, 95 % CI: -1.46 to -0.44, p < 0.001), indicating impaired glymphatic function. Heterogeneity was moderate to high (I2 = 76.07 %), but sensitivity analyses confirmed robustness. Meta-regression analyses identified the sources of heterogeneity as the apnea-hypopnea index (β = -0.039, p = 0.009) and the Epworth Sleepiness Scale (β = -0.150, p = 0.032), with no effects observed for age or male ratio. Qualitative (funnel plot) and quantitative publication bias assessments (Egger's and Begg's tests) showed no significant bias, and risk of bias evaluations using the Newcastle-Ottawa Scale indicated high methodological quality across studies.

These findings suggest that severe OSA disrupts glymphatic activity. The DTI-ALPS index emerges as a promising tool for assessing glymphatic dysfunction in OSA.

Nomophobia (no mobile phone phobia) is a term used to describe discomfort or anxiety experienced when individuals are unable to use or access their mobile phones. Although not formally recognized in the DSM-5 or ICD-11, nomophobia has gained increasing research attention. The present study systematically reviewed and meta-analyzed the global prevalence of nomophobia, based on 43 studies (n = 36,656 participants) from 18 countries. Only studies using validated self-report instruments, primarily the Nomophobia Questionnaire (NMP-Q), were included. Subgroup analysis and meta-regression were conducted to determine the sources of heterogeneity. Results indicated that nomophobia is widespread, with 26 % of participants reporting mild symptoms, 51 % moderate symptoms, and 21 % severe symptoms. Importantly, these figures reflect self-reported levels of distress rather than clinical diagnoses. Higher prevalence was observed among university students and young adults. The wide variation across regions and instruments suggests nomophobia is influenced by cultural, behavioral, and technological contexts. Despite ongoing debates regarding whether nomophobia is an anxiety disorder, these findings highlight the critical need for precise definitions and continued exploration of its psychological correlates.

Sleep disturbances are common in Parkinson's disease (PD), significantly impacting quality of life. Melatonin may help, but evidence regarding dosage, formulation, and treatment duration remains inconclusive.

To quantitatively analyze the effect of melatonin on sleep quality and daytime sleepiness in patients with PD.

We comprehensively searched multiple databases up to February 2025, selecting relevant randomized controlled trials (RCTs). RevMan software was used for analysis. Subgroup analyses included treatment duration (4 weeks vs. 8-12 weeks), dose (≤4 mg vs. >4 mg), and formulation (immediate-release vs. prolonged-release).

Five RCTs (206 patients) were included. Doses ≤4 mg showed no significant improvement in total Pittsburgh Sleep Quality Index (PSQI) scores (MD = -1.26, 95 % CI: -2.72 to 0.20). Doses >4 mg demonstrated a stronger effect (MD = -2.90, 95 % CI: -4.02 to -1.78). Short-term use (4 weeks) significantly improved PSQI scores (MD = -2.43, 95 % CI: -3.98 to -0.88), whereas longer treatment (8-12 weeks) showed a non-significant effect (MD = -1.24, 95 % CI: -3.15 to 0.67). Immediate-release formulations significantly improved PSQI scores (MD = -2.20, 95 % CI: -3.32 to -1.08), while prolonged-release formulations showed no significant effect (MD = -0.61, 95 % CI: -4.15 to 2.93). Melatonin modestly reduced excessive daytime sleepiness measured by the Epworth Sleepiness Scale (ESS) (MD: -0.97, 95 % CI: -1.81, -0.14).

Melatonin may improve sleep quality and reduce daytime sleepiness in PD patients, particularly with short-term use of immediate-release formulations.

Action anticipation is crucial for athletes, enabling them to make the most accurate decisions possible under time constraints and significantly impacting sports performance. This study systematically consolidates key findings from research on action anticipation in sports using the temporal occlusion paradigm to achieve the following five objectives: (1) quantifying the magnitude of the advantage of sports experts in action anticipation; (2) examining whether this expert advantage transfers to familiar and unfamiliar sports and, if so, quantifying its magnitude; (3) testing whether methodological manipulations significantly affect the quantification of action anticipation abilities; (4) reviewing whether temporal occlusion training can improve action anticipation abilities; and (5) inferring the relationship between action anticipation scores in the laboratory and actual movement performance in sports. We identified 111 original articles from databases including Web of Science, APA PsycInfo, PubMed, and Cochrane Library for qualitative analysis. Of these, 127 effect sizes contributed by 100 studies were analyzed using a three-level meta-analysis to achieve objectives (1) to (3), and 12 studies were included in a systematic review to achieve objectives (4) to (5). Corresponding to five objectives, our data indicate that: (1) The magnitude of the advantage of sports experts in action anticipation is strong (Hedges' g = 1.15, 95 % CI [0.97, 1.33], p < 0.001). (2) This expert advantage neither transfers to familiar sports nor unfamiliar sports. (3) Commonly used manipulations, such as stimulus size, response mode, participant selection, and sport category, in the temporal occlusion paradigm consistently yield substantial effects. (4) Temporal occlusion training can improve action anticipation abilities. (5) A small to moderate correlation exists between action anticipation scores in the laboratory and actual movement performance in sports. These findings provide a comprehensive understanding of the crucial role of action anticipation in specific sports performance.

Developmental psychology focuses on how psychological constructs change with age. In cognitive development research, however, the specifics of this emergence is often underspecified. Researchers often provisionally assume linear growth by including chronological age as a predictor in regression models. In this work, we aim to evaluate this assumption by examining the functional form of age trajectories across 25 phenomena in early linguistic and cognitive development by combining the results of multiple meta-analyses in Metalab, an open database. Surprisingly, for most meta-analyses, the effect size for the phenomenon did not change meaningfully across age. We investigated four possible hypotheses explaining this pattern: (1) age-related selection bias against younger infants; (2) methodological adaptation for older infants; (3) change in only a subset of conditions; and (4) positive growth only after infancy. None of these explained the lack of age-related growth in most datasets. Our work challenges the assumption of linear growth in early cognitive development and suggests the importance of uniform measurement across children of different ages.

X-linked hypophosphatemia (XLH) is a rare genetic disorder caused by PHEX gene variants, leading to elevated FGF23 levels and impaired phosphate reabsorption, resulting in abnormal bone growth. Skull abnormalities, including craniosynostosis, are often reported in children with XLH, but the true prevalence of craniosynostosis among children with XLH is unknown.

We performed a systematic review and meta-analysis to estimate craniosynostosis prevalence in children with XLH. We searched PubMed, Embase, and Web of Science for cohort studies or large case series published before June 2024. Eligible studies included at least ten children with XLH and reported craniosynostosis prevalence without selection based on skull abnormalities. Pooled prevalence was calculated using a random-effects model, with heterogeneity assessed.

Of 517 studies initially identified, ten studies with 461 patients met the criteria for inclusion. The pooled prevalence of craniosynostosis among children with XLH was 22 % (95 % confidence interval (CI) 9.0 % to 44 %) with significant heterogeneity across studies (I2 = 88.5 %, p < 0.01). This prevalence is far greater than the prevalence of craniosynostosis in the general pediatric population, which is estimated to be one in 2100-2500 births. We confirmed an expected female predominance among children with XLH (median 65.9 % female, interquartile range [IQR] 53.7 % to 68.4 %) but not among children with XLH and craniosynostosis (median 42 % female, range 21 % to 48 %).

Craniosynostosis is more common among children with XLH compared to the general pediatric population and may be disproportionately common among males. Increased vigilance for craniosynostosis is warranted for children with XLH.

Atrial Fibrillation (AF) and Type 2 Diabetes Mellitus (T2DM) are comorbid conditions associated with increased adverse outcomes. Recent evidence suggests that antidiabetic therapies such as sodium-glucose co-transporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 agonists (GLP1a) may influence the risk of AF and stroke differently. This study aims to compare the risk of new-onset AF and stroke in T2DM patients treated with SGLT2i versus GLP1a. A systematic literature review was performed on Pubmed and Embase, including studies comparing the effect of SGLT2i or GLP1a on new-onset AF and stroke incidence in T2DM patients. A random effects model was used to pool relative risk and 95% confidence intervals to assess the study outcomes. Univariate metaregression analysis was performed for selected demographics and comorbidities. Six observational studies were included in the analysis comprising 847,028 patients. Our meta-analysis found a significantly lower risk of new-onset AF in patients with T2DM treated with SGLT2i compared to those receiving GLP1a (RR = 0.76, 95% CI: 0.65 to 0.89). There was no statistically significant difference in the risk of stroke between SGLT2i and GLP1a (RR = 1.09, 95% CI = 0.98 to 1.21). Univariate meta-regression indicated male sex was a significant negative effect modifier for new-onset AF (coefficient = -0.0191, p-value = 0.0158). In conclusion, SGLT2i may reduce AF risk in T2DM patients, while GLP1a may provide a modest, nonsignificant protective effect against stroke. Further research is needed to confirm these results and guide cardiovascular risk management in patients with T2DM.

Individuals with anorexia nervosa (AN) are typically anhedonic, leading to the suggestion that intrinsic disturbances of reward processing may represent a trait marker of the disorder. Previous studies have used task-based functional magnetic resonance imaging (fMRI) to investigate reward-related brain activity in AN and reported altered activation in the prefrontal cortex, dorsal posterior cingulate cortex, and rostral anterior cingulate cortex. However, likely due to the varied paradigms and methodologies used, as well as the heterogeneity in sample characteristics, results have proved inconsistent. To determine whether AN patients with the restrictive subtype (AN-r) show different reward-induced activation patterns to matched healthy controls (HCs) at different illness stages, we conducted a meta-analysis of 19 task-based fMRI studies of reward-processing. Using the seed-based differential mapping (SDM) technique, we found differences in reward-related brain activity between AN-r and HCs. Moreover, different brain regions showed differential activation across illness stages, with the direction and magnitude of effects dependent on specific task stimuli. These findings suggest that those with AN-r show distorted reward processing as a consequence of reward contamination and alterations in valence assignment to reward stimuli. In weight-recovered AN-r patients, differences to HCs persisted but were limited to regions known to exhibit significant atrophy in AN-r, indicating that altered reward processing is associated with anorectic undernutrition. These findings have implications for developing pharmacological treatments to aid psychological recovery in AN-r.

Physical literacy is a unifying concept that encompasses the physical competence, knowledge and understanding, motivation and confidence for engagement in life-long physical activity. In this study, we conducted a random-effects meta-analysis with meta-regression to examine (a) whether existing interventions were effective in enhancing individual's physical literacy and physical activity engagement, and (b) which factors moderated effectiveness of the interventions. The protocol of the meta-analysis was pre-registered in PROSPERO (Ref: CRD42020213898) on November 22, 2020. Specifically, a comprehensive literature search was conducted, and studies that evaluated any controlled intervention aimed to enhance physical literacy were included. Studies using either randomized or non-randomized designs were included. Intervention effects pertaining to each physical literacy component and activity engagement were pooled using a meta-analytical approach. Using meta-regressions, we investigated if study effects were moderated by characteristics of the interventions. Of the 29 studies included in the analyses, interventions successfully increased: physical competence (k = 18, g = 0.57), knowledge and understanding (k = 13, g = 0.55), motivation and confidence (k = 12, g = 0.44), global physical literacy (k = 27, g = 0.52), and engagement in physical activity (k = 13, g = 0.14). Intervention effects were weaker in school or university settings compared to non-educational settings and a positive bias for studies with smaller samples was found. While these findings were robust, long-term effectiveness of interventions should be further examined, as most included studies only evaluated short-term effects. Systematic approaches for the design and reporting of intervention components are also needed to help researchers design effective and scalable interventions in the future.

Effective treatments for post-traumatic stress disorder (PTSD) have been established, but their applicability in complex post-traumatic stress disorder (CPTSD) is largely unknown.

We searched Pubmed, Web of Science, PsycInfo, Embase, CNKI, wanfang data, and SinoMed databases to seek out studies assessing the impact of psychological therapies on CPTSD among individuals with complex trauma. The quality of studies was assessed using the Cochrane Risk of Bias tool, and the moderating influence of study characteristics on the effect was examined.

The pooled effect of psychotherapies compared with the control groups was significant, with PTSD (k = 27, g = -1.16, 95 % CI: -1.49 to -0.82), depression (k = 23, g = -1.12, 95%CI: -1.47 to -0.75), anxiety (k = 13, g = -1.25, 95%CI: -1.82 to -0.68), and dissociation (k = 7, g = -0.47, 95%CI: -0.74 to -0.19). At follow-up, the effect sizes decreased slightly, but there was still significant remission of symptoms except for anxiety and dissociation symptoms. Subgroup analysis and meta-regression showed that participants with childhood trauma had lower effects than those with other trauma types, and risk of bias and female proportion were the moderators. There were some indications of publication bias.

Psychological interventions for CPTSD showed significant effects after the intervention, and the effect was largely maintained during follow-up. Future studies could investigate how interventions can be further optimized and tailored to suit individuals' performance.

Functional Near-Infrared Spectroscopy (fNIRS) holds promise for clinical applications in the field of balance impairment amelioration; however, the relationship between fNIRS metrics and balance performance remains uncertain. We aimed to quantify the correlations between fNIRS-derived brain activation and standing balance performance, and determine variables that influence these associations.

We systematically reviewed English-language studies, published across PuBMed, PsycINFO, Embase, CINAHL, Ovid Medline, and Web of Science from inception up until July 1, 2024, that assessed standing balance tasks in adults > 18 years old with or without medical diagnosis measured with fNIRS. Pooled correlation coefficients were synthesized using a random effects restricted maximum likelihood model.

Overall, 17 studies were included with 420 participants. Key factors influencing the identified relationships were brain region and participant diagnosis. We identified moderate correlations between balance performance and cortical activation recorded by fNIRS in the supplementary motor area (SMA) (r = 0.52, 95 % CI = 0.39 0.64), and the prefrontal cortex (PFC) (r = 0.47, 95 % CI=0.32 - 0.60). In the PFC, increased oxygenated haemoglobin (HbO) was negatively associated with balance measures. The reverse relationship was reported in the PFC for individuals with physical and cognitive impairment. In the SMA, HbO was positively associated with balance. Few studies found associations between deoxygenated haemoglobin (HbR) and total hemoglobin (HbT) with balance performance.

Current evidence supports a relationship between fNIRS measures, specifically HbO, with standing balance performance. This relationship depends on the brain region measured, age, and the diagnosis of the participants. To better understand this relationship, there is a need to report standardized balance performance metrics alongside other metrics of interest to better synthesize data across publications. Improved understanding the neural basis of standing balance with fNIRS will lead to more informed interventions for balance rehabilitation.

Previous studies have consistently demonstrated that exercise mitigates cognitive decline in older adults. However, the most effective types of exercise, along with optimal frequency and duration of interventions, remain inadequately defined. To address these gaps, we conducted a network meta-analysis synthesizing direct and indirect evidence from existing literature to identify the most effective exercise interventions for enhancing cognitive function in older adults.

We conducted a systematic search across databases including PubMed and Web of Science to identify randomized controlled trials (RCTs) evaluating the impact of various exercise interventions on cognitive function in older adults. We assessed the quality of included studies and performed a traditional meta-analysis with Review Manager 5.3. Subsequently, a network meta-analysis was conducted using Stata 17.0 to evaluate the effects of different exercise modalities on cognitive outcomes, specifically memory, inhibitory control, and task-switching abilities.

A total of 37 studies encompassing 2585 older adults met the inclusion criteria. The network meta-analysis revealed that resistance training exerted the strongest effect on overall cognitive improvement. Aerobic exercise, multimodal exercise, and physical-mental training followed in effectiveness. Specifically, resistance training significantly enhanced inhibitory control compared to high-intensity interval training (HIIT), aerobic exercise, and other modalities. Physical-mental training emerged as the most effective intervention for improving task-switching ability and demonstrated superior efficacy in enhancing working memory compared to aerobic exercise. Conversely, aerobic exercise showed the strongest effect on memory function, outperforming resistance training, multimodal exercise, and physical-mental training.

Resistance training is the most effective exercise modality for enhancing overall cognitive function and inhibitory control in older adults. Physical-mental training offers the greatest benefits for improving working memory and task-switching ability, while aerobic exercise is most beneficial for enhancing memory function. Based on these findings, the recommended exercise protocols are: Resistance Training: 12 weeks, 2-3 times per week, 45 min per session. Aerobic Exercise: 21 weeks, twice per week, 60 min per session. These tailored exercise interventions can inform public health strategies and clinical practices aimed at optimizing cognitive health in the aging population.

The protocol for this review was registered in PROSPERO (CRD42024597545).

Drinking water disinfection byproducts (DBPs) have received widespread attention due to their high concentrations and toxicity. However, the correlation between exposure to disinfection byproducts and bladder cancer in published papers is inconsistent. In this study, a time-updated meta-analysis was conducted, which aimed to elucidate the relationship between the historical exposure time and exposure levels of trihalomethanes (THMs) in drinking water and the associated risk of bladder cancer. A total of 433 relative publications was obtained from databases, however only 16 publications satisfied the inclusive criteria, including 13 case-control studies and 3 cohort studies. The case-control studies encompassed 8126 bladder cancer cases and 13,843 controls, while the cohort studies included 112,654 cases and 955 bladder cancer patients. In comparison to individuals who have never been exposed to or have only experienced brief exposure to THMs, the odds ratio (OR) for medium-term and long-term exposure of THMs was 1.30 (95 % CI = (1.11, 1.53)), and 1.59 (95 % CI = (1.40, 1.81)), respectively. This suggests a statistically significant positive correlation between long-term exposure to chlorinated drinking water and an increased risk of bladder cancer. The pooled OR for low and high exposure group was 1.28 (95 % CI = (1.06, 1.55)) and 1.45 (95 % CI = (1.14, 1.85)), respectively, indicating an increased risk of bladder cancer occurrence compared to the unexposed group. Interestingly, subgroup analysis revealed that high levels of THM exposures of males caused an increased risk of bladder cancer (OR= 1.59, 95 % CI = (1.11, 1.53)), while this association was not significant for females (OR = 1.05, 95 % CI = (0.61, 1.80)). More importantly, although the case-control studies were consistent with the overall findings, the cohort studies suggest that there is insufficient evidence to establish a definitive causal link between THMs exposure levels and bladder cancer. In general, long-term consumption of chlorinated drinking water was associated with the occurrence of bladder cancer of male rather than female.

According to previous studies, omega-3 polyunsaturated fatty acids (PUFAs) are controversial for the efficacy of treating depression.

This meta-analysis aims to investigate whether omega-3 PUFAs are able to treat depression, and find out the most beneficial clinical portrait.

More than two reviewers searched six registries, and 36 studies were eventually considered eligible. The PRISMA guidelines were used for data extraction, Cochrane Handbook for quality assessment, and random effects model for data pooling.

Significant heterogeneity and publication bias were observed. According to the results, significant efficacy was detected in the overall analysis [SMD = -0.26, 95 % CI = (-0.41, -0.11)] and several subgroups, while total daily dosage might be a potential heterogeneity source (P < 0.05). No between-group difference was observed in the rate of response [RR = 0.99, 95 % CI = (0.82, 1.20)], remission [RR = 1.17, 95 % CI = (0.92, 1.48)], and adverse events [RR = 1.07, 95 % CI = (0.90, 1.29)]. Total daily intake of eicosapentaenoic acid (EPA) and remission rate conformed to linear correlation (P < 0.05).

1) Omega-3 PUFAs might be effective in treating depression; 2) For Asian patients with mild to moderate depression and no other baseline medication, over 8 weeks of omega-3 PUFAs 1000-1500 mg/day with ratio of EPA/docosahexaenoic acid (DHA) between 1:1 and 2:1 might benefit the most; 3) Omega-3 PUFAs are no superior than placebo in rates of response, remission, and adverse events. Although several limitations exist, the evidence-based information provides guidance for clinical practice and directions for further research.

CRD42023464823.

Forcibly displaced populations are growing exponentially and are at increased risk of experiencing mental health difficulties. However, it remains unclear if, and how, their resilience and mental health are associated. This systematic review and meta-analyses investigated the relationship between resilience and mental health outcomes among forcibly displaced groups.

MEDLINE Ultimate, APA PsycInfo and SCOPUS were searched up until January 2024. Peer-reviewed studies measuring a statistical association between resilience and mental health among forced migrants were eligible for inclusion. Random-effects meta-analyses for each identified mental health category were conducted. Study quality was evaluated using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.

Thirty-one studies were included in the review (n = 6656). Meta-analyses revealed a significant negative association between resilience and symptoms of post-traumatic stress (k = 13, n = 2446, r = -0.15, 95 % CI [-0.23; -0.06]), depression (k = 14; n = 2952, r = -0.34, 95 % CI [-0.41; -0.26]), anxiety (k = 7, n = 1516, r = -0.19, 95 % CI [-0.27; -0.11]), and psychological distress (k = 10; n = 2712, r = -0.29, 95 % CI [-0.36; -0.23]).

Effect sizes were highly heterogenous, most studies recruited small samples using non-random sampling strategies, and data was collected cross-sectionally.

Our findings point to an association between resilience and mental health difficulties in forcibly displaced groups. Directions for future research are discussed.

PROSPERO (CRD42023395925).

Oxidation of low-density lipoprotein (LDL) accelerates atherosclerosis. Vitamin E is a powerful fat-soluble antioxidant; some studies have shown its beneficial effects in reducing oxidized LDL levels. Due to the inconsistent reports, we performed a systematic review and meta-analysis to evaluate the impact of vitamin E supplementation on oxidation of LDL levels. PubMed, Scopus, Web of Science, and Google Scholar were systematically searched to find clinical trials published in English. A total of 21 records with 29 intervention arms were included in this review. In the meta-analysis of 6 studies that reported changes in oxidized LDL levels, a significant decrease in LDL oxidation was observed (95% CI: -1.44 [-2.5, -0.38]; I2 = 95.8%, P < 0.001; Tau-squared: 1.6171). Moreover, a meta-analysis of 7 studies that reported lag time as a measure of LDL oxidation showed that vitamin E supplementation significantly increased the lag time of LDL oxidation (95% CI: 20.45 [12.46, 28.43]; I2 = 95.9%, P < 0.001; Tau-squared: 103.3545). Two studies used the thiobarbituric acid-reactive substances (TBARS) assay to evaluate the susceptibility to LDL oxidation. One of them showed a significant decrease in LDL susceptibility to oxidation after supplementation with tocopherol, while the other one did not show a significant effect. Vitamin E significantly reduced the susceptibility of LDL to oxidation and increased the lag time of LDL oxidation.