The standard clinical genetic testing model for hereditary cancers applies stringent eligibility criteria and consistently misses large numbers of at-risk cancer-susceptibility-gene (CSG) carriers in the general population, leading to missed opportunities for cancer screening/prevention. Advances in technology and understanding of genetics make it possible to expand such testing beyond clinical settings, across different countries and various healthcare settings. Population-based genetic testing (PBGT), which involves offering genetic testing to a broad, unselected population, is a promising strategy for identifying high-risk yet unaffected individuals, helping to maximise prevention and early detection. Successful large-scale implementation of PBGT requires it to be psychologically acceptable, socially responsible, and ethically sound. This review will examine the evidence on psychological, social, and ethical aspects explored in PBGT studies, assess the quality of evidence, and highlight gaps to inform the future design and implementation of PBGT programmes. A systematic scoping review will be conducted across three databases (PubMed, Embase, PsycINFO). Studies are eligible if they: (1) are peer-reviewed; (2) are published between 1994 and 2025; (3) are written in English; (4) recruit otherwise healthy adults (≥18 years); (5) offer predictive germline genetic testing for CSGs, or hypothetical genetic testing and are inferred as population-based; and (6) assess psychological, social, and/or ethical implications. Four reviewers will undertake study screening, data extraction, and evidence synthesis. Data will be extracted from included full-text articles by two independent reviewers. Study quality will be evaluated using the Mixed Methods Appraisal Tool. This systematic scoping review synthesises empirical evidence on the psychological, social, and ethical implications of PBGT. Protocol publication increases transparency and minimises biases such as the selective reporting of outcomes, enhancing the reliability of our findings. The review findings will provide an initial evidence base within the broader assessment of PBGT, highlighting additional evidence needed to inform future research, policy, and practice to support the responsible implementation of PBGT programmes. The Open Science Framework registration number: osf.io/zwjxg.
To investigate the effectiveness of different acupuncture and moxibustion therapies in improving symptoms in patients with atopic dermatitis (AD) to determine the optimal approach. This study aims to provide insights into clinical decision-making in the complementary and alternative management of AD. Systematic review and Network meta-analysis. Randomized controlled trial (RCT) studies were retrieved from various databases, including PubMed, Embase, the Cochrane Library, Web of Science, CNKI, WANFANG Data, and VIP. The RoB 2.0 assessment tool was used to assess the risk of bias in the included studies. The meta-analysis was conducted via Stata 17 software. A total of 23 RCTs involving 1,658 participants were included. Compared with controls, traditional pairwise meta-analyses revealed that acupuncture and moxibustion therapies significantly improved the overall response rate (OR: 2.83, 95
Large language models (LLMs) show promise for accelerating systematic review (SR) stages, yet comprehensive comparative evaluations against validated standards remain lacking. To compare the accuracy, agreement, and time efficiency of four LLMs (GPT, Claude, Gemini, and DeepSeek) across five SR stages—search strategy formulation, deduplication, article selection, risk of bias assessment, and evidence synthesis—against published Cochrane Reviews as the reference standard. Comparative study with randomized assignment using a Williams Latin square design. Twenty five Cochrane SRs of interventions (2020–2025) will be evaluated by 15 researchers stratified by experience. Prompts will be developed using the 4D framework; the underlying process model will be validated via Delphi consensus, and resulting prompt wording via expert content review. Outcomes include recall, sensitivity, Cohen’s kappa, and execution time. Ethical exemption will be requested. Results will be disseminated through five peer-reviewed publications.
Diabetes distress (DD) refers to the emotional and psychological burden experienced by individuals living with diabetes. Randomized controlled trials (RCTs) have investigated the efficacy of interventions on DD among adults with type 1 diabetes or type 2 diabetes. We aimed to systematically identify, summarize and critically appraise all available evidence from RCTs assessing the efficacy of interventions for reducing DD (either as primary or secondary outcome) among adults with type 1 diabetes or type 2 diabetes. Four electronic databases (PubMed, Cochrane Database of Systematic Reviews, PsycINFO and CINAHL) were searched from inception until 23 September 2024. Retrieved papers were screened for eligibility by two independent reviewers, who also screened the reference lists of all included publications. Studies were included if the study was an RCT performed in an adult population (≥18 years), in which the efficacy of an active intervention on DD as primary or secondary outcome was described. Data were extracted using an a priori developed form. Two independent reviewers assessed the risk of bias of included studies using the Cochrane RoB 2 tool for RCTs. For each type of intervention, a narrative data synthesis was conducted, and, if possible, meta-analyses were conducted when two or more studies reported on the same outcome. Heterogeneity between studies was assessed using the I2 statistic and a certainty of evidence assessment (GRADE) was conducted. In case of substantial heterogeneity, subgroup analysis was conducted. Data regarding the efficacy of interventions on DD was summarized and discussed. Future implications and recommendations for clinical care were presented. This systematic review and meta-analysis served as the basis for a European Association for the Study of Diabetes (EASD) guideline on the management of DD. PROSPERO CRD42024598512.
Chronic primary low back pain (LBP) is a costly and disabling condition, with complex interacting factors contributing to pain experience and disability. Although multimodal therapy, including physiotherapy, behavioural therapy/psychotherapy and education is recommended, implementation is limited due to shortcomings in healthcare delivery. Digital solutions such as virtual reality (VR) could offer possibilities to address these shortcomings and become increasingly common. However, the evidence base for VR in chronic LBP is conflicting. Nine existing meta-analyses show substantial variance in effect sizes, ranging from SMD 0.07 to 8.15, due to heterogeneity in population, interventions and outcome measurements, with most often limited quality of evidence. Therefore, a high-quality systematic review focussing on chronic primary LBP, incorporating mechanisms of action and state-of-the-art meta-analysis is warranted. We will conduct a systematic review, employing a comprehensive and sensitive search strategy in all relevant databases. We will include randomised controlled studies that investigate the effects of virtual reality versus other interventions (active and non-active) or no intervention on physical functioning, pain intensity and health related quality of life in patients with chronic primary low back pain. We will assess risk of bias with the Cochrane risk of bias tool 2 (RoB2) and certainty of the evidence with GRADE criteria. We will use a random-effects model for all statistical analyses. This systematic review will provide trustworthy evidence about the effects of VR in chronic primary low back pain by employing rigorous methods of search string development, comprehensive database search, quality evaluation and control, data extraction, documentation and analysis incorporating theory of change. Anticipated intervention heterogeneity will be addressed by pre-specified subgroup analyses and appropriate methods of meta-analysis. PROSPERO 2025 CRD420251250648
Autonomy is regarded as a fundamental principle in the global reform of mental health care, as promoted by the Convention on the Rights of Persons with Disabilities (CRPD) and reflected in various international initiatives aimed at eliminating coercive practices and fostering rights-based recovery approaches. However, its meaning and application remain contested, with interpretations varying widely across cultural, theoretical, and institutional contexts. This scoping review aims to identify and characterize the various conceptualizations and implementations of autonomy for users and ex-users of mental health services, with the goal of clarifying its scope and informing future policies and practices. The review will follow the Arksey and O’Malley framework, supplemented by the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Searches will be conducted in Web of Science, Scopus, PubMed, PsycInfo, and Dialnet, as well as Google Scholar and gray literature databases. Reference lists of relevant studies will be reviewed. Eligible documents include peer-reviewed articles, conference abstracts, dissertations, and unpublished research addressing conceptualizations or implementations of autonomy related to mental health service users and ex-users. Data will be analyzed using descriptive and thematic analysis, based on the Braun and Clarke approach. The review will be conducted from May to December 2025. This scoping review will map international definitions and practices of autonomy in mental health, contributing to policy development and aligning with human rights standards, particularly the CRPD. The findings will be relevant to policymakers, practitioners, and organizations aiming to promote autonomy-based initiatives. Registration with Open Science Framework can be found under registration number https://doi.org/10.17605/OSF.IO/DKFBR.
Artificial intelligence (AI) has shown significant promise in medical diagnostics. However, children and pregnant women represent “vulnerable populations” often underrepresented in large-scale training datasets. This paper summarizes a protocol for an umbrella review aiming to identify and summarize the performance metrics reported in systematic reviews and meta-analyses (SRMAs) of AI-based prediction tools for pediatric and obstetric conditions and to evaluate the methodological quality of these reviews. We will search the PubMed, EMBASE, Web of Science, and Cochrane Library from inception to identify eligible studies. Eligibility criteria include SRMAs of health conditions specific to children and pregnant women, and full-text articles published in English. Following screening and selection, two independent reviewers will perform data extraction in accordance with the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis. Methodological quality will be assessed using the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR2) tool. Our review will involve categorization by AI-based methodology, presence of external validation, and the type of health outcomes. The model types, performance metrics, and bias-mitigation strategies reported in the included systematic reviews will be reviewed. Following title and abstract screening, we will include only SRMAs that focus on AI-based prediction models for health conditions specific to children and pregnant women, or stratified analysis by children and pregnancy status. The results will be presented through narrative synthesis and summary tables. Our anticipated findings will emphasize the specific health conditions addressed by these SRMAs, along with the absence of consistent reporting standards for both performance and fairness metrics within these populations. This review will highlight the need for standardization of AI performance reporting, focusing on commonly researched domains in pediatric and obstetric care. This is critical for ensuring the fair and equitable adoption and implementation of these advanced technologies. PROSPERO CRD420251142360
Patient reported outcome measures (PROMs) are essential tools for capturing the quality of life and symptom burden from the patient’s perspective, particularly relevant in cataract surgery due to its subjective impact on vision. Cataract surgery, a highly cost-effective intervention, faces a growing demand for high-quality PROMs to measure diverse patient experiences and outcomes. Contemporary studies identify 14 domains of vision-related quality of life, such as convenience, visual symptoms, and driving, which traditional PROMs may inadequately address. Additionally, the changing cataract surgery landscape, driven by advancements in intraocular lenses (IOLs) and patient populations, necessitates a re-evaluation of PROMs for cataract patients. A systematic review will examine literature on PROMs in cataract surgery, including consensus studies, instrument development, psychometric evaluations, and implementation studies. Studies will be sourced from databases including PubMed, MEDLINE, Embase, Epub, CINAHL, CENTRAL, CDSR and Northern Light. Inclusion criteria focus on adult lens removal surgery, excluding non-ophthalmic, paediatric, or non-cataract studies. Articles will be screened by multiple reviewers. PROMs will be mapped to the 14 identified domains and evaluated using the COSMIN framework for psychometric assessment. Implementation aspects, including clinical usage, digitisation, and barriers to adoption, will also be assessed. The review will address critical gaps in PROMs for cataract surgery, including domain coverage, psychometric quality, and implementation in clinical and academic settings. It will highlight the evolving needs of a diverse patient population, including refractive lens exchanges, and the impact of modern IOL technologies on PROMs. A well validated quality assessment of cataract PROMs will provide a strong platform to understand the established instruments. This comprehensive analysis will guide future research directions, including the development of new instruments or item banks, and inform best practices for PROM implementation, ensuring alignment with value-based healthcare principles. PROSPERO CRD420251007771
Fatigue is a prevalent and disabling non-motor symptom in Parkinson’s disease (PD), significantly impairing patients’ quality of life. Non-invasive, non-pharmacological interventions, including acupuncture, Tai Chi, and transcranial magnetic stimulation, have gained attention for their favorable safety profiles and cost-effectiveness. However, current evidence is limited by significant heterogeneity in intervention protocols, diverse fatigue measurement scales, and varying methodological quality of existing trials. This study aims to rigorously evaluate the efficacy and safety of non-pharmacological interventions for PD fatigue through a systematic review and network meta-analysis (NMA), providing an evidence-based foundation for clinical practice. A comprehensive systematic search will be conducted across eight electronic databases (PubMed, Web of Science, Cochrane Library, Embase, SinoMed, VIP, CNKI, and WanFang) and two clinical trial registries (ClinicalTrials.gov and ChiCTR) from inception to April 20, 2026. Eligible randomized controlled trials (RCTs) comparing non-invasive, single-modality non-pharmacological interventions against inactive controls or active pharmacotherapy will be included. To ensure transitivity and clinical interpretability, the primary outcome will be strictly restricted to the change in Fatigue Severity Scale (FSS) scores, utilizing mean differences. Secondary outcomes will include other fatigue scales, motor symptoms, and quality of life, and systematically categorized adverse events (serious vs. non-serious). Risk of bias will be assessed using the Cochrane ROB2 tool. Pairwise meta-analysis will be conducted using RevMan v5.4 software, and STATA 18.0 will be utilized for NMA, with intervention rankings generated only for nodes meeting a predefined threshold of at least three studies. Evidence certainty will be evaluated using an NMA-specific GRADE framework. This protocol outlines a rigorous methodology to synthesize current evidence on the efficacy and safety of non-pharmacological interventions for PD fatigue. The findings are anticipated to inform patient-centered clinical guidelines and highlight critical research gaps. PROSPERO CRD420251017727.
Cardiovascular disease (CVD) is the leading cause of death and imposes a substantial burden on women’s health. Early onset of menopause, as a unique trait of reproductive aging, has been associated with a higher risk of adverse cardiovascular events in traditional observational studies. However, the findings yielded from Mendelian randomization (MR) studies were inconsistent. This systematic review aimed to (1) synthesize existing evidence on the relationship between genetically determined menopausal timing and CVD risk and (2) assess the methodological quality of the included MR studies. A systematic literature search was conducted in PubMed, EMBASE, and Web of Science from their inception to June 2025, supplemented by manual searches of the reference lists from retrieved studies and other sources. MR studies using genetic variants as instrumental variables to infer causality between menopausal timing and the risk of cardiovascular-related outcomes were included. The risk of bias of included studies was assessed based on three core MR assumptions and other potential sources of bias. Meta-analyses pooled the inverse-variance weighted-derived odds ratios (ORs) from individual studies using random-effects (RE) models. Seventeen articles were included in the systematic review, with study populations predominantly of European ancestry. Cardiovascular outcomes of interest included coronary artery disease, ischemic and hemorrhagic stroke, atrial fibrillation, heart failure, hypertension, ventricular structure and function, and cardiometabolic traits. Meta-analyses showed that genetically determined menopausal timing was not significantly associated with the risk of coronary heart disease (OR = 0.97; 95
Biological and targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs), including tumor necrosis factor-α inhibitors (TNFi), interleukin-17 inhibitors (IL-17i), and Janus kinase inhibitors (JAKi), are standard treatments for axial spondyloarthritis (axSpA). However, comparative evidence on the safety profiles of these three drug classes, particularly regarding infection-related adverse events, remains limited. No previous study has simultaneously integrated real-world pharmacovigilance data, interventional trial evidence, and causal inference methods within a triangulation framework to systematically evaluate the safety of these agents in axSpA. This study will employ three complementary components. First, a disproportionality analysis of the FDA Adverse Event Reporting System (FAERS) database (Q1 2004–Q4 2025) will use four signal detection algorithms (ROR, PRR, MGPS, BCPNN), supplemented by time-to-onset analysis (Weibull distribution), geographic analysis, and a weighted composite scoring system. Only drug–event combinations where the target drug is coded as Primary Suspect (PS) will be included in the primary analysis. Second, a systematic review incorporating dose–response network meta-analysis (NMA) of double-blind randomized controlled trials will focus on upper respiratory tract infections (URTIs) and opportunistic infections (OIs), with OIs analyzed by subtype (tuberculosis, herpes zoster, candidiasis, PJP). An Emax dose–response model will serve as the primary analytical approach, with linear and conventional NMA models as fallbacks. Databases will include PubMed, Embase, Cochrane Library (CENTRAL), Web of Science, MEDLINE via Ovid, SCOPUS, and ProQuest, in addition to the ClinicalTrials.gov trial registry. The certainty of evidence will be assessed using the CINeMA framework. Third, multivariable Mendelian randomization (MVMR) and causal mediation analysis (FLOW-MR) will employ a sequential complementary framework: MVMR will estimate independent direct effects of each drug target pathway on infection outcomes while conditioning on AS, and FLOW-MR will decompose these effects along the temporal causal cascade (AS → drug target pathway → infection outcome), enabling mediation-based target validation. Signals identified for URTIs and OIs from both FAERS and NMA will be carried forward to the final triangulation stage. By triangulating evidence from real-world pharmacovigilance, randomized trials, and genetic causal inference within a structured qualitative framework with pre-specified convergence criteria, this multi-method protocol will provide a comprehensive and robust safety evaluation of b/tsDMARDs in axSpA. The integration of dose–response modeling and a sequential MVMR-to-FLOW-MR drug-target Mendelian randomization strategy represents a methodological advancement in the safety assessment of biologic therapies. Findings will inform clinical decision-making regarding the comparative safety of these agents. PROSPERO CRD420261417010.
Late-life depression (LLD) is associated with significant impairment in cognitive functions including memory, processing speed, and executive functions. Although depression is a well-established risk factor for the progression from mild cognitive impairment (MCI) to dementia, there is still no consensus in the literature regarding the specific impact of this comorbidity on the neuropsychological profile: while some studies suggest a predominantly dysexecutive profile, others emphasise deficits in attention or in memory. This divergence in findings reflects a clear knowledge gap regarding the precise cognitive signature of this comorbidity. To address this knowledge gap, this study aims to (1) determine whether older patients with MCI and depressive symptomatology exhibit poorer cognitive performance than those with MCI alone and (2) identify the specific cognitive domains most affected. The findings will inform diagnostic accuracy, prognostic evaluation, and personalised treatment strategies within this clinical population. This protocol follows the PRISMA-P and PRISMA guidelines for systematic review protocols and systematic reviews. The research question and article selection criteria are defined according to the PICOS method. The search strategy will combine the main concepts, depression, mild cognitive impairment, and older adults, and will be implemented in the following databases: PubMed, Cochrane, and Web of Science. Two reviewers will independently screen the retrieved records. Risk of bias will be assessed using the JBI checklist. The following data will be synthesised: (i) the diagnostic criteria employed for MCI, (ii) the measures used to quantify depression, (iii) the specific cognitive functions assessed, (iv) the instruments utilised for cognitive evaluation, and (v) the comparative results of cognitive performance between the MCI + LLD and MCI-only groups. Finally, the GRADE system will be applied to assess the certainty of the cumulative evidence. By integrating the available findings, this review will inform future research on the relationship between MCI and LLD and provide evidence-based guidance for clinical interventions, clarifying prognostic and treatment pathways and thereby advancing the knowledge and clinical management of these conditions. PROSPERO registration number: CRD42025607733.
A substantial proportion of patients with Staphylococcus aureus bacteremia (SAB) continue to have persistent culture positivity. However, the magnitude and consistency of its association with mortality remain uncertain. Data were extracted from PubMed/MEDLINE, Embase, Scopus, and the Cochrane Library from inception to January 2026. Observational studies comparing 30-day all-cause mortality between S. aureus persistent and non-persistent bacteremia were included. Persistent bacteremia was defined as continued positivity of blood cultures for S. aureus for ≥ 48 h after initiation of appropriate antimicrobial therapy. Risk of bias and quality were evaluated with the ROBINS-E tool. Pooled odds ratios (ORs) for 30-day mortality were estimated using a random-effects meta-analysis model. Heterogeneity was investigated through subgroup analyses, sensitivity analyses, and meta-regression. Nineteen studies comprising 7,993 patients with SAB met the inclusion criteria. In pooled unadjusted analysis, persistent bacteremia was associated with increased 30 day all-cause mortality (OR 1.97, 95
Abstract Background Heart failure (HF) is a long-term illness, frequently requiring hospital stay and having a significant morbidity and mortality rate. In order to avoid decompensation, lower readmission rates, and promote quality of life, adequate self-care is vital. This review synthesised nursing interventions intended to improve self-care among adults and older adults with HF and retrospectively interpreted their components using the Capability, Opportunity, Motivation–Behaviour (COM-B) model. Method A systematic search was conducted on 11 November 2025 across seven electronic databases: PubMed, Scopus, Web of Science, CINAHL, Embase, MEDLINE, and PsycINFO. The review included randomised controlled studies evaluating behavioural, educational, psychological, or nursing interventions aimed at improving self-care among adults and older adults with HF. Risk of bias was assessed using the Joanna Briggs Institute Checklist for Randomised Controlled Trials. Database-specific search strategies and publication-year filters are reported in Additional file 1. Results Nine studies met the inclusion criteria. The interventions included structured education, motivational interviewing, pre-discharge education, technology-based support, and multimodal programmes. Several studies reported improvements in self-care maintenance, management, or confidence; however, the direction and magnitude of effects varied across interventions and follow-up periods. Although none of the studies explicitly used the COM-B model, their intervention components could be retrospectively mapped to Capability, Opportunity, and Motivation. Conclusions Nursing interventions may improve selected dimensions of HF self-care, particularly when education is combined with follow-up, motivational support, or practical monitoring resources. However, the evidence was heterogeneous, and the magnitude and consistency of effects remain uncertain. COM-B may provide a useful framework for interpreting intervention components, but the retrospective mapping does not demonstrate that COM-B mechanisms were prospectively tested. Systematic review registration The procedure of this study was recently filed in the International Prospective Register of Systematic Reviews (PROSPERO) at the National Institute for Health Research (No: CRD420251237974).
Allogeneic hematopoietic cell transplantation (HCT) has become a curative treatment option for many hematological disorders. However, female recipients face unique challenges related to their reproductive and gynecological health that are often overlooked in clinical practice and research. Despite the growing recognition of sex and gender considerations in transplantation medicine, there remains a significant gap in data to devise comprehensive guidelines addressing gynecological health concerns specifically following allogeneic HCT. These complications can significantly impact quality of life, fertility, sexual function, and long-term health outcomes. We will conduct a scoping review to map and synthesize the available evidence on gynecological health concerns following allogeneic HCT and their clinical management. Our review will include female recipients of allogeneic HCT ≥ 18 years old. We will search MEDLINE, Embase, CINAHL, and the APA PsycINFO for relevant literature without date or language restrictions. Additionally, we will search gray literature sources including clinical trial registries and transplantation and gynecological society guidelines. Two reviewers will independently evaluate the eligibility of all identified titles and abstracts for inclusion in the full text review, as well as data extraction. Data extraction will focus on types of gynecological complications, their prevalence or incidence, and identified risk factors, screening and treatment approaches, clinical outcomes, and management recommendations. Descriptive statistics and narrative synthesis will be used to analyze and present the findings. This scoping review will consolidate the current knowledge on gynecological health concerns following allogeneic HCT and identify best practices for their management. Our findings will highlight critical gaps in current medical literature and practice, paving the way to inform the development of evidence-based clinical management recommendations for female allogeneic HCT recipients. By addressing this understudied aspect of transplantation medicine, our review aims to improve overall health, enhance quality of life, and ensure comprehensive personalized care for women undergoing HCT. https://doi.org/10.17605/OSF.IO/5NPJF
Patients with incurable cancer prioritize health-related quality of life (HRQoL)—a key target of palliative care. But shortages of palliative care professionals create critical access barriers, leaving patients with unmet HRQoL needs. In addition to palliative care provided by professionals, non-pharmacological strategies such as palliative care educational intervention (PEI) and cognitive behavioral therapy (CBT) have been proposed to address these gaps. Recent studies about PEI have shown promise in improving HRQoL for patients with incurable cancer. However, it remains an emerging approach that has not been thoroughly and systematically evaluated, especially compared with CBT—an intervention with extensive systematic reviews. Furthermore, due to the scarcity of head-to-head comparisons between PEI and CBT, a network meta-analysis (NMA) is needed to clarify their relative effectiveness. This systematic review and NMA will include randomized controlled trials evaluating PEI and/or CBT in adults (≥ 18 years) with incurable cancer. Electronic databases (MEDLINE, EMBASE, the Cochrane Library, PsycINFO, and CINAHL) and trial registers (ClinicalTrials.gov) will be searched from inception. The primary outcome is HRQoL (measured via validated scales such as the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire [EORTC QLQ-C30]); secondary outcomes include symptoms (pain, fatigue, anxiety, depression) assessed by validated scales. Effect sizes (standardized mean differences [SMD]) will be calculated, and SMDs will be re-expressed to the EORTC QLQ-C30 global health/quality of life scale. NMA will estimate relative effects, with subgroup analyses (based on delivery setting, mode, etc.) and sensitivity analyses. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) will assess evidence quality. Comparing PEI with CBT will offer evidence for palliative care professionals and policymakers. Clear PEI definition and comprehensive literature retrieval are foundational to this systematic review and NMA, while analyzing study and intervention details may address heterogeneity in HRQoL outcomes and guide development of more effective interventions. PROSPERO CRD420251146822.
Oral cancer remains a major public health problem in regions with a high prevalence of betel quid chewing, tobacco use, and alcohol consumption. Emerging evidence suggests that Candida species may contribute to oral carcinogenesis. However, their independent and combined effects with established behavioural risk factors have not been systematically synthesised. This review aims to evaluate whether Candida species act as an independent risk factor or have a synergistic effect with betel quid, tobacco, and/or alcohol exposure in the development of oral potentially malignant disorders (OPMDs) and oral squamous cell carcinoma (OSCC) among exposed adults. Published and unpublished studies will be searched in PubMed, Embase, Scopus, the Cochrane Library, Google Scholar, and the Open Science Framework without any geographical, language, or time restriction. Studies will be eligible if they include adults aged 18 years or above with histopathologically confirmed OPMDs or OSCC and documented exposure to betel quid, tobacco in smoked or smokeless forms, and/or alcohol. Included studies must report results as risk ratios (RR) or odds ratios (OR) or provide sufficient raw data to calculate these measures. Oral Candida colonisation must be confirmed using recognised laboratory methods. Studies involving immunocompromised individuals will be excluded. Two reviewers will independently screen studies, assess methodological quality, extract data, and perform meta-analysis using a random-effects model where appropriate. Heterogeneity, publication bias, and sensitivity analyses will be assessed. The certainty of evidence will be evaluated using the GRADE approach. This review will clarify whether Candida colonisation independently or synergistically increases risk in the presence of betel quid, tobacco, and alcohol use. PROSPERO CRD420251235354
Type 1 diabetes is a lifelong condition usually diagnosed in childhood. It requires daily management to control blood glucose and avoid complications. Physical activity brings important physical and emotional benefits, but children with the condition are often less active than their peers. Schools have a key role in encouraging active lifestyles, yet managing diabetes around physical activity can be difficult and requires specific knowledge. Teachers are central to enabling participation, but many feel unprepared owing to limited training, low confidence, and persistent misconceptions. Exploring their views is vital for improving school-based support. This review aims to assess and summarise qualitative research on teachers’ knowledge, attitudes, and experiences in supporting children with type 1 diabetes in physical activity, to guide future training, policy, and practice. This review will follow the Joanna Briggs Institute methodology for qualitative evidence synthesis, using meta-aggregation. A comprehensive search will be conducted across multiple databases: MEDLINE, Embase, CINAHL, PsycINFO, ERIC, ProQuest, and TRIP Database. The SPIDER tool will guide the search strategy and inclusion criteria. All records will be independently screened and appraised by at least two reviewers using the Joanna Briggs Institute critical appraisal tool, with discrepancies resolved through discussion. NVivo 15 qualitative data analysis software will be used to support data management, organisation, and analysis. Confidence in the findings will be assessed using the GRADE-CERQual approach. The review will follow PRISMA 2020 guidelines to ensure transparency and methodological rigour. This review addresses a key evidence gap and considers practical and contextual challenges across school settings. Practical and contextual challenges, including variations in study reporting, educational systems, and school-level policies, will be considered. A multidisciplinary review team will ensure methodological rigour and support nuanced interpretation. While the exclusion of non-English studies may introduce language bias and systemic factors influencing teacher perspectives may not always be fully captured, the review adopts a transparent and robust methodology. The findings will inform tailored training, school-based strategies, and policy recommendations to improve teacher confidence and enable safer, more inclusive physical activity participation. PROSPERO 2025 CRD420251071101
Congenital cytomegalovirus (cCMV) infection is the most common cause of congenital infection worldwide. Neurodevelopmental sequelae have been reported in children with cCMV across different developmental stages, from infancy to adolescence. However, the evidence on the involved neurodevelopmental domains and the severity of adverse outcome remains unclear and not well defined. This protocol describes a systematic review and meta-analysis aimed at evaluating neurodevelopmental outcome in children with cCMV aged 18 years old or below and identifying predictors associated with adverse neurodevelopmental trajectories. This systematic review and meta-analysis protocol will be conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. The final systematic review and meta-analysis will be conducted and reported according to the PRISMA statement. Electronic searches will be performed in Embase (via Ovid), MEDLINE, PsycINFO, and Scopus without publication date restrictions. Studies evaluating neurodevelopmental outcomes in children with cCMV infection, classified as symptomatic or asymptomatic at birth, assessed through standardized neurodevelopmental tests, will be included. Studies investigating predictors of neurodevelopmental impairment and additional clinical characteristics associated with cCMV infection will also be considered. Study selection and data extraction will be performed independently by two reviewers. Any disagreements will be resolved through discussion and consensus; if consensus cannot be reached, a third reviewer will be consulted for arbitration. Quantitative synthesis will include pooled effect sizes, heterogeneity assessment, subgroup analyses, and publication bias evaluation. This research will provide a comprehensive overview of neurodevelopmental outcomes in children with symptomatic and asymptomatic cCMV infection. The findings may support the implementation of structured neurodevelopmental follow-up programmes and early targeted interventions aimed at optimizing children’s neurodevelopmental outcomes. PROSPERO registration number CRD420251065006. Date of registration 03 June 2025.
The process of consolidating research through meta-analyses is time-consuming and costly. Using text-mining approaches to (semi-)automate the step of screening and selecting articles eligible for inclusion might potentially save hours of workload and costs. A lack of evaluative research on the use of text-mining for literature screening prevents the widespread adoption of text-mining approaches among the psychology research community. This study explores the possibilities of applying text-mining approaches to facilitate or (semi-)automate screening articles for inclusion in psychology meta-analyses. The performances of two publicly accessible text-mining approaches were evaluated and compared against three recent meta-analyses from different subfields of psychology. Averaged over 10 text-mining runs per meta-analysis, across the three meta-analyses the approaches achieved recall performances between 62.5
