Objectives: There is a need for formal guidance around antiracist research practices to dismantle structural racism, which has been embedded into the design and conduct of health sciences research. Our objective is to review and summarize recommendations from published literature published on antiracist research practices applicable to all health sciences research studies. Method: In 2022, we systematically reviewed PubMed, SCOPUS, Excerpta Medica Database, British Nursing Index, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and Sociological Abstracts using search terms about antiracist research. We found 5362 papers, screened 3962 titles, assessed 171 abstracts for eligibility, and reviewed 103 using a standardized extraction form. We reviewed 11 papers twice to confirm accuracy. We narratively synthesized recommendations relevant to six stages of the research process via combined deductive and inductive qualitative analysis. Results: A total of 1407 individual recommendations were grouped into themes and subthemes within each research stage. Project development had the most themes (n = 7) and subthemes (n = 24); dissemination of findings had the fewest (2 themes and 5 subthemes). When designing a project, researchers are encouraged to develop diverse, representative, and empowered research teams; design projects important to marginalized groups; and use conceptual frameworks that build on the work of marginalized scholars. Researchers were encouraged to promote inclusive consent processes, accessible recruitment materials, and recruitment and retention strategies that maximized diversity. When analyzing data, recommendations included involving community partners to ensure appropriate conceptualization and measurement of race, justifying the selection of reference groups, and considering intersectional identities. Recommendations for data interpretation include contextualizing findings, considering structural racism, and improving community involvement to enhance the transparency of data analysis. During dissemination, recommendations highlighted increasing accessibility of research findings. Conclusions: We identified a comprehensive list of recommendations describing antiracist research practices. Our synthesis can be used to guide individual research teams, institutional review boards, and grant committees, and to develop educational curricula around antiracist research practices.

Abstract Background Worldwide, anemia impacts 40% of children aged 6 to 59 months and 30% of reproductive-aged women; about half of these cases are due to iron deficiency (IDA). Iron ingots are inexpensive, lightweight, and easy-to-use IDA treatments. This systematic review assessed the effect of iron ingots on IDA and described variability in iron ingot use. Methods We included studies that evaluated the effectiveness of iron ingots for dietary iron supplementation and described ingot use conditions. Our search yielded 106 articles, 10 of which met inclusion criteria. Multiple authors independently performed data extraction and quality assessment. Results Four articles were laboratory-based, and five were community trials, and one was both. Acidic conditions, longer cooking durations, and simultaneous use of multiple ingots were associated with higher concentrations of iron leaching. Four studies reported increased hemoglobin levels with ingot use. Notably, studies differed on ingot use instructions, study design, and adherence measurement. Conclusion The factors that might influence iron ingot effectiveness have not been consistently reported. We recommend that studies provide explicit instructions on ingot use, assess adherence, and investigate contextually relevant conditions to maximize ingot effectiveness in community settings.

CONTEXT:An increasing number of US children have parents who prefer languages other than English (LOEs). However, many LOE families are excluded from participation in qualitative research because of English proficiency requirements. Guidance to promote inclusion of LOE populations in qualitative research is limited. OBJECTIVE:To synthesize published child health cross-language qualitative research and examine trends in how studies are conducted when a language barrier exists between researchers and participants. DATA SOURCES:PubMed, CINAHL, and Sociological Abstracts. STUDY SELECTION:US-based cross-language research studies published between January 2010 and July 2025 that included adult LOE caregivers and discussed child health topics. DATA EXTRACTION:Two reviewers examined each manuscript to describe cross-language processes for handling qualitative data collected with LOE participants, including study design/preparation, data collection, and analysis. RESULTS:Fifty-two studies were included. Most studies included only Spanish-speaking participants. Studies covered a wide range of health issues and populations. Studies used varying procedures to obtain information from LOE caregivers. Most studies conducted qualitative analysis in English after translating interviews from the source language. Many relied on bilingual research study staff or community members. Few described how findings were disseminated back to the community of interest. LIMITATIONS:Cross-language qualitative child health research has increased in recent years; best practices for handling language data in LOEs might be emerging. CONCLUSIONS:This review identified variability in methods in published qualitative cross-language child health research. We share recommendations to promote inclusive practices in cross-language qualitative research to improve the generalizability and quality of child health research in the United States.

Haitian immigrant women living in the U.S. have a higher rate of cervical cancer mortality than any other ethnic group, primarily due to lower rates of screening test utilization. Therefore, it is important to understand the issues affecting their pap smear screening behaviors. We conducted a narrative review of articles from PubMed, SCOPUS, Embase, CINAHL/Nursing, and Psych Info. Inclusion criteria: U.S. Haitian immigrant, screening, cervical cancer, health beliefs/perceptions. Exclusion criteria: HPV-vaccine. Primary barriers: (1) lack of knowledge of cervical cancer, HPV, and pap smears; (2) lack of culturally appropriate dissemination of information; and (3) difficulty obtaining the test. Primary facilitators: (1) provider recommendations, (2) Haitian media to disseminate health information, and (3) having health insurance. This review highlights the points for intervention by health professionals and policy makers to address this group’s low pap smear utilization.

BackgroundThe Academy of Nutrition and Dietetics-American Society for Parenteral and Enteral Nutrition Indicators of Malnutrition (AAIM) is a tool that uses nutrition assessment parameters to diagnose patients with malnutrition. Evaluation of the content validity of AAIM relative to the Subjective Global Assessment (SGA) or Patient Generated-Subjective Global Assessment (PG-SGA) is needed. Predictive validity of malnutrition diagnosed by AAIM for clinical outcomes in hospitalized adults is also important.ObjectiveThe purpose of this systematic review of the published literature was to evaluate the content validity of the AAIM approach relative to SGA/PG-SGA and to determine whether malnutrition diagnosed by AAIM at or near hospital admission is associated with increased mortality, length of stay, hospitalization cost, or readmissions.MethodsObservational studies of hospitalized adult patients published in English during 5/1/2012-6/1/2023 were identified using Pubmed, CINAHL, EMBASE or Cochrane Library. The risk of bias of outcome studies was evaluated by the National Institutes of Health quality assessment tool for observational studies. Effect sizes from three or more studies were combined into forest plots using Review Manager 5.0 to produce effect sizes expressed as odds ratios or mean differences with 95% confidence intervals (CI) using the inverse variance method with a random effects model, and computation of the I2 statistic to indicate heterogeneity. Visual examination of funnel plots was used to assess likelihood of publication bias.ResultsEighteen studies with data from 14,794 patients were included. In the nine studies that provided content validation data, five did not measure hand grip strength. Nonetheless, AAIM demonstrated 89% sensitivity, 84% specificity, and substantial agreement with the SGA/PG-SGA. Sixteen studies reported clinical outcomes. Malnutrition diagnosed by AAIM was associated with greater OR (95% CI) hospital mortality of 2.37(1.58 to 3.55) and increased OR (95% CI) 30-day readmissions of 2.26 (1.97 to 2.58) than patients without malnutrition. While a specific effect size was not established due to study heterogeneity, longer length of stay was confirmed in five adjusted models. Two studies reported significantly increased costs of hospitalization in patients with malnutrition.ConclusionsThe AAIM criteria are valid in content relative to SGA/PG-SGA. Malnutrition diagnosed by AAIM identifies patients with greater odds of hospital mortality, and 30-day readmissions as well as longer hospital length of stay.

Heightened sleep disturbances occur in adolescence, yet existing research has predominantly focused on individual factors linked to poor sleep and a limited set of sleep outcomes, such as sleep duration and timing. This scoping review aimed to identify the multilevel social determinants of adolescent sleep health across domains, including regularity, satisfaction/quality, alertness/sleepiness, timing, efficiency/continuity, duration, and behavior. Social determinants of health (SDoH) were categorized through a socio-ecological lens, while sleep health domains were aligned with the RU-SATED and Peds B-SATED sleep health frameworks. A systematic database search resulted in 57 studies of non-clinical adolescent and young adult populations (age 10-24 y) in North America, published between 2014-2022. Research gaps include 1) absence of other sleep health domains other than duration which is predicated on the included studies using a limited set of sleep outcome measures rather than a more comprehensive measurement strategy that align with the multifaceted domains of sleep health, and 2) inconsistent terminology and/or absent conceptual and operational definitions of subjective sleep reports. The findings highlight the multilevel SDoH that influence adolescent sleep health, underscoring the need for more comprehensive research. Such efforts will facilitate the development of interventions focused on fostering optimal adolescent sleep health this populations.

Background Current research highlights the positive impact of nutrition therapy, particularly enteral nutrition, in critical illness. However, little attention is given to the impact of nutrition on skin integrity during critical illness. Skin integrity is at risk in critically ill children owing to necessary clinical therapies and challenges of providing nutrition therapy. Methods We conducted a narrative literature review with three main thematic concepts to drive our literature search: the association of nutrition therapy with (1) skin integrity; (2) injury, wounds, and wound healing; and (3) differences of skin color. Using pertinent search and subject terms, PubMed, CINAHL, EMBASE, and SCOPUS databases were searched, yielding 316 articles. After removal of duplicates, articles were reviewed based on inclusion and exclusion criteria defined by the authors; only eight articles met the defined criteria to inform this review. Results Large and important gaps exist in the current literature regarding an association between nutrition therapy, skin injury, and wound healing. Little to no attention was found for associations with skin color. The resulting narrative review addresses these topics and subtopics with additional references included that are independent of the original search strategy. Conclusions A dearth of evidence exists describing associations between nutrition and disruption of skin integrity in pediatric critical illness. Children with dark skin are at increased risk, as manifestation and identification of disruption to skin integrity may not be recognized. Research is needed to describe these associations and the impact of nutrition on skin integrity, including differences of skin color.

Background Telehealth use in pediatrics increased during the COVID-19 pandemic and may improve health care access. It may also exacerbate health care disparities among families with limited English proficiency (LEP). Objective To systematically review the feasibility, acceptability, and/or associations between telehealth delivery and health outcomes for interventions delivered synchronously in the United States. Data Sources PubMed, Embase, and Scopus. Study Eligibility Criteria Original research exploring pediatric health outcomes after telehealth delivery and studies that explored the feasibility and acceptability including surveys and qualitative studies. Participants Patients 0 to 18 years with LEP and/or pediatric caregivers with LEP. Study Appraisal and Synthesis Methods Two authors independently screened abstracts, conducted full-text review, extracted information using a standardized form, and assessed study quality. A third author resolved disagreements. Results Of 1831 articles identified, 9 were included in the review. Half of the studies explored videoconferencing and the other half studied health care delivered by telephone. Feasibility studies explored telehealth for children with anxiety disorders and mobile phone support for substance abuse treatment among adolescents. Acceptability studies assessed parental medical advice-seeking behaviors and caregivers’ general interest in telehealth. Health outcomes studied included follow-up of home parenteral nutrition, developmental screening, and cognitive behavioral therapy. Limitations The articles were heterogeneous in approach and quality. Conclusions and Implications of Key Findings Telehealth appears acceptable and feasible among children in families with LEP, with a limited evidence base for specific health outcomes. We provide recommendations both for the implementation of pediatric telehealth and future research. Prospero Registration CRD42020204541.

The obesity epidemic has become a major public health concern globally, and the food supply is a significant driver of this trend. Front-of-package (FOP) labels have been implemented in many countries to encourage healthier food choices. This systematic review aimed to examine the effect of FOP label implementation on food manufacturers’ practices. A comprehensive search of multiple databases was conducted following PRISMA guidelines, identifying 39 relevant articles from 1990 to 2021. The studies indicated that FOP labels conveying intuitive information influenced product reformulation, whereas those with numerical information without specific guidance had no impact on reducing unhealthy nutrients. The most common outcomes were sodium, sugar, and calorie reduction. Mandatory policies reported higher and more consistent effects on product reformulation compared to voluntary approaches. Voluntary FOP labeling resulted in low uptake and tended to be applied to healthier products. Food manufacturers responded to FOP labeling heterogeneously, depending on the label design and type of enforcement. FOP label implementation can reduce nutrients of concern but food manufacturers behave strategically by labeling healthier choices. This review provides recommendations for maximizing the benefits of using FOP labels to prevent obesity, and findings can inform future public health research and policymaking.

OBJECTIVE:To conduct a systematic review of studies reporting prevalence rates of depression in women living in low-income circumstances in developed countries.METHODS:The published and unpublished literature was searched for studies reporting prevalence of depression in women with low income in developed countries. Searches, data extraction, and methodological appraisal were conducted twice independently. To perform the analysis, the meta and metafor packages in R, a random effect model to account for both between and within studies' variances, and the restricted maximum likelihood method for estimation were used.RESULTS:One-hundred sixty-four studies, involving 218,035 participants, were located through the search process. The point prevalence of depression among women in low-income circumstances using self-report instruments in 134 studies was 37.4% (95% CI, 34.0%-40.7%). Additionally, the point prevalence according to depression diagnosis in 25 studies was 22.9% (95% CI, 17.8%-28.5%).CONCLUSIONS:The high rate of depression among women living in low-income circumstances is of serious public health concern.POLICY IMPLICATIONS:Women living in low-income circumstances should receive screening and referral/treatment in not only medical service settings, but also in social service settings serving women receiving welfare benefits.

Background The estimated incidence of sports related concussion has increased from 300,000 in 2007 to over 1.6 million in 2017, with a large percentage occurring in youth athletes. There are growing concerns about the cognitive and emotional wellbeing of young athletes during concussion recovery. Objective To review research evaluating how concussion relates to changes in emotion and mood in high school and college athletes. Design/methods Relevant articles from 1997 to 2017 were searched on PubMed using keywords and official MeSH terms such as: (1) concussion; or brain injuries, traumatic; or TBI and (2) high school; or college; and, (3) depression; or affect; or mood. English language articles were included for analysis if they measured concussed high school or college athletes using a validated instrument for assessing emotion and mood. Results Ten published studies met the inclusion criteria. Five studies measured changes in emotional response in athletes after concussion. The other studies compared emotional response in athletes after concussion to the emotional response in athletes after non-concussive sports injury, such as musculoskeletal, or orthopedic injury. Conclusion Despite heterogeneity in methods and limitations in the literature, our review suggests growing consensus that concussions result in altered emotions and mood. However, current research shows conflicting results on whether alterations in emotional response are different post-concussion than post non-concussive sports injury.

Importance The human and financial costs of treating surgical site infections (SSIs) are increasing. The number of surgical procedures performed in the United States continues to rise, and surgical patients are initially seen with increasingly complex comorbidities. It is estimated that approximately half of SSIs are deemed preventable using evidence-based strategies. Objective To provide new and updated evidence-based recommendations for the prevention of SSI. Evidence Review A targeted systematic review of the literature was conducted in MEDLINE, EMBASE, CINAHL, and the Cochrane Library from 1998 through April 2014. A modified Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach was used to assess the quality of evidence and the strength of the resulting recommendation and to provide explicit links between them. Of 5759 titles and abstracts screened, 896 underwent full-text review by 2 independent reviewers. After exclusions, 170 studies were extracted into evidence tables, appraised, and synthesized. Findings Before surgery, patients should shower or bathe (full body) with soap (antimicrobial or nonantimicrobial) or an antiseptic agent on at least the night before the operative day. Antimicrobial prophylaxis should be administered only when indicated based on published clinical practice guidelines and timed such that a bactericidal concentration of the agents is established in the serum and tissues when the incision is made. In cesarean section procedures, antimicrobial prophylaxis should be administered before skin incision. Skin preparation in the operating room should be performed using an alcohol-based agent unless contraindicated. For clean and clean-contaminated procedures, additional prophylactic antimicrobial agent doses should not be administered after the surgical incision is closed in the operating room, even in the presence of a drain. Topical antimicrobial agents should not be applied to the surgical incision. During surgery, glycemic control should be implemented using blood glucose target levels less than 200 mg/dL, and normothermia should be maintained in all patients. Increased fraction of inspired oxygen should be administered during surgery and after extubation in the immediate postoperative period for patients with normal pulmonary function undergoing general anesthesia with endotracheal intubation. Transfusion of blood products should not be withheld from surgical patients as a means to prevent SSI. Conclusions and Relevance This guideline is intended to provide new and updated evidence-based recommendations for the prevention of SSI and should be incorporated into comprehensive surgical quality improvement programs to improve patient safety.

In patients with gastroesophageal reflux disease (GERD) and erosive esophagitis, treatment with proton pump inhibitors (PPIs) is highly effective. However, in some patients, especially those with nonerosive reflux disease or atypical GERD symptoms, acid-suppressive therapy with PPIs is not as successful. Alginates are medications that work through an alternative mechanism by displacing the postprandial gastric acid pocket. This study performed a systematic review and meta-analysis to examine the benefit of alginate-containing compounds in the treatment of patients with symptoms of GERD. PubMed/MEDLINE, Embase, and the Cochrane library electronic databases were searched through October 2015 for randomized controlled trials comparing alginate-containing compounds to placebo, antacids, histamine-2 receptor antagonists (H2RAs), or PPIs for the treatment of GERD symptoms. Additional studies were identified through a bibliography review. Non-English studies and those with pediatric patients were excluded. Meta-analyses were performed using random-effect models to calculate odds ratios (OR). Heterogeneity between studies was estimated using the I-2 statistic. Analyses were stratified by type of comparator. The search strategy yielded 665 studies and 15 (2.3%) met inclusion criteria. Fourteen were included in the metaanalysis (N = 2095 subjects). Alginate-based therapies increased the odds of resolution of GERD symptoms when compared to placebo or antacids (OR: 4.42; 95% CI 2.45-7.97) with a moderate degree of heterogeneity between studies (I-2 = 71%, P =.001). Compared to PPIs or H2RAs, alginates appear less effective but the pooled estimate was not statistically significant (OR: 0.58; 95% CI 0.27-1.22). Alginates are more effective than placebo or antacids for treating GERD symptoms.

In patients with gastroesophageal reflux disease (GERD) and erosive esophagitis, treatment with proton pump inhibitors (PPIs) is highly effective. However, in some patients, especially those with non-erosive reflux disease or atypical GERD symptoms, acid suppressive therapy with PPIs is not as successful. Alginates are medications that work through an alternative mechanism by displacing the post-prandial gastric acid pocket. We performed a systematic review and meta-analysis to examine the benefit of alginate-containing compounds in the treatment of patients with symptoms of GERD.PubMed/MEDLINE, Embase and the Cochrane library electronic databases were searched through October 2015 for randomized controlled trials comparing alginate-containing compounds to placebo, antacids, histamine-2 receptor antagonists (H2RAs) or PPIs for the treatment of GERD symptoms. Additional studies were identified through bibliography review. Non-English studies and those with pediatric patients were excluded. Meta-analyses were performed using random-effects models to calculate odds ratios (OR). Heterogeneity between studies was estimated using the I2 statistic. Analyses were stratified by type of comparator. The search strategy yielded 665 studies and 15 (2.3%) met inclusion criteria. Fourteen were included in the meta-analysis (N = 2095 subjects). Alginate-based therapies increased the odds of resolution of GERD symptoms when compared to placebo or antacids (OR: 4.42; 95% CI 2.45-7.97) with a moderate degree of heterogeneity between studies (I2 = 71%, P = .001). Compared to PPIs or H2RAs, alginates appear less effective but the pooled estimate was not statistically significant (OR: 0.58; 95% CI 0.27-1.22). Alginates are more effective than placebo or antacids for treating GERD symptoms.

Anesthesia information management systems (AIMS) are sophisticated hardware and software technology solutions that can provide electronic feedback to anesthesia providers. This feedback can be tailored to provide clinical decision support (CDS) to aid clinicians with patient care processes, documentation compliance, and resource utilization. We conducted a systematic review of peer-reviewed articles on near real-time and point-of-care CDS within AIMS using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Studies were identified by searches of the electronic databases Medline and EMBASE. Two reviewers screened studies based on title, abstract, and full text. Studies that were similar in intervention and desired outcome were grouped into CDS categories. Three reviewers graded the evidence within each category. The final analysis included 25 articles on CDS as implemented within AIMS. CDS categories included perioperative antibiotic prophylaxis, post-operative nausea and vomiting prophylaxis, vital sign monitors and alarms, glucose management, blood pressure management, ventilator management, clinical documentation, and resource utilization. Of these categories, the reviewers graded perioperative antibiotic prophylaxis and clinical documentation as having strong evidence per the peer reviewed literature. There is strong evidence for the inclusion of near real-time and point-of-care CDS in AIMS to enhance compliance with perioperative antibiotic prophylaxis and clinical documentation. Additional research is needed in many other areas of AIMS-based CDS.

Introduction: Gastroesophageal reflux disease (GERD) is common and therapy with a proton pump inhibitor (PPI) is highly effective. In patients whose symptoms do not completely respond to PPI, it is recommended to try further acid suppression. Alginates are a class of medications that work through an alternative mechanism to create a mechanical barrier to reflux. These anti-refluxants may provide an effective primary or adjunctive choice for the management of GERD. We performed a systematic review and meta-analysis to examine the benefit of alginate-containing compounds in the treatment of GERD in those with non-erosive reflux disease (NERD). Methods: PubMed, Embase and the Cochrane library electronic databases were searched through January 2015 for trials comparing alginate-containing compounds to placebo, antacids, histamine-2 receptor antagonists or PPI for the treatment of GERD in those with NERD. Additional studies were identified through bibliography review. Studies not published in English, with pediatric patients or with treatment duration less than one week were excluded. An effect estimate for improvement in GERD symptoms was calculated using an odds ratio (OR) with random-effects models. Heterogeneity between studies was estimated using the I2 statistic, and was explored through subgroup analyses. Results: The search strategy yielded 599 studies of which 15 (2.5%) met inclusion criteria. Fourteen were included in the meta-analysis (N=2095 subjects). Alginate-based therapies are favored compared to alternative therapies (OR: 1.93; 95% CI; 1.02, 3.64) in the management of GERD symptoms. There is a high degree of heterogeneity (I2 = 88%, p < .001) between studies due primarily to different comparators. Alginate benefit is most pronounced compared to placebo or antacids (OR: 3.49; 95% CI 2.05, 5.95). Conclusion: Alginates are more efficacious than placebo or antacids for symptomatic relief of NERD.Figure 1

Malnutrition in the critically ill or injured child is associated with increased morbidities and mortality in the pediatric intensive care unit (PICU), whether present upon admission or acquired during the PICU stay. Particular subpopulations such as those with congenital heart disease or severe thermal injury are at highest risk for malnutrition which can worsen with illness progression. A growing body of evidence suggests the presence of a positive association between nutrition support during critical illness and patient outcomes. Enteral nutrition (EN), the preferred route of nutrient delivery, may be a crucial component of care provided in the PICU which modifies the response to critical illness or injury, resulting in improved outcomes. Numerous challenges exist in the delivery of the EN goal in critically ill children. These include accurate assessment of nutrient requirements, hemodynamic instability, feeding intolerance, feeding interruptions, and the lack of a standardized approach to nutrition support. This article describes the current state of the science and challenges related to EN prescription and delivery in the critically ill child. Suggestions for improving EN practice are then presented, in addition to a platform for further research inquiry.

The US federal government has enacted legislation for a federal incentive program for health care providers and hospitals to implement electronic health records. The primary goal of the Meaningful Use (MU) program is to drive adoption of electronic health records nationwide and set the stage to monitor and guide efforts to improve population health and outcomes. The MU program provides incentives for the adoption and use of electronic health record technology and, in some cases, penalties for hospitals or providers not using the technology. The MU program is administrated by the Department of Health and Human Services and is divided into 3 stages that include specific reporting and compliance metrics. The rationale is that increased use of electronic health records will improve the process of delivering care at the individual level by improving the communication and allow for tracking population health and quality improvement metrics at a national level in the long run. The goal of this narrative review is to describe the MU program as it applies to anesthesiologists in the United States. This narrative review will discuss how anesthesiologists can meet the eligible provider reporting criteria of MU by applying anesthesia information management systems (AIMS) in various contexts in the United States. Subsequently, AIMS will be described in the context of MU criteria. This narrative literature review also will evaluate the evidence supporting the electronic health record technology in the operating room, including AIMS, independent of certification requirements for the electronic health record technology under MU in the United States.