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Interoception is crucial for emotional processing. It relies on the bidirectional connections between the insula, a crucial structure in interoception, and the frontal lobe, which is implicated in emotional experiences. Acquired frontal brain injury often leads to emotional disorders. Our goal was to explore the interoceptive profiles of patients with frontal lesions with or without insular involvement.
Method:
Given the neuroanatomical links between interoception and emotions, we conducted a systematic Preferred Reporting Items for Systematic Reviews and Meta-analyses guided review of studies assessing at least one dimension of interoception in adults with acquired frontal injuries, with or without associated insular lesions.
Results:
Seven articles were included. The review indicated that interoceptive accuracy declines after frontal injuries. The two studies that investigated interoceptive sensitivity found lower scores in patient groups. Finally, inconsistent results were found for interoceptive metacognition after frontal damage.
Conclusions:
This review is the first to explore interoceptive disorders after acquired frontal brain injury. The findings reveal deficits in cardiac interoceptive accuracy and interoceptive sensitivity following frontal damage. Inconsistent results were observed for interoceptive metacognition. Further research is needed to confirm the presence of interoceptive deficits following a frontal lesion. Additionally, the relationship between interoceptive deficits and emotional disorders, often reported after frontal brain injury, should be investigated.
Resilience is the dynamic process of adapting to or recovering from stressors, maintaining positive mental health. While most studies have investigated resilience after major life events, less is known about resilience in everyday life. To understand how individuals recover from everyday stressors, and associations with other psychosocial variables, well-being and mental health, we conducted a systematic review of studies to daily resilience, i.e., recovery from daily stressors, using the experience sampling method (ESM). Out of 36 included studies, 11 studies investigated daily resilience in youth (10.9–24.7 years) and 25 in adult samples. Daily resilience was operationalized either with self-report items adapted from trait measures (17 studies) or in terms of affective recovery from daily stressors (20 studies). The self-reported ability to recover from daily stressors reflects subjective experiences of coping with stressors, whereas daily resilience as recovery from daily stressors captures the dynamic process, but is understudied in youth. Daily resilience was associated with psychosocial variables, including better sleep quality and greater optimism. Furthermore, individuals with mental health problems consistently showed longer recovery times after daily stressors. Overall, ESM studies highlight that daily resilience could help to identify individuals at-risk for mental health problems. The findings may facilitate timely interventions.
State repression of ethno-religious minorities is a widespread practice among dictatorships. Nevertheless, political science literature on the topic presents inconsistent findings regarding the causes and consequences of this phenomenon, largely due to the challenges associated with researching human rights violations in non-democratic regimes. The present systematic literature review covers theme-related articles indexed in the Web of Science database and published in English, Spanish, Japanese, Korean, or Chinese from January 1990 to December 2022 (n=169). By reviewing a wide array of theoretical frameworks, methodologies, and data collection strategies, this article identifies causes, consequences, and endogenous relationships, as well as key gaps in the literature on ethno-religious repression in non-democratic settings, providing a solid starting point for further research.
Acceptance and commitment therapy (ACT) is recognized as an effective treatment for a variety of mental illnesses. Several meta-analyses have reported the efficacy of ACT in various mental and physical conditions, including depression, anxiety, and pain, but not for suicidality. This study aimed to determine the therapeutic effectiveness of ACT on suicidality through a systematic review and meta-analysis.
Methods:
Electronic databases such as PubMed, Embase, Scopus, and the Cochrane Library were searched for studies. The primary outcome measure was the effectiveness of ACT for suicidality which includes suicidal ideations and attempts.
Results:
This systematic review and meta-analysis included eight studies, all of which were judged to have a high risk of bias. In the meta-analysis, the pooled standardized mean difference for suicidal ideations was 1.122 (95% confidence interval (CI) = 0.261 to 1.982).
Conclusion:
This meta-analysis suggests that ACT is effective for reducing suicidal ideation, but the high risk of bias across studies should be considered as a major limitation. Further well-designed studies are needed to confirm these findings.
Dog-assisted interventions (DAIs) to improve health-related outcomes for people with mental health or neurodevelopmental conditions are becoming increasingly popular. However, DAIs are not based on robust scientific evidence.
Aims
To determine the effectiveness of DAIs for children and adults with mental health or neurodevelopmental conditions, assess how well randomised controlled trials (RCTs) are reported, and examine the use of terminology to classify DAIs.
Methods
A systematic search was conducted in Embase, PsycINFO, PubMed, CINAHL, Web of Science and the Cochrane Library. RCTs were grouped by commonly reported outcomes and described narratively with forest plots reporting standardised mean differences and 95% confidence intervals without a pooled estimate. The quality of reporting of RCTs and DAIs was evaluated by assessing adherence to CONSORT and the Template for Intervention Description and Replication (TIDieR) guidelines. Suitability of use of terminology was assessed by mapping terms to the intervention content described.
Results
Thirty-three papers were included, reporting 29 RCTs (with five assessed as overall high quality); a positive impact of DAIs was found by 57% (8/14) for social skills and/or behaviour, 50% (5/10) for symptom frequency and/or severity, 43% (6/14) for depression and 33% (2/6) for agitation. The mean proportion of adherence to the CONSORT statement was 48.6%. The TIDieR checklist also indicated considerable variability in intervention reporting. Most DAIs were assessed as having clear alignment for terminology, but improvement in reporting information is still required.
Conclusions
DAIs may show promise for improving mental health and behavioural outcomes for those with mental health or neurodevelopmental conditions, particularly for conditions requiring social skill support. However, the quality of reporting requires improvement.
There is a prominent literature explaining how policy entrepreneurs, as active agents, promote policy changes. However, most existing studies focus on policy entrepreneurship at the national level, with limited attention paid to the vibrant dynamics of numerous local government innovations typically driven by entrepreneurial individuals. This systematic review seeks to take stock of the empirical literature on subnational policy entrepreneurship, in order to consolidate scholarly knowledge, identify generalizable patterns, and inform future research. Following a well-established review protocol, we collected 64 articles through a thorough literature search, with 122 sets of individual entrepreneurs reported in the sample, and coded all cases based on individual-level attributes and processual characteristics. Remarkable diversity is noted in terms of (1) the policy sector; (2) forms of entrepreneurship; (3) policy change outcomes; (4) level of jurisdiction; and (5) key characteristics of the individual entrepreneurs. We find salient patterns in the entrepreneurial motivations and strategies used.
Accurate delivery of radiotherapy to head, neck and brain cancer relies on the use of sophisticated immobilisation devices, usually using a restrictive thermoplastic mask. These masks can cause anxiety and can make treatment difficult for many patients. Open-face or maskless techniques are alternatives which can improve the patient experience. This systematic review aimed to compare the effectiveness of open-face (OF) masks and maskless surface guided radiotherapy (SGRT) with conventional masks.
Method:
Primary research papers from the last 10 years were gathered from Scopus, PUBMED, Web of Science and OVID databases. Quantitative data reporting interfractional set-up errors and intrafractional patient motion were extracted from included studies and subjected to descriptive statistical analysis. Additional qualitative data relating to patient tolerance were also extracted to inform discussion.
Results:
Ten studies were identified for inclusion. The data identified that OF masks can reproduce patient set-up with an accuracy of <2 mm and <1° and can restrict movement to <1 mm and 0·4°, while maskless SGRT can achieve accuracy to within 0·05 mm and 0·1°.
Conclusion:
This review indicates comparable reduction of intrafractional motion between conventional masks, Open-Face masks and maskless SGRT techniques. More research is needed into the impact of maskless SGRT techniques on translational and rotational motions compared to traditional masks.
People with dementia (PwD) and their carers often consider maintaining good quality of life (QoL) more important than improvements in cognition or other symptoms of dementia. There is a clinical need for identifying interventions that can improve QoL of PwD. There are currently no evidence-based guidelines to help clinicians, patients and policy makers to make informed decisions regarding QoL in dementia.
Aims
To conduct the first comprehensive systematic review of all studies that investigated efficacy of any pharmacological or non-pharmacological intervention for improving QoL of PwD.
Method
Our review team identified eligible studies by comprehensively searching nine databases. We completed quality assessment, extracted relevant data and performed GRADE assessment of eligible studies. We conducted meta-analyses when three or more studies investigated an intervention for improving QoL of PwD.
Results
We screened 14 389 abstracts and included 324 eligible studies. Our meta-analysis confirmed level 1 evidence supporting the use of group cognitive stimulation therapy for improving QoL (standardised mean difference 0.25; P = 0.003) of PwD. Our narrative data synthesis revealed level 2 evidence supporting 42 non-pharmacological interventions, including those based on cognitive rehabilitation, reminiscence, occupational therapy, robots, exercise or music therapy. Current evidence supporting the use of any pharmacological intervention for improving QoL in dementia is limited.
Conclusions
Current evidence highlights the importance of non-pharmacological interventions and multidisciplinary care for supporting QoL of PwD. QoL should be prioritised when agreeing care plans. Further research focusing on QoL outcomes and investigating combined pharmacological and non-pharmacological interventions is urgently needed.
Inflammation and oxidative stress contribute to the progression of chronic diseases, and the volume of research in this area is rapidly expanding. Various dietary indices have been developed to determine the overall inflammatory or oxidative stress potential of a diet; however, few have been validated in cardiometabolic disease populations. This review aimed to explore the association between dietary indices and biomarkers of inflammation and oxidative stress in adults with cardiometabolic conditions. Four databases were systematically searched for literature in any language (Embase, CINAHL, CENTRAL, and MEDLINE) with 12,177 deduplicated records identified. Seventeen studies of adults with metabolic syndrome, cardiovascular disease, type 2 diabetes, non-alcoholic fatty liver disease or chronic kidney disease were included. Fourteen studies were observational studies, one study was a clinical trial, and one was a randomised controlled trial. Four dietary indices were reported on with most studies (n=11) reporting on the dietary inflammatory index. The most reported biomarker was C-reactive protein. The findings were narratively synthesised. Results were inconclusive due to the heterogeneity of dietary indices and their use, disease states, and biomarkers reported. Only one study reporting on the dietary inflammatory index assessed all 45 parameters. Observational studies, particularly retrospective designs (n=7) are subject to recall and selection biases, potentially presenting overestimated results. Further research is required to determine the relationship between dietary indices and biomarkers of inflammation and oxidative stress in cardiometabolic disease populations. Future research should be rigorous, prospective, assess the full range of index parameters, and examine biomarkers the tool was developed for.
Dementia with Lewy Bodies (DLB) and Parkinson’s Disease Dementia (PDD) are collectively called as Lewy body dementia (LBD). Despite the urgent clinical need, there is no reliable protein biomarker for LBD. Hence, we conducted the first comprehensive systematic review of all Differentially Abundant Proteins (DAP) in all tissues from people with LBD for advancing our understanding of LBD molecular pathology that is essential for facilitating discovery of novel diagnostic biomarkers and therapeutic targets for LBD.
Methods:
We identified eligible studies by comprehensively searching five databases and grey literature (PROSPERO protocol:CRD42020218889). We completed quality assessment and extracted relevant data. We completed narrative synthesis and appropriate meta-analyses. We analysed functional implications of all reported DAP using DAVID tools.
Results:
We screened 11,006 articles and identified 193 eligible studies. 305 DAP were reported and 16 were replicated in DLB. 37 DAP were reported and three were replicated in PDD. Our meta-analyses confirmed six DAP (TAU, SYUA, NFL, CHI3L1, GFAP, CLAT) in DLB, and three DAP (TAU, SYUA, NFL) in PDD. There was no replicated blood-based DAP in DLB or PDD. The reported DAP may contribute to LBD pathology by impacting misfolded protein clearance, dopamine neurotransmission, apoptosis, neuroinflammation, synaptic plasticity and extracellular vesicles.
Conclusion:
Our meta-analyses confirmed significantly lower CSF TAU levels in DLB and CSF SYUA levels in PDD, when compared to Alzheimer’s disease. Our findings indicate promising diagnostic biomarkers for LBD and may help prioritising molecular pathways for therapeutic target discovery. We highlight ten future research priorities based on our findings.
To evaluate the prognostic utility of Palliative Prognostic Index (PPI) scores in predicting the death of adults with advanced cancer.
Methods
A systematic review and meta-analysis were conducted. Six databases were searched for articles published from inception till 16 February 2024. Observational studies reporting time-to-event outcomes of PPI scores used in any setting, timing and score cutoffs were eligible. Participants were adults with advanced cancer residing in any setting. Random effects meta-analysis was used to pool hazard, risk, or odds ratios. Findings were narratively synthesized when meta-analysis was not possible.
Results
Twenty-three studies (n = 11,235 patients) were included. All meta-analyses found that higher PPI scores or risk categories were significantly associated with death and, similarly, in most narratively synthesized studies. PPI > 6 vs PPI ≤ 4 (pooled adjusted HR = 5.42, 95% confidence intervals [CI] 2.01–14.59, p = 0.0009; pooled unadjusted HR = 5.05, 95% CI 4.10–6.17, p < 0.00001), 4 < PPI ≤ 6 vs PPI ≤ 4 (pooled adjusted HR = 2.04, 95% CI 1.30–3.21, p = 0.002), PPI ≥ 6 vs PPI < 6 (pooled adjusted HR = 2.52, 95% CI 1.39–4.58, p = 0.005), PPI ≤ 4 vs PPI > 6 for predicting inpatient death (unadjusted RR = 3.48, 95% CI 2.46–4.91, p < 0.00001), and PPI as a continuous variable (pooled unadjusted HR = 1.30, 95% CI 1.22–1.38, p < 0.00001) were significant predictors for mortality. Changes in PPI scores may also be useful as a prognostic factor.
Significance of results
A higher PPI score is likely an independent prognostic factor for an increased risk of death, but more research is needed to validate the risk groups as defined by the original development study. Meta-analysis results need to be interpreted cautiously, as only 2–4 studies were included in each analysis. Clinicians and researchers may find this useful for guiding decision-making regarding the suitability of curative and/or palliative treatments and clinical trial design.
Catatonia in psychotic patients presents unique challenges. While antipsychotics are the cornerstone of schizophrenia treatment, their use in catatonic patients is sometimes discouraged for fear of worsening the signs. Reports on the successful use of second-generation antipsychotics have been published. We conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines to describe the outcomes of antipsychotic-treated catatonic events.
Methods
We searched Medline and Web of Science databases from 2000 to 2023 using search terms including “catatonia” and “antipsychotic agents” for all original peer-reviewed articles, including clinical trials, observational studies, and case-reports. We included antipsychotic-treated catatonic events and extracted data on patient characteristics, pharmacological context, agent involved, and treatment outcomes for each antipsychotic trial.
Results
After screening 6,219 records, 79 full-text articles were included. Among them, we identified 175 antipsychotic trials (in 110 patients). Only 41.1% of the patients benefited from a previous benzodiazepine trial. Antipsychotic use was considered beneficial in 60.0% of the trials, neutral in 29.1%, and harmful in 10.9%. Trials tended to be reported as beneficial for amisulpride, clozapine, and risperidone, equivocal for aripiprazole and olanzapine, and mostly detrimental for haloperidol and quetiapine. Psychotic disorders were the most common underlying etiology (65.8%).
Conclusions
Antipsychotics could be an option in the treatment of catatonia in psychotic patients. However, with few exceptions, we found non-beneficial outcomes with all second-generation antipsychotics in varying proportions in this largest review to date. Although olanzapine is widely used, it is associated with mitigated reported outcomes.
This critical appraisal of a Cochrane Review assesses the efficacy of ketamine for treating unipolar major depressive disorder. The review included 31 randomised controlled trials involving ketamine. Results indicate that intravenous (i.v.) ketamine significantly improves antidepressant response compared with i.v. saline and, to a lesser extent, i.v. midazolam within 24–72 h. However, the evidence is constrained by performance bias owing to masking (‘blinding’) concerns and study heterogeneity, necessitating further robust research to confirm ketamine's clinical potential.
Cannabis use is highly prevalent in people with schizophrenia and is related to adverse clinical outcomes, including relapse and hospitalization. However, the relationship between cannabis and suicide remains inconclusive. This study aimed to systematically review and meta-analyze the relationship between cannabis use and suicide-related outcomes in people with schizophrenia. A comprehensive search of Medline, Embase, and PsycINFO for cross-sectional, case-control, and longitudinal studies was conducted using search terms from database inception to November 2024 inclusive. Computation of odds ratios (ORs) and hazard ratios (HRs) was performed using random effects models with DerSimonian-Laird estimation. All studies were appraised for quality. We also evaluated heterogeneity, publication bias and performed sub-group analyses and meta-regression. Twenty-nine studies comprising 36 samples met eligibility criteria. Cannabis use was not associated with odds of suicide death or suicidal ideation but was associated with risks of suicide death (HR = 1.21, 95% CI = 1.04 – 1.40) and odds of attempted suicide (OR = 1.40, 95% CI = 1.16 – 1.68). While between-sample heterogeneity was moderate in analyses of attempted suicide (I2 = 39.6%, p = 0.03), there was no publication bias. Summary effects remained significant in most sub-groups, but just failed to reach significance in longitudinal studies of attempted suicide (OR = 1.40, 95% CI = 0.97 – 1.68) and studies investigating first episode samples (OR = 1.24, 95% CI = 0.99 – 1.55). Cannabis use is significantly associated with some, but not all, suicide-related outcomes in people with schizophrenia. More work is needed to examine potential mechanisms of significant relationships.
Chronic headache after aneurysmal subarachnoid hemorrhage (aSAH) remains an ongoing area of investigation, with uncertainty regarding its prevalence and long-term outcomes.
Methods:
A systematic review was conducted across five databases – Medline (Ovid), the Cochrane Central Register of Controlled Trials (Ovid), PsychInfo (Ovid), Embase (Ovid) and Scopus (Elsevier) – to identify all studies investigating the prevalence of chronic headaches after aSAH. A total of five studies were identified and included in our review.
Results:
There were five observational studies (three cohort and two cross-sectional). The overall prevalence of chronic headaches after aSAH ranged from 16.1% to 41%, albeit across a follow-up time frame of 12 months to 7.5 years. Outcome measurements included quantitative pain scores and opioid usage; however, these were inconsistent across studies, and the studies did not address the long-term impacts of chronic headaches on quality of life or their psychosocial implications.
Conclusion:
The prevalence of chronic headache after aSAH is not well-characterized, and long-term outcomes are seldom studied, highlighting a critical gap in the current literature. Longitudinal cohort studies with standardized approaches to ascertain the psychosocial and physiological burden associated with post-aSAH chronic headaches are urgently needed.
The aim of this study was to perform a systematic literature review of the purpose, design, and use of family trees by family physicians (FPs).
Background:
Family trees offer a valuable contribution to understanding the relevance of the patient’s family history in comprehensive primary healthcare provision. There is little research on the role of family trees in the everyday practice of FPs. Studies often focus on specific diseases and their context: however, a comprehensive exploration of the usefulness of family trees is crucial for FPs.
Methods:
A systematic literature review was conducted through a keyword search in the PubMed and Cochrane databases. Based on the inclusion and exclusion criteria selected, 24 studies were identified and a qualitative analysis was performed.
Findings:
A total of 369 publications were identified across 32 fields. Twenty-four studies were included in the final analysis according to the QUOROM statement. The results underscore the role of family trees and highlight the value of this tool’s multidimensionality. The use of this tool directs FPs to consider a genetic cause and a possible referral to a geneticist. The value of a family tree lies in the personalized patient-oriented treatment in connection with hereditary risks for chronic diseases. For FPs, the greatest challenge in treating patients is determining their risk of developing a chronic disease or cancer. Using a family tree can improve the quality of their healthcare.
Food hygiene practices are crucial to avoid foodborne illness and improve human well-being. Millions of people get sick, and many of them pass away due to eating unhealthy food. Foodborne diseases are still a public health problem in developing countries.
Objective:
This study aimed to determine the prevalence and factors associated with food hygiene practices among food handlers in sub-Saharan Africa.
Methods:
An extensive search was conducted using various databases including PubMed, Science Direct, African Journal Online, and Google Scholar. The search results were then extracted using Microsoft Excel. The data analysis was conducted using STATA version 14. Publication bias was checked by funnel plot, and more objectively through Begg and Egger regression test, with P < 0.05 considered to indicate potential publication bias. A random effect model was used to calculate the pooled prevalence of hygienic food handling practices. Sub-group analysis was done by country and study site.
Results:
To estimate the pooled prevalence of food hygiene practices in sub-Saharan Africa, 42 reviewed studies and 12,367 study participants were included. The pooled prevalence of food hygiene practices among food handlers in sub-Saharan Africa was found to be 50.68% (95% CI: 45.35, 56.02) in this study. Factors associated with food hygiene practices included lack of food safety training (OR = 2.14 95% CI: 0.68, 6.76), negative attitude (OR: 2.36, 95% CI: 1.36, 4.09), and lack of regular medical checkups (OR: 2.66, 95% CI: 1.52, 4.65) among food handlers.
Conclusion:
This research found that only half of sub-Saharan Africa’s food handlers had good food hygiene practices. Lack of food safety training, a lack of regular medical checkups, and unfavorable attitudes toward food hygiene practices were factors contributing to food hygiene practices. Thus, the authors recommended that food workers receive food safety training about food hygiene and safety procedures.
Understanding the correlation between genes and diet holds significance in formulating tailored nutritional guidance and enhancing public health initiatives. Consequently, a thorough examination is undertaken to clarify the interplay between varying nutrient intake, glutathione S-transferases Mu1 and Theta 1 (GSTM1 & T1) gene variants and susceptibility to cancer development. In this study, we conducted a comprehensive search on MEDLINE/PubMed, Scopus and Web of Science databases up to 30 April 2023. The review included observational studies that explored the relationship between dietary consumption of acrylamide, fruits, vegetables, plant-based foods, total meat, red meat, coffee and green tea, as well as the presence of GSTM1 and T1 gene polymorphisms, and the risk of cancer in adult populations. The review findings indicated that high levels of risk factors, particularly red meat, have been linked to a higher chance of developing colorectal cancer risk among individuals with the GSTM1 null genotype. In contrast, heightened levels of protective factors, such as cruciferous vegetables, green tea, coffee and fruit, have been associated with a decreased risk of lung cancer, adult leukaemia, cutaneous melanoma and lung cancer in individuals exhibiting GST polymorphisms. There is a scarcity of comprehensive studies examining different types of cancer due to various dietary patterns and genetic variations. Research has illuminated the complex interplay among dietary factors, gene polymorphisms and cancer risk, further comprehensive studies are needed to understand and validate these findings fully. More robust investigations across diverse populations are crucial to developing personalised nutritional interventions and strengthening public health strategies.
Cannabis is one of the most commonly used drugs globally, although its legal status varies across regions. Public support for its decriminalization has increased, but gaps in our understanding of the health consequences of cannabis use remain, particularly related to its impact on mental health. This article provides an updated systematic review and meta-analysis (previous being Lev-Ran et al., 2014) looking at the relationship between cannabis and depression.
Methods
Literature available before March 2023 was screened for longitudinal studies that included cannabis use and depression. Cross-sectional studies and those only looking at special populations were excluded. Studies must have also controlled for depression at baseline to allow for investigation of a temporal relationship. Extracted data included cannabis measures, depression outcomes, adjusted odds ratios, and study settings. Meta-analysis employed a random effects model with multilevel meta-regression for effect size moderators.
Results
The search yielded 1,599 titles from various databases, resulting in 22 studies for meta-analysis, including 14 from Lev-Ran et al. Eleven studies were US-based, with participants mostly under 18. Meta-analysis showed a higher risk of depression among cannabis users (OR: 1.29, 95% CI: 1.13–1.46). Risk of bias assessment showed medium risk across studies with exposure measurement being a key bias area. The funnel plot and Egger’s Sandwich test did not suggest publication bias.
Conclusions
This study underscores the association between cannabis use and depression but also emphasizes the need for further research, especially in understanding usage patterns, heavy use definitions, and long-term effects on depression risk amidst changing cannabis trends.