Conectar
Sodium-glucose cotransporter (SGLT) inhibitors have shown substantial benefit in reducing cardiovascular and kidney events across diverse clinical populations, but the underlying physiological mechanisms remain unclear. However, existing mechanistic studies on renal and cardiovascular haemodynamics show variability in design, have limited statistical power and yield inconsistent outcomes, thus limiting the ability to draw generalisable conclusions. To address this gap, we conducted a systematic review and proposed the first meta-analysis to aggregate individual participant-level data from mechanistic studies to identify consistent physiological patterns and enhance understanding of the therapeutic effects of SGLT inhibition.
Gold-standard measured glomerular filtration rate (mGFR) was selected as the primary outcome for this systematic review, which aimed to identify all completed mechanistic studies investigating the effects of SGLT inhibition. Electronic databases including Ovid MEDLINE; Ovid Embase; Cochrane Database of Systematic Reviews; and Cochrane Central Register of Controlled Trials were searched using a detailed search strategy. In total, 24 studies (n=1296) were identified. This systematic review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Key variables including demographics, medical history, concomitant medications, vital signs, mGFR, renal haemodynamics, urine and plasma biochemistry, tubular sodium handling, echocardiography, cardiac output monitoring, arterial stiffness and fluid volume will be extracted. A one-stage individual participant data meta-analysis under a Bayesian framework will be conducted, using hierarchical models to simultaneously analyse data from all eligible studies. The risk of bias due to missing results will be assessed. Sensitivity analyses and subgroup evaluations will be incorporated to explore sources of heterogeneity and assess robustness of findings.
Ethics approval was obtained from University Health Network, Toronto, Canada. Findings from the Mechanisms of SGLT Inhibitor Action and Physiological Mediators (MOSAIC) meta-analysis will be published in peer-reviewed journals and results will be disseminated at scientific conferences.
CRD420251001413.
The study evaluated the feasibility and efficacy of a non-immersive virtual reality (VR) system on upper extremity (UE) recovery in ischaemic stroke patients in comparison to a conventional physiotherapy.
An open-label, parallel-group, randomised controlled trial randomly assigned the participants to two groups, VR intervention or conventional physiotherapy.
Two tertiary stroke care centres in South India participated in the study.
Sixty first-ever ischaemic stroke patients (1–6 months of stroke onset) having spasticity grades of 1 or 1+ as per Modified Ashworth scale and Brunnstrom recovery stages of 3, 4 or 5 in the UE were included in the intention-to-treat analysis.
High-intensity non-immersive VR-based comprehensive rehabilitation gaming system with a duration of 12 weeks (3 days/week) was compared with equally intensive conventional physiotherapy.
The feasibility outcome was the compliance with the treatment. The primary efficacy outcome was the improvement in the motor function assessed by the Fugl-Meyer assessment (FMA) and Wolf motor function test (WMFT). The secondary outcomes included the performance in activities of daily living by the Barthel index (BI) and the quality of life by the 36-item short form health survey (SF-36).
The treatment compliance was similar in two groups (p=0.19). Both groups improved in motor performance, activities of daily living and quality of life. However, there were no significant differences in the FMA (p=0.58), WMFT (functional ability scale, p=0.33; performance time, p=0.44), BI (p=0.84) and SF-36 (physical, p=0.87; mental, p=0.99) scores between the groups.
The non-immersive VR system was feasible, effective and safe; however, it was not found to be superior to conventional physiotherapy. The trial was stopped early and did not reach its proposed sample size and hence, the findings are to be interpreted cautiously.
Clinical trial registry India: CTRI/2021/11/038339 (https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=NTc1OTI=&Enc=&userName=CTRI/2021/11/038339).
by Md. Masud Reza, Hasibul Hasan Shanto, Samira Dishti Irfan, A. K. M. Masud Rana, Mohammad Niaz Morshed Khan, Golam Sarwar, Mohammad Sha Al Imran, Mahbubur Rahman, Md. Safiullah Sarker, Muntasir Alam, Md. Abu Hena Chowdhury, Mustafizur Rahman, Sharful Islam Khan
BackgroundUnintended pregnancy among female sex workers (FSW) is a pressing reproductive health concern attributable to risky sexual behaviors, healthcare inequities and poor negotiation powers with male sex partners. However, evidence is scarce on the prevalence and determinants of unintended pregnancies among FSW, which is crucial for enhancing reproductive healthcare. This analysis aims to measure the prevalence of lifetime unintended pregnancies and their associated factors.
MethodsA cross-sectional study was conducted on 327 FSW in Jashore (a border belt district of Bangladesh) from September 2022 to March 2023. Participants were recruited through take-all sampling. Data were collected on the lifetime history of unintended pregnancies and other relevant variables through face-to-face interviews. Chi-square statistic was used to compare the characteristics of FSW reporting unintended pregnancies. To assess the net association of factors associated with unintended pregnancy, multiple logistic regression was applied.
ResultThe lifetime prevalence of unintended pregnancies was reported at 75.8% (95%CI: 71.0–80.1). Among those who reported unintended pregnancies, 37.1% (95%CI: 30.8–43.8) had no education, 39.9% (95%CI: 32.8–47.5) were 25–34 years old, 49.6% (95%CI: 39.3–59.9) were currently married and 62.9% (95%CI: 49.7–74.4) earned ≤10,000 BDT per month compared to those who did not report lifetime unintended pregnancies. The likelihood of unintended pregnancies was significantly higher among those who reported having sex with non-transactional male sex partners (AOR: 2.4, 95%CI: 1.1–5.3, p = 0.036) than those who never had sex with any non-transactional male sex partner. The likelihood was also higher among those who reported rape in their lifetime (AOR: 2.0, 95%CI: 1.0–3.8, p = 0.037) and who self-reported mental health problems (AOR: 2.1, 95%CI: 1.0–4.2, p = 0.045) within the past year, compared to their counterparts.
ConclusionThis study highlights the considerable prevalence and associated determinants of unintended pregnancies among FSW in Jashore. These determinants need to be considered to strengthen reproductive healthcare interventions and policies for FSW. Reproductive health of FSW cannot be improved unless these factors are addressed in the ongoing interventions.
This study aims to investigate the association between physical fitness and markers of cognitive function in adults aged 40 and above in Qatar.
A cross-sectional study.
The Qatar Biobank, data of 1000 adults aged 40 and above.
A population of 1000 adults aged 40 years and older was included. Available data comprised measures of physical fitness including cardiorespiratory fitness, muscular strength, body composition and physical fitness capacity, as well as cognitive function assessed through tests of short-term visual memory and psychomotor coordination.
This paper investigated the physical fitness effect on cognitive functioning through short-term visual memory and psychomotor coordination testing. Logistic regression was used to measure the association between physical fitness and cognitive functioning tests.
Our study showed that lower physical fitness capacity was significantly associated with lower psychomotor coordination in females (OR=1.57, p=0.040) and showed no significant association in males (OR=1.65, p=0.062). For short-term visual memory, the association was significant in females (OR=1.68, p=0.042) unlike in males (OR=1.58, p=0.062). Males with greater muscle strength were about half as likely to have lower psychomotor coordination (OR=0.48, p=0.04). In females, a higher body fat percentage was associated with poorer cognitive function, with each 1% increase in body fat being linked to 6% higher odds of low short-term visual memory (p=0.02) and low psychomotor coordination (p=0.006). Cardiorespiratory fitness showed no statistically significant association with short-term visual memory and psychomotor coordination level in either sex.
Our findings suggest that overall physical fitness capacity is associated with better cognitive function in Qatari adults. The relationship between specific fitness measures and cognitive function varied by sex, with muscle strength having a stronger effect for males and body composition for females. These results highlight the potential importance of maintaining physical fitness for cognitive health in adulthood.
To assess the sex-specific status of dietary diversity (DD) and its associated factors among older men and women (aged ≥60 years) in Bangladesh.
A nationally representative cross-sectional survey was conducted in 2018–2019 on food security, nutrition and health of older adults of both sexes.
Data were collected from 82 clusters (rural 57, non-slum urban 15 and slum 10) from all eight administrative divisions of Bangladesh.
A total of 4817 participants aged ≥60 years (2482 men and 2335 women) were enrolled.
A list-based (24-item) recall method was employed, and the items were later aggregated into 10 food groups. The outcome variable was the prevalence of inadequate DD, defined as consumption of less than 5 food groups out of 10.
Men and women had mean DD scores of 4.33±1.6 and 4.13±1.7, respectively. Women had a higher prevalence of inadequate DD than men (61.2% vs 56.3%, p=0.028). Among the food groups, women consumed significantly less fish and eggs than men (fish: 50.96% vs 57.76%, p=0.002; eggs: 17.13% vs 22.10%, p=0.004). Poor education, rural dwellings, living in homes with fewer individuals and living in food-insecure households were associated with inadequate DD in both sexes. Furthermore, among men, older age and not being currently married, and among women, lower age and living in households with middle wealth status were associated with inadequate DD.
The study found that older women consume relatively less diverse diets than men, and several sociodemographic factors influence inadequate DD among older adults of both sexes in Bangladesh. These factors should be considered while developing policies and programmes to promote equitable access to a diversified diet and improve geriatric health and nutritional outcomes.
Current research lacks a comprehensive understanding of evidence-based practice (EBP) adoption and its predictors across diverse healthcare professionals (HCPs) in the Eastern Mediterranean Region (EMR), particularly with a direct comparison between nurses and other professional groups.
This study aims to evaluate the EBP competencies, adoption levels, identified barriers, and associated predictors among nurses and other healthcare professionals (HCPs) within the EMR.
A cross-sectional, correlational, and comparative design was used. An electronic survey was distributed (April 27th–August 17th, 2023) via convenience/snowball sampling, inviting nurses, physicians, physiotherapists, dentists, and pharmacists across the EMR to complete the survey. Multivariate regression analysis and structural equation modeling (SEM) were used to identify predictors of EBP adoption.
A total of 4673 HCPs participated and reported several barriers to EBP adoption, including time constraints, difficulties in interpreting statistics, lack of authority to change practices, and insufficient equipment. Nurses had fewer postgraduate degrees but more work experience and full-time employment than other HCPs. Despite reporting more workplace EBP support, nurses read less research, had lower EBP scores and adoption propensity, and perceived greater barriers than other HCPs (p < 0.002). Multivariate regression showed the highest barrier scores in Syria/Tunisia and the lowest in the United Arab Emirates. Nurses reported significantly higher barriers compared to other HCPs (p < 0.001). Fear of Change was not a primary barrier overall, but was elevated in specific subgroups of nurses. SEM showed good fit: RMSEA = 0.077, SRMR = 0.053, CFI = 0.80, χ 2(df) = 917, p < 0.001. SEM showed that EBP adoption propensity and fear of change significantly mediate the relationship between HCPs' characteristics and EBP scores.
Despite having a positive attitude and propensity towards EBP, nurses lack the necessary knowledge and support to adopt it, and they face more barriers than other healthcare professionals. Nurses require greater support from healthcare leaders to enhance their EBP competencies and address the reported barriers. Policymakers and organizations should prioritize tailored, role-specific training and supportive structures and environments to ensure equitable and effective EBP implementation for improving patient outcomes across the EMR.
by Lauren Riehm, Keean Nanji, Moiz Lakhani, Evelina Pankiv, Dean Hasanee, Wesla Pfeifer
PurposeLarge language models (LLMs) have the potential to change medical education. Whether LLMs can generate multiple-choice questions (MCQs) that are of similar quality to those created by humans is unclear. This investigation assessed the quality of MCQs generated by LLMs compared to humans.
MethodsThis review was registered with PROSPERO (CRD42025608775). A systematic review and frequentist random-effects network meta-analysis (NMA) or pairwise meta-analysis was performed. Ovid MEDLINE, Ovid EMBASE, and Scopus were searched from inception to November 1, 2024. The quality of MCQs was assessed with seven pre-defined outcomes: question relevance, clarity, accuracy/correctness; distractor quality; item difficulty analysis; and item discrimination analysis (point biserial correlation and item discrimination index). Continuous data were transformed to a 10-point scale to facilitate statistical analysis and reported as mean differences (MD). The MERSQI and the Grade of Recommendations, Assessment, Development and Evaluation (GRADE) NMA guidelines were used to assess risk of bias and certainty of evidence assessments.
ResultsFive LLMs were included. NMA demonstrated that ChatGPT 4 generated similar quality MCQs to humans with regards to question relevance (MD −0.13; 95% CI: −0.44,0.18; GRADE: VERY LOW), question clarity (MD −0.03; 95% CI: −0.15,0.10; GRADE: VERY LOW), and distractor quality (MD −0.10; 95% CI: −0.24,0.04; GRADE: VERY LOW); however, MCQs generated by Llama 2 performed worse than humans with regards to question clarity (MD −1.21; 95% CI: −1.60,-0.82; GRADE: VERY LOW) and distractor quality (MD −1.50; 95% CI: −2.03,-0.97; GRADE: VERY LOW). Exploratory post-hoc t-tests demonstrated that ChatGPT 3.5 performed worse than Llama 2 and ChatGPT 4 with regards to question clarity and distractor quality (p Conclusion
ChatGPT 4 may create similar quality MCQs to humans, whereas ChatGPT 3.5 and Llama 2 may be of worse quality. Further studies that directly compare these LLMs to human-generated questions and administer MCQs to students are required.
by Reem Alhasan, Talal Alshatti
Inflammatory bowel disease (IBD), a lifelong inflammatory condition of the gastrointestinal tract, is influenced by complex interactions between genetics and environmental exposures. While IBD rates have increased globally, largely due to Westernized lifestyle shifts, the contributors to IBD in Kuwait remain poorly understood. This cross-sectional study aimed to explore lifestyle, dietary, and occupational exposures associated with IBD in this unique population. A total of 520 adults (412 with IBD and 108 without IBD) completed a 40-item online questionnaire assessing early-life, lifestyle, occupational, and dietary exposures. Of the IBD participants, 174 had ulcerative colitis (UC) and 238 had Crohn’s disease (CD). The questionnaire was adapted from a previously validated tool, but was not formally validated in the Kuwaiti population. Associations between these factors and IBD status were analyzed using multivariable logistic regression with adjusted odds ratios (AORs) and 95% confidence intervals (CIs) reported after adjusting for potential confounders. Factors associated with increased odds of IBD included male sex (AOR = 2.487, p = 0.005), younger age (AOR = 0.964, p = 0.004), positive family history (AOR = 2.141, p = 0.023), mentally demanding jobs (AOR = 1.818, p = 0.039), alcohol consumption (AOR = 6.508, p = 0.016), frequent spicy food intake 1–2 times/week (AOR = 2.631, p = 0.008), and prior parasitic infection (AOR = 0.484, p = 0.042). A history of appendectomy was also associated (AOR = 7.158, p = 0.003). Several modifiable exposures were found to be associated with IBD status in Kuwait. These findings underscore the multifactorial nature of IBD. However, the cross-sectional design, reliance on self-reporting, and use of a non-validated instrument limit causal interpretation. Future longitudinal research is needed to better understand temporal relationships.by Annur Ferdous, Munira Jahan Raisa, Md Hijbullah, Nafiz Imtiaz Siam, Shatabdy Barua Trisha, Sadia Biswas Mumu, Md Aminul Haque, Javed Ibne Hasan, Muhammed Mahfuzur Rahman, Md Shaki Mostaid
Background/ObjectivesObesity is a chronic metabolic disorder, and its prevalence in Bangladesh is increasing at an alarming rate. Previous reports have suggested a significant association between Vitamin D receptor (VDR) gene polymorphisms and obesity, but with inconsistent results. The purpose of our study was to investigate the association between two single-nucleotide polymorphisms (SNPs) (Apal, rs7975232, and Taql, rs731236) of the VDR gene and the risk of obesity in the Bangladeshi population. Moreover, we looked at serum VDR levels and serum 25-hydroxy vitamin D levels in people with obesity (n = 124) and healthy controls (n = 126).
MethodsGenotyping was performed using Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP). General linear model and multivariate logistic regression analysis were used to calculate the adjusted odds ratio (OR) along with 95% confidence intervals (CI) and P-values.
ResultsSerum VDR level was downregulated in people with obesity compared to healthy controls (P A) polymorphism, the CA Heterozygous genotype carried a 1.93-fold higher risk of developing obesity (OR=1.93, 95% CI = 1.10–3.41, P = 0.023). On the contrary, for TaqI, rs731236 (T > C), no significant association was found for both heterozygous and mutant homozygous genotypes.
ConclusionWe report the downregulation of serum VDR levels and serum 25-hydroxy vitamin D levels in people with obesity. Moreover, a polymorphism of Apal (rs7975232 C > A) in the VDR gene increases the risk of developing obesity in the Bangladeshi population.
by Winitra Kaewpila, Thanavadee Prachasan, Ratana Saipanish, Thanita Tantrarungroj, Fred Stevens
ObjectiveThis mixed-method study aimed to investigate factors associated with treatment-seeking behaviors in people with obsessive-compulsive (OC) symptoms in the community and explore their experiences along the dynamic of treatment-seeking processes.
MethodEighty-one subjects with OC symptoms (27 treatment seekers and 54 non-seekers) completed online questionnaires about treatment history, symptom severity, and factors influencing treatment-seeking. The characteristics of treatment seekers and non-seekers were compared using Pearson’s Chi-square and independent T-tests. Qualitative data were derived from a subset of 26 participants undergoing a follow-up telephone interview and subsequently analyzed by thematic analysis.
ResultsTreatment seeking was associated with more severe overall OC and obsessive symptoms and more feeling out of control over the symptoms (p Conclusion
The symptom severity and feeling out of control are critical factors associated with treatment-seeking among people with OC symptoms in the community. Enhancing the feeling of control could be pivotal in promoting help-seeking behaviors in this population.
The comparative efficacy of brief behavioral therapy for insomnia (BBTI) remains unclear.
This systematic review and network meta-analysis examined the effectiveness of different BBTI approaches and compared BBTI with other nonpharmacological interventions, such as cognitive behavioral therapy for insomnia (CBT-I).
Three databases were searched from inception to December 27, 2024. Primary outcomes were insomnia severity and sleep quality. Secondary outcomes included total sleep time, sleep onset latency, wake after sleep onset, sleep efficiency, and daytime sleepiness. A frequentist network meta-analysis with random-effects modeling was conducted. Heterogeneity was assessed using the I 2 statistic.
Eighteen randomized controlled trials involving 1104 participants (mean age: 52.6 years) were included. Compared with usual care, BBTI significantly reduced insomnia severity (mean difference [MD] = −4.79; 95% confidence interval [CI = −6.05, −3.53]; I 2 = 0%) and improved sleep quality (MD = −3.45; 95% CI [−4.97, −1.94]; I 2 = 0%). BBTI also shortened sleep onset latency (MD = −19.81 min; 95% CI = −30.64, −8.98; I 2 = 17%) and wake after sleep onset (MD = −15.51 min; 95% CI [−22.75, −8.27]; I 2 = 47%) and increased sleep efficiency (MD = 10.78%; 95% CI [7.67%, 13.89%]; I 2 = 8%). No significant differences were found in total sleep time or daytime sleepiness. Face-to-face BBTI and CBT-I demonstrated similar outcomes. Face-to-face BBTI ranked as the most effective approach based on the surface under the cumulative ranking curve.
Face-to-face BBTI is an optimal nonpharmacological option for improving sleep quality and efficiency and reducing insomnia severity, sleep onset latency, and wake after sleep onset.
PROSPERO number: CRD42021242589
Despite a high disease burden, care-seeking for mental health symptoms is low in Bangladesh, particularly among women.
To evaluate help-seeking behaviours for anxiety and depression symptoms among Bangladeshi women aged 15–49 and its association with women’s empowerment.
Data from the Bangladesh Demographic and Health Survey 2022 including 2881 women reporting anxiety or depression symptoms were analysed. Help-seeking behaviours, sociodemographics and women’s empowerment using the Survey-based Women’s Empowerment (SWPER) index were assessed. Logistic regression models were used to explore associations.
The mean age of participants was 33.3 years (SD 8.7); two-thirds lived in rural areas. In the SWPER index, 83% of women had high empowerment in the attitude to violence domain, 16% in social independence and 60% in decision-making. Among women with anxiety or depression symptoms, 18.7% sought help, mainly from spouses (43%) or family (52%), and 15% consulted doctors. Women aged >30 years (adjusted OR, aOR 1.25, 95% CI 1.02 to 1.53), from rich households (aOR 1.49, 95% CI 1.09 to 1.89), and with secondary (aOR 1.47, 95% CI 1.08 to 2.01) or higher education (aOR 1.56, 95% CI 1.03 to 2.36) were more likely to seek help. High empowerment in attitude to violence (aOR 0.54, 95% CI 0.37 to 0.81) and decision-making (aOR 0.53, 95% CI 0.41 to 0.68) correlated negatively with help-seeking.
Few Bangladeshi women seek help for mental health symptoms, relying on informal sources. Age, education, wealth and employment predict help-seeking, while high empowerment level in attitude to violence and decision-making domain of SWPER index shows an inverse relationship.
Alzheimer’s disease (AD) impacts over 55 million individuals worldwide and remains the leading cause of dementia (60–70% of cases). By 2050, South and Southeast Asia are projected to have an older adult population more than double, bearing a major share of Alzheimer’s disease burden. This will exert a heavy strain on healthcare systems, particularly in resource-limited countries where support and infrastructure are already stretched. Despite this, no review has yet explored the regional epidemiology and associated risk factors in this context. Thus, this study protocol outlines to synthesise prevailing evidence from these densely populated regions, particularly low- and middle-income nations within South and Southeast Asia.
This review will include studies that reported epidemiological characteristics including prevalence, age of onset, mortality, and risk factors of AD and related dementias comprising in South and Southeast Asian regions. Studies published in any language from inception to date will be extracted from PubMed, Scopus, CINAHL, EMBASE and APA PsycNet, following Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) and Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines. We will also search grey literature sources and screen the reference lists of the articles selected for full-text review to identify additional relevant studies. Observational studies including case–control, cohort, and cross-sectional designs reporting desired outcomes will be included and appraised for quality assessment with the modified Newcastle-Ottawa Scale (mNOS). The included articles will be appraised by two independent reviewers, with a third resolving any conflicts. Pooled estimates of prevalence, age of onset and mortality will be analysed using random effect meta-analysis (REML) model. Associated risk factors, including modifiable and non-modifiable will be narratively synthesised. Forest plots will be used to visualise the findings, and heterogeneity across the included studies will be assessed using the I² and Cochrane’s Q statistics. Potential publication bias will be assessed using a funnel plot along with the Begg’s and Egger’s tests. Sensitivity and subgroup analyses will also be conducted to assess the robustness of pooled estimates and to explore potential sources of heterogeneity. Statistical analysis will be conducted using Rstudio (v.4.3.2) and GraphPad Prism V.9.0.2.
The systematic review is focused on the analysis of secondary data from published literature; thus, no ethical approval will be needed. The protocol will follow international standard guidelines, findings will be reported in a reputed journal and disseminated through (inter)national conferences, webinars and key stakeholders to inform policy, research and AD management strategies.
CRD 420251047105.
Scoping reviews, mapping reviews and evidence and gap maps (collectively known as ‘big picture reviews’) in health continue to gain popularity within the evidence ecosystem. These big-picture reviews are beneficial for policy-makers, guideline developers and researchers within the field of health for understanding the available evidence, characteristics, concepts and research gaps, which are often needed to support the development of policies, guidelines and practice. However, these reviews often face criticism related to poor and inconsistent methodological conduct and reporting. There is a need to understand which areas of these reviews require further methodological clarification and exploration. The aim of this project is to develop a research agenda for scoping reviews, mapping reviews and evidence and gap maps in health by identifying and prioritising specific research questions related to methodological uncertainties.
A modified e-Delphi process will be adopted. Participants (anticipated N=100) will include patients, clinicians, the public, researchers and others invested in creating a strategic research agenda for these reviews. This Delphi will be completed in four consecutive stages, including a survey collecting the methodological uncertainties for each of the big picture reviews, the development of research questions based on that survey and two further surveys and four workshops to prioritise the research questions.
This study was approved by the University of Adelaide Human Research Ethics Committee (H-2024-188). The results will be communicated through open-access peer-reviewed publications and conferences. Videos and infographics will be developed and placed on the JBI (previously Joanna Briggs Institute) Scoping Review Network webpage.
FreshRSS 