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- Si los dientes dañados se "empastan en bloque" (el material se coloca en una sola capa grande) o con un material de resina compuesta estándar (que se coloca en múltiples capas), es probable que haya poca o ninguna diferencia en el fracaso entre los materiales para empaste (también conocidos como materiales restauradores o para obturación).
- La evidencia más antigua encontró que la amalgama dental (empastes de color plata) podría presentar menos fallos del material que la resina compuesta. Pero este hallazgo se basó en los estudios más antiguos. La resina compuesta moderna es mejor, los dentistas tienen más experiencia en su uso y es probable que haya menos fracasos.
A veces el tejido dental se daña y se pueden formar agujeros (cavidades) en los dientes. Estas cavidades se producen por la caries dental, que es principalmente una enfermedad evitable si las personas mantienen una buena higiene bucodental y reducen el consumo de alimentos y bebidas azucaradas.
Cuando la caries dental provoca un daño permanente, los dentistas pueden rellenar (empastar) la cavidad para restaurar la forma y la función del diente.
Tradicionalmente, las cavidades se llenaban con amalgama. Este material de empaste de color plata (hecho principalmente de estaño, plata y cobre, y mezclado con mercurio líquido) es económico y fácil de usar. Pero ahora se sabe que el mercurio puede ser perjudicial para la salud de las personas y el medio ambiente. En una reunión internacional se acordó reducir (o eliminar) el uso del mercurio, incluso en los empastes dentales. Los materiales de empaste alternativos sin mercurio que se pueden colocar en una única cita dental incluyen:
- resina compuesta: material estándar blanco o del color del diente que se aplica en capas o en bloque.
- cemento de ionoméro de vidrio (GIC): a veces se utiliza como empaste temporal y no es tan resistente en algunas situaciones, por lo que no es adecuado para las superficies de masticación de los dientes.
- GIC modificado con resina (RMGIC): un GIC híbrido, más fuerte que los GIC pero no tan fuerte como el RBC.
- compómeros: alternativa al RMGIC pero más cercano al material de resina compuesta que a los GIC.
La resina compuesta, el RMGIC y los compómeros utilizan un sistema adhesivo para fijar el material a los dientes y necesitan fotocurado para endurecer el material. Con el GIC no son necesarios.
Quisimos averiguar lo siguiente:
- los beneficios de un material de empaste en comparación con otro para reducir la pérdida del diente (porque el empaste ha fallado), el fracaso (cuando el empaste no funciona según lo previsto), el tiempo transcurrido hasta la aparición de problemas y sensibilidad dental tras la intervención.
- si un material de empaste es más rentable que otro.
Buscamos revisiones sistemáticas que analizaran los materiales utilizados para los empastes dentales en las muelas permanentes de las personas. Estas revisiones recopilan toda la evidencia disponible a partir de los estudios publicados y analizan sus resultados. Resumimos los resultados de las revisiones y calificamos la confianza (según factores como los métodos y los tamaños las revisiones o los estudios) en la evidencia que proporcionaron.
También buscamos estudios económicos acerca de la relación entre el coste y la efectividad de estos materiales.
Encontramos 14 revisiones con 57 estudios. Los estudios se realizaron entre 1980 y 2023; 1 estudio tuvo un seguimiento de 10 años, pero en general el seguimiento fue mucho más corto. Algunas revisiones no informaron de los resultados de nuestros desenlaces clave, y a veces se incluyeron los mismos estudios en más de una revisión. Priorizamos la evidencia de 6 revisiones, con 25 estudios únicos.
Encontramos 7 estudios acerca de la relación entre el coste y la efectividad.
No encontramos revisiones con evidencia sobre la pérdida de dientes ni sobre el tiempo transcurrido hasta el fracaso.
- Aunque los empastes de amalgama podrían dar lugar a menos fracasos que los empastes con resina compuesta (8 estudios, 3486 empastes), los estudios comenzaron a finales de los años noventa. Las resinas compuestas y la experiencia de los dentistas al utilizarlas han mejorado desde entonces. Hoy en día la probabilidad de fracaso con la resina compuesta es del 5% (frente al 15% en los estudios más antiguos). Esto significa que la evidencia más antigua que compara la amalgama con la resina compuesta tiene una utilidad limitada en la práctica clínica actual.
- Probablemente no haya diferencias entre resina compuesta en bloque y resina compuesta estándar para reducir los fracasos (7 estudios, 511 empastes). Es probable que la mayoría de las personas no experimenten sensibilidad dental después del uso de cualquiera de los dos tipos de material de resina compuesta (5 estudios, 510 empastes).
- Es posible que no haya diferencias entre la resina compuesta estándar y el GIC en la reducción de los fracasos (1 estudio, 60 empastes) ni en la sensibilidad dental (4 estudios, 311 empastes). El RMGIC podría tener más probabilidades de reducir los fracasos que el GIC (1 estudio, 50 o 38 empastes). Encontramos revisiones que compararon el GIC con la amalgama y el compómero, pero no informaron sobre los fracasos ni la sensibilidad posoperatoria.
- La mayoría de los estudios económicos no establecieron conclusiones generales acerca de la relación coste-efectividad de ninguno de los materiales. Un estudio económico encontró que los empastes con amalgama probablemente duraran más y fueran más rentables que los empastes con resina compuesta, aunque esta conclusión se basó en un estudio más antiguo (de finales de los años noventa).
La mayoría de revisiones no cumplieron con los estándares más altos. Consideramos que solo 2 revisiones estaban bien realizadas. Sin embargo, la mayoría de las revisiones presentaron resultados muy similares, incluso cuando incluyeron estudios diferentes.
Tenemos menos confianza en la evidencia sobre el GIC y el RMGIC ya que los estudios fueron, por lo general, de pequeño tamaño y con pocos participantes.
La evidencia está actualizada hasta abril de 2025.
Sleep is an important natural process carried out by the human body. It allows the body to rest and the brain to process information attained over the course of the day. Sleep is intrinsically linked to mental health, with those with mental illness more likely to require support in attaining adequate sleep. Recently, the College of Psychiatrists in Ireland’s REFOCUS committee has sought to co-design an information leaflet for those with mental illness detailing the latest recommendations from the literature regarding sleep for this population, regardless of whether or not they take psychotropic medications. Given the rapidly expanding research focus on this topic, there are many published systematic reviews on the subject. As such, this proposed umbrella review seeks to collate the existing qualitative-based systematic reviews into sleep and mental illness and synthesise them in order to draw out the key recommendations that can be used by the committee to co-design an information leaflet to be used in practice to support service users with sleep disturbance.
This proposed review aims to explore how service users of mental health services experience sleep with and without the medication used to treat mental illness. An umbrella review that is compliant with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) is proposed. Search terms are stated, and a variety of databases
(Medline, Embase, CINAHL, Web of Science, Scopus) will be searched. The search range is from 1 January 2016 to present (2026).
Given that this paper presents a protocol for an umbrella review into sleep and mental illness, no ethical approval was required. The proposed umbrella review has been registered with the repository: PROSPERO on 18 March 2026 where it is freely available. The results of the umbrella review will be disseminated through both a peer reviewed publication and through an information leaflet co-designed by the College of Psychiatrists in Ireland’s REFOCUS committee. This protocol and subsequent umbrella review is and will be co-designed by psychiatrists, service users and family members of those with mental illness. Such individuals are named authors on this protocol and will be named authors on the proposed umbrella review as well.
CRD420261343674.
Professional nursing organizations play a central role in connecting nurse leaders across borders, advancing leadership science, and addressing shared challenges, including workforce sustainability, burnout, and policy influence. Little is known about how specialized professional nursing organizations with a primarily national membership base can build and sustain meaningful international membership. Barriers to and facilitators of international membership in professional nursing leadership organizations have received limited attention in the literature, particularly from the perspectives of international members themselves. The aims of the study are to explore the perspectives of international nurse leaders enrolled in the Association for Leadership Science in Nursing International Ambassador Program on what motivates and sustains their engagement, the leadership-related benefits they seek, the organizational supports that would make engagement more feasible, and the contributions they bring as members of an international nursing leadership community.
A qualitative descriptive design was used.
Data were collected using a Zoom-based focus group with five of 11 nurse leader ambassadors enrolled in the program. Data were analyzed using Braun and Clarke's six-phase reflexive thematic analysis. Trustworthiness was supported through investigator triangulation, peer debriefing, an audit trail, and reflexive review of researcher perspectives.
Four themes were developed: (1) reciprocal exchange, in which members positioned themselves as contributors as well as recipients; (2) engaging on our own terms, framing access and context-sensitivity as preconditions of membership; (3) belonging as more than membership, distinguishing formal affiliation from felt inclusion in a community of nurse leaders; and (4) growth through sustained international relationships, in which professional growth depends on ongoing cross-border connection rather than time-bound programs.
Findings suggest that international nursing leadership organizations should build infrastructure for reciprocal contribution, equitable access, substantive belonging, and sustained cross-border relationships to engage and retain global members.
Engagement in global nursing communities facilitates the exchange of knowledge, best practices, and innovations across healthcare settings. These opportunities can strengthen leadership development, support evidence-based practice, and ultimately improve patient outcomes.
Neonatal size and body composition, including fat mass and fat-free mass, are influenced by maternal nutritional status, lifestyle and overall health during pregnancy. Paternal health and household factors may also be contributory to neonatal body composition and subsequent growth trajectories. Neonatal anthropometry and body composition are important predictors of early morbidity, growth faltering, stunting and childhood adiposity and long-term risk of obesity and non-communicable diseases (NCDs). In South Africa, 28% of children under 5 years are stunted, alongside a growing overweight and obesity prevalence and NCD risk in children. Limited evidence exists regarding the maternal and paternal determinants of neonatal body composition in this setting.
This prospective cohort study aims to investigate maternal and paternal nutritional, health, body composition and lifestyle factors that influence neonatal size and body composition in Bloemfontein. The study will enrol 200 mother–neonate pairs at birth from Universitas Academic Hospital and follow them to 6 weeks postpartum. Maternal assessments at enrolment include anthropometry, body composition (using bioimpedance analysis), dietary intake, medical history, mental health, household food security and socio-economic and lifestyle factors. Neonatal measurements include birth weight and length, gestational age and body composition (using air displacement plethysmography). Paternal data include anthropometry, body composition, dietary intake, chronic disease risk and lifestyle factors, including alcohol use and smoking. At 6 weeks postpartum, infant feeding practices, growth and body composition are assessed. Multiple linear and logistic regression models will be used to assess the relationships between maternal and paternal factors and neonatal outcomes.
This study is approved by the Health Sciences Research Ethics Committee of the University of the Free State and the Free State Department of Health. Findings of this study will be published as scientific articles in peer-reviewed journals, presented at scientific conferences and workshops and disseminated at hospital staff forums and in local media.
by Natalie S. Pandher, Leslie Yack, Esther Li, Quentin Coppola, Kaitlin B. Cassaletto, Lea T. Grinberg, Thomas C. Neylan, Joel H. Kramer, Christine M. Walsh
This study aimed to compare subjective and objective circadian measures with a focus on sex differences and cognition in healthy older adults. A total of 126 participants (aged 65–90 years) completed the Horne & Ostberg Morning-Eveningness Questionnaire (MEQ) and the Circadian Type Inventory (CTI) to assess their morning-evening preference and four circadian traits: rigidity vs flexibility (CTI-FR) and languidity vs vigor (CTI-LV). These self-report measures were compared to actigraphy data from a sub-cohort of 63 individuals who wore wrist actigraphs for 24 hours a day over a 7-day period. Results showed that cognitively healthy older adults tend towards rigidity and vigor (on the CTI) and morningness (on the MEQ). Overall, the languid vs vigorous types and flexible vs rigid types displayed differences in MEQ scores. Sex moderated the association between the CTI-LV and MEQ with a steeper association in males than females (p = 0.012). Actigraphy data showed that males had less stable (interdaily stability, IS, p = 0.03) and more fragmented (interdaily variability, IV, p = 0.001) circadian rhythms than older females. Subjective MEQ scores were strongly predictive of acrophase time (p = 0.009) in males but not females. Using information processing speed (IPS) as a marker of cognitive function, we found that greater circadian rhythm fragmentation (IV) was linked to slower verbal IPS (p = 0.004) in males. Morning preference on the MEQ predicted faster spatial IPS in the overall sample (pAmbulance staff have the highest sickness absence, burnout and turnover intentions in the National Health Service, with work-related stress and anxiety identified as key drivers. Although multiple occupational stressors have been reported, it remains unclear which have the greatest impact. This study examined which work stressors are most strongly associated with mental health, well-being and intention to leave; whether these associations are explained by stress appraisals and mental rest; and which staff are most vulnerable to adverse outcomes.
A mixed-methods, explanatory, sequential design, stress audit was conducted in one ambulance service in England. An online survey with ambulance staff (n=420) assessed key stress elements (work stressors, stress appraisals, mental rest) and key outcomes (depression, well-being, intention to leave). Semistructured interviews with staff (n=8) explored the findings of the survey in more depth. Linear regression analyses examined relationships between predictors (eg, stressors) and outcomes (eg, well-being) and analysis of variances and t-tests explored differences between groups (eg, gender). A thematic analysis of qualitative data was conducted.
Quantitative and qualitative findings suggest that stress related to manager support (ie, upper management prioritising efficiency over staff needs), workplace demands (ie, organisational demands creating extra burden), poor relationships (eg, with non-peer staff) and constant change had the most negative impact on staff. Low mental rest and threat appraisals (ie, feeling ‘overwhelmed’ by work demands) were strong predictors of all negative outcomes, alongside cumulative stress exposure and negative emotional responses. Longer tenure, supervisory roles, mixed urban–rural working and male gender were associated with greater risk of poorer outcomes.
This study offers a comprehensive and novel insight into the stress experiences of ambulance staff. Findings underscore the need for theoretically-informed, evidence-based interventions that integrate organisational reform and individual support strategies to mitigate sickness absence, safeguard well-being and prevent attrition.
Non-attendance to healthcare appointments among young people with long-term conditions (LTCs) presents significant challenges to continuity of care and clinical outcomes. Although factors associated with non-attendance have been explored in broader populations, there remains an evidence gap concerning the specific drivers among adolescents and young adults aged 10–24 years living with chronic physical or mental health conditions. This review aims to identify and synthesise factors associated with healthcare appointment non-attendance among young people with LTCs.
We will conduct a systematic review and narrative synthesis of peer-reviewed quantitative, qualitative and mixed-methods studies reporting factors associated with non-attendance among young people with LTCs. MEDLINE, Embase, PsycINFO, Scopus and CINAHL will be searched from database inception. Searches will be conducted in March 2026 and will include studies with no geographic restrictions, and with eligibility extended to any language where translated full text is available. Two reviewers will independently screen studies, extract data and assess risk of bias using the ROBINS-I (quantitative), Critical Appraisal skills programme (qualitative) or mixed-methods appraisal tool (mixed-methods). A narrative synthesis will be undertaken, grouping factors thematically and comparing findings by age subgroup, condition type (physical vs mental health) and socioeconomic/geographical context. Reporting will follow Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidance.
Ethical approval is not required as no primary data will be collected. Findings will be disseminated through peer-reviewed publication and relevant conference presentations.
CRD420251080477.
Frailty is a common condition in older adults which becomes more prevalent and more severe with age. Health and care services designed to meet the needs of older adults living with frailty are expanding in number and scope, but information on the workforce needed to deliver services both now and in the future is lacking.
To understand the service design and staffing configurations for frailty services through gathering data on the setting and purpose of services; target population; referral methods into the service; specific activities delivered; frailty assessment tools; key service and patient outcomes; staff involved; future service priorities and anticipated future workforce requirements.
National survey, circulated electronically via national networks and organisations involved in the care of patients with frailty (n=26).
England health and care settings.
Health and care professionals delivering services for people living with frailty.
There were 93 survey responses from frailty services across England, of which 82 contained usable information. Respondents included clinicians and managers in a range of health and care sectors and the voluntary sector. Frailty services across settings commonly prioritised reducing frailty-associated risks but few focused on prevention. Staff teams included representation across professions, with specialists in older people’s care (eg, geriatricians, advanced practitioners) present in most teams, but non-specialist team members (eg, therapists, social workers and care co-ordinators) comprised a large proportion of the total workforce. All respondents identified similar priorities for their service in future, including reducing frailty progression, and specified needs for additional staff which broadly reflected the current team configurations. However, staff vacancies or unmet patient need due to low capacity was highlighted, and all respondents identified the need for additional staff in future.
Services designed to identify and manage people with frailty are complex and require a workforce with specialist training to assess, plan and deliver care. Current services are understaffed with insufficient capability to prevent frailty onset or slow progression, thereby failing to address unmet need. Workforce planning and resourcing to address frailty-related needs is urgently required.
A proportion of patients hospitalised for COVID-19 acquire the disease during their hospital stay, underscoring the risk of hospital-acquired COVID-19 (HA-COVID-19). This risk is presumed to be high, given how commonly and intensely air and surfaces within hospitals are reportedly contaminated with SARS-CoV-2. However, the true extent of HA-COVID-19 worldwide remains unknown, with limited understanding of factors that influence its occurrence and how these have evolved over time. This review will therefore aim to estimate the pooled prevalence of HA-COVID-19 among hospitalised COVID-19 patients globally and investigate differences by country, type of hospitals, medical specialty, length and timing of studied periods.
A systematic review and meta-analysis will be conducted adhering to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. MEDLINE and PubMed Central (via PubMed), Scopus, Embase (via Ovid), the Web of Science Core Collection as well as websites of public health agencies (PHA) will be searched until 1 July 2026. All journal articles and sources from PHAs reporting any primary data on the prevalence of HA-COVID-19 will be included. Methodological quality will be assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data. The primary outcome will be the global prevalence of HA-COVID-19. Data synthesis will include random-effects proportional meta-analysis. Estimates will be presented with two-sided 95% CIs and heterogeneity assessed using the I² statistic.
Ethical approval is not needed as no original data will be generated. This review will be published in an international, peer-reviewed journal.
CRD420251136884.
The initiation of buprenorphine for patients with opioid use disorder (OUD) in the emergency department (ED) has been associated with improved outcomes including reduced ED visits and increased treatment engagement. Though both standard-dose (8 mg buprenorphine equivalent) and high-dose (24 mg buprenorphine equivalent) strategies to initiate buprenorphine have been used in the ED, no prospective trials comparing outcomes among patients receiving these treatments have been reported.
This multisite randomised clinical trial is a multisite double-blind, double-dummy, randomised clinical trial enrolling 360 emergency department patients with moderate-to-severe OUD. Enrolled patients will be randomised to one of two study arms: standard-dose induction or high-dose induction, both provided in the ED. This study will engage, train and provide resources to five EDs throughout the US to recruit patients with untreated OUD into a randomised clinical trial. The primary aim is to evaluate the effects of the standard-dose induction and high-dose induction on rates of OUD treatment participation within 10 days post-randomisation. The secondary aims are to evaluate differences between standard-dose induction and high-dose induction on the outcomes of opioid craving, opioid withdrawal symptoms and illicit drug use assessed during 10 days post randomisation and evaluate the effects between treatment arms on rates of OUD treatment participation within 30 days post randomisation.
This study is funded by the National Institute on Drug Abuse and has been approved by the WCG Instutitional Review Board. It has been registered at clinicaltrials.gov. This study will inform the strategy for treatment initiation with buprenorphine among diverse ED settings and will provide ongoing evidence to support the safety and efficacy of initiating treatment for OUD in the ED.
Chronic musculoskeletal pain often extends beyond pathology alone. Augmented central pain processing is linked to pain severity, persistence and treatment outcomes. A practical clinical tool is needed to identify individuals likely to have persistent or worsening pain, likely due to augmented central pain mechanisms. Quantitative Sensory Testing (QST) offers mechanistic insight, while the Central Aspects of Pain (CAP) Questionnaire captures symptom profiles that potentially reflect central mechanisms. Combining a brief clinical QST protocol with CAP may support early risk stratification and guide personalised pain management.
This prospective observational study will recruit 250 individuals with inflammatory arthritis, osteoarthritis, chronic low back pain or fibromyalgia from existing cohorts, primary or secondary care. Participants will complete validated patient-reported outcomes at baseline, 6 and 12 weeks, with no additional intervention. The risk stratification tool completed at baseline will include clinical QST (Pressure Pain Threshold, Temporal Summation of Pain, Conditioned Pain Modulation), tender point count and the CAP questionnaire. Baseline laboratory versions of the clinical QST, plus Heat Pain Threshold, Offset Analgesia and the Central Sensitisation Inventory short form-9 questionnaire, will provide pain profiling to evaluate the predictive validity and psychometric properties of the tool. Data collection will include demographics, medical history, cognitive and neurological assessments and sleep quality via actigraphy (Actigraph wGT3X-BT). Interviews with patients and healthcare professionals will inform refinement, feasibility and acceptability of the tool.
Ethical approval was obtained from the Yorkshire & The Humber—South Yorkshire Research Ethics Committee (reference number: 24/YH/1062). Findings will be disseminated through peer-reviewed publications, conference presentations and patient-facing summaries and podcasts. The study aims to develop a clinically feasible tool to identify individuals at risk of persistent or worsening pain due to augmented central pain processing, enabling targeted treatment strategies.
FreshRSS 