Methodological evaluation of systematic reviews based on the use of artificial intelligence systems in chest radiography.

INTRODUCTION: In recent years, systems that use artificial intelligence (AI) in medical imaging have been developed, such as the interpretation of chest X-ray to rule out pathology. This has produced an increase in systematic reviews (SR) published on this topic. This article aims to evaluate the methodological quality of SRs that use AI for the diagnosis of thoracic pathology by simple chest X-ray. MATERIAL AND METHODS: SRs evaluating the use of AI systems for the automatic reading of chest X-ray were selected. Searches were conducted (from inception to May 2022): PubMed, EMBASE, and the Cochrane Database of Systematic Reviews. Two investigators selected the reviews. From each SR, general, methodological and transparency characteristics were extracted. The PRISMA statement for diagnostic tests (PRISMA-DTA) and AMSTAR-2 were used. A narrative synthesis of the evidence was performed. Protocol registry: Open Science Framework: https://osf.io/4b6u2/. RESULTS: After applying the inclusion and exclusion criteria, 7 SRs were selected (mean of 36 included studies per review). All the included SRs evaluated "deep learning" systems in which chest X-ray was used for the diagnosis of infectious diseases. Only 2 (29%) SRs indicated the existence of a review protocol. None of the SRs specified the design of the included studies or provided a list of excluded studies with their justification. Six (86%) SRs mentioned the use of PRISMA or one of its extensions. The risk of bias assessment was performed in 4 (57%) SRs. One (14%) SR included studies with some validation of AI techniques. Five (71%) SRs presented results in favour of the diagnostic capacity of the intervention. All SRs were rated "critically low" following AMSTAR-2 criteria. CONCLUSIONS: The methodological quality of SRs that use AI systems in chest radiography can be improved. The lack of compliance in some items of the tools used means that the SRs published in this field must be interpreted with caution.

Brief CBT-based psychological interventions to improve mental health outcomes in refugee populations: a systematic review and meta-analysis.

Background: Refugees, asylum seekers, and internally displaced people experience a high burden of mental health problems owing to their experiencing traumas and stressful events.Objective: To summarise the available evidence and analyse the efficacy of brief psychological interventions (< 3 months) on improving mental health outcomes, including depression, anxiety, and post-traumatic stress disorder (PTSD)-related symptoms in refugees.Method: We searched Medline, EMBASE, PsycINFO, CINAHL, and Global Index Medicus from inception to 19 December 2023. We included controlled studies using any cognitive behavioural therapy (CBT) or CBT-based therapies delivered over a short time (< 3 months), which reported mental health outcomes pre-and post-intervention. We conducted meta-analyses using random effects to derive pooled summary statistics. The quality of the evidence was assessed with the Cochrane Risk of Bias (RoB2) and ROBINS-I tools. This study is registered on the Open Science Framework, DOI 10.17605/OSF.IO/9CXU4.Results: 34 eligible studies across 37 publications were retrieved for analysis, and 33 studies with 4479 participants were included in the meta-analysis. There was an overall improvement in immediate mental health outcomes for all three domains, with analysis of 13 studies on anxiety outcomes (SMD -1.12, 95% CI -1.72 to -0.52), 20 studies on depression (SMD -1.04, 95% CI -1.97 to -0.11), and 24 studies on PTSD (SMD -0.82, 95% CI -1.20 to -0.45). At 3 to 6-month follow-up, however, analysis of mental health outcomes shows no significant change from baseline, with a SMD of 0.24 (95% CI -0.94 to 1.42) across 4 studies, -0.73 (95% CI -2.14 to 0.68) across 9 studies, and 0.29 (95% CI -0.94 to 1.53) across 12 studies for anxiety, depression, and PTSD respectively.Conclusion: Low-quality evidence shows brief psychological interventions have a positive immediate effect on refugees and internally displaced people's mental well-being. However, these effects do not persist in the short-term follow up. Heterogeneity was high, even among subgroups, impacting our findings' generalisability.

We analysed the evidence on the use of brief CBT-based psychological interventions to improve mental health outcomes in forcibly displaced persons.These interventions had a positive effect on anxiety, depression and PTSD, though there was high heterogeneity between studies.Positive effects on mental health disappeared at long-term follow-up.

Traumatic loss: a systematic review of potential risk factors differentiating between posttraumatic stress disorder and prolonged grief disorder.

Background: When traumatic events and losses intersect in the form of traumatic loss, these events can trigger both posttraumatic stress disorder and pathological grief.Objective: This systematic review investigates which characteristics differentiate between the development of the respective disorders or are associated with comorbidity.Method: A systematic literature search using Medline, PubMed, APA PsycInfo and Web of Science yielded 46 studies which met the inclusion criteria. In these studies, PTSD was assessed using 17 and pathological grief using 16 different validated instruments. In the quality assessment, 12 studies were classified as average, 30 as above average, and 4 as excellent. The investigated risk factors were categorized into 19 superordinate clusters and processed using narrative synthesis.Results: The relationship to the deceased, mental health issues, and religious beliefs seem to be associated specifically with pathological grief symptoms compared to PTSD symptoms. Social support and social emotions emerged as significant correlates and potential risk factors for both PTSD and pathological grief. Included studies had mainly cross-sectional designs.Conclusions: Differentiating factors between pathological grief and PTSD appear to exist. The results should be considered within the limitations of the heterogeneity of the included studies and the research field. There is a lack of studies (1) using a longitudinal study design, (2) starting data collection early following the traumatic loss, (3) using standardized, up-to-date measurement instruments and (4) including comorbidity in their analyses. Further research is urgently needed for more accurate (acute) screenings, prognoses, and interventions following traumatic loss.

When traumatic events and losses intersect in the form of traumatic loss, these events can trigger both posttraumatic stress disorder and pathological grief. This systematic review investigates which characteristics can differentiate between the development of the respective disorders or are associated with comorbidity.The relationship to the deceased, mental health issues, and religious beliefs seem to be specific characteristics for predicting pathological grief. Social support and social emotions were frequently reported as significant correlates of both PTSD and pathological grief.The studies to date have been very heterogeneous and mainly cross-sectional. Further research considering both disorders after traumatic loss in longitudinal study designs is urgently indicated for better (acute) screenings, prognoses, and interventions.

Management, development and methodology of the Clinical Practice Guidelines and Recommendations of the Spanish Society of Rheumatology.

The Spanish Society of Rheumatology (SER) brings together the majority of Spain's rheumatologists and, among the many services it offers its members, has a Research Unit (RU). This unit provides methodological support to SER members in clinical and epidemiological research, coordinates and carries out research projects, designs and maintains large patient databases, develops qualitative research projects and produces evidence-based medicine (EBM) documents. Through this last activity, the RU of the SER produces clinical practice guidelines and recommendation documents on topics relevant to rheumatology that meet the most demanding methodological standards. The aim of this article is to describe the management process and methodology followed by the UI of the SER to identify the topics of its EBM documents and how it executes and develops its guidelines and recommendations.

Nursing interventions in patients with substance use disorders. A systematic review.

OBJECTIVE: To analyze the current available evidence on non-pharmacological interventions for increasing the withdrawal of patients with substance use disorder. METHOD: A systematic review of randomized clinical trials with a control group has been carried out where a non-pharmacological intervention is carried out in which nurses participate. The search was carried out in Pubmed, Cinahl, Web of Science, Scopus and Cochrane. randomized clinical trials with a control group published between 2018 and 2023 were selected. RESULTS: 15 articles were selected. A longer abstinence time was observed in the interventions that proposed a personalized telematic follow-up with a health worker, the establishment of the figure of the care coordinator or financial rewards based on the abstinence time. No significant differences regarding abstinence were observed in the formative interventions or with relaxation techniques only. However, relaxation techniques combined with other interventions could be effective. CONCLUSIONS: The identified interventions can be incorporated into nursing practice. They present encouraging results, although it would be advisable to study their long-term effectiveness.

Anterior approach for pediatric supracondylar humerus fractures: A systematic review. / [Artículo traducido] Abordaje anterior para fracturas supracondíleas de húmero pediátrica: revisión sistemática.

BACKGROUND AND PURPOSE: Open reduction is rarely performed in pediatric supracondylar humerus fractures. However, clear evidence is lacking regarding the optimal open approach to achieve satisfactory results. The anterior approach provides direct visualization of the fracture and excellent exposure to neurovascular structures, although its utilization is less common. The objective of this study was to review the indications, outcomes, and complications associated with the anterior approach for open reduction of these fractures. METHODS: Our protocol was registered at PROSPERO: CRD42023446923. MEDLINE/PubMed, Embase, Web of Science, Clinicaltrials.gov, and Cochrane Library were searched from database inception to search date (December 2023) and screened in duplicate for relevant studies. Data were collected regarding patient demographics, indications for open reduction, Flynn's functional and cosmetic outcomes, and complications. Study quality was assessed using the Methodological Index for Non-Randomized Studies Criteria. RESULTS: A total of 19 studies involving 483 patients were included. One study was classified as Level 2 evidence, ten as Level 3, and eight as Level 4. The mean MINORS score was 13.05±3.47. The primary indication for open reduction was failed closed reduction, observed in 46% of patients. 97.7% and 98.6% of patients achieved Flynn's functional and cosmetic satisfactory results, respectively. The postsurgical neurovascular injury rate was 1.4%. One patient required reintervention. CONCLUSION: The anterior approach is safe and effective for managing pediatric supracondylar humerus fractures requiring open reduction. LEVEL OF EVIDENCE: Systematic review of Level 2-4 evidence studies.

Exploring the impact of pharmacogenetics on personalized medicine: A systematic review. / [Artículo traducido] Exploración del impacto de la farmacogenética en la medicina personalizada: una revisión sistemática.

INTRODUCTION: Pharmacogenetics evaluates how genetic variations influence drug responses. Nowadays, genetic tests have advanced, becoming more affordable, and its integration is supported by stronger clinical evidence. Guidelines such as those from CPIC (Clinical Pharmacogenetics Implementation Consortium) and resources like PharmGKB facilitate genotype-based prescribing; and organizations like the FDA promote genetic testing before initiating certain medications. Preventive pharmacogenetic panels seem promising, but further research on biomarkers and diverse populations is needed. The aim of this review is to analyze recent evidence on the genotype-drug response relationship to examine how the genetic profile of patients influences the clinical response to treatments, and analyze the areas of research that need further study to advance towards a genetic-based precision medicine. MATERIALS AND METHODS: A systematic search was conducted on PubMed to identify articles investigating the genotype-drug response relationship. The search strategy included terms such as "pharmacogenetics", "personalized treatment", "precision medicine", "dose adjustment", "individualized dosing", "clinical routine" and "clinical practice." Clinical trials, observational studies, and meta-analyses published in English or Spanish between 2013 and 2023 were included. The initial search resulted in a total of 136 articles for analysis. RESULTS: 49 articles were included for the final analysis following review by two investigators. A relationship between genetic polymorphisms and drug response or toxicity was found for drugs such as opioids, GLP-1 agonists, tacrolimus, oral anticoagulants, antineoplastics, atypical antipsychotics, efavirenz, clopidogrel, lamotrigine, anti-TNF-α agents, voriconazole, antidepressants, or statins. However, for drugs like metformin, quetiapine, irinotecan, bisoprolol, and anti-VEGF agents, no statistically significant association between genotype and response was found. CONCLUSION: The studies analyzed in this review suggest a strong correlation between genetic variability and individual drug responses, supporting the use of pharmacogenetics for treatment optimization. However, for certain drugs like metformin or quetiapine, the influence of genotype on their response remains unclear. More studies with larger sample sizes, greater ethnic diversity, and consideration of non-genetic factors are needed. The lack of standardization in analysis methods and accessibility to genetic testing are significant challenges in this field. As a conclusion, pharmacogenetics shows immense potential in personalized medicine, but further research is required.

Anterior approach for pediatric supracondylar humerus fractures: A systematic review.

BACKGROUND AND PURPOSE: Open reduction is rarely performed in pediatric supracondylar humerus fractures. However, clear evidence is lacking regarding the optimal open approach to achieve satisfactory results. The anterior approach provides direct visualization of the fracture and excellent exposure to neurovascular structures, although its utilization is less common. The objective of this study was to review the indications, outcomes, and complications associated with the anterior approach for open reduction of these fractures. METHODS: Our protocol was registered at PROSPERO: CRD42023446923. MEDLINE/PubMed, Embase, Web of Science, Clinicaltrials.gov, and Cochrane Library were searched from database inception to search date (December 2023) and screened in duplicate for relevant studies. Data were collected regarding patient demographics, indications for open reduction, Flynn's functional and cosmetic outcomes, and complications. Study quality was assessed using the Methodological Index for Non-Randomized Studies Criteria. RESULTS: A total of 19 studies involving 483 patients were included. One study was classified as Level 2 evidence, ten as Level 3, and eight as Level 4. The mean MINORS score was 13.05±3.47. The primary indication for open reduction was failed closed reduction, observed in 46% of patients. 97.7% and 98.6% of patients achieved Flynn's functional and cosmetic satisfactory results, respectively. The postsurgical neurovascular injury rate was 1.4%. One patient required reintervention. CONCLUSION: The anterior approach is safe and effective for managing pediatric supracondylar humerus fractures requiring open reduction. LEVEL OF EVIDENCE: Systematic review of Level 2-4 evidence studies.

[Value of the biomarker soluble tyrosine kinase 1 type fms (sFLT-1) in the diagnosis and prognosis of sepsis: a systematic review]. / Valor del biomarcador tirosina quinasa 1 soluble tipo fms (sFLT-1) en el diagnóstico y pronóstico de la sepsis: una revisión sistemática.

INTRODUCTION: The present systematic review analyses the role of soluble fms-like tyrosine kinase-1 (sFLT-1) as an indirect biomarker of endothelial dysfunction in sepsis or septic shock from articles published in PubMed between 2010 and March 2022. MATERIALS AND METHODS: A systematic review of studies studying sFLT-1 monitoring in intensive care units in adults with sepsis or septic shock vs. controls for sepsis diagnosis and prognosis has been carried out (PROSPERO CRD42023412929 Registry). RESULTS: The endothelial dysfunction of sepsis is one of the keys to the development of the disease. VEGF binds to sFLT-1 acting as a competitive inhibitor of VEGF signalling in endothelial cells and thus neutralizes its pro-inflammatory effects. Endothelial dysfunction is reflected in increased sFLT-1 levels. High values of sFLT-1 were used for the differential diagnosis of sepsis versus other inflammatory pathologies, septic shock versus other types of shock, were elevated over time, estimation of disease prognosis, correlation with sepsis severity, organ dysfunction, and mortality prediction. CONCLUSIONS: It is evident that sepsis is based on endothelial dysfunction. sFLT-1 is one of the main biomarkers of microvascular alteration and is a predictive diagnostic and prognostic biomarker.

Topical agents for the prevention ofradiodermatitis in cancer patients: A systematic review / Agentes tópicos para prevenção de radiodermatiteem pacientes com câncer: revisão sistemática

Objetivo: Analisar as evidências sobre o efeito dos agentes tópicos empregados para a prevenção da radiodermatite em pacientes com câncer. Método: Revisão sistemática de estudos clínicos randomizados duplos-cegos construída conforme recomendações do Joanna Briggs Institute e busca nas bases de dados MEDLINE/PubMed, CINAHL, LILACS, Web of Science, Embase, Scopus, além da literatura cinzenta. Utilizaram-se a ferramenta de avaliação crítica do JBI para ensaios clínicos randomizados para avaliar a possibilidade de viés, o Grading of Recommendations, Assessment, Development and Evaluation para a qualidade das evidências e o Gradepro® para recomendá-las. Resultados: Selecionaram-se 13 estudos que avaliaram diferentes agentes tópicos para prevenir a radiodermatite, a saber: corticosteroides, de ação antioxidante e fitoterápicos. A qualidade metodológica de cada estudo foi apropriada, mas a qualidade da evidência gerada pela reunião deles foi baixa, independentemente do tipo de agente tópico empregado, sugerindo que a confiança no seu efeito é limitada e tornando a força de recomendação fraca. Conclusão: Alguns agentes tópicos mostraram-se promissores para a prevenção de radiodermatite, mas as evidências aqui reunidas sobre a eficácia deles não permitem indicar seu uso para a prevenção de radiodermatite em pacientes com câncer. (AU)

Objective: To analyze the evidence on the effect of topical agents to prevent radiodermatitis in cancer patients. Methods: Systematic review of double-blind randomized clinical studies built according to JBI recommendations and search in the databases MEDLINE/PubMed, CINAHL, LILACS, Web of Science, Embase and Scopus, in addition to the Gray Literature. The JBI critical assessment tool for randomized clinical trials was used to assess the possibility of bias, GRADE for the quality of evidence, and Gradepro® to recommend them. Results: Thirteen studies were selected that evaluated different topical agents to prevent radiodermatitis, namely: corticosteroids, with antioxidant action and herbal medicines. The methodological quality of each study was appropriate. Still, the quality of evidence generated by pooling them was low, regardless of the type of topical agent employed, suggesting that confidence in its effect is limited and weakening the strength of the recommendation. Conclusions: Some topical agents have shown promise for the prevention of radiodermatitis, but the evidence gathered here about their effectiveness does not indicate their use for the prevention of radiodermatitis in cancer patients. (AU)

Objetivo: Analizar la evidencia sobre el efecto de los agentes tópicos utilizados para la prevención de la radiodermatitis en pacientes con cáncer. Método: Revisión sistemática de estudios clínicos aleatorizados, doble ciego, elaborados según las recomendaciones del JBI y buscados en MEDLINE/PubMed, CINAHL, LILACS, Web of Science, Embase y Scopus, además de literatura gris. Se utilizó la herramienta de evaluación crítica JBI para ensayos clínicos aleatorios para evaluar la posibilidad de sesgo, GRADE para la calidad de la evidencia y Gradepro® para recomendarla. Resultados: Se seleccionaron trece estudios que evaluaron diferentes agentes tópicos para prevenir la radiodermatitis, a saber: corticosteroides, con acción antioxidante y fitoterapia. La calidad metodológica de cada estudio fue apropiada, pero la calidad de la evidencia generada al combinarlos fue baja, independientemente del tipo de agente tópico empleado, lo que sugiere que la confianza en su efecto es limitada y debilita la fuerza de la recomendación. Conclusión: Algunos agentes tópicos se han mostrado prometedores para la prevención de la radiodermatitis, pero la evidencia aquí reunida sobre su eficacia no nos permite indicar su uso para la prevención de la radiodermatitis en pacientes con cáncer. (AU)

Eye Movement Desensitization and Reprocessing (EMDR) treatment in the medical setting: a systematic review.

Background: Literature points towards the potential benefits of the application of Eye Movement and Desensitization Processing (EMDR)-therapy for patients in the medical setting, with cancer and pain being among the domains it is applied to. The field of applying EMDR-therapy for patients treated in the medical setting has evolved to such an extent that it may be challenging to get a comprehensive overview.Objective: This systematic literature review aims to evaluate the use and effectiveness of Eye Movement Desensitization and Reprocessing (EMDR) therapy in patients treated in the medical setting.Methods: We performed a literature search following the PRISMA guidelines. Studies were included if the effectiveness of EMDR-therapy was assessed in adult patients treated in a medical setting. Excluded were patients exclusively suffering from a mental health disorder, without somatic comorbidity. A risk of bias analysis was performed. This review was registered on PROSPERO (CRD42022325238).Results: Eighty-seven studies, of which 26 (pilot)-RCTs were included and categorized in 14 medical domains. Additionally, three studies focusing on persistent physical complaints were included. Most evidence exists for its application in the fields of oncology, pain, and neurology. The overall appraisal of these studies showed at least moderate to high risks of bias. EMDR demonstrated effectiveness in reducing symptoms in 85 out of 87 studies. Notably, the occurrence of adverse events was rarely mentioned.Conclusions: Overall, outcomes seem to show beneficial effects of EMDR on reducing psychological and physical symptoms in patients treated in a medical setting. Due to the heterogeneity of reported outcomes, effect sizes could not be pooled. Due to the high risk of bias of the included studies, our results should be interpreted with caution and further controlled high-quality research is needed.

First overview on the use of EMDR for adult patients treated in the medical setting.EMDR seems beneficial in improving psychological and physical symptoms.Given the heterogeneity of studies and high risk of bias, further controlled studies are needed in this field.

Emotional Regulation as a Transdiagnostic Process of Emotional Disorders in Therapy: A Systematic Review and Meta-Analysis.

CONTEXT: Several studies have shown that emotional regulation (ER) is a transdiagnostic construct of emotional disorders. Therefore, if therapy improves ER, it would improve psychological distress. OBJECTIVE: This review assesses and compares the changes in ER due to psychological treatment in different therapies. METHODS: A systematic review and meta-analysis of RCTs published in the databases PubMed, PsycINFO and Web of Science was performed. It was registered in PROSPERO under the number CRD42023387317. Two independent experts in the field reviewed the articles. RESULTS: A total of 18 articles met the criteria for inclusion in the review. Analysis of these studies suggests that in unified protocol (UP), cognitive behaviour therapy, dialectical behaviour therapy (DBT) and mindfulness, there is evidence to support that a moderate effect occurs during treatment. Furthermore, in mindfulness and DBT, the effect was moderate in the follow-up period, while in UP, it was high. LIMITATIONS: Given the heterogeneity of the applied interventions and the methodological limitations found in the reviewed trials, the results should be interpreted with caution. CONCLUSIONS: UP, cognitive behaviour therapy, DBT and mindfulness can improve ER after therapy, while UP, DBT and mindfulness in the follow-up period. Other therapies, such as SKY or Flotation REST, require more research.

INTRODUCCIÓN: Varios estudios han demostrado que la regulación emocional es un constructo transdiagnóstico de los trastornos emocionales. Por lo tanto, si la terapia mejora la regulación emocional, también mejorará el malestar psicológico. OBJETIVO: Evaluar y comparar el cambio en la regulación emocional debido al tratamiento psicológico en diferentes terapias. MÉTODO: Se realizó una revisión sistemática y metaanálisis de ECA publicados en las bases de datos PubMed, PsycINFO y Web of Science. Se registró en PROSPERO con el número CRD42023387317. Dos expertos independientes en la materia revisaron los artículos. RESULTADOS: Un total de 18 artículos cumplieron los criterios de inclusión en la revisión. El análisis de estos estudios sugiere que en el Protocolo Unificado, la Terapia Cognitivo Conductual, la Terapia Dialéctica Conductual y terapias basadas en mindfulness existen evidencias que apoyan que se produce un efecto moderado durante el tratamiento. Además, en las terapias basadas en mindfulness y en la Terapia Dialéctica Conductual, el efecto se moduló en el periodo de seguimiento, mientras que en el Protocolo Unificado fue mayor. LIMITACIONES: Dada la heterogeneidad de las intervenciones aplicadas y las limitaciones metodológicas encontradas en los ensayos revisados, los resultados podrán interpretarse con cautela. CONCLUSIONES: UP, CBT, DBT y mindfulness pueden mejorar la ER tras la terapia, mientras que UP, DBT y mindfulness pueden mejorar la recuperación tras un tiempo de seguimiento. Otras terapias, como SKY o Flotation REST, requieren más investigación.

[Prevalence of burnout syndrome in physicians working in Spain: systematic review and meta-analysis]. / Prevalencia del síndrome de burnout en médicos que trabajan en España: revisión sistemática y metaanálisis.

OBJECTIVE: To analyze the prevalence of burnout syndrome in physicians working in Spain through a systematic review with meta-analysis METHOD: We searched PubMed/MEDLINE, Embase, and PsycINFO (up to June 2023). Observational studies conducted in Spain reporting the prevalence of burnout in physicians were included. From each study, methodological characteristics and results were extracted, and their quality was evaluated. We performed a narrative synthesis with random effects meta-analysis to calculate proportions. RESULTS: Sixty-seven studies with 16,076 participants were included. For the primary outcome, the meta-analysis revealed a global prevalence of burnout in physicians of 24% (95%CI: 19%-29%; 46 studies; 8821 participants; I2=97%). From subgroup analysis, differences were observed depending on the diagnostic criteria used: 18% (95%CI: 13%-23%) for three dimensions of burnout, 29% (95%CI: 24%-34%) for two dimensions and 51% (95%CI: 42%-60%) for one dimension. The heterogeneity between studies could not be fully explained through additional analyses where non-statistically significant differences were found with other variables (e.g., study quality, setting, professional category or medical specialty). CONCLUSIONS: A high prevalence of burnout syndrome was found in physicians working in Spain. These results can contribute to estimating the burden associated with burnout in physicians at a national level and to the design of future studies. Strategies appear to be necessary to prevent and mitigate this situation. PROTOCOL REGISTRATION: Open Science Framework: https://osf.io/b2h4m/.

Systematic review of the impact of restrictive wildlife trade measures on conservation of iconic species in southern Africa.

Trade restrictions are often advocated and implemented as measures to protect wild species threatened by overexploitation. However, in some instances, their efficacy has been questioned, notably by governments in the southern African (SADC) region, which tend to favor a sustainable use approach to wildlife management. We conducted a systematic review of published literature guided by the PRISMA process to examine the effectiveness of trade restrictions and directly related control measures in addressing threats to species conservation in the SADC region, with a focus on elephants (Loxodonta sp.), rhinoceroses (Ceratotherium simum, Diceros bicornis), lions (Panthera leo), and pangolins (Manis sp.). We focused in particular on the direct conservation impact of trade restrictions at species or population level, indirect conservation impact at human behavior or attitude level, and socioeconomic impact on rural livelihoods and well-being and on national economies. Research on these topics was uneven and focused strongly on the effects of trade restrictions and law enforcement on crime-related behavior. Research gaps include socioeconomic impacts of trade restrictions, including effects of international restrictions on local livelihoods and consequent secondary conservation impacts, and evaluations of attempts to disrupt criminal networks. Based on the reviewed impact evidence, the effectiveness of international trade restrictions depends on a range of fully aligned measures in countries of origin, transit, and consumption. For example, our results suggest positive ecological short-term but negative or unknown long-term socioeconomic impacts of domestic restrictions. Based on these findings, key policy requirements include more nuanced approaches to incorporate a range of appropriate measures in range, transit, and consumer countries, that focus on capacity development for early detection and apprehension of incursions inside protected areas; measures for constructive engagement with relevant local communities outside protected areas; and future research to improve understanding of the socioeconomic contribution of wildlife.

Revisión sistemática del impacto de las medidas restrictivas de comercio de vida silvestres sobre la conservación de especies icónicas en el sur de África Resumen Las restricciones comerciales a menudo se promueven e implementan como medidas para proteger a las especies silvestres amenazadas por la sobreexplotación. Sin embargo, en algunas instancias, su eficacia ha sido cuestionada, en particular por gobiernos de la región del sur de África (SADC), que tienden a favorecer un enfoque de uso sustentable para el manejo de la vida silvestre. Realizamos una revisión sistemática de la literatura publicada guiada por el proceso PRISMA para examinar la efectividad de las restricciones comerciales y las medidas de control directamente relacionadas para enfrentar las amenazas a la conservación de especies en la región de la SADC, con un enfoque en elefantes (Loxodonta sp.), rinocerontes (Ceratotherium simum, Diceros bicornis), leones (Panthera leo) y pangolines (Manis sp.). Nos centramos en particular en el impacto directo sobre la conservación de las restricciones comerciales a nivel de especie o población, el impacto indirecto sobre la conservación a nivel de comportamiento o actitud humana, y el impacto socioeconómico en los medios de vida y el bienestar rurales y en las economías nacionales. La investigación sobre estos temas fue desigual y se centró principalmente en los efectos de las restricciones comerciales y la aplicación de la ley en el comportamiento relacionado con el delito. Los vacíos a investigar incluyen los efectos de las restricciones internacionales sobre los medios de vida locales y los consiguientes impactos secundarios en la conservación, y evaluación de los intentos de desarticular las redes criminales. Con base en la revisión de la evidencia del impacto, la efectividad de las restricciones de comercio internacional depende de una gama de medidas totalmente alineadas en los países de origen, tránsito y consumo. Por ejemplo, nuestros resultados sugieren impactos socioeconómicos ecológicos positivos a corto plazo, pero negativos o desconocidos a largo plazo, de las restricciones nacionales. Con base en estos hallazgos, los requisitos clave para la definición de políticas incluyen enfoques más matizados para incorporar una variedad de medidas apropiadas ­ en los países de origen, tránsito y consumidores ­ que se centren en el desarrollo de capacidades para la detección temprana y la detención de incursiones dentro de áreas protegidas; medidas para un compromiso constructivo con las comunidades locales relevantes fuera de las áreas protegidas; e investigaciones futuras para mejorar la comprensión de la contribución socioeconómica de la vida silvestre.

Investigación del Proceso de Cambio en Psicoterapia en la Adultez en Pacientes con Depresión: Una Revisión Sistemática de la Última Década

La investigación del proceso de cambio en psicoterapia es el estudio de los procesos por los cuales ocurre el cambio en psicoterapia. Siendo la depresión una problemática con altas prevalencias y diversas complicaciones, es una tarea ineludible de los clínicos poder entender cómo ocurre el proceso de cambio en pacientes con este diagnóstico. Por ello, este estudio tiene como objetivo realizar una revisión sistemática de la literatura, para explorar y analizar la investigación empírica del proceso de cambio en psicoterapia individual en la adultez en pacientes con depresión, en los últimos diez años. La revisión se realizó en las bases de datos Web of Science, APA PsycNet, PubMed y EBSCO, siguiendo los lineamientos que señala la metodología PRISMA. Luego del proceso de tamizaje y revisión, se seleccionaron y analizaron 39 artículos. Se aprecia una clara tendencia a la utilización de metodologías mixtas de investigación, es decir, cualitativas y cuantitativas, con diseños longitudinales en casi la totalidad de estudios y una amplia gama de instrumentos para la recolección de datos. Los resultados sugieren que el proceso de cambio suele seguir un desarrollo no lineal, originando comúnmente cambios positivos profundos en áreas diversas y con trayectorias que tienden a patrones comunes.

Change process research in psychotherapy is the study of the processes by which change occurs in psychotherapy. Since depression is a problem with high prevalence and various complications, it is an unavoidable task for clinicians to be able to understand how the process of change occurs in patients with this diagnosis. Therefore, this study aims to carry out a systematic review of the literature, to explore and analyze the empirical investigation of the process of change in individual psychotherapy in adulthood in patients with depression, in the last ten years. The review was carried out in the Web of Science, APA PsycNet, PubMed and EBSCO databases, following the guidelines indicated by the PRISMA methodology. After the screening and review process, 39 articles were selected and analyzed. There is a clear tendency to use mixed research methodologies, that is, qualitative and quantitative, with longitudinal designs in almost all the studies and a wide range of instruments for data collection. The results suggest that the change process tends to follow a non-linear development, commonly causing deep positive changes in diverse areas and with trajectories that tend to common patterns.

An Analysis of Approaches to Reduction of HIV Stigma across the World through educational interventions: A Scoping Review / Análisis de los enfoques para reducir el estigma del VIH en todo el mundo mediante intervenciones educativas: Una revisión de alcanza / Análise das abordagens para reduzir o estigma do HIV em nível global por meio de intervenções educacionais: uma análise de escopo

Objective. To determinate the educational interventions for reducing the stigma caused by HIV worldwide. Methods. This scoping review study analyzed all papers published from early 2000 to the end of 2022 by searching all the scientific databases, Scopus, Web of Science, PubMed, Cochrane, Embase and CINHAL. The quality assessment of the papers was done using the ROBIS tool checklist. Results. 31papers were admitted to the scoping review process. Stigma reduction intervention was founded on three parts: Society, health and therapeutic services providers, and the patients who had HIV and their families. The interventions included education on the reduction of fear, and shame, observation of protective standards, conducting tests and treatment at the above levels, as well as the support provided by the society, policymakers, religious leaders and families of patients in economic, psychological and cultural terms, together with the establishment of social centres and organization of campaigns. Conclusion. The stigma associated with HIV is a significant obstacle before treatment, life expectancy and living quality of patients. Therefore, the stigma associated with this disease can be reduced, and the living quality of patients can be raised using approaches such as education of healthcare service providers and afflicted people, as well as economic, social, cultural, and psychological support.

Objetivo. Determinar las intervenciones educativas para reducir el estigma causado por el VIH en todo el mundo. Métodos. Revisión de alcance en el que se analizaron los artículos publicados desde 2000 a 2022 recuperados en las bases de datos científicas Scopus, Web of Science, PubMed, Cochrane, Embase y CINHAL. La evaluación de la calidad de los artículos se realizó mediante la lista de comprobación de la herramienta ROBIS. Resultados. Se admitieron 31 artículos. Las intervenciones para la reducción del estigma se basaron principalmente en tres componentes: La sociedad, los proveedores de los servicios de salud, y los pacientes con VIH y sus familias. Las intervenciones incluyeron la educación sobre la reducción del miedo y la vergüenza, la observación de las normas de protección, la realización de pruebas y el tratamiento en los niveles de atención, así como el apoyo prestado por la sociedad, los responsables políticos, los líderes religiosos y las familias de los pacientes en términos económicos, psicológicos y culturales, junto con la creación de centros sociales y la organización de campañas. Conclusión. El estigma asociado al VIH es un obstáculo importante ante el tratamiento, la esperanza y la calidad de vida de los pacientes. Por lo tanto, es posible reducir el estigma asociado a esta enfermedad y elevar la calidad de vida de los pacientes mediante enfoques como la educación de los proveedores de servicios sanitarios y de las personas afectadas; así como el apoyo económico, social, cultural y sicológico.

Objetivo. Analisar as intervenções educacionais implementadas para reduzir o estigma relacionado ao HIV. Métodos. A revisão de escopo analisou artigos publicados de 2000 a 2022 recuperados dos bancos de dados científicos Scopus, Web of Science, PubMed, Cochrane, Embase e CINHAL. A avaliação da qualidade dos artigos foi realizada usando a lista de verificação da ferramenta ROBIS. Resultados.31 artigos foram admitidos. As intervenções para redução do estigma baseavam-se principalmente em três componentes: Sociedade, prestadores de serviços de saúde e pacientes com HIV e suas famílias. As intervenções incluíram educação sobre a redução do medo e da vergonha, adesão a normas de proteção, testagem e tratamento nos níveis de atendimento, bem como apoio fornecido pela sociedade, formuladores de políticas, líderes religiosos e familiares dos pacientes em termos econômicos, psicológicos e culturais, juntamente com a criação de centros sociais e a organização de campanhas. Conclusão. O estigma associado ao HIV é um grande obstáculo ao tratamento, à esperança e à qualidade de vida dos pacientes. Portanto, é importante reduzir o estigma associado a esta doença e aumentar a qualidade de vida dos pacientes através de abordagens como a educação dos prestadores de cuidados de saúde e das pessoas afetadas; bem como apoio económico, social, cultural e psicológico.

The effect of erythropoiesis-stimulating agents on systolic and diastolic blood pressure in hemodialysis patients: A systematic review and meta-analysis of clinical trials.

OBJECTIVE: Anemia is a common condition in end-stage renal disease (ESRD) patients. Erythropoiesis-stimulating agents (ESAs) are commonly used to treat anemia in these patients. However, concerns have been raised regarding their potential effects on blood pressure. This systematic review and meta-analysis aim to investigate the relationship between ESAs and changes in systolic and diastolic blood pressure in hemodialysis patients. METHOD: This study is a systematic review and meta-analysis based on clinical trial studies published in various databases, including Web of Science, Cochrane Library, Science Direct, PubMed, Embase, Scopus, and Google Scholar, between 1980 and the end of 2022. We evaluated the quality of articles using the Jadad scale checklist and analyzed the data using Stata 15 software. RESULTS: Our meta-analysis included 34 clinical trial studies. The results showed a significant increase in both systolic blood pressure (SBP) and diastolic blood pressure (DBP) after the consumption of ESAs compared to before consumption. The mean difference in SBP was 4.84mmHg (95% CI: 2.74-6.94; p-value<0.001) and in DBP was 4.69mmHg (95% CI: 2.67-6.71; p-value<0.001). No publication bias was observed. Our meta-regression analysis showed that sample size, quality assessment score, and geographical location of the study were significant factors related to observed heterogenicity in to mean difference of SBP (p-value≤0.20). For DBP, the sample size, quality assessment score and follow-up duration were significant variables (p-value≤0.20). CONCLUSION: Based on the findings of our study, it appears that receiving ESAs is associated with a significant increase in both SBP and DBP in hemodialysis patients, with an increase of about 5mmHg.

Prevalence of elder abuse in the community and care settings: An umbrella review.

OBJECTIVE: Elder abuse, an important human rights issue and public health problem, contributes to increased disability and mortality. In the last decades, several reviews have synthesized primary studies to determine its prevalence. This umbrella review aimed to estimate the worldwide overall prevalence rate of elder abuse in the community and care setting. METHODS: Following prospective registration at PROSPERO (CRD42021281866) we conducted a search of eight electronic databases to identify systematic reviews from inception until 17 January 2023. The corrected covered area was calculated to estimate the potential overlap of primary studies between reviews. The quality of the selected reviews was assessed using a modified AMSTAR-2 instrument. We extracted data on the prevalence of any type of elder (people aged 60 years old or older) abuse in the community and care setting. RESULTS: There were 16 systematic reviews retrieved between 2007 and 2022, out of which ten captured prevalence globally, three in Iran, one in Turkey, one in China and one in Brazil. The 16 reviews included 136 primary studies in total between 1988 and 2020. The overlapping of studies between reviews was found to be moderate (5.5%). The quality of reviews was low (2, 12.5%) or critically low (14, 87.5%). The estimated range of global prevalence of overall elder abuse was wide (1.1-78%), while the estimations of specific abuse prevalence ranged from 0-81.8% for neglect, 1.1-78.9% for psychological abuse, 0.7-78.3% for financial abuse, 0.1-67.7% for physical abuse, and 0-59.2% for sexual abuse. CONCLUSIONS: Although the low quality of the evidence and the heterogeneity of the phenomenon makes it hard to give precise prevalence data, it is without a question that elder abuse is a prevalent problem with a wide dispersion. The focus of attention should shift towards interventions and policymaking to prevent this form of abuse.