The effects of probiotics administration during pregnancy on preeclampsia and associated maternal, fetal, and newborn outcomes: a systematic review and meta-analysis.

OBJECTIVE: This study aimed to synthesize the available evidence on probiotic administration during pregnancy for the prevention of preeclampsia and its effects on related maternal, fetal, and newborn outcomes. DATA SOURCES: Six databases were systematically searched for eligible studies, namely Ovid MEDLINE, Embase, CINAHL, Cochrane, Global Index Medicus, and the Maternity and Infant Care Database, from inception to August 2, 2023. STUDY ELIGIBILITY CRITERIA: Randomized controlled trials that evaluated the effects of probiotic administration on women during any stage of pregnancy were eligible for inclusion. METHODS: The protocol was registered with the International Prospective Register of Systematic Reviews under identifier CRD42023421613. Evaluating study eligibility, extracting data, assessing risk of bias (ROB-2 tool), and rating certainty (Grading of Recommendations, Assessment, Development and Evaluations) were conducted independently by 2 authors. The primary outcomes were incidence of preeclampsia, eclampsia, and maternal mortality. A meta-analysis was performed, and the results were reported as risk ratios with 95% confidence intervals. RESULTS: A total of 29 trials (7735 pregnant women) met the eligibility criteria. There was heterogeneity across the trials in the population of enrolled women and the type of probiotic tested (20 different strains), although most used oral administration. Probiotics may make no difference to the risk of preeclampsia (risk ratio, 1.14; 95% confidence interval, 0.84-1.53; 11 trials; 2401 women; low certainty evidence), preterm birth at <37 weeks' gestation (risk ratio, 0.93; 95% confidence interval, 0.66-1.30; 18 trials, 4016 women; low certainty evidence), or gestational age at delivery (mean difference, -0.03 weeks [≈0.2 days]; 95% confidence interval, -0.16 to 0.10 weeks [≈ -1.1 to 0.7 days]; 13 trials, 2194 women; low certainty evidence). It is difficult to assess the effects of probiotics on other secondary outcomes because the evidence was of very low certainty, however, no benefits or harms were observed. CONCLUSION: Limited evidence suggests that probiotic supplementation does not affect the risk for preeclampsia. Further high-quality trials are needed to definitively assess the benefits and possible harms of probiotic supplementation during pregnancy. There is also a lack of data from trials that included women who were undernourished or who experienced microbial dysbiosis and for whom probiotic supplementation might be useful.

Development of a search filter to retrieve reports of interrupted time series studies from MEDLINE and PubMed.

BACKGROUND: Interrupted time series (ITS) studies contribute importantly to systematic reviews of population-level interventions. We aimed to develop and validate search filters to retrieve ITS studies in MEDLINE and PubMed. METHODS: A total of 1017 known ITS studies (published 2013-2017) were analysed using text mining to generate candidate terms. A control set of 1398 time-series studies were used to select differentiating terms. Various combinations of candidate terms were iteratively tested to generate three search filters. An independent set of 700 ITS studies was used to validate the filters' sensitivities. The filters were test-run in Ovid MEDLINE and the records randomly screened for ITS studies to determine their precision. Finally, all MEDLINE filters were translated to PubMed format and their sensitivities in PubMed were estimated. RESULTS: Three search filters were created in MEDLINE: a precision-maximising filter with high precision (78%; 95% CI 74%-82%) but moderate sensitivity (63%; 59%-66%), most appropriate when there are limited resources to screen studies; a sensitivity-and-precision-maximising filter with higher sensitivity (81%; 77%-83%) but lower precision (32%; 28%-36%), providing a balance between expediency and comprehensiveness; and a sensitivity-maximising filter with high sensitivity (88%; 85%-90%) but likely very low precision, useful when combined with specific content terms. Similar sensitivity estimates were found for PubMed versions. CONCLUSION: Our filters strike different balances between comprehensiveness and screening workload and suit different research needs. Retrieval of ITS studies would be improved if authors identified the ITS design in the titles.

Effectiveness of care bundles for prevention and treatment of postpartum hemorrhage: a systematic review.

OBJECTIVE: Care bundles are a promising approach to reducing postpartum hemorrhage-related morbidity and mortality. We assessed the effectiveness and safety of care bundles for postpartum hemorrhage prevention and/or treatment. DATA SOURCES: We searched MEDLINE, Embase, Cochrane CENTRAL, Maternity and Infant Care Database, and Global Index Medicus (inception to June 9, 2023) and ClinicalTrials.gov and the International Clinical Trials Registry Platform (last 5 years) using a phased search strategy, combining terms for postpartum hemorrhage and care bundles. STUDY ELIGIBILITY CRITERIA: Peer-reviewed studies evaluating postpartum hemorrhage-related care bundles were included. Care bundles were defined as interventions comprising ≥3 components implemented collectively, concurrently, or in rapid succession. Randomized and nonrandomized controlled trials, interrupted time series, and before-after studies (controlled or uncontrolled) were eligible. METHODS: Risk of bias was assessed using RoB 2 (randomized trials) and ROBINS-I (nonrandomized studies). For controlled studies, we reported risk ratios for dichotomous outcomes and mean differences for continuous outcomes, with certainty of evidence determined using GRADE. For uncontrolled studies, we used effect direction tables and summarized results narratively. RESULTS: Twenty-two studies were included for analysis. For prevention-only bundles (2 studies), low-certainty evidence suggests possible benefits in reducing blood loss, duration of hospitalization, and intensive care unit stay, and maternal well-being. For treatment-only bundles (9 studies), high-certainty evidence shows that the E-MOTIVE intervention reduced risks of composite severe morbidity (risk ratio, 0.40; 95% confidence interval, 0.32-0.50) and blood transfusion for bleeding, postpartum hemorrhage, severe postpartum hemorrhage, and mean blood loss. One nonrandomized trial and 7 uncontrolled studies suggest that other postpartum hemorrhage treatment bundles might reduce blood loss and severe postpartum hemorrhage, but this is uncertain. For combined prevention/treatment bundles (11 studies), low-certainty evidence shows that the California Maternal Quality Care Collaborative care bundle may reduce severe maternal morbidity (risk ratio, 0.64; 95% confidence interval, 0.57-0.72). Ten uncontrolled studies variably showed possible benefits, no effects, or harms for other bundle types. Nearly all uncontrolled studies did not use suitable statistical methods for single-group pretest-posttest comparisons and should thus be interpreted with caution. CONCLUSION: The E-MOTIVE intervention improves postpartum hemorrhage-related outcomes among women delivering vaginally, and the California Maternal Quality Care Collaborative bundle may reduce severe maternal morbidity. Other bundle designs warrant further effectiveness research before implementation is contemplated.

Variation observed in consensus judgments between pairs of reviewers when assessing the risk of bias due to missing evidence in a sample of published meta-analyses of nutrition research.

OBJECTIVES: To evaluate the risk of bias due to missing evidence in a sample of published meta-analyses of nutrition research using the Risk Of Bias due to Missing Evidence (ROB-ME) tool and determine inter-rater agreement in assessments. STUDY DESIGN AND SETTING: We assembled a random sample of 42 meta-analyses of nutrition research. Eight assessors were randomly assigned to one of four pairs. Each pair assessed 21 randomly assigned meta-analyses, and each meta-analysis was assessed by two pairs. We calculated raw percentage agreement and chance corrected agreement using Gwet's Agreement Coefficient (AC) in consensus judgments between pairs. RESULTS: Across the eight signaling questions in the ROB-ME tool, raw percentage agreement ranged from 52% to 100%, and Gwet's AC ranged from 0.39 to 0.76. For the risk-of-bias judgment, the raw percentage agreement was 76% (95% confidence interval 60% to 92%) and Gwet's AC was 0.47 (95% confidence interval 0.14 to 0.80). In seven (17%) meta-analyses, either one or both pairs judged the risk of bias due to missing evidence as "low risk". CONCLUSION: Our findings indicated substantial variation in assessments in consensus judgments between pairs for the signaling questions and overall risk-of-bias judgments. More tutorials and training are needed to help researchers apply the ROB-ME tool more consistently.

Self-collection of samples for group B streptococcus testing during pregnancy: a systematic review and meta-analysis.

BACKGROUND: Sample self-collection for reproductive tract infection diagnosis has been found to offer greater convenience, privacy, autonomy, and expanded access to testing in non-pregnant adults. This review aimed to determine whether sample self-collection is as accurate as provider-collection for detection of group B streptococcus colonisation in pregnancy and whether a strategy of self-collection compared to provider-collection might improve maternal and neonatal health outcomes. METHODS: We searched CINAHL Plus, Medline, EMBASE, Maternity and Infant Care Database, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews in June 2022. Eligible studies compared self-collected and provider-collected samples taken from the same participants or participants randomised to either self-collection or provider-collection for reproductive tract infection testing using the same test and testing method in pregnant individuals. We included trials and observational studies. Reviewers assessed risk of bias using the QUADAS-2 checklist and independently extracted data. Sensitivity and specificity for group B streptococcus colonisation of self-collected compared to provider-collected samples were pooled using a bivariate, random-effects, meta-analytic model. This review was registered with PROSPERO (CRD42023396573). RESULTS: The search identified 5909 references, of which eleven diagnostic accuracy group B streptococcus studies were included (n = 3269 participants). No studies assessed the effects of self-collection in pregnancy on health outcomes. All studies had high or unclear risk of bias. Pooled sensitivities of self-collected samples for group B streptococcus detection were 82% (95% CI: 66-91%; I2 = 68.85%) in four trials (n = 1226) and 91% (95% CI: 83-96%; I2 = 37.38%) in seven non-randomised studies (n = 2043). Pooled specificities were 99% (95% CI: 98-99%; I2 = 12.08%) and 97% (95% CI: 94-99%; I2 = 72.50%), respectively. CONCLUSIONS: Self-collected samples for group B streptococcus detection in pregnancy had high specificity compared to provider-collection, but lower sensitivity, particularly for included trials. Studies investigating the effect of self-collection on health outcomes, and further higher quality trials comparing accuracy of self-collection to provider-collection, are required.

Moisture stress limits radial mixing of non-structural carbohydrates in sapwood of trembling aspen.

Dynamics in non-structural carbohydrate (NSC) pools may underlie observed drought legacies in tree growth. We assessed how aridity influences the dynamics of different-aged NSC pools in tree sapwood at two sites with differing climate conditions ('wet' vs. 'dry') that also experienced widespread regional drought five years earlier. We used an incubation method to measure radiocarbon (Δ14C) in CO2 respired from Populus tremuloides (aspen) tree rings to evaluate NSC storage and mixing patterns, coupled with measurements of NSC (soluble sugars, starch) concentrations and respired δ13C-CO2. At a wet site, CO2 respired from rings formed during 1962-1967 was only ~ 11 years old, suggesting deep sapwood mixing of NSCs as starch. At a dry site, total NSC was about one-third of wet site totals, maximum ages in deep rings were lower, and ages more rapidly increased in shallow rings then plateaued. These results suggest historically shallower mixing and/or relatively higher consumption of NSCs under dry conditions. Both sites, however, had similar aged NSC (<1 yr) in the most recent six rings, indicative of deep radial mixing following relatively wet conditions during the sampling year. We suggest significant differences in NSC mixing among sites are driven by moisture stress, where aridity reduces NSC reserves and restricts the depth of radial mixing. However, dynamic climate conditions in the southwestern US resulted in more complex radial patterns of sapwood NSC age than previously described. We suggest a novel conceptual framework to understand how moisture variability might influence the dynamics of NSC mixing in the sapwood.

Are COVID-19 systematic reviews up to date and can we tell? A cross-sectional study.

BACKGROUND: COVID-19 led to a rapid acceleration in the number of systematic reviews. Readers need to know how up to date evidence is when selecting reviews to inform decisions. This cross-sectional study aimed to evaluate how easily the currency of COVID-19 systematic reviews published early in the pandemic could be determined and how up to date these reviews were at the time of publication. METHODS: We searched for systematic reviews and meta-analyses relevant to COVID-19 added to PubMed in July 2020 and January 2021, including any that were first published as preprints. We extracted data on the date of search, number of included studies, and date first published online. For the search date, we noted the format of the date and where in the review this was reported. A sample of non-COVID-19 systematic reviews from November 2020 served as a comparator. RESULTS: We identified 246 systematic reviews on COVID-19. In the abstract of these reviews, just over half (57%) reported the search date (day/month/year or month/year) while 43% failed to report any date. When the full text was considered, the search date was missing from 6% of reviews. The median time from last search to publication online was 91 days (IQR 63-130). Time from search to publication was similar for the subset of 15 rapid or living reviews (92 days) but shorter for the 29 reviews published as preprints (37 days). The median number of studies or publications included per review was 23 (IQR 12-40). In the sample of 290 non-COVID SRs, around two-thirds (65%) reported the search date while a third (34%) did not include any date in the abstract. The median time from search to publication online was 253 days (IQR 153-381) and each review included a median of 12 studies (IQR 8-21). CONCLUSIONS: Despite the context of the pandemic and the need to easily ascertain the currency of systematic reviews, reporting of the search date information for COVID-19 reviews was inadequate. Adherence to reporting guidelines would improve the transparency and usefulness of systematic reviews to users.

Self-care interventions for preconception, antenatal, intrapartum and postpartum care: a scoping review.

OBJECTIVE: To identify current and emerging self-care interventions to improve maternity healthcare. DESIGN: Scoping review. DATA SOURCES: MEDLINE, Embase, EmCare, PsycINFO, Cochrane CENTRAL/CDSR, CINAHL Plus (last searched on 17 October 2021). ELIGIBILITY CRITERIA: Evidence syntheses, interventional or observational studies describing any tool, resource or strategy to facilitate self-care in women preparing to get pregnant, currently pregnant, giving birth or post partum. DATA EXTRACTION/SYNTHESIS: Screening and data collection were conducted independently by two reviewers. Self-care interventions were identified based on predefined criteria and inductively organised into 11 categories. Characteristics of study design, interventions, participants and outcomes were recorded. RESULTS: We identified eligible 580 studies. Many included studies evaluated interventions in high-income countries (45%) and during antenatal care (76%). Self-care categories featuring highest numbers of studies were diet and nutrition (26% of all studies), physical activity (24%), psychosocial strategies (18%) and other lifestyle adjustments (17%). Few studies featured self-care interventions for sexual health and postpartum family planning (2%), self-management of medication (3%) and self-testing/sampling (3%). Several venues to introduce self-care were described: health facilities (44%), community venues (14%), digital platforms (18%), partner/peer support (7%) or over-the-counter products (13%). Involvement of health and community workers were described in 38% and 8% of studies, who supported self-care interventions by providing therapeutics for home use, training or counselling. The most common categories of outcomes evaluated were neonatal outcomes (eg, birth weight) (31%), maternal mental health (26%) and labour outcomes (eg, duration of labour) (22%). CONCLUSION: Self-care interventions in maternal care are diverse in their applications, implementation characteristics and intended outcomes. Many self-care interventions were implemented with support from the health system at initial stages of use and uptake. Some promising self-care interventions require further primary research, though several are matured and up-to-date evidence syntheses are needed. Research on self-care in the preconception period is lacking.

Effect of nature prescriptions on cardiometabolic and mental health, and physical activity: a systematic review.

Nature prescriptions are gaining popularity as a form of social prescribing in support of sustainable health care. This systematic review and meta-analysis aims to synthesise evidence on the effectiveness of nature prescriptions and determine the factors important for their success. We searched five databases from inception up to July 25, 2021. Randomised and non-randomised controlled studies featuring a nature prescription (ie, a referral or an organised programme, by a health or social professional, to encourage spending time in nature) were included. Two reviewers independently conducted all steps of study selection; one reviewer collected summary data from published reports and conducted the risk of bias assessment. Random-effect DerSimonian-Laird meta-analyses were conducted for five key outcomes. We identified 92 unique studies (122 reports), of which 28 studies contributed data to meta-analyses. Compared with control conditions, nature prescription programmes resulted in a greater reduction in systolic blood pressure (mean difference -4·82 mm Hg [-8·92 to -0·72]) and diastolic blood pressure (mean difference -3·82 mm Hg [-6·47 to -1·16). Nature prescriptions also had a moderate to large effect on depression scores (post-intervention standardised mean difference -0·50 [-0·84 to -0·16]; change from baseline standardised mean difference -0·42 [-0·82 to -0·03]) and anxiety scores (post-intervention standardised mean difference -0·57 [-1·12 to -0·03]; change from baseline standardised mean difference -1·27 [-2·20 to -0·33]). Nature prescriptions resulted in a greater increase in daily step counts than control conditions (mean difference 900 steps [790 to 1010]) but did not improve weekly time of moderate physical activity (mean difference 25·90 min [-10·26 to 62·06]). A subgroup analysis restricted to studies featuring a referring institution showed stronger effects on depression scores, daily step counts, and weekly time of moderate physical activity than the general analysis. Beneficial effects on anxiety and depression scores were mainly provided by interventions involving social professionals whereas beneficial effects on blood pressures and daily step counts were provided mainly by interventions involving health professionals. Most studies have a moderate to high risk of bias. Nature prescription programmes showed evidence of cardiometabolic and mental health benefits and increases in walking. Effective nature prescription programmes can involve a range of natural settings and activities and can be implemented via social and community channels, in addition to health professionals.

Impact of searching clinical trials registers in systematic reviews of pharmaceutical and non-pharmaceutical interventions: Reanalysis of meta-analyses.

Systematic reviewers are advised to search trials registers to minimise risk of reporting biases. However, there has been little research on the impact of searching trials registers on the results of meta-analyses. We aimed to evaluate the impact of searching clinical trials registers for systematic reviews of pharmaceutical or non-pharmaceutical interventions. We searched PubMed, Scopus, Science Citation Index and Social Sciences Citation Index, and Education Collection for systematic reviews with meta-analyses indexed from 2 November to 2 December 2020. A random sample of systematic reviews was initially drawn, and for reviews which considered randomised trials eligible for inclusion, which had not searched a trials register, we searched ClinicalTrials.gov, EudraCT, ANZCTR, and the WHO ICTRP search portal for eligible trials. We compared meta-analytic effect estimates before and after including results from additional trials identified. We found additional trials for 63% (63/101) of eligible reviews; however, trials with results that could contribute to a meta-analysis were identified for only 20% (20/101) of the reviews. On average, there was no difference in the meta-analytic effect estimates before versus after adding the new trials. In summary, searching clinical trial registers led to identification of additional trials for many reviews; however, very few trials had results available for inclusion in meta-analyses. Including results from the new trials led to no change in the meta-analytic estimates, on average. Trials registers would be even more valuable to systematic reviewers if more trialists made use of them (i.e., registered their trials and posted results in a timely manner).

Changing patterns in reporting and sharing of review data in systematic reviews with meta-analysis of the effects of interventions: cross sectional meta-research study.

OBJECTIVES: To examine changes in completeness of reporting and frequency of sharing data, analytical code, and other review materials in systematic reviews over time; and factors associated with these changes. DESIGN: Cross sectional meta-research study. POPULATION: Random sample of 300 systematic reviews with meta-analysis of aggregate data on the effects of a health, social, behavioural, or educational intervention. Reviews were indexed in PubMed, Science Citation Index, Social Sciences Citation Index, Scopus, and Education Collection in November 2020. MAIN OUTCOME MEASURES: The extent of complete reporting and the frequency of sharing review materials in the systematic reviews indexed in 2020 were compared with 110 systematic reviews indexed in February 2014. Associations between completeness of reporting and various factors (eg, self-reported use of reporting guidelines, journal policies on data sharing) were examined by calculating risk ratios and 95% confidence intervals. RESULTS: Several items were reported suboptimally among 300 systematic reviews from 2020, such as a registration record for the review (n=113; 38%), a full search strategy for at least one database (n=214; 71%), methods used to assess risk of bias (n=185; 62%), methods used to prepare data for meta-analysis (n=101; 34%), and source of funding for the review (n=215; 72%). Only a few items not already reported at a high frequency in 2014 were reported more frequently in 2020. No evidence indicated that reviews using a reporting guideline were more completely reported than reviews not using a guideline. Reviews published in 2020 in journals that mandated either data sharing or inclusion of data availability statements were more likely to share their review materials (eg, data, code files) than reviews in journals without such mandates (16/87 (18%) v 4/213 (2%)). CONCLUSION: Incomplete reporting of several recommended items for systematic reviews persists, even in reviews that claim to have followed a reporting guideline. Journal policies on data sharing might encourage sharing of review materials.

Have Deaths of Despair Risen during the COVID-19 Pandemic? A Systematic Review.

This systematic review synthesized literature on potential impacts of protracted isolation and other disruptions during the COVID-19 pandemic on deaths of despair (suicide, overdoses, and drug-related liver diseases). Five electronic databases were searched yielding 70 eligible articles. Extant evidence mostly from high-income countries indicates COVID-19-related disruption may not have influenced suicide rates so far, but there have been reports of increased drug-related and liver disease mortality. Minority groups and women were more vulnerable, indicating the need for stronger equity focus on pandemic recovery and resilience strategies. Further high-quality studies with longer-term follow-up, especially from low-income countries, will inform these strategies.

Data and code availability statements in systematic reviews of interventions were often missing or inaccurate: a content analysis.

OBJECTIVES: To estimate the frequency of data and code availability statements in a random sample of systematic reviews with meta-analysis of aggregate data, summarize the content of the statements and investigate how often data and code files were shared. METHODS: We searched for systematic reviews with meta-analysis of aggregate data on the effects of a health, social, behavioral, or educational intervention that were indexed in PubMed, Education Collection via ProQuest, Scopus via Elsevier, or Social Sciences Citation Index and Science Citation Index Expanded via Web of Science during a 4-week period (between November 2, and December 2, 2020). Records were randomly sorted and screened independently by two authors until our target sample of 300 systematic reviews was reached. Two authors independently recorded whether a data or code availability statement (or both) appeared in each review and coded the content of the statements using an inductive approach. RESULTS: Of the 300 included systematic reviews with meta-analysis, 86 (29%) had a data availability statement, and seven (2%) had both a data and code availability statement. In 12/93 (13%) data availability statements, authors stated that data files were available for download from the journal website or a data repository, which we verified as being true. While 39/93 (42%) authors stated data were available upon request, 37/93 (40%) implied that sharing of data files was not necessary or applicable to them, most often because "all data appear in the article" or "no datasets were generated or analyzed". DISCUSSION: Data and code availability statements appear infrequently in systematic review manuscripts. Authors who do provide a data availability statement often incorrectly imply that data sharing is not applicable to systematic reviews. Our results suggest the need for various interventions to increase data and code sharing by systematic reviewers.

Temperature memory and non-structural carbohydrates mediate legacies of a hot drought in trees across the southwestern USA.

Trees are long-lived organisms that integrate climate conditions across years or decades to produce secondary growth. This integration process is sometimes referred to as 'climatic memory.' While widely perceived, the physiological processes underlying this temporal integration, such as the storage and remobilization of non-structural carbohydrates (NSC), are rarely explicitly studied. This is perhaps most apparent when considering drought legacies (perturbed post-drought growth responses to climate), and the physiological mechanisms underlying these lagged responses to climatic extremes. Yet, drought legacies are likely to become more common if warming climate brings more frequent drought. To quantify the linkages between drought legacies, climate memory and NSC, we measured tree growth (via tree ring widths) and NSC concentrations in three dominant species across the southwestern USA. We analyzed these data with a hierarchical mixed effects model to evaluate the time-scales of influence of past climate (memory) on tree growth. We then evaluated the role of climate memory and the degree to which variation in NSC concentrations were related to forward-predicted growth during the hot 2011-2012 drought and subsequent 4-year recovery period. Populus tremuloides exhibited longer climatic memory compared to either Pinus edulis or Juniperus osteosperma, but following the 2011-2012 drought, P. tremuloides trees with relatively longer memory of temperature conditions showed larger (more negative) drought legacies. Conversely, Pinus edulis trees with longer temperature memory had smaller (less negative) drought legacies. For both species, higher NSC concentrations followed more negative (larger) drought legacies, though the relevant NSC fraction differed between P. tremuloides and P. edulis. Our results suggest that differences in tree NSC are also imprinted upon tree growth responses to climate across long time scales, which also underlie tree resilience to increasingly frequent drought events under climate change.

Green Space Quality and Health: A Systematic Review.

(1) Background: As cities densify, researcher and policy focus is intensifying on which green space types and qualities are important for health. We conducted a systematic review to examine whether particular green space types and qualities have been shown to provide health benefits and if so, which specific types and qualities, and which health outcomes. (2) Methods: We searched five databases from inception up to June 30, 2021. We included all studies examining a wide range of green space characteristics on various health outcomes. (3) Results: 68 articles from 59 studies were found, with a high degree of heterogeneity in study designs, definitions of quality and outcomes. Most studies were cross-sectional, ecological or cohort studies. Environment types, vegetation types, and the size and connectivity of green spaces were associated with improved health outcomes, though with contingencies by age and gender. Health benefits were more consistently observed in areas with greater tree canopy, but not grassland. The main outcomes with evidence of health benefits included allergic respiratory conditions, cardiovascular conditions and psychological wellbeing. Both objectively and subjectively measured qualities demonstrated associations with health outcomes. (4) Conclusion: Experimental studies and longitudinal cohort studies will strengthen current evidence. Evidence was lacking for needs-specific or culturally-appropriate amenities and soundscape characteristics. Qualities that need more in-depth investigation include indices that account for forms, patterns, and networks of objectively and subjectively measured green space qualities.

Green Space and Health in Mainland China: A Systematic Review.

Non-communicable diseases (NCDs) have become a major cause of premature mortality and disabilities in China due to factors concomitant with rapid economic growth and urbanisation over three decades. Promoting green space might be a valuable strategy to help improve population health in China, as well as a range of co-benefits (e.g., increasing resilience to climate change). No systematic review has so far determined the degree of association between green space and health outcomes in China. This review was conducted to address this gap. Five electronic databases were searched using search terms on green space, health, and China. The review of 83 publications that met eligibility criteria reports associations indicative of various health benefits from more green space, including mental health, general health, healthier weight status and anthropometry, and more favorable cardiometabolic and cerebrovascular outcomes. There was insufficient evidence to draw firm conclusions on mortality, birth outcomes, and cognitive function, and findings on respiratory and infectious outcomes were inconsistent and limited. Future work needs to examine the health benefits of particular types and qualities of green spaces, as well as to take advantage of (quasi-)experimental designs to test greening interventions within the context of China's rapid urbanization and economic growth.

Reemergence of Human Monkeypox and Declining Population Immunity in the Context of Urbanization, Nigeria, 2017-2020.

A monkeypox outbreak in Nigeria during 2017-2020 provides an illustrative case study for emerging zoonoses. We built a statistical model to simulate declining immunity from monkeypox at 2 levels: At the individual level, we used a constant rate of decline in immunity of 1.29% per year as smallpox vaccination rates fell. At the population level, the cohort of vaccinated residents decreased over time because of deaths and births. By 2016, only 10.1% of the total population in Nigeria was vaccinated against smallpox; the serologic immunity level was 25.7% among vaccinated persons and 2.6% in the overall population. The substantial resurgence of monkeypox in Nigeria in 2017 appears to have been driven by a combination of population growth, accumulation of unvaccinated cohorts, and decline in smallpox vaccine immunity. The expanding unvaccinated population means that entire households, not just children, are now more susceptible to monkeypox, increasing risk of human-to-human transmission.

Mask use, risk-mitigation behaviours and pandemic fatigue during the COVID-19 pandemic in five cities in Australia, the UK and USA: A cross-sectional survey.

OBJECTIVES: To determine patterns of mask wearing and other infection prevention behaviours, over two time periods of the COVID-19 pandemic, in cities where mask wearing was not a cultural norm. METHODS: A cross-sectional survey of masks and other preventive behaviours in adults aged ≥18 years was conducted in five cities: Sydney and Melbourne, Australia; London, UK; and Phoenix and New York, USA. Data were analysed according to the epidemiology of COVID-19, mask mandates and a range of predictors of mask wearing. RESULTS: The most common measures used were avoiding public areas (80.4%), hand hygiene (76.4%), wearing masks (71.8%) and distancing (67.6%). Over 40% of people avoided medical facilities. These measures decreased from March-July 2020. Pandemic fatigue was associated with younger age, low perceived severity of COVID-19 and declining COVID-19 prevalence. Predictors of mask wearing were location (US, UK), mandates, age <50 years, education, having symptoms and knowing someone with COVID-19. Negative experiences with mask wearing and low perceived severity of COVID-19 reduced mask wearing. Most respondents (98%) believed that hand washing and distancing were necessary, and 80% reported no change or stricter adherence to these measures when wearing masks. CONCLUSION: Pandemic mitigation measures were widely reported across all cities, but decreased between March and July 2020. Pandemic fatigue was more common in younger people. Cities with mandates had higher rates of mask wearing. Promotion of mask use for older people may be useful. Masks did not result in a reduction of other hygiene measures.