BackgroundActive workstations have been proposed as a feasible approach for reducing occupational sedentary time. This study used a network meta-analysis (NMA) to assess and compare the overall efficacy of active workstation interventions according to type and concomitant strategy for reducing work-specific sitting time in office workers.MethodsPubMed, Web of Science, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched from database inception until May 2022 to obtain randomized controlled trials (RCTs) assessing the efficacy of active workstations with or without concomitant strategies for reducing occupational sedentary time in office workers. The risk of bias of the RCTs included in this study was assessed according to the Cochrane Handbook. An NMA with STATA 15.1 was used to construct a network diagram, league figures, and the final surface under the cumulative ranking curve (SUCRA) values. The certainty of evidence was assessed using the grading of recommendations, assessment, development, and evaluation (GRADE) approach.ResultsA total of 23 eligible studies including eight different types of interventions with 1428 office workers were included. NMA results showed that compared to a typical desk, multicomponent intervention (standardized mean difference (SMD) = - 1.50; 95% confidence interval (CI) - 2.17, - 0.82; SUCRA = 72.4%), sit-stand workstation + promotion (Reminders of rest breaks, posture variation, or incidental office activity) (SMD = - 1.49; 95%CI - 2.42, - 0.55; SUCRA = 71.0%), treadmill workstation + promotion (SMD = - 1.29; 95%CI - 2.51, - 0.07; SUCRA = 61.6%), and sit-stand workstation (SMD = - 1.10, 95%CI - 1.64, - 0.56; SUCRA = 50.2%) were effective in reducing occupational sedentary time for office workers.ConclusionsMulticomponent intervention, sit-stand workstation + promotion, treadmill workstation + promotion, and sit-stand workstation appear to be effective in reducing work-specific sedentary time for office workers. Furthermore, multicomponent interventions and active workstations + promotion better reduced work-specific sedentary time than active workstation alone. However, the overall certainty of the evidence was low.

Background: Based on randomized controlled trials, a network meta-analysis was conducted to compare treatment effects across varenicline and related smoking interventions. Methods: English databases were screened for randomized controlled trials reporting the effect of varenicline as treatment for smoking. The risk of bias in included trials was assessed using the Cochrane Handbook tool. Stata 15.1 software was used to perform network meta-analysis, and the GRADE approach was used to assess the evidence credibility on the tobacco treatment effects of different interventions. Results: Thirty-four studies involving 26,130 smokers were included in the network meta-analysis. Varenicline and 11 other interventions were reported, yielding 66 pairs of comparisons. Network meta-analysis showed that varenicline monotherapy or its combination with other interventions were superior in achieving smoking cessation compared to bupropion, nicotine replacement therapy, counselling, and placebo. Furthermore, compared to the varenicline, evident abstinence superiority was found in varenicline + bupropion (odds ratio = 1.49, 95% confidence interval [1.02, 2.18]). Finally, the surface under the cumulative ranking curve value indicated that varenicline + bupropion has the highest probability to become the best intervention. Conclusions: Varenicline monotherapy increased the odds of smoking cessation further than bupropion monotherapy, nicotine replacement therapy, counselling, and placebo, while varenicline combined with other interventions may even achieve a better abstinence effect. More credible evidence has been reported indicating that the combination of varenicline and bupropion is a superior treatment for smoking.

Aim To assess the effect of lubricants on reducing perineal trauma during vaginal delivery. Methods PubMed, Embase, the Cochrane Library, CINAHL, China National Knowledge Infrastructure, China Biology Medicine disc, WanFang databases, and , were searched for literature up to 25 June 2021. Randomized controlled trials published in English or Chinese that compared the vaginal application of lubricant with standard care for women were included. Two reviewers independently performed study screening, data extraction, risk of bias assessment, and certainty of evidence assessment. Pooled effect sizes and corresponding 95% confidence intervals (CI) were calculated using meta-analysis. Results Nineteen trials enrolling 5445 pregnant women were included. Compared with standard care, women using lubricants had a lower incidence of perineal trauma (risk ratio [RR] 0.84, 95% CI 0.76-0.93; low certainty evidence), second-degree perineal laceration (RR 0.72, 95% CI 0.64-0.82; moderate certainty evidence) and episiotomy (RR 0.77, 95% CI 0.62-0.96; very low certainty evidence), and had a shorter duration of the second-stage labor (MD -13.72 min, 95% CI -22.68 to -4.77; very low certainty evidence). Conclusion Lubricants might reduce the incidence of perineal trauma, especially second-degree perineal laceration, and shorten the duration of the second-stage labor. More well-designed studies will continue developing high-quality evidence in this field.

Objective: A network meta-analysis (NMA) was conducted to investigate the effect of varenicline (VAR), bupropion (BUP), and nicotine replacement therapy (NRT) on smoking cessation. Methods: Eight databases were searched in May 2021, and only randomized controlled trials (RCTs) using varenicline, bupropion, or NRT (single or combined) for smoking cessation were included. The risk of bias in the included RCTs was assessed using the Cochrane Handbook tool. Stata 15.1 software was used to perform NMA, and the quality of the evidence was evaluated using Confidence in Network Meta-analysis (CINeMA). Findings: Twenty RCTs involving 16,702 smokers were included. The risk of bias results showed that 10 RCTs were rated as high, three were low, and seven were unclear. A total of 21 pairs were compared based on seven interventions. The NMA showed that, compared to the placebo (PLA), the other six interventions had significant efficacy in smoking cessation, where VAR + BUP showed the best effect of all treatments (odds ratio (OR) = 6.08, 95% confidence interval (CI) [3.47, 10.66]). Moreover, VAR + BUP was superior to VAR + NRT (OR = 1.66, 95% CI [1.07, 2.59]) and the three monotherapies (VAR, BUP, and NRT). In the monotherapies, the results of pairwise comparisons of VAR, BUP, and NRT did not show significant differences. Finally, the surface under the cumulative ranking curve (SUCRA) value indicated that VAR + BUP had the greatest probability of becoming the best intervention. Conclusions: The efficacy of VAR, BUP, and NRT alone increased the odds of smoking abstinence better than the placebo, combined interventions were superior to monotherapy, and VAR combined with other interventions had a better smoking cessation effect.

Since the outbreak of coronavirus disease in 2019, the controversy over the effectiveness, safety, and enforceability of masks used by the public has been prominent. This study aims to identify, describe, and organize the currently available high-quality design evidence concerning mask use during the spread of respiratory viruses and find evidence gaps. Databases including PubMed, Cochrane Library, Web of Science, EMBASE, WHO International Clinical Trials Registry Platform (ICTRP), clinical trial registry, gray literature database, and reference lists of articles were searched for relevant randomized controlled trials (RCTs) and systematic reviews (SRs) in April 2020. The quality of the studies was assessed using the risk of bias tool recommended by the Cochrane Handbook Version 5.1.0 and the Assessment of Multiple Systematic Reviews (AMSTAR 2) tool. A bubble plot was designed to display information in four dimensions. Finally, twenty-one RCTs and nine SRs met our inclusion criteria. Most studies were of "Low quality" and focused on healthcare workers. Six RCTs reported adverse effects, with one implying that the cloth masks reuse may increase the infection risk. When comparing masks with usual practice, over 70% RCTs and also SRs showed that masks were "beneficial" or "probably beneficial"; however, when comparing N95 respirators with medical masks, 75% of SRs showed "no effect", whereas 50% of RCTs showed "beneficial effect". Overall, the current evidence provided by high-quality designs may be insufficient to deal with a second impact of the pandemic. Masks may be effective in interrupting or reducing the spread of respiratory viruses; however, the effect of an N95 respirator or cloth masks versus medical masks is unclear. Additional high-quality studies determining the impact of prolonged mask use on vulnerable populations (such as children and pregnant women), the possible adverse effects (such as skin allergies and shortness of breath) and optimal settings and exposure circumstances for populations to use masks are needed.

Background Mild cognitive impairment (MCI) is a cognitive state falling between normal aging and dementia. The relation between alcohol intake and risk of MCI as well as progression to dementia in people with MCI (PDM) remained unclear. Objective To synthesize available evidence and clarify the relation between alcohol intake and risk of MCI as well as PDM. Method We searched electronic databases consisting of PubMed, EMBASE, Cochrane Library, and China Biology Medicine disc (CBM) from inception to October 1, 2019. Prospective studies reporting at least three levels of alcohol exposure were included. Categorical meta-analysis was used for quantitative synthesis of the relation between light, moderate and heavy alcohol intake with risk of MCI and PDM. Restricted cubic spline and fixed-effects dose-response models were used for dose-response analysis. Result Six cohort studies including 4244 individuals were finally included. We observed an unstable linear relation between alcohol intake (drinks/week) and risk of MCI (P linear = 0.0396). It suggested that a one-drink increment per week of alcohol intake was associated with an increased risk of 3.8% for MCI (RR, 1.038; 95% CI 1.002-1.075). Heavy alcohol intake (> 14 drinks/week) was associated with higher risk of PDM (RR = 1.76; 95% CI 1.10-2.82). And we found a nonlinear relation between alcohol intake and risk of PDM. Drinking more than 16 drinks/week (P nonlinear = 0.0038, HR = 1.42; 95% CI 1.00-2.02), or 27.5 g/day (P nonlinear = 0.0047, HR = 1.46; 95% CI 1.00-2.11) would elevate the risk of PDM. Conclusion There was a nonlinear dose-response relation between alcohol intake and risk of PDM. Excessive alcohol intake would elevate the risk of PDM.