Objective: By studying the Technology-Organization-Environment Framework (TOE), this research explores the impact of various indicators in technology, organization, and environment on the performance of family doctor services during major public health emergencies. It aims to identify the driving paths to improve performance. Methods: A stratified sampling of 34 community health service centers in Shanghai was conducted, using the comprehensive performance score of family doctors as the outcome variable. The Average Internet Medical Service Person-times and the Information Technology Expenditure per Thousand Population were considered as technology-related variables. The Fiscal Allocation per Thousand Population (/1,000), the Family Doctor Team Members per Thousand Population, and the Medical Social Workers and Volunteers per Thousand Population were identified as organization-related variables. The Proportion of Older Adult Population, Fiscal Allocation per Thousand Population, and the number of patient self-education organizations per thousand population were taken as environment-related variables. Fuzzy-set Qualitative Comparative Analysis (fsQCA) was employed to conduct necessity analysis, truth table analysis, and configurational analysis of antecedent conditions, with robustness tests performed by adjusting consistency thresholds and case frequencies. Results: The study found that the performance of family doctor services was influenced by multiple factors, with no single decisive factor. In overall communities, five configurations, including per capita fiscal allocation and community participation, affected performance, explaining 4.2% of the variance. In central urban areas, information technology expenditure and the Proportion of Older Adult Population were core conditions, influencing 27.5% of performance paths. In non-central urban areas, core conditions such as financial support and IT covered 53.9% of data cases. The fsQCA results, which were robustly tested, begin to provide a strong basis for resource allocation and policy formulation. Conclusion: This study begins to fill the gap in research on family doctor service performance during major public health emergencies, exploring the synergistic effects and causal asymmetry among multiple indicators such as technology, organization, and environment from a holistic, or configurational, perspective.

Objective: This meta-analysis aimed to qualitatively analyze the different aspects of the successful aging (SA) criteria and quantitatively assess the rate of SA and its different dimensions among people aged ≥60 years globally to provide a basis for constructing criteria for SA. Design: This is a systematic review and meta-analysis, which has been registered on PROSPERO (CRD42024585934). Setting and participants: Older adults (≥60 years). Methods: PubMed, Embase, CINAHL, Web of science, SCOPUS, and PsycINFO (inception to July 17, 2023) were used to search for relevant studies to evaluate the comprehensive level of SA. A random effects model was used to synthesize SA rates and 95% CIs. Quality assessment was conducted using the Agency for Healthcare Quality and Research criteria and the Newcastle-Ottawa Scale. Statistical analyses were conducted using Revman 5.3 and Stata 11.0. Results: A total of 546,228 older adults from 64 studies were incorporated into the meta-analysis. In the 64 studies, SA criteria mentioned 11 aspects: psychology, disease, cognitive function, physical function, social engagement, disability, independence, self-rated health, economy, memory impairment, and obesity. The meta-analysis indicated that the summary estimate of SA rate among people aged ≥60 years was 22.0% (95% CI 19.0%-25.0%) globally. A meta-analysis was conducted on the 6 aspects included more commonly in SA criteria, and the results showed that the rate of no disability was the highest (72.0%), followed by good psychological status (69%), active social engagement (65%), high cognitive function (64%), and high physical function (62%), with no major diseases being the lowest (50.0%). Conclusions and implications: The overall estimated SA rate among people aged ≥60 years was 22% globally. The SA criteria mainly include 6 aspects: good psychological status, no major diseases, high cognitive function, high physical function, active social engagement, and no disability. Emphasizing the importance of psychological well-being and chronic disease management, the findings offer valuable insights for future research and policy making related to the welfare of aging populations.

Importance: Speech and language delays and disorders can pose significant problems for children and their families. Evidence suggests that school-aged children with speech or language delays may be at increased risk of learning and literacy disabilities, including difficulties with reading and writing. Objective: The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate benefits and harms of screening for speech and language delay and disorders in children 5 years or younger. Population: Asymptomatic children 5 years or younger whose parents or clinicians do not have specific concerns about their speech, language, hearing, or development. Evidence assessment: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for speech and language delay and disorders in children who do not present with signs or symptoms or parent/caregiver concerns. Recommendation: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for speech and language delay and disorders in children 5 years or younger without signs or symptoms. (I statement).

Purpose: Though a growing crop of health care reforms aims to encourage health care-based social screening, no literature has synthesized existing social screening implementation research to inform screening practice and policymaking. Methods: Systematic scoping review of peer-reviewed literature on social screening implementation published 1/1/2011-2/17/2022. We applied a 2-concept search (health care-based screening; social risk factors) to PubMed and Embase. Studies had to explore the implementation of health care-based multi-domain social screening and describe 1+ outcome related to the reach, adoption, implementation, and/or maintenance of screening. Two reviewers extracted data related to key study elements, including sample, setting, and implementation outcomes. Results: Forty-two articles met inclusion criteria. Reach (n = 7): We found differences in screening rates by patient race/ethnicity; findings varied across studies. Patients who preferred Spanish had lower screening rates than English-preferring patients. Adoption (n = 13): Workforce education and dedicated quality improvement projects increased screening adoption. Implementation (n = 32): Time was the most cited barrier to screening; administration time differed by tool/workforce/modality. Use of standardized screening tools/workflows improved screening integration. Use of community health workers and/or technology improved risk disclosure and facilitated screening in resource-limited settings. Maintenance (n = 1): Only 1 study reported on maintenance; results showed a drop in screening over 21 months. Conclusions: Critical evidence gaps in social screening implementation persist. These include gaps in knowledge about effective strategies for integrating social screening into clinical workflows and ways to maximize screening equity. Future research should leverage the rapidly increasing number of screening initiatives to elevate and scale best practices.

Vaccination decision making in low- and middle-income countries (LMICs) has become increasingly complex, particularly in the context of numerous competing health challenges. LMICs have to make difficult choices on which vaccines to prioritize for introduction while considering a wide range of factors such as disease burden, vaccine impact, vaccine characteristics, financing and health care infrastructures, whilst adapting to each country's specific contexts. Our scoping review reviewed the factors that influence decision-making among policymakers for the introduction of new vaccines in LMICs. We identified the specific data points that are factored into the decision-making process for new vaccine introduction, whilst also documenting whether there have been any changes in decision-making criteria in new vaccine introduction over the last two decades. A comprehensive database search was conducted using a search strategy consisting of key terms and Medical Subject Headings (MeSH) phrases related to policy, decision-making, vaccine introduction, immunization programmes and LMICs. Articles were screened following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 843 articles were identified, with 34 articles retained after abstract screening, full-text screening and grading with the mixed methods appraisal tool (MMAT). The Burchett framework for new vaccine introduction was used to identify indicators for vaccine-decision making and guided data extraction. Articles in our study represented a diverse range of perspectives and methodologies. Across articles, the importance of the disease, which included disease burden, costs of disease and political prioritization, coupled with economic factors related to vaccine price, affordability and financing were the most common criteria considered for new vaccine introduction. Our review identified two additional criteria in the decision-making process for vaccine introduction that were not included in the Burchett framework: communication and sociocultural considerations. Data from this review can support informed decision-making for vaccine introduction amongst policymakers and stakeholders in LMICs.

Background:Pharmacotherapy provides an option for adults with overweight and obesity to reduce their bodyweight if lifestyle modifications fail. We summarised the latest evidence for the benefits and harms of weight-lowering drugs. Methods:This systematic review and network meta-analysis included searches of PubMed, Embase, and Cochrane Library (CENTRAL) from inception to March 23, 2021, for randomised controlled trials of weight-lowering drugs in adults with overweight and obesity. We performed frequentist random-effect network meta-analyses to summarise the evidence and applied the Grading of Recommendations Assessment, Development, and Evaluation frameworks to rate the certainty of evidence, calculate the absolute effects, categorise interventions, and present the findings. The study was registered with PROSPERO, CRD 42021245678. Findings:14 605 citations were identified by our search, of which 132 eligible trials enrolled 48 209 participants. All drugs lowered bodyweight compared with lifestyle modification alone; all subsequent numbers refer to comparisons with lifestyle modification. High to moderate certainty evidence established phentermine-topiramate as the most effective in lowering weight (odds ratio [OR] of ≥5% weight reduction 8·02, 95% CI 5·24 to 12·27; mean difference [MD] of percentage bodyweight change -7·98, 95% CI -9·27 to -6·69) followed by GLP-1 receptor agonists (OR 6·33, 95% CI 5·00 to 8·00; MD -5·79, 95% CI -6·34 to -5·25). Naltrexone-bupropion (OR 2·69, 95% CI 2·10 to 3·44), phentermine-topiramate (2·40, 1·68 to 3·44), GLP-1 receptor agonists (2·22, 1·74 to 2·84), and orlistat (1·71, 1·42 to 2·05) were associated with increased adverse events leading to drug discontinuation. In a post-hoc analysis, semaglutide, a GLP-1 receptor agonist, showed substantially larger benefits than other drugs with a similar risk of adverse events as other drugs for both likelihood of weight loss of 5% or more (OR 9·82, 95% CI 7·09 to 13·61) and percentage bodyweight change (MD -11·40, 95% CI -12·51 to -10·29). Interpretation:In adults with overweight and obesity, phentermine-topiramate and GLP-1 receptor agonists proved the best drugs in reducing weight; of the GLP-1 agonists, semaglutide might be the most effective.

Objectives: To compare the effectiveness of remineralizing agents in the prevention and reversal of white spot lesions (WSLs), which occur during fixed orthodontic treatment, through a systematic review and network meta-analysis. Materials and methods: We reviewed controlled randomized clinical trial (RCT) data querying nine databases combined with a manual search (last search date: March 10, 2020). Of 2273 identified studies, 36 RCTs were finally included. After study selection and data extraction, pair-wise and network meta-analyses were performed to analyze the effectiveness of remineralizing agents in the prevention and reversal of WSLs in the short term (≤ 3 months) and long term (> 3 months). The risk of bias was assessed based on the Cochrane guidelines. Statistical heterogeneity, inconsistencies, and cumulative ranking were also evaluated. Results: In terms of WSL prevention, sodium fluoride (NaF) varnish had the highest cumulative ranking for the short-term decalcification index (99.3%); acidulated phosphate fluoride (APF) foam ranked first for long-term incidence (96.9%), followed by difluorosilane (Dfs) varnish and high-concentration fluoride toothpaste (HFT) (79.4% and 77.4%, respectively). In the reversal of WSLs, no significant difference was found among different agents or their combinations for the two available outcomes (short-term integrated fluorescence loss and short-term percentage of fluorescence loss). Conclusions: In the prevention of WSLs, APF foam showed the best remineralizing effectiveness in the long term (after debonding), followed by Dfs varnish and HFT. It is unclear whether remineralizing agents can effectively reverse WSLs based on the existing evidence. Clinical relevance: APF foam may be recommended as a remineralizing agent for preventing orthodontically induced WSLs. Prospero registration number: CRD42019116852.

Objectives To explore the health research capacity (HRC) and factors associated with professional and technical personnel (PTP) in a first-class tertiary hospital in northwest China. Methods We collected the repeated measurement data from a first-class tertiary hospital in northwest China between 2013 and 2017. HRC of PTP was assessed by a comprehensive evaluation system and measured by research capacity score (RCS). The participants were divided into research group (RCS >0) and comparison group (RCS = 0); participants of the comparison group were selected by two-stage stratified random sampling. Multilevel model for repeated measures was used to investigate the potential factors associated with HRC. Results A total of 924 PTP were included (308 in the research group and 616 in the comparison group). This study found consistent growth in RCS and associated 95% CIs for the hospital during 2013 and 2017. The linear multilevel model showed PTP with a doctorate degree had higher RCS than those with a master's degree (beta, 1.74;P<0.001), bachelor's degree (beta, 2.02;P <0.001) and others without a degree (beta, 2.32;P<0.001). Furthermore, the PTP with intermediate (beta, 0.13;P = 0.015), vice-high (beta, 0.27;P= 0.001) and senior (beta, 0.63;P<0.001) professional titles had higher RCS than those with junior positions. Compared with PTP in the administration, those in paediatrics had higher RCS (beta, 0.28;P= 0.047) though similar to PTP in other departments. PTP with an administrative position had a higher RCS than those in non-administrative positions (beta, 0.26;P<0.001). The RCS increased with the research fund (beta, 0.15;P<0.001). However, no associations were found between RCS and sex, age, ethnic, graduate school or technical type. Conclusions HRC with associated variation of PTP for the hospital in northwest China increasingly improved and degree, professional title, administrative position, and research fund were related to HRC of PTP. Multi-central prospective studies are needed to clarify the potential relationship of related factors and HRC of PTP.

Background. Staples closure technology has been widely used in total knee arthroplasty (TKA) and achieved good results. In recent years, a new type of material called skin closure tape (SCT) has been applied to TKA which also showed good treatment results. However, since it is still not clear yet which one is better, this paper collects literatures for statistical analysis so as to provide evidence for the use of SCT in TKA. Methods. The comparative study on effects between SCT and staples is reviewed after the primary release of TKA in PubMed, the Cochrane library, and the EMBASE database up to March 2019. The two researchers independently screened the literature and evaluated the quality of the literature using bias risk tools. Results. A total of four studies (3330 knees) have been included in our meta-analysis. For the main point, the results show that the SCT can reduce readmission rates compared to staples (RR 0.68, 95% CI 0.49–0.95, P = 0.03), with no significant difference in complications (RR 0.85, 95% CI 0.27–2.64, P = 0.77). Secondly, the results suggest that although there is no significant difference in removal time between the two groups, the SCT can reduce pains, save time and costs, and have a better cosmetic effect. Conclusions. Our study indicates SCT as a closure method with fewer complications and faster speed compared with staples. Nevertheless, the cost and pain need to be further confirmed because of the small sample size included in this study.

Background White spot lesions (WSLs) are common adverse effects in fixed orthodontic treatment. Remineralising agents are widely used to prevent WSLs formation and are the first-line treatment for existing WSLs. Previous systematic reviews have evaluated the effectiveness of remineralisation agents in the management of WSLs. However, their conclusions were contradictory. The objective of this study will be to compare the effectiveness and safety of current remineralising agents used in the management of WSLs in patients treated with fixed orthodontic appliances in any orthodontic setting. Methods Literature searches will be conducted in several electronic databases (from inception onwards): MEDLINE (via Ovid), Scopus, Embase, the Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL), among others. Grey literature will be identified through searching clinical trials registries. Randomised controlled trials that compared the effectiveness of different remineralisation agents in the prevention and treatment of WSLs will be included. Two researchers will independently screen all citations, full-text articles, and abstract data. The study risk bias will be appraised using an appropriate tool. The primary outcomes will be WSLs incidence and severity of WSLs. Secondary outcomes will be subjective measures of WSLs and adverse effects. The mean difference (MD) and relative risk (RR) with corresponding 95% confidence intervals (CI) will be chosen as effect measures for continuous and binary outcomes, respectively. If feasible, fixed and random-effects pairwise meta-analyses and frequentist network meta-analyses will be conducted where appropriate. Discussion This network meta-analysis will compare the effectiveness of remineralising agents in the prevention and treatment of orthodontically induced WSLs. By integrating the evidence from direct and indirect comparisons and ranking all evaluated interventions, our findings have the potential to help clinicians make more accurate treatment decisions. Systematic review registration PROSPERO CRD42019116852, registered on March 15, 2019

Background Acupuncture is widely used worldwide, and systematic reviews on acupuncture are increasingly being published. Although acupuncture systematic reviews share several essential elements with other systematic reviews, some essential information for the application of acupuncture is not covered by the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. Considering this, we aimed to develop an extension of the PRISMA statement for acupuncture systematic reviews. Methods We used the PRISMA statement as a starting point, and conducted this study referring to the development strategy recommended by the EQUATOR network. The initial items were collected through a wide survey among evidence users and a review of relevant studies. We conducted a three-round Delphi survey and one-day face-to-face meeting to select items and formulate the checklist. After the consensus meeting, we drafted the manuscript (including the checklist) and sent it to our advisory experts for comments, following which the checklist was refined and circulated to a group of acupuncture systematic review authors for pilot test. We also selected a sample of acupuncture systematic reviews published in 2017 to test the checklist. Results A checklist of five new sub-items (including sub items) and six modified items was formulated, involving content related to title, rationale, eligibility criteria, literature search, data extraction, and study characteristics. We clarified the rationales of the items and provided examples for each item for additional guidance. Conclusion The PRISMA for Acupuncture checklist is developed for improving the reporting of systematic reviews of acupuncture interventions.

Our aim was to systematically review data about the risk of sexually transmitted infections (STI) and bacterial vaginosis among lesbian women and to suggest strategies to improve prevention, diagnosis and treatment. A search strategy for lesbian, STI and bacterial vaginosis was applied to PubMed, LILACS and BDENF databases. Of 387 unique references retrieved, 22 fulfilled the inclusion criteria (cross-sectional studies reporting prevalence for 8 STIs/bacterial vaginosis and history of a STI). The most frequent infection reported was bacterial vaginosis, and none study reported data on hepatitis B. A wide range of prevalence was observed for most infections. In terms of risk factors, the number of sexual partners, the past or current smoking, a history of forced sex and sexual stigma seem to increase the risk of STI and bacterial vaginosis. The findings of this review are discussed considering guidelines directly addressing the LGBT community's health and relevant studies investigating both safe sexual practices and the intricate relationship between LGBT people and their care providers. A set of recommendations to improve preventive care for lesbian women is proposed. Affirming that little is known about the extent of STIs and bacterial vaginosis transmission in female-to-female sexual activities or about the risk factors for STI and bacterial vaginosis among lesbian women is reasonable. In fact, the overall quality of the studies was low or very low with significant uncertainty around their findings. However, we consider that the available knowledge indicates some paths to be followed by care providers and policy decision-makers to improve their actions towards better sexual health of lesbian women.