INTRODUCTION: Exercise -based cardiac rehabilitation (CR) plays a critical role in coronary heart disease (CHD) management. There is heritage in the effect of exercise -based CR with different exercise programs or intervention settings. This study developed an evidence matrix that systematically assesses, organizes, and presents the available evidence regarding exercise -based CR in CHD management. EVIDENCE ACQUISITION: A comprehensive literature search was conducted across six databases. Two reviewers screened the identified literature, extracted relevant data, and assessed the quality of the studies. An evidence -mapping framework was established to present the findings in a structured manner. Bubble charts were used to represent the included systematic reviews (SRs). The charts incorporated information, exercise prescriptions, outcome indicators, associated P -values, research quality, and the number of original studies. A descriptive analysis summarized the types of CR, intervention settings, influential factors, and adverse events. EVIDENCE SYNTHESIS: Sixty-two SRs were included in this analysis, focusing on six exercise types in addition to assessing major adverse cardiovascular events (MACE), cost and rehabilitation outcomes. The most commonly studied exercise types were unspecified (28 studies, 45.2%) and aerobic (11 studies, 17.7%) exercises. All -cause mortality was the most frequently reported MACE outcome (22 studies). Rehabilitation outcomes primarily centered around changes in cardiac function (135 outcomes from 39 SRs). Only 8 (12.9%) studies were rated as "high quality." No significant adverse events were observed in the intervention group. Despite some variations among the included studies, most SRs demonstrated the benefits of exercise in improving one or more MACE or rehabilitation outcomes among CHD patients. CONCLUSIONS: The proportion of high -quality evidence remains relatively low. Limited evidence is available regarding the effectiveness of specific exercise types and specific populations, necessitating further evaluation.

Introduction: Health workers in rural and remote areas shoulder heavy responsibilities for rural residents. This systematic review aims to assess the effectiveness of continuing education programs for health workers in rural and remote areas.Methods: Eight electronic databases were searched on 28 November 2021. Randomized controlled trials (RCTs) and quasi -experimental studies evaluating the effectiveness of continuing education for health workers in rural and remote areas were included. The quality of the studies was assessed using the risk of bias tool provided by Effective Practice and Organization of Care. A meta-analysis was performed for eligible trials, and the other findings were presented as a narrative review because of inconsistent study types and outcomes. Results: A total of 17 studies were included, four of which were RCTs. The results of the meta-analysis showed that compared to no intervention, continuing education programs significantly improved the knowledge awareness rate of participants (odds ratio=4.09, 95% confidence interval 2.51-6.67, p<0.05). Qualitative analysis showed that 12 studies reported on the level of knowledge of participants, with all showing positive changes. Eight studies measured the performance of health workers in rural and remote areas, with 87.50% (n=7) finding improved performance. Two studies reported on the impact of continuing education programs for health workers in rural and remote areas on patient health, with only one showing a positive change. One study from India measured the health of communities, which showed a positive change.Conclusion: The results of this study showed that continuing education programs are an effective way to address the lack of knowledge and skills among health workers in rural and remote areas. Few studies have examined the effectiveness of education programs for health workers in rural and remote areas in improving patient health outcomes. It is not yet known whether the delivery of continuing education programs to health workers in rural areas has a positive impact on patient and community health. Future attention should continue to be paid to the impact on these outcomes.

This is the protocol for a Campbell systematic review. The objectives are as follows. The objectives of the present study are to answer the following questions: (1) What types of home-based interventions are currently being studied to prevent child neglect? (2) How effective are the different home-based interventions for preventing child neglect? (3) What are the causes of heterogeneity among included studies and their impact on study effects?

Gut microbiota has been identified as a unique endocrine organ linked to the development of cardiovascular disease and other illnesses, especially deteriorated in overweight and obese postmenopausal women. The object of this systematic review and meta-analysis aimed to assess the effects of oral supplementation with probiotics for overweight and obese postmenopausal women. We performed a systematic search for randomized controlled trials (RCTs) from inception to April 2022 in MEDLINE, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov. We also performed a hand search by reviewing reference lists to identify trials. The risk of bias in individual studies was assessed with the Cochrane risk of bias tool for randomized trials (RoB). Two reviewers independently selected studies and collected data. There were 6 studies from 5 RCTs with 281 participants in this systematic review. Compared with the placebo, the probiotics supplementation group had reductions in insulin (MD - 4.20 IU/L (95% CI - 8.11 to - 0.30 IU/L), I-2 = 54%), HOMA-IR (MD - 1.25 (95% CI - 2.49 to - 0.01), I-2 = 50%), and TNF-alpha (MD - 0.12 pg/mL (95% CI - 0.22 to - 0.01 pg/mL), I-2 = 44%). Improvements were also shown in body adiposity and lipid profile, but these effects were nonsignificant. In addition to body adiposity and cardiovascular risk markers, one trial showed the administration of probiotics also had an effect on iron metabolism. In conclusion, probiotics have a potential benefit on glucose metabolism and inflammatory process in overweight and obese postmenopausal women, but this effect is mild. It demonstrates that oral probiotics supplementation can be a complementary treatment for improving the fitness of postmenopausal women with overweight and obesity.

This is the protocol for a Campbell systematic review. The objectives are as follows. We will solve the following questions: (1) What are the characteristics of skills training services for individuals experiencing or at risk of homelessness? (2) How effectively do the different skills training programs improve employment status, work and life skills, or housing stability? (3) What factors are associated with the variation in the effectiveness of skills training services?

This is the protocol for an evidence and gap map. The objectives are as follows: To map available randomized control trials, economic evaluations, and systematic reviews that assess the effectiveness and cost-effectiveness of non-pharmacological interventions for older people with a diagnosis of depression and identify any existing gaps in the evidence that can inform future research.

Aim Although Cognitive behavioural therapy (CBT) potentially holds efficacy in addressing functional abdominal pain disorders (FAPDs) amongst children and adolescents, the persistent efficacy is uncertain. Methods We searched three databases to identify related randomized controlled trials (RCTs). Meta-analysis was performed using RevMan and Stata. Subgroup analyses were mainly conducted based on follow-up time. The GRADE approach was used to evaluate the certainty of the evidence. Results A total of 14 RCTs evaluating 858 patients were included. All RCTs were rated as having a high risk of bias. Compared with control groups, CBT was associated with improvement of general functional impairment (standardized mean difference (SMD) = -0.77, 95% CI [-1.12, −0.42], p < 0.05), higher treatment success (relative risk (RR) = 2.35, 95% CI [1.50, 3.69], p < 0.05), improvement of abdominal pain symptoms (SMD = −0.48, 95% CI [-0.73, −0.23], p < 0.05), QoL (SMD = 0.42, 95% CI [0.20, 0.64], p < 0.05), and psychological states (SMD = −0.95, 95% CI [-1.62, −0.27], p < 0.05). Conclusion This meta-analysis provides low to moderate quality evidence that CBT could significantly improve clinical outcomes and QoL for children and adolescents with FAPDs with improvement persisting until short-term follow-up. However, there were discrepancies regarding CBT's effects at mid- and long-term follow-up across different outcomes. More high-quality and longer-duration studies are thus warranted to explore the effectiveness of CBT in the future. Systematic review registration on prospero CRD42022369353.

Background: Metabolic syndrome has been linked to an increased risk of colorectal cancer (CRC) incidence and mortality, but whether adopting a healthy lifestyle could attenuate the risk of CRC conferred by metabolic syndrome remains unclear. The aim of the study is to investigate the individual and joint effects of modifiable healthy lifestyle and metabolic health status on CRC incidence and mortality in the UK population. Methods: This prospective study included 328,236 individuals from the UK Biobank. An overall metabolic health status was assessed at baseline and categorized based on the presence or absence of metabolic syndrome. We estimated the association of the healthy lifestyle score (derived from 4 modifiable behaviors: smoking, alcohol consumption, diet, physical activity and categorized into "favorable," "intermediate", and "unfavorable") with CRC incidence and mortality, stratified by metabolic health status. Results: During a median follow-up of 12.5 years, 3,852 CRC incidences and 1,076 deaths from CRC were newly identified. The risk of incident CRC and its mortality increased with the number of abnormal metabolic factors and decreased with healthy lifestyle score (P trend = 0.000). MetS was associated with greater CRC incidence (HR = 1.24, 95% CI: 1.16 - 1.33) and mortality (HR = 1.24, 95% CI: 1.08 - 1.41) when compared with those without MetS. An unfavorable lifestyle was associated with an increased risk (HR = 1.25, 95% CI: 1.15 - 1.36) and mortality (HR = 1.36, 95% CI: 1.16 - 1.59) of CRC across all metabolic health status. Participants adopting an unfavorable lifestyle with MetS had a higher risk (HR = 1.56, 95% CI: 1.38 - 1.76) and mortality (HR = 1.75, 95% CI: 1.40 - 2.20) than those adopting a favorable healthy lifestyle without MetS. Conclusion: This study indicated that adherence to a healthy lifestyle could substantially reduce the burden of CRC regardless of the metabolic status. Behavioral lifestyle changes should be encouraged for CRC prevention even in participants with MetS.

Background and ObjectiveConsidering that physicians and patients widely use acupuncture, it is necessary to explore its adverse effects during treatment. Herein, an evidence map was generated based on published studies to identify acupuncture-induced adverse effects and assess their severity, with the overarching goal of providing references for safe and effective implementation.MethodsA comprehensive literature search was performed in four public databases (PubMed, Embase, Web of science, and the Cochrane Library) to identify relevant studies published up to 15(th) June 2022. In addition, relevant studies were explored in the Epistemonikos database and reference lists were retrieved as a supplement. A MeaSurement Tool to Assess systematic Reviews, Version 2 (AMSTAR-2) quality assessment tool was applied to determine the methodological quality of included systematic reviews (SRs) and/or meta-analysis (MAs), whereas Microsoft Excel 2019 tool was used for data extraction and coding. Heatmaps were generated to display disease type, countries of origin for the first authors, and the sample sizes of original studies. Moreover, bubble charts comprehensively presented intervention categories, adverse reaction types, and evidence levels.ResultsA total of 535 SRs involving 33 adverse reactions were included. Among them, 22 studies were rated as high quality, 28 as moderate, 106 as low, and the rest were of critically-low quality. Numerous adverse effects were described in the studies, including syncope (86 SRs), organ or tissue injury (233 SRs), systemic reactions (113 SRs), infection (19 SRs), and other adverse events (373 SRs). Importantly, these adverse reactions were mainly associated with 19 acupuncture techniques, including electroacupuncture (n = 67), manual acupuncture (n = 47) and acupoint catgut embedding (n = 41). Furthermore, the 535 SRs described 23 diseases, among which symptoms, signs or clinical findings (83 SRs), mental, behavioral or neurodevelopmental disorders (67 SRs), and diseases of the nervous system (66 SRs) had the highest incidence.ConclusionThis evidence mapping explores the adverse effects of acupuncture, showing that there are multiple types of adverse reactions to acupuncture, with milder symptoms. The methodological assessment revealed that most of the included studies were of low- or critically low-quality. Therefore, there is a need for future randomized controlled trials and SRs to comprehensively analyze acupuncture-related adverse events in order to provide reliable and credible evidence.

Background and Objectives: To evaluate and map the reporting and methodological quality of network meta-analysis (NMA) on acupuncture.Methods: Published acupuncture NMAs were searched through eight databases from inception to February 2022. The reporting and methodological quality of included studies was assessed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Network Meta-Analysis (PRISMA-NMA) statement and the Assessment of Multiple Systematic Reviews 2 (AMSTAR-2) checklist.Results: A total of 113 NMAs were identified. Most (99, 87.61%) studies were performed in China. Most studies focused on multiple acupuncture techniques (82.30%), and the main studied ailments were pain and poststroke sequelae (20.24%). The median (interquartile range (IQR)) score of the reporting quality was 26.5 (25-28.5). However, poor reporting rates in the protocol and registration (33.63%) and geometry of the network (35.40%), especially for China-based studies, were identified. The methodological quality of only 2 (1.77%) English studies was high. The reporting rate of Chinese studies was below 15% on each of items 4, 7, 10, and 12.Conclusion: The reporting quality of the NMAs was moderate, but the methodological quality was very low. The reporting and methodological quality of future NMAs, especially for Chinese studies, need further improvement. (c) 2022 Elsevier Inc. All rights reserved.