Veronica Phillips

Little is known about the stigma and discrimination children with leprosy are subject to and the subsequent impact on their psychological well-being. The aim of this study is to systematically review the literature for evidence that closes this knowledge gap and informs practice. In line with a PRISMA-P Protocol (PROSPERO CRD420251089128), we conducted a systematic review, underpinned by an extensive search strategy. There was no inclusion restriction on methodology, time period, country, or language. Data extraction was completed through a double-review process, which was guided by a deductive theoretical framework and shaped by inductive coding. This was followed by a data synthesis and double-blinded quality appraisal. The search strategy identified 914 items. Following a double-blind review with conflict mediation, we included 48 items. The review found evidence for nine domains of discrimination, 16 stigma types, and seven individual-level mental health responses. Social/interpersonal stigma and affective/cognitive mental health responses were the most prevalent findings. Fourteen moderating factors were identified, with disease awareness/knowledge the most frequent. Children affected by leprosy are subject to multiple stigma types and discrimination in numerous life domains, which adversely affects their mental health. Policy and practice recommendations include a multisectoral response including community engagement, public health and education sectors, a whole-family approach including all family members directly/indirectly affected by leprosy, and recognition of the inter-relationships between moderating factors. Despite the novel findings this review presents, there are limitations stemming from the dataset and from methodological choices. Given the gaps in primary academic research and the identified limitations, the topic deserves substantial future attention.

Introduction Paediatric major trauma patients with more severe injuries and physiological or biochemical abnormalities as a result of the injury are more likely to require invasive management in the form of an operation/interventional radiology (IR). Adverse psychological outcomes, such as post-traumatic stress disorder, anxiety, depression and adjustment disorder, are frequently observed in paediatric patients with major trauma. Similarly, it is recognised that children and adolescents who have invasive management are also at an increased risk of adverse psychological outcomes. However, it is not known to what extent major trauma patients requiring invasive management are at risk of adverse psychological outcomes compared with those managed conservatively. This study aims to determine whether paediatric major trauma patients who require an operation/IR have increased odds of having an adverse psychological outcome compared with those who are managed conservatively. Methods and analysis The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines will be used to construct this review. The databases Medline (via Ovid), Embase (via Ovid), PsycInfo (via Ebscohost) and Cinahl (via Ebscohost) will be searched from inception to February 2025. Both title and abstract screening and full-text screening will be done by two reviewers, with an adjudicating third reviewer. For randomised controlled trials, the Cochrane Risk of Bias Tool will be employed, while for non-randomised studies, the Newcastle-Ottawa Quality Assessment Scale will be used. We will assess bias using contoured funnel plots (with p set at 0.01, 0.05 and 0.10), non-parametric trim-fill analysis, leave-one-out analysis and Galbraith plotting. We will execute formal (Egger) testing for funnel plot asymmetry and also calculate prediction intervals if sufficient study N of 10 is accrued. Certainty and confidence in cumulative evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Ethics and dissemination Ethical review is not required as no original data will be collected. Results will be disseminated through peer-reviewed publications and at academic conferences. PROSPERO registration number CRD42025643459.

Background: Cerebral small vessel disease (CSVD) is a common neurological condition that contributes to strokes, dementia, disability, and mortality worldwide. We conducted a systematic review and meta-analysis to investigate the use of neuroimaging CSVD markers in machine learning (ML) based diagnosis and prognosis of cognitive impairment and dementia, and identify both methodological changes over time and barriers to clinical translation. Methods: Following the PRISMA guidelines, we systematically searched for original studies that used both neuroimaging CSVD markers and ML methods for diagnosing and prognosing neurodegenerative diseases (preregistration in PROSPERO: CRD42022366767). Each paper was independently reviewed by a pair of reviewers at all stages, with a third consulted to resolve conflicts. We meta-analysed the effectiveness of ML models to distinguish healthy controls from Alzheimer’s dementia and cognitive impairment, using area under the curve (AUC) as the performance metric. Results: We identified 75 studies: 43 on diagnosis, 27 on prognosis, and 5 on both. Nearly 60% of studies were published in the past two years, reflecting a growing interest in using CSVD markers in ML-based diagnosis and prognosis of neurodegenerative diseases, especially Alzheimer’s dementia. This rising interest may be linked to the strong performance of such models: according to our meta-analysis, ML approaches using CSVD markers perform well in differentiating healthy controls from Alzheimer’s dementia (AUC 0.88 [95%-CI 0.85–0.92]) and cognitive impairment (AUC 0.84 [95%-CI 0.74–0.95]). However, the growing interest has not been matched by methodological rigour: only 16 studies met the criteria for inclusion in the meta-analysis due to inconsistent reporting, only five assessed the generalisability of their models on external datasets, and six lacked clear diagnostic criteria. Conclusions: Interest in incorporating CSVD markers into ML models for neurodegenerative disease classification is on the rise, and their performance suggests that this is worth further exploration. Serious methodological issues, including inconsistent reporting, limited generalisability testing, and other potential biases, are unfortunately common and hinder further adoption. Our targeted recommendations provide a roadmap to accelerate the integration of ML into clinical practice.

SUMMARY: Background: Consumption of sugar-sweetened beverages (SSBs) is associated with weight, weight gain and incidence of a number of chronic diseases. The World Health Organization recommends taxation on SSBs to reduce consumption. In 2018 the United Kingdom introduced the Soft Drinks Industry Levy (SDIL), a tiered tax on manufacturers and importers of SSBs. We aimed to review the consequences of the SDIL across all potential outcomes, informed by a systems thinking approach, to understand the range and importance of its effects. Methods: We undertook a systematic scoping review of empirical studies of the SDIL. We used a conceptual systems map of the hypothesised pathways of effect to inform data extraction and narrative synthesis. Findings are presented in an evidence map and their consistency assessed. Results: 38 studies met our inclusion criteria. The SDIL was consistently associated with reformulation of soft drinks to reduce sugar content. It was also consistently associated with: reduced purchasing of sugar from eligible drinks without increasing purchasing of substitute products such as alcohol and confectionary; longer-term improvements in acute and chronic health outcomes; and reduced health and social care costs, with few negative economic impacts for industry. Conclusions: By systematically mapping all outcomes evaluated, we have demonstrated the systemic and interconnected impacts of the SDIL. Further research should seek deeper understanding of how to evaluate such interventions as events in complex adaptive systems.

Objective: To evaluate the overall risk of conversion from unilateral to bilateral Méniere's disease (MD), the time interval from initial diagnosis to conversion, and any risk factors or audiometric trends associated with this process. Databases Reviewed: Medline, Embase, Cochrane Library, Scopus, Web of Science, and ClinicalTrials.Gov. Methods: This review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies reporting longitudinal progression of unilateral to bilateral MD were included. Random-effects meta-analyses were performed to evaluate the proportion of cases that converted and the mean time to conversion, and a narrative synthesis described risk factors and audiometric data. Results: A total of 11 studies met the inclusion criteria. For overall conversion risk, meta-analysis of the 9 relevant studies (n = 1583) yielded a risk of 13% (95% CI, 12–15%). Mean time to conversion was 8.2 years (95% CI, 5.9–10.6; I ² = 46%), and a combined Kaplan-Meier analysis revealed a prolonged distribution of conversions including 10% that converted 20 years or later after initial diagnosis. Risk factors and audiometric data were sparsely reported, but there may be a correlation between conversion risk and first-sided ear surgery (protective), history of tympanic membrane perforation, and baseline hearing loss in the unaffected ear. Conclusion: There is a significant risk of conversion from unilateral to bilateral MD that must be taken into account when considering ablative treatment options, even late into its course. Further work will be required to better characterize risk/protective factors and audiometric trends.

Background: The acute mortality and morbidity associated with COVID-19 are well recognised, but the longer-term consequences for patients who survive hospitalisation are less clear. This systematic review aims to establish the longer-term (90 days or beyond) readmission and all-cause mortality outcomes of adult patients discharged after an index hospital admission with COVID-19. Methods: The systematic review was registered with PROSPERO (CRD42021253290) and reported according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Five databases were searched on 7 May 2024 for studies in English: Medline, Embase, Scopus, Web of Science and Global Health. Two reviewers independently screened studies and assessed eligibility. Risk of bias assessments were undertaken using ROBINS-E, funnel plots and Egger's test. The GRADE framework was used to evaluate the evidence quality. Data were pooled using a random-effects model with sensitivity and subgroup analyses. Results: Of 339 studies screened for morbidity, 39 were included (295 892 patients). Meta-analysis showed readmission frequency was 12% (95% CI 9–16%) at 90+ days (range 3–22 months). Of 5831 studies screened for mortality, 56 were included (176 920 patients). The post-hospital all-cause mortality was 5% (95% CI 4–6%) at 90+ days (range 3–36 months). Heterogeneity and risk of bias were generally high, with possible publication bias, resulting in GRADE evidence quality being very low. Conclusions: Patients who survive an index hospital admission with COVID-19 remain at longer-term risk of hospital readmission and/or death following discharge, which has implications for healthcare resource allocation and planning, and the search for interventions to reduce chronic complications.

Background/Objectives: Cochlear implantation (CI) is an effective intervention for individuals with severe to profound hearing loss; however, it may impact vestibular function due to its proximity to related anatomical structures. Vestibular evoked myogenic potentials (VEMPs) assess the function of the saccule and utricle, critical components of the vestibular system. This review examines CI’s impact on air conduction (AC) and bone conduction (BC) VEMP responses. Methods: A scoping review was conducted following PRISMA guidelines, using databases such as Medline, Embase, Cochrane Library, Scopus, and ProQuest Dissertations. Studies reporting on AC and/or BC-VEMP in CI recipients were included. Data extraction focused on VEMP response rates, amplitudes, and latencies pre- and post-CI. Risk of bias/quality assessment was performed using the Newcastle–Ottawa Scale. Results: Out of 961 studies identified, 4 met the inclusion criteria, encompassing a total of 245 CI-implanted ears. Results indicated that AC-VEMP responses were often reduced or absent post-CI, reflecting the influence of surgical changes in the middle ear mechanics rather than otolith dysfunction. In contrast, BC-VEMP responses were more consistently preserved, suggesting that BC stimuli bypass the middle ear and more accurately delineate otolith function. Variations in VEMP outcomes were noted depending on the surgical approach and individual patient factors. Conclusions: CI impacts vestibular function as measured by VEMP, with AC-VEMP showing greater susceptibility to postoperative changes compared to BC-VEMP. The presence of preserved BC-VEMP alongside absent AC-VEMP underscores the need to differentiate between these measures in assessing vestibular function.

Background: Extrusion of electrodes outside the cochlea and tip fold overs may lead to suboptimal outcomes in cochlear implant (CI) recipients. Intraoperative measures such as Trans-Impedance Matrix (TIM) measurements may enable clinicians to identify electrode malposition and direct surgeons to correctly place the electrode array during surgery. Objectives: To assess the current literature on the effectiveness of TIM measurements in identifying extracochlear electrodes and tip fold overs. Methods: A scoping review of studies on TIM-based measurements were carried out using the Databases-Medline/PubMed, AMED, EMBASE, CINAHL and the Cochrane Library following PRISMA guidelines. Eleven full texts articles met the inclusion criteria. Only human studies pertaining to TIM as a tool used in CI were included in the review. Further, patient characteristics, electrode design, and TIM measurement outcomes were reported. Results: TIM measurements were available for 550 implanted ears with the subjects age ranged between 9 months to 89 years. Abnormal TIM measurements were reported for 6.55% (36). Tip fold over was detected in 3.64% (20) of the cases, extracochlear electrodes in 1.45% (8), and 1.45% (8) were reported as buckling. Slim-modiolar electrode array designs were more common (54.71%) than pre-curved (23.34%) or lateral wall (21.95%) electrode array. Abnormal cochlear anatomy was reported for five ears (0.89%), with normal cochlear anatomy for all other patients. Conclusion: TIM measurement is a promising tool for the intraoperative detection of electrode malposition. TIM measurement has a potential to replace intraoperative imaging in future. Though, TIM measurement is in its early stages of clinical utility, intuitive normative data sets coupled with standardised criteria for detection of abnormal electrode positioning would enhance its sensitivity.