scholarly journals The worldwide burden of HIV in transgender individuals: An updated systematic review and meta-analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0260063
Author(s):  
Sarah E. Stutterheim ◽  
Mart van Dijk ◽  
Haoyi Wang ◽  
Kai J. Jonas
Keyword(s):  
Systematic Review ◽  
Sampling Methods ◽  
Meta Analysis ◽  
Geographic Region ◽  
Hiv Prevalence ◽  
Future Research ◽  
Care Needs ◽  
Hiv Risks ◽  
Exposure Prophylaxis ◽  
The Impact

Introduction Transgender individuals are at risk for HIV. HIV risks are dynamic and there have been substantial changes in HIV prevention (e.g., pre-exposure prophylaxis [PrEP]). It is thus time to revisit HIV prevalence and burden among transgender individuals. The objective of this systematic review and meta-analysis was thus to examine worldwide prevalence and burden of HIV over the course of the epidemic among trans feminine and trans masculine individuals. Methods We conducted an updated systematic review by searching PsycINFO, PubMed, Web of Science, and Google Scholar, for studies of any research design published in in a peer-reviewed journal in any language that reported HIV prevalence among transgender individuals published between January 2000 and January 2019. Two independent reviewers extracted the data and assessed methodological quality. We then conducted a meta-analysis, using random-effects modelling, to ascertain standardized prevalence and the relative burden of HIV carried by transgender individuals by country and year of data collection, and then by geographic region. We additionally explored the impact of sampling methods and pre-exposure prophylaxis (PrEP). Results Based on 98 studies, overall standardized HIV prevalence over the course of the epidemic, based on weights from each country by year, was 19.9% (95% CI 14.7% - 25.1%) for trans feminine individuals (n = 48,604) and 2.56% (95% CI 0.0% - 5.9%) for trans masculine individuals (n = 6460). Overall OR for HIV infection, compared with individuals over age 15, was 66.0 (95% CI 51.4–84.8) for trans feminine individuals and 6.8 (95% CI 3.6–13.1) for trans masculine individuals. Prevalence varied by geographic region (13.5% - 29.9%) and sampling method (5.4% - 37.8%). Lastly, PrEP effects on prevalence could not be established. Conclusion Trans feminine and trans masculine individuals are disproportionately burdened by HIV. Their unique prevention and care needs should be comprehensively addressed. Future research should further investigate the impact of sampling methods on HIV prevalence, and monitor the potential impact of PrEP.

scholarly journals Impact of cardiovascular disease and cardiac injury on in-hospital mortality in patients with COVID-19: a systematic review and meta-analysis

Heart ◽  
2020 ◽  
Vol 106 (15) ◽  
pp. 1142-1147 ◽  
Author(s):  
Xintao Li ◽  
Bo Guan ◽  
Tong Su ◽  
Wei Liu ◽  
Mengyao Chen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiovascular Disease ◽  
Hospital Mortality ◽  
Mortality Risk ◽  
Meta Analysis ◽  
Cardiac Injury ◽  
Sensitivity Analyses ◽  
Future Research ◽  
Cardiovascular Comorbidities ◽  
The Impact

BackgroundCoronavirus disease 2019 (COVID-19) has produced a significant health burden worldwide, especially in patients with cardiovascular comorbidities. The aim of this systematic review and meta-analysis was to assess the impact of underlying cardiovascular comorbidities and acute cardiac injury on in-hospital mortality risk.MethodsPubMed, Embase and Web of Science were searched for publications that reported the relationship of underlying cardiovascular disease (CVD), hypertension and myocardial injury with in-hospital fatal outcomes in patients with COVID-19. The ORs were extracted and pooled. Subgroup and sensitivity analyses were performed to explore the potential sources of heterogeneity.ResultsA total of 10 studies were enrolled in this meta-analysis, including eight studies for CVD, seven for hypertension and eight for acute cardiac injury. The presence of CVD and hypertension was associated with higher odds of in-hospital mortality (unadjusted OR 4.85, 95% CI 3.07 to 7.70; I2=29%; unadjusted OR 3.67, 95% CI 2.31 to 5.83; I2=57%, respectively). Acute cardiac injury was also associated with a higher unadjusted odds of 21.15 (95% CI 10.19 to 43.94; I2=71%).ConclusionCOVID-19 patients with underlying cardiovascular comorbidities, including CVD and hypertension, may face a greater risk of fatal outcomes. Acute cardiac injury may act as a marker of mortality risk. Given the unadjusted results of our meta-analysis, future research are warranted.

scholarly journals Prevalence and associated factors of active smoking among individuals living with hypertension and/or diabetes in Africa: a systematic review and meta-analysis protocol

BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e015444 ◽  
Author(s):  
Guy S Wafeu ◽  
Aurel T Tankeu ◽  
Francky Teddy A Endomba ◽  
Jobert Richie Nansseu ◽  
Arnaud D Kaze ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Geographic Region ◽  
Future Research ◽  
P Value ◽  
Published Data ◽  
Final Report ◽  
Active Smoking ◽  
Analysis Model ◽  
Factors Associated

IntroductionTobacco use significantly increases cardiovascular complications in people living with hypertension and/or diabetes. We aim to summarise data on the prevalence and factors associated with active smoking in these conditions in Africa.Method and analysisWe will search PubMed, Embase, Google Scholar and African Journals Online for relevant abstracts of studies on active smoking in individuals living with diabetes and/or hypertension published from 1 January 2000 to 31 December 2016, with no language restriction. Additionally, relevant unpublished papers and conference proceedings will be checked, as well as references of included articles. Two investigators will independently screen, select studies, extract data and assess the risk of bias in each study. Data will be analysed using Stata software (Stata V.14, Texas, USA). The study-specific estimates will be pooled through a random-effects meta-analysis model to obtain an overall summary estimate of the prevalence of smoking across studies. Also, we will assess factors associated to smoking. Heterogeneity of studies will be evaluated by the χ2 test on Cochrane’s Q statistic. Funnel plots analysis and Egger’s test will be done to detect publication bias. Results will be presented by geographic region (central, eastern, northern, southern and western Africa). A p value less than 0.05 will be considered significant for factors associated to smoking.Ethics and disseminationThis study is based on published data, and therefore ethical approval is not a requirement. This systematic review and meta-analysis is expected to serve as a basis for designing cost-effective interventions to reduce and prevent smoking in patients with diabetes and/or hypertension, and as a guide for future research based on the remaining gaps. The final report of this study in the form of a scientific paper will be published in peer-reviewed journals. Findings will further be presented at conferences and submitted to relevant health authorities.

scholarly journals The Impact of Childhood Psychological Maltreatment on Mental Health Outcomes in Adulthood: A Protocol for a Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Zhuoni Xiao ◽  
Mina Murat Baldwin ◽  
Franziska Meinck ◽  
Ingrid Obsuth ◽  
Aja Louise Murray
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Emotional Abuse ◽  
Meta Analysis ◽  
Psychological Maltreatment ◽  
Future Research ◽  
Long Term Effects ◽  
Post Traumatic Stress ◽  
Eligibility Criteria ◽  
The Impact

Abstract Background: Research suggests that childhood psychological maltreatment (i.e., emotional abuse and emotional neglect) is associated with mental and physical health problems that persist into adulthood, for example anxiety, depression, post-traumatic stress disorder (PTSD), suicidal ideation, and aggression; however, a systematic review and meta-analysis of the existing literature would help clarify the magnitude and moderators of these associations, and the extent to which they may be affected by publication bias, as well as the methodological strengths and weakness of studies in this area.Method: Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guideline will be employed to structure the review. Several searches will be carried out via databases including Web of Science, Medline, PubMed, PsycINFO, Applied Social Science Index and Abstract, ERIC and EMBASE. Empirical peer reviewed research articles that fit pre-specified eligibility criteria will be included in the review. This review will include literature written in either English or Chinese. Two independent reviewers will screen and assess studies for inclusion in the review as well as extract the data, with consensus reached through discussion in cases of discrepancy. A third reviewer will be consulted to resolve any discrepancies that cannot be resolved through discussion between the original reviewers. The relevant Newcastle-Ottawa scales will be used for assessing the quality of studies. If a sufficient number of comparable studies are retrieved, a meta-analysis will be conducted using a random effects model. Discussion: This systematic review will provide an understanding of the long-term effects of childhood psychological maltreatment on adult mental health, which adds to previous reviews focusing primarily on the effects of physical and sexual abuse. The results of the review will help inform clinical practice in approaches to treating those with a history of psychological maltreatment in childhood. The gaps and weaknesses in the evidence identified will also inform recommendations for future research.

scholarly journals Remote home monitoring (virtual wards) during the COVID-19 pandemic: a living systematic review

2020 ◽  
Author(s):  
Cecilia Vindrola-Padros ◽  
Kelly E Singh ◽  
Manbinder S Sidhu ◽  
Theo Georghiou ◽  
Chris Sherlaw-Johnson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Patient Safety ◽  
Outcome Measures ◽  
Secondary Care ◽  
Meta Analysis ◽  
Eligible Patient ◽  
Home Monitoring ◽  
Healthcare Sector ◽  
Future Research ◽  
The Impact

ABSTRACTObjectivesThe aim of this review was to analyse the implementation and impact of remote home monitoring models (virtual wards) during COVID-19, identifying their main components, processes of implementation, target patient populations, impact on outcomes, costs and lessons learnt. The review will be kept ‘live’ through regular updates.DesignThe review was designed as a living systematic review to capture a rapidly evolving evidence base. We used the Preferred Reporting Items for Systematic Reviews and Meta- Analysis (PRISMA) statement.SettingThe review included remote home monitoring models led by primary and secondary care across seven countries.Participants17 examples of remote home monitoring models were included in the review.Main outcome measuresImpact of remote home monitoring on virtual length of stay, escalation, Emergency department attendance/reattendance, admission/readmission and mortality.ResultsThe primary aim of the remote home monitoring models was the early identification of deterioration for patients self-managing COVID-19 symptoms at home. Most models were led by secondary care. Broad criteria for the eligible patient population were used and confirmation of COVID-19 was not required (in most cases). Monitoring was carried via online platforms, paper-based systems with telephone calls or (less frequently) through wearable sensors. We could not reach conclusions regarding patient safety and the identification of early deterioration due to lack of standardised reporting across articles and missing data. None of the articles reported any form of economic analysis, beyond how the resources were used.ConclusionsThe review pointed to variability in the implementation of the models, in relation to healthcare sector, monitoring approach and selected outcome measures. Lack of standardisation on reporting prevented conclusions on the impact of remote home monitoring on patient safety or early escalation during COVID-19. Future research should focus on staff and patient experiences of care and potential inequalities in patients’ access to these models. Attention needs to be paid to the processes used to implement these models, the evaluation of their impact on patient outcomes through the use of comparators, the use of risk-stratification tools, and cost-effectiveness of the models and their sustainability.Protocol registrationThe review protocol was published on PROSPERO (CRD: 42020202888).

scholarly journals A systematic review exploring the bidirectional relationship between puberty and autoimmune rheumatic diseases

2020 ◽  
Author(s):  
Nina M de Gruijter ◽  
Meena Naja ◽  
Hannah Peckham ◽  
Anna Radziszewska ◽  
Matthew Kinsella ◽  
...  
Keyword(s):  
Systematic Review ◽  
Rheumatic Diseases ◽  
Lupus Erythematosus ◽  
Meta Analysis ◽  
Severe Disease ◽  
Delayed Puberty ◽  
Future Research ◽  
Autoimmune Rheumatic Diseases ◽  
Bidirectional Relationship ◽  
The Impact

Abstract Background: Autoimmune rheumatic diseases (ARDs) are associated with a significant sex-bias which becomes more evident post-puberty. This systematic review aims to elucidate the bidirectional relationship between puberty and ARDs related outcomes.Methods: Studies published in English until October 2019 were identified using a systematic search of endocrinology and rheumatology literature. Information was extracted on study design, sample size, demographics, puberty outcome measures, and main findings. The methodological quality of the studies included was analysed using the Newcastle-Ottawa Scale (NOS).Results: 14 non-randomised studies reporting on the impact of puberty on ARD outcomes (n = 7), ARD impact on puberty-related outcomes (n = 6), or both (n = 1) have been identified. The impact of puberty on ARD outcomes have been investigated in patients with juvenile idiopathic arthritis (JIA)-associated uveitis (n = 1), juvenile systemic lupus erythematosus (JSLE) (n = 5) or in healthy controls who developed adult-onset SLE (n = 1) or had non-specific symptoms (n = 1). The impact of ARD on puberty outcomes was explored in JIA (n = 4) and JSLE (n = 3). Quality assessment of studies showed a small to moderate risk of bias overall (NOS 4–9/9). Due to large heterogeneity of the studies it was not possible to perform a meta-analysis. Multiple studies reported on delayed puberty in patients with JIA/JSLE, menstrual and hormonal abnormalities, and lower height and weight than controls. Earlier (pre-pubertal) onset of JSLE was correlated with more severe disease and more need for systemic treatment.Conclusion: A bidirectional relationship exists between puberty and ARDs; however, more and better research is required to elucidate the complexity of this relationship. We propose puberty-related clinical assessments in patients with ARDs, which can improve patient outcomes and facilitate future research.

Systematic review and meta-analysis of interventions for operating room to intensive care unit handoffs

2021 ◽  
pp. bmjqs-2020-012474
Author(s):  
Joanna Abraham ◽  
Alicia Meng ◽  
Sanjna Tripathy ◽  
Michael S Avidan ◽  
Thomas Kannampallil
Keyword(s):  
Systematic Review ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Operating Room ◽  
Meta Analysis ◽  
Intervention Group ◽  
Future Research ◽  
Original Research ◽  
Cochrane Central Register ◽  
The Impact

ObjectiveTo conduct a systematic review and meta-analysis to ascertain the impact of operating room (OR) to intensive care unit (ICU) handoff interventions on process-based and clinical outcomes.MethodWe included all English language, prospective evaluation studies of OR to ICU handoff interventions published as original research articles in peer-reviewed journals. The search was conducted on 11 November 2019 on MEDLINE, CINAHL, EMBASE, Scopus and the Cochrane Central Register of Controlled Trials databases, with no prespecified criteria for the type of comparison or outcome. A meta-analysis of similar outcomes was conducted using a random effects model. Quality was assessed using a modified Downs and Black (D&B) checklist.Results32 studies were included for review. 31 studies were conducted at a single site and 28 studies used an observational study design with a control. Most studies (n=28) evaluated bundled interventions which comprised information transfer/communication checklists and protocols. Meta-analysis showed that the handoff intervention group had statistically significant improvements in time to analgesia dosing (mean difference (MD)=−42.51 min, 95% CI −60.39 to −24.64), fewer information omissions (MD=−2.22, 95% CI −3.68 to –0.77), fewer technical errors (MD=−2.38, 95% CI −4.10 to –0.66) and greater information sharing scores (MD=30.03%, 95% CI 19.67% to 40.40%). Only 15 of the 32 studies scored above 9 points on the modified D&B checklist, indicating a lack of high-quality studies.DiscussionBundled interventions were commonly used to support OR to ICU handoff standardisation. Although the meta-analysis showed significant improvements for a number of clinical and process outcomes, the statistical and clinical heterogeneity must be accounted for when interpreting these findings. Implications for OR to ICU handoff practice and future research are discussed.

scholarly journals Influence of Plant and Animal Proteins on Inflammation Markers among Adults with Chronic Kidney Disease: A Systematic Review and Meta-Analysis

Nutrients ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 1660
Author(s):  
Danielle Francesca Aycart ◽  
Sofía Acevedo ◽  
Lucía Eguiguren-Jimenez ◽  
Jeanette Mary Andrade
Keyword(s):  
Systematic Review ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Meta Analysis ◽  
Protein Isolate ◽  
Risk Of Bias ◽  
Future Research ◽  
Plant Proteins ◽  
Inflammation Markers ◽  
The Impact

Proteins, especially plant proteins, may reduce inflammation among adults with chronic kidney disease (CKD). This systematic review and meta-analysis were conducted to evaluate the effect protein types (animal or plant) have on inflammation markers (CRP, IL-6, TNF-α) among adults with varying stages of CKD. The Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) was conducted to identify articles from inception until January 2021, utilizing six databases. Controlled trials that compared the effects of different protein types were analyzed using random-effects meta-analysis. Quality assessment and risk of bias of the included articles were assessed by using Cochrane risk of bias instrument and ROBINS-I. Out of the 10 studies that met the criteria, there was a decreasing trend in CRP levels when consuming plant proteins compared to animal proteins among non-dialysis participants. There was a statistically significant decrease when comparing animal proteins to unspecified proteins in CRP levels among dialysis participants [Hedges’ g = 2.11; 95% CI 1.12, 3.11; p ≤ 0.001], favoring unspecified proteins. Furthermore, animal proteins (eggs, red meat) showed increasing trends in CRP levels compared to whey protein isolate. Caution must be considered regarding these results as controlled, non-randomized, trials were included in the analysis, which may have contributed to high risk of bias. Future research should focus on protein types and the impact they have on kidney disease progression and inflammation markers.

scholarly journals The Effects of Gamification on Computerized Cognitive Training: Systematic Review and Meta-Analysis

10.2196/18644 ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. e18644 ◽  
Author(s):  
Julie F Vermeir ◽  
Melanie J White ◽  
Daniel Johnson ◽  
Geert Crombez ◽  
Dimitri M L Van Ryckeghem
Keyword(s):  
Systematic Review ◽  
Cognitive Training ◽  
Meta Analysis ◽  
Empirical Studies ◽  
Age Groups ◽  
Future Research ◽  
Computerized Cognitive Training ◽  
Meta Analyses ◽  
Game Elements ◽  
The Impact

Background There has been a growing interest in the application of gamification (ie, the use of game elements) to computerized cognitive training. The introduction of targeted gamification features to such tasks may increase motivation and engagement as well as improve intervention effects. However, it is possible that game elements can also have adverse effects on cognitive training (eg, be a distraction), which can outweigh their potential motivational benefits. So far, little is known about the effectiveness of such applications. Objective This study aims to conduct a systematic review and meta-analysis to investigate the effect of gamification on process outcomes (eg, motivation) and on changes in the training domain (eg, cognition), as well as to explore the role of potential moderators. Methods We searched PsycINFO, Cumulative Index to Nursing and Allied Health Literature, ProQuest Psychology, Web of Science, Scopus, PubMed, Science Direct, Excerpta Medica dataBASE, Institute of Electrical and Electronics Engineers Xplore, Association for Computing Machinery, and a range of gray-area literature databases. The searches included papers published between 2008 and 2018. Meta-analyses were performed using a random-effects model. Results The systematic review identified 49 studies, of which 9 randomized controlled trials were included in the meta-analysis. The results of the review indicated that research in this context is still developing and lacks well-controlled empirical studies. Gamification in cognitive training is applied to a large range of age groups and audiences and is mostly delivered at a research site through computers. Rewards and feedback continue to dominate the gamification landscape, whereas social-oriented features (eg, competition) are underused. The meta-analyses showed that gamified training tasks were more motivating/engaging (Hedges g=0.72) and more demanding/difficult (Hedges g=–0.52) than non- or less-gamified tasks, whereas no effects on the training domain were found. Furthermore, no variables moderated the impact of gamified training tasks. However, meta-analytic findings were limited due to a small number of studies. Conclusions Overall, this review provides an overview of the existing research in the domain and provides evidence for the effectiveness of gamification in improving motivation/engagement in the context of cognitive training. We discuss the shortcomings in the current literature and provide recommendations for future research.

scholarly journals A systematic review of the relationship between behavioral and psychological symptoms (BPSD) and caregiver well-being

2016 ◽  
Vol 28 (11) ◽  
pp. 1761-1774 ◽  
Author(s):  
Alexandra Feast ◽  
Esme Moniz-Cook ◽  
Charlotte Stoner ◽  
Georgina Charlesworth ◽  
Martin Orrell
Keyword(s):  
Systematic Review ◽  
Motor Behavior ◽  
Psychological Symptoms ◽  
Meta Analysis ◽  
Well Being ◽  
Future Research ◽  
The Individual ◽  
The Impact ◽  
Behavioral And Psychological Symptoms

ABSTRACTBackground:Behavioral and psychological symptoms in dementia (BPSD) are important predictors of institutionalization as well as caregiver burden and depression. Previous reviews have tended to group BPSD as one category with little focus on the role of the individual symptoms. This review investigates the role of the individual symptoms of BPSD in relation to the impact on different measures of family caregiver well-being.Methods:Systematic review and meta-analysis of papers published in English between 1980 and December 2015 reporting which BPSD affect caregiver well-being. Paper quality was appraised using the Downs and Black Checklist (1998).Results:Forty medium and high quality quantitative papers met the inclusion criteria, 16 were suitable to be included in a meta-analysis of mean distress scores. Depressive behaviors were the most distressing for caregivers followed by agitation/aggression and apathy. Euphoria was the least distressing. Correlation coefficients between mean total behavior scores and mean distress scores were pooled for four studies. Irritability, aberrant motor behavior and delusions were the most strongly correlated to distress, disinhibition was the least correlated.Conclusions:The evidence is not conclusive as to whether some BPSD impact caregiver well-being more than others. Studies which validly examined BPSD individually were limited, and the included studies used numerous measures of BPSD and numerous measures of caregiver well-being. Future research may benefit from a consistent measure of BPSD, examining BPSD individually, and by examining the causal mechanisms by which BPSD impact well-being by including caregiver variables so that interventions can be designed to target BPSD more effectively.

scholarly journals The impact of childhood psychological maltreatment on mental health outcomes in adulthood: a protocol for a systematic review and meta-analysis

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Zhuoni Xiao ◽  
Mina Murat Baldwin ◽  
Franziska Meinck ◽  
Ingrid Obsuth ◽  
Aja Louise Murray
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Emotional Abuse ◽  
Mental Health Problems ◽  
Meta Analysis ◽  
Psychological Maltreatment ◽  
Future Research ◽  
Long Term Effects ◽  
The Impact

Abstract Background Research suggests that childhood psychological maltreatment (i.e., emotional abuse and emotional neglect) is associated with mental health problems that persist into adulthood, for example anxiety, depression, post-traumatic stress disorder (PTSD), suicidal ideation, and aggression; however, a systematic review and meta-analysis of the existing literature would help clarify the magnitude and moderators of these associations, and the extent to which they may be affected by publication bias, as well as the methodological strengths and weakness of studies in this area. Method The reporting of this protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) Statement. Searches will be carried out via several databases, including Web of Science, Medline, PubMed, PsycINFO, Applied Social Science Index and Abstract, ERIC and EMBASE. Empirical peer-reviewed research articles that fit pre-specified eligibility criteria will be included in the review. Studies will be eligible if they include participants age 18 or over at time of mental health assessment, include information on childhood psychological maltreatment (emotional abuse and/or neglect) perpetrated by a primary caregiver or adult in the same household, and provide quantitative information on the association between these factors. Studies using prospective and retrospective designs and written in either English or Chinese will be eligible. Two independent reviewers will screen and assess studies for inclusion in the review as well as extract the data, with consensus reached through discussion in cases of discrepancy. A third reviewer will be consulted to resolve any discrepancies that remain. The relevant Newcastle–Ottawa scales will be used for assessing the quality of studies. If a sufficient number of comparable studies are retrieved, a meta-analysis will be conducted using a random effects model. Study-level moderators (i.e., year of publication, quality of the study and study geographical location) will be examined in the meta-analyses. Discussion This systematic review will provide an understanding of the long-term effects of childhood psychological maltreatment on adult mental health, which adds to previous reviews focusing primarily on the effects of physical and sexual abuse. The results of the review will help inform clinical practice in approaches to treating those with a history of psychological maltreatment in childhood. The gaps and weaknesses in the evidence identified will also inform recommendations for future research.

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