Search Results (132)

Transfer accuracy is widely used to evaluate orthodontic indirect bonding workflows, particularly in the context of digital CAD/CAM planning and three-dimensional bracket positioning. However, substantial heterogeneity in its definition, measurement, and reporting may limit comparability and clinical interpretability across systematic reviews. This methodological umbrella review examined how transfer accuracy is operationalized as an outcome construct, with specific focus on conceptual definitions, dimensional frameworks, reference systems, measurement pipelines, and interpretative strategies rather than pooled quantitative deviation estimates. A systematic search of major biomedical databases was conducted to identify systematic reviews evaluating transfer accuracy in orthodontic indirect bonding. Data extraction was performed independently by two reviewers using a predefined methodological mapping framework, and methodological quality was assessed with AMSTAR-2. Four systematic reviews met the inclusion criteria. Across reviews, transfer accuracy was operationalized through heterogeneous linear and angular geometric deviation metrics derived from planned–achieved bracket position comparisons, without use of a standardized composite accuracy indicator. Nevertheless, substantial heterogeneity was found in outcome definitions, dimensional architectures, reference system selection, and analytical workflows, resulting in structurally non-equivalent representations of transfer accuracy and limiting cross-review comparability. Within the included systematic reviews, transfer accuracy functioned primarily as a workflow-dependent geometric measurement construct rather than as an outcome systematically operationalized within clinically validated frameworks. We recommend standardized construct definitions, mandatory reporting of reference systems and registration algorithms, routine uncertainty quantification, and harmonized dimensional frameworks as essential steps toward valid evidence synthesis, reproducible digital orthodontic workflows, and clinically interpretable transfer accuracy measurement. Full article

Background: Mild traumatic brain injury (mTBI) is frequently followed by persistent cognitive, affective, and sensory complaints despite unremarkable conventional structural imaging. Resting-state functional MRI (rs-fMRI) has been increasingly employed to detect subtle alterations in large-scale brain networks. However, variability in analytical approaches and the potential influence of neurovascular factors complicate interpretation of BOLD-derived connectivity findings. Objective: This study provides a focused, evidence-informed synthesis integrating umbrella review principles with a targeted narrative analysis of recent high-quality rs-fMRI studies in mild traumatic brain injury (mTBI). Rather than a comprehensive systematic review, the aim was to identify convergent patterns of network dysfunction while critically examining methodological constraints, including neurovascular confounds and variability in analytical approaches. Conclusions: This synthesis supports a network-level model of mTBI characterized by distributed connectivity disturbances. However, given the limited number of eligible studies and substantial methodological heterogeneity, findings should be interpreted as qualitative convergence rather than quantitative generalization. Future longitudinal, multimodal, and standardized imaging approaches are required to clarify the translational relevance of rs-fMRI findings. Full article

Inclusive education for students with special educational needs (SEN) has become a major international policy and research priority since the Salamanca Statement (1994). Yet no recent synthesis has mapped how review-level evidence in this field has developed over time. This umbrella review examined 53 review studies, which together synthesized approximately 2000 primary studies on inclusive education for students with SEN. Using Joanna Briggs Institute (JBI) umbrella review methodology and PRISMA (2020) reporting procedures, records were identified through five databases, screened in Covidence, appraised using the JBI Critical Appraisal Checklist, and analyzed to examine thematic emphases, bibliometric patterns, and methodological shifts. The findings show an expansion and diversification of studies, particularly after 2015, with dominant themes focusing on teacher attitudes and professional development, inclusive practices and outcomes, specific student populations, social inclusion, and policy, systems, and implementation barriers. The review also identified a shift from early narrative overviews to more rigorous systematic qualitative reviews and meta-analyses, alongside increasing international representation. Overall, findings indicate that review-level research on inclusive education for students with SEN has matured considerably since Salamanca, reflecting both the growing complexity of inclusive schooling and the influence of global policy agendas on the production of evidence syntheses. Full article

Background: Prehabilitation aims to optimise patients before cardiac procedures through interventions including exercise training, respiratory conditioning, nutritional support, psychological preparation and multimodal lifestyle programmes. Evidence from systematic reviews and meta-analyses is increasing but remains heterogeneous due to variation in intervention design, patient populations and overlap of primary studies. Methods: We conducted an umbrella review of 17 systematic reviews and meta-analyses evaluating prehabilitation prior to cardiac surgery and structural heart interventions in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Methodological quality of included reviews was assessed using A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2). Outcomes of interest were postoperative pneumonia, hospital length of stay (LOS), and mortality. Results: Across pooled analyses, the most consistent finding was a reduction in postoperative pneumonia, particularly in studies incorporating inspiratory muscle training (IMT), with relative risk reductions of approximately 55–62%, corresponding to a modest absolute risk reduction. Reductions in hospital LOS were also reported, although effect sizes were smaller and more variable. In contrast, no consistent reduction in short-term mortality was demonstrated, likely reflecting low event rates. The evidence base was limited by substantial overlap between reviews and predominantly low or critically low methodological quality. Conclusions: Prehabilitation, particularly when incorporating IMT, is consistently associated with a reduction in postoperative pneumonia and may contribute to modest reductions in hospital LOS. However, the evidence base is constrained by heterogeneity, study overlap and low methodological quality. Further high-quality, adequately powered randomised trials are required to define the role of prehabilitation in contemporary cardiac surgical and structural intervention practice. Full article

Background: Growing evidence suggests that vitamin D plays a role in the pathophysiology of childhood asthma. However, its effectiveness in reducing asthma exacerbations and improving asthma-related outcomes remains controversial. Methods: We systematically searched PubMed, Embase, and the Cochrane Library from inception to 25 February 2026. Meta-analyses of randomized controlled trials (RCTs) evaluating the effects of vitamin D supplementation on any health outcomes in children with asthma were included. Methodological quality was assessed using the AMSTAR 2 tool. The credibility of evidence was evaluated using pre-specified evidence classification criteria, and the certainty of evidence was graded using the GRADE approach. Results: A total of 14 systematic reviews were included, of which one was rated as high quality, six as low quality, and seven as critically low quality according to AMSTAR 2. Vitamin D supplementation significantly increased serum 25-hydroxyvitamin D levels in children with asthma (MD = 10.68 ng/mL; 95% CI, 6.30 to 15.05; n = 8 RCTs), although the evidence was of low credibility (class IV) and very low certainty. No significant improvements were observed in Childhood Asthma Control Test scores (MD = 0.15; 95% CI, −0.43 to 0.74; n = 3 RCTs; class V; moderate), overall asthma exacerbations (RR = 0.84; 95% CI, 0.65 to 1.08; n = 11 RCTs; class V; low), or lung function as measured by percent predicted forced expiratory volume in 1 second (SMD = 0.49; 95% CI, −0.05 to 1.04; n = 5 RCTs; class V; moderate). One meta-analysis suggested a possible reduction in asthma recurrence (RR = 0.53; 95% CI, 0.35 to 0.79; n = 6 RCTs; class IV; moderate). Conclusions: This umbrella review found no convincing evidence that vitamin D supplementation improves asthma control, reduces exacerbations, or enhances lung function in children with asthma, despite its effect on increasing serum 25-hydroxyvitamin D levels and a possible benefit for asthma recurrence. However, these findings should be interpreted with caution, considering that the available evidence was limited by generally low methodological quality, substantial overlap among meta-analyses, and incomplete reporting of clinically relevant modifiers. Full article

Background/Objectives: Nurse transition programmes are widely implemented to support newly hired nurses and promote workforce retention. Despite the growing number of published reviews, conceptual inconsistency and methodological heterogeneity limit the interpretability and cumulative value of the evidence. This umbrella review aimed to synthesise and critically examine review-level evidence on nurse transition programmes, clarifying programme typologies, contexts, methodological approaches, reported outcomes, and thematic patterns. Methods: An umbrella review was conducted in accordance with PRISMA 2020 guidance. Systematic searches were performed in CINAHL, PubMed, Scopus, Web of Science, and Google Scholar, supplemented by citation tracking. Results: Fourteen reviews published between 2010 and 2025 were included: 12 reviews of primary studies and two reviews of secondary evidence (one umbrella review and one meta-review). Programme models and outcome measures were highly heterogeneous, and primary study overlap was slight (CCA = 2.55), indicating that reviews in the corpus drew on largely non-overlapping sets of primary studies. Transition programmes for new nurses commonly use one-on-one preceptorships with supernumerary practice, simulation-based learning, and active methods like case studies and reflective journaling to build competence and confidence. Their duration varies from a few days to 12 months, aligning with the progressive learning curve of new graduates. Professional outcomes, particularly competence and confidence, were consistently reported, whereas organisational outcomes, such as retention, showed mixed, methodologically constrained evidence. Patient-level outcomes were rarely examined. Thematic analysis revealed a shift over time from individual professional readiness towards implementation and organisational considerations. Conclusions: Given this conceptual plurality, there is an urgent need to standardise key indicators for evaluating the effectiveness of nurse transition programmes across healthcare settings globally. Full article

Background: Fibromyalgia is a chronic nociplastic pain condition often accompanied by mental health comorbidities, with anxiety and depression being the most prevalent. The objective of this umbrella review is to analyze the effects of physical exercise on anxiety and depression symptoms in individuals with fibromyalgia. Methods: Following Cochrane and PRIOR guidelines, a systematic search was conducted in PubMed, Web of Science, Scopus, and CINAHL Complete up to 28 August 2025. Systematic reviews with or without meta-analyses that evaluated physical exercise interventions in adults with fibromyalgia and reported anxiety or depressive symptom outcomes were included. Risk of bias was assessed with AMSTAR-2; overlap was evaluated using MOoR and CCA. Results: Fourteen reviews (eight meta-analyses, three systematic reviews, two meta-analyses treated as descriptive, and one network meta-analysis) were included, synthesizing 98 randomized controlled trials (RCTs) with 4325 participants (in the 12 reviews that provided data). The majority of the patients were women and people aged between 10 and 65. Regarding anxiety, five of seven reviews reported significant improvements. Aquatic exercise showed the greatest effect (SMD = −1.14). Regarding depression, eight of 11 reviews reported significant benefits. Aquatic exercise again stood out with the highest effect (SMD = −1.18). Adherence varied between 64% and 97%. Methodological quality according to AMSTAR-2 showed considerable heterogeneity. Conclusions: Physical exercise, especially aerobic and aquatic modalities, may support the reduction of symptoms of anxiety and depression in people with fibromyalgia. These findings support its inclusion in rehabilitation programs, although methodological and prescription variability suggests caution in interpreting optimal parameters. PROSPERO-ID: CRD42024590799. Full article

Background/Objectives: A non-surgical orthodontic treatment strategy for transverse maxillary deficiencies, especially in late adolescents and young adults, is microscrew-assisted rapid palatal expansion (MARPE). The literature indicates several concerns regarding its long-term efficacy and potential complications. Recent studies have provided valuable insights into the MARPE technique, particularly focusing on its efficacy, potential complications, and treatment failures. The present scoping review aims to synthesize and critically appraise clinical evidence on MARPE in post-pubertal patients, with a specific focus on treatment outcomes, mechanisms of failure, and local and systemic adverse effects to inform risk–benefit assessment and clinical decision-making. Methods: A systematic search was conducted across four electronic databases (PubMed, EMBASE, Scopus, and Cochrane Library) to identify English-language clinical trials, observational studies, and systematic reviews published between January 2015 and December 2025. The search strategy employed controlled vocabulary (MeSH terms) and Boolean operators targeting MARPE, treatment failure, and adverse effects in patients aged ≥ 16 years. After title/abstract screening and full-text assessment using predetermined inclusion criteria, 15 studies (3 systematic reviews with meta-analysis, 2 umbrella reviews, 4 systematic/scoping reviews, 2 randomized controlled trials, and 4 observational studies) were selected for qualitative synthesis. Results: Fifteen studies were finally included, which demonstrated significant heterogeneity in methodological design, sample characteristics, outcome measurement protocols, and MARPE device specifications. Mean success rates of 92.5% for maxillary transverse expansion were reported, with mean expansion duration ranging between 20 and 126 days. Key adverse effects comprised dentoalveolar tipping (buccal inclination of maxillary molars and premolars), periodontal complications (buccal bone resorption of 0.6–0.9 mm, gingival recession, papilla recession in 18% of cases), root resorption, miniscrew loosening, midpalatine/circummaxillary sutures, and potential but minimally documented intracranial effects. Conclusions: MARPE appears to be a valid non-surgical option for selected post-pubertal patients, but its success depends on careful case selection and monitoring for dentoalveolar, periodontal, sutural, and rare intracranial adverse effects. Full article

Objective: The goal was to investigate the relationship between methodological adherence and clinical outcomes in Progressive Resistance Training (PRT) for Parkinson’s Disease (PD), specifically identifying why findings of “superiority” over active controls remain inconsistent. Methods: This umbrella review utilized a multi-stage process to identify a sample of the primary literature for methodological analysis. An initial search identified 38 systematic reviews published within the specified timeframe. From the reference lists of these reviews, a subset of 34 primary clinical studies was purposefully selected. Inclusion was prioritized for studies providing comprehensive methodological data on PRT protocols and standardized clinical outcomes. Interventions were evaluated using a three-tiered framework: (1) training protocol with specifications of Frequency, Intensity, Time, Type, Volume, and Progression (FITT-VP) (General Exercise), (2) FITT-VP integrated with the American College of Sports Medicine (ACSM) Supplementary Guidelines (Integrated Guidelines), and (3) principles of progression (mechanistic growth). Studies were categorized by control type (active (e.g., aerobic or balance), n = 26; passive (e.g., standard care or no exercise), n = 8). Results: In trials that compared PRT with an active control group, PRT achieved clinical superiority in 57% (n = 15) of trials and 46% (n = 12) when focusing on trials with an effect on specific functional or balance outcomes. Among these successful interventions, 75% maintained high adherence (≥70%) to the Integrated Guidelines, and 58% maintained high adherence to the principles of progression. In the 53% (n = 14) of studies where PRT was found non-superior (equivalent or inferior in functional or balance outcomes) to an active control, 0% met the high adherence threshold for progression. While general FITT-VP compliance remained high (78%), the failure to implement systematic load, specificity, and variation served as a definitive barrier to competitive superiority. In the 100% of studies where PRT outperformed passive controls, high progression was present in 57% of cases. This may suggest that while a baseline resistance stimulus outperforms inactivity, it is fundamentally insufficient to outperform other active clinical therapies. Conclusions: This umbrella review indicates that adherence to the principles of progression may be an important factor influencing the clinical outcomes of PRT in individuals with PD. The variability observed in the current literature suggests that inconsistent application of established exercise frameworks—rather than the failure of the modality itself—could be a contributing element to the reported “inconclusiveness.” To potentially enhance functional outcomes and the comparative effectiveness of PRT, future research should consider prioritizing structured adherence to FITT-VP, Integrated Guidelines, and progression-based frameworks. Establishing a 70% adherence threshold is proposed as a potential benchmark to improve protocol consistency and support rehabilitation efficacy in this population. Full article

Background: Neoadjuvant therapy (NAT) is increasingly investigated in operable pancreatic ductal adenocarcinoma (PDAC), yet its role in strictly resectable disease remains controversial. Randomized trials have been conducted both in borderline resectable and resectable PDAC and have demonstrated survival advantages, while evidence in strictly resectable tumors remains poor. We conducted an umbrella review of systematic reviews and meta-analyses (SRMAs) to comprehensively evaluate the highest level of available evidence on NAT versus upfront surgery in operable PDAC. Methods: We performed an umbrella review of completed SRMAs assessing neoadjuvant chemotherapy (NAC) and/or chemoradiotherapy (NACRT) in resectable and borderline resectable PDAC. MEDLINE/PubMed, Embase, and Cochrane Library were searched from inception through November 2025. Eligible SRMAs reported at least one clinical outcome, including overall survival (OS), disease-free/event-free survival (DFS/EFS), resection rate, R0 resection, nodal status, or perioperative outcomes. Methodological quality was appraised using AMSTAR-2 and ROBIS tools. Overlap among SRMAs was quantified using the Corrected Covered Area (CCA), and RCT-only evidence was prioritized for causal inference. Evidence credibility was graded using an Ioannidis-style classification framework. Results: Thirty-four SRMAs published between 2010 and 2025 were included. In strictly resectable PDAC, RCT-only meta-analyses showed no definitive OS benefit for NAT compared with upfront surgery (pooled HR approximately 0.85, 95% CI 0.68–1.05), although a significant improvement in EFS was observed (HR approximately 0.77, 95% CI 0.65–0.90). Trial sequential analyses suggested insufficient information size for conclusive OS benefit in resectable disease. Conversely, in pooled resectable and borderline resectable populations, NAT significantly improved OS (HR approximately 0.66, 95% CI 0.52–0.85), with subgroup analyses indicating that the survival advantage was primarily driven by borderline resectable tumors. NAT consistently increased R0 resection and node-negative (pN0) rates and reduced non-curative explorations. However, neoadjuvant strategies were associated with treatment-related attrition and, in some analyses, lower overall resection rates. Comparative evidence suggested improved pathological outcomes with chemoradiotherapy versus chemotherapy alone, without a consistent survival advantage. Conclusions: Current high-level evidence supports NAT as the preferred strategy for borderline resectable PDAC, demonstrating consistent survival and pathological benefits. In strictly resectable disease, NAT improves disease-control endpoints and pathological surrogates, but a definitive OS advantage has not been consistently demonstrated in RCT-only syntheses. This should not be interpreted as evidence of equivalence between NAT and a surgery-first strategy, given the heterogeneity, limited power, and therapeutic-era effects of the available literature. Treatment decisions in resectable PDAC should therefore be individualized, balancing potential oncologic benefits against attrition risk. Future adequately powered randomized trials employing contemporary multi-agent regimens are needed to clarify the survival impact of NAT in strictly resectable disease. Full article

Background/Objective: Prehabilitation aims to improve physiological reserve before surgery to enhance postoperative outcomes. Multiple systematic reviews have evaluated preoperative interventions in adult cardiac surgery; however, variability in scope, methodological quality, and overlap of primary trials complicates interpretation. The aim of this study is to synthesise and critically appraise evidence from systematic reviews and meta-analyses evaluating prehabilitation interventions in adults undergoing cardiac surgery. No funding was received for this study. Methods: We conducted an umbrella systematic review following a prospectively registered protocol (PROSPERO: CRD420261292354) and PRISMA 2020 guidance. PubMed, Web of Science, and Scopus were searched from inception to 31 December 2025. Eligible reviews included adults (≥18 years) undergoing cardiac surgery, evaluated and compared preoperative inspiratory muscle training (IMT), respiratory muscle training, and exercise-based, educational, or multimodal prehabilitation with usual care or sham intervention. Reviews focused solely on postoperative interventions or non-cardiac surgery were excluded. Methodological quality was assessed using AMSTAR-2. Certainty of evidence was evaluated using GRADE. Overlap of primary studies was quantified using the Corrected Covered Area (CCA). A structured narrative synthesis with a direction-of-effect framework was applied. Results: Eighteen systematic reviews (published 2012–2025) were included, comprising 46 unique primary studies and more than 6674 participants (exact totals unavailable due to incomplete reporting in at least one review). Overall overlap was high (CCA 12.5%). Respiratory-focused prehabilitation, particularly IMT, demonstrated consistent reductions in postoperative pulmonary complications (PPCs) (risk ratios approximately 0.42–0.53), pneumonia (RR ~0.44–0.45), and atelectasis (RR ~0.49–0.59), favouring prehabilitation over usual care. Hospital length of stay was reduced by approximately 1.5–3 days across multiple reviews. Inspiratory muscle strength improved consistently (mean difference ~+12 to +17 cmH₂O). Effects on ICU length of stay and mechanical ventilation duration were inconsistent or non-significant. Exercise-based programmes improved functional capacity (6 min walk distance increase ~50–75 m) and showed modest reductions in hospital stay, but heterogeneity was substantial. No intervention demonstrated a consistent reduction in postoperative mortality. Evidence was limited by clinical heterogeneity, performance bias in primary trials, inconsistent outcome definitions, and high overlap of key IMT trials across reviews. Mortality outcomes were underpowered. Conclusions: Preoperative IMT provides evidence for reducing pulmonary complications and shortening hospital stays in adult cardiac surgery. Exercise-based prehabilitation improves functional capacity but requires further high-quality, standardised trials. Integration of respiratory prehabilitation into cardiac surgical pathways appears supported by the current evidence. Full article

Objective: This umbrella review synthesizes and critically appraises the evidence on the efficacy and safety of tegoprazan-based versus proton pump inhibitor (PPI)-based regimens for Helicobacter pylori (H. pylori) eradication. Methods: This umbrella review was pre-registered in PROSPERO (CRD420251271120). Systematic reviews and meta-analyses published between 1 January 2018 and 10 December 2025 were identified through MEDLINE/PubMed, EMBASE, and the Cochrane Library. Reviews comparing tegoprazan-based and PPI-based eradication regimens in adult patients were included. Methodological quality was assessed using AMSTAR-2, risk of bias with ROBIS, and certainty of evidence with GRADE. Pooled relative risks (RRs) were calculated, with subgroup analyses by study design, treatment duration, and therapeutic regimen. Results: Eight systematic reviews and meta-analyses encompassing 17 primary studies and 12,714 participants were included. Tegoprazan-based regimens were associated with a statistically significant improvement in eradication efficacy compared with PPI-based therapies (RR = 1.019; 95% CI: 1.003–1.035; p = 0.021). In randomized controlled trials, the benefit was more pronounced (RR = 1.037; 95% CI: 1.015–1.061; p = 0.001), whereas no statistically significant benefit was observed in non-randomized studies (RR = 1.014; 95% CI: 0.991–1.037; p = 0.235). The efficacy advantage was mainly confined to quadruple therapy regimens (RR = 1.044; 95% CI: 1.002–1.088; p = 0.038). Tegoprazan-based regimens were associated with a lower incidence of overall adverse events compared with the PPI group (RR = 0.930; 95% CI: 0.885–0.976; p = 0.003). Conclusions: Tegoprazan-containing regimens were associated with a modest but statistically significant improvement in H. pylori eradication compared with PPI-containing regimens, particularly in randomized controlled trials and quadruple therapy regimens. Full article

Background/Objectives: Despite being a standard biological therapy for knee osteoarthritis, inconsistent results across studies—due to varied protocols—have obscured the clinical standing of platelet-rich plasma. This meta-analysis evaluates the efficacy and safety of PRP for pain, function, and adverse events, and examines the potential benefits of combining it with hyaluronic acid. Methods: An umbrella review was conducted following the PRIOR (Preferred Reporting Items for Umbrella Reviews) and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations. Meta-analyses evaluating PRP in knee osteoarthritis were included. Quantitative estimates of pain, function, and safety were extracted. Random-effects models were applied when possible. Methodological quality was assessed using AMSTAR 2, and study overlaps were assessed using the CCA method. Publication bias was analyzed using a funnel plot. Results: The meta-analyses included consistently showed the superiority of PRP over hyaluronic acid and placebo in reducing pain and improving function. Pooled estimates indicated clinically relevant improvements, especially in mild-to-moderate osteoarthritis. The combination of PRP and hyaluronic acid demonstrated superior functional recovery and a potential reduction in adverse events compared to PRP monotherapy. The overall safety profile was favorable. Conclusions: PRP is an effective and safe therapy for knee osteoarthritis, with consistent evidence of superiority over conventional intra-articular treatments. Combined PRP and HA administration suggests superior clinical efficacy compared to monotherapy. Standardization of protocols and appropriate patient selection will be key in future clinical guidelines. Full article

Crises such as pandemics, displacement, climate change, and economic downturns disrupt grassroots sport, undermining participation, equity, and resilience. This umbrella review synthesised evidence on strategies that sustain and adapt community sport participation during crises. Following PRISMA 2020, a protocol was registered in PROSPERO (CRD420251132267). PubMed, Scopus, and EBSCO were used as sources, and eligible studies were selected: systematic reviews on grassroots or community sport in crisis contexts. Methodological quality and evidence certainty were assessed using established appraisal frameworks (AMSTAR-2, GRADE, and CERQual). Fifteen reviews (2021 to 2025) were included, spanning health, climate, economic, and displacement crises. Overall certainty of evidence was low. Quantitative evidence showed moderate certainty that psychosocial interventions reduced anxiety and depressive symptoms among youth during COVID-19. Qualitative syntheses provided moderate confidence that organisational safeguarding, culturally tailored programmes, instructor role modelling, and collaborative community approaches support participation and resilience. Conceptual and policy reviews offered frameworks for governance, sustainability, and crisis management, although confidence in these syntheses was generally low–moderate. Across evidence types, recurrent strategies included community-driven and culturally tailored programmes, digital or hybrid delivery, infrastructural and environmental adaptations, and integration of sport within broader sustainability and crisis-recovery policies. This umbrella review integrates heterogeneous evidence to identify key organisational and policy strategies capable of strengthening resilience and equitable participation in grassroots sport during periods of societal disruption. Full article

Hearing loss is among the most common chronic diseases worldwide, affecting approximately 466 million people. Increasing evidence suggests that several cardiovascular risk factors traditionally associated with cardiovascular disease may be associated with hearing loss; therefore, we conducted an umbrella review to synthesize existing systematic reviews and meta-analyses evaluating this association. Systematic reviews and meta-analyses were searched in PubMed, Scopus, Web of Science, and the Cochrane Library from inception to April 2025. Methodological quality was assessed using the AMSTAR-2, and the certainty of evidence was evaluated using the GRADE criteria. Ten systematic reviews were included. Associations were observed between hearing loss and multiple cardiovascular risk factors and comorbidities, with the most consistent evidence for cardiovascular disease, metabolic syndrome, hypertension, diabetes, obesity, smoking, and alcohol consumption; findings for total cholesterol and low-density lipoprotein cholesterol were inconsistent or not statistically significant. The reported odds ratios ranged from 0.78 to 4.22. These associations may be related to mechanisms such as microvascular damage and inflammation; however, the certainty of the evidence was generally low. Overall, the findings suggest a possible association between cardiovascular risk factors and hearing loss, although they highlight the need for further longitudinal studies with standardized hearing loss definitions and improved control of confounding factors. Full article