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ObjectivesMethodResultsConclusionWe conducted the current systematic review to investigate the association between dietary inflammatory index (DII) and severe headaches or migraine among adults via synthesizing observational evidence.We conducted a systematic literature search of observational studies through PubMed, Scopus, and Web of Science databases from inception until July 2024. The PECO framework was implemented to select eligible studies as follows: Population (adults with severe headache or migraine), Exposure (individuals with the highest adherence to a pro-inflammatory diet), Comparison (individuals with the lowest adherence to a pro-inflammatory diet), Outcome (risk of developing severe headache or migraine, headaches frequency, duration, severity, and migraine-related disability).After reviewing six studies involving 31,958 individuals, we found that following an anti-inflammatory diet is associated with a lower frequency and severity of migraine headaches. Additionally, our research revealed that individuals with migraines tend to have lower adherence to an anti-inflammatory diet when compared to people without migraines. Surprisingly, adherence to a pro-inflammatory diet was linked to a reduced risk of chronic daily headaches.Present findings imply a negative link between an inflammatory diet and severe headaches or migraine. However, further well-designed longitudinal studies are needed to interpret the causality and shed light on the underlying mechanisms. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to present how data mining (DM) and machine learning (ML) contribute to the product development process (PDP). The Methodi Ordinatio methodology was used to identify important articles for this study, and VOSviewer software was applied to generate visual maps. A systematic review was conducted on the Web of Science, Scopus and Science Direct databases. Forty-six articles were designated for analysis in order to evaluate the most commonly used DM and ML techniques to support the PDP, as well as to demonstrate which specific phases are most often applied. In addition, the main limitations of the analyzed techniques were identified. The results show that the association rule technique was the most commonly used, followed by text mining, and the most used phases were planning and design. In this context, this study intends to stimulate companies to use computational techniques, more precisely DM and ML, to assist in the generation of knowledge and become a strategic factor in the PDP. [ABSTRACT FROM AUTHOR]

PurposeMethodsResultsConclusionVitamin D deficiency has been associated with higher rates of autoimmune disease, including noninfectious uveitis. This PRISMA-compliant review and meta-analysis aimed to analyze the correlation between noninfectious uveitis and vitamin D levels.We searched PubMed, Embase, Cochrane, and Web of Science databases for studies, published in English, assessing vitamin D levels in patients diagnosed with noninfectious uveitis. The outcomes of interest were vitamin D deficiency, vitamin D mean level, vitamin D supplementation, and smoking rates. A subgroup analysis of inactive uveitis and active uveitis was performed. The heterogeneity was assessed with Cochrane Q-test and I2 statistics; p > 0.10 and I2 > 50% were considered significant for heterogeneity. Statistical analysis was conducted using Review Manager 5.3.9 studies were included in the meta-analysis comprising a total of 10 711 patients, of whom 1,368 were diagnosed with noninfectious uveitis. Patients with noninfectious uveitis had worse results regarding vitamin D deficiency when compared with the control group (OR 0.58; CI 95% 0.44 to 0.77; p = 0.0002; I2 = 61%). Patients with inactive uveitis had better results towards vitamin D deficiency when compared with active uveitis (OR 5.00; CI 95% 2.84 to 8.81; p < 0.001; I2 = 0%).Our research supports the increasing evidence that associates vitamin D deficiency with noninfectious uveitis and its activity. Further investigation into the efficacy of vitamin D screening and supplementation in reducing the recurrence of uveitis is necessary. [ABSTRACT FROM AUTHOR]

Acquired brain injury (ABI) is a worldwide public health issue for its high prevalence rate and the disability it produces. The consequences of ABI, including cognitive deficits, may impact return to work. This review focuses on the association between executive functions (EFs) and return to work after ABI. A systematic review of the literature between 1998 and 2023 was conducted following PRISMA guidelines. The articles were retrieved from the Pubmed, Medline and Web of Science databases. A total of 49 studies were finally selected. Impairments of EF were consistently shown to have a negative impact on return to work after an ABI. There is evidence that specific executive functions and neurobehavioral variables may affect return to work Studies showed a significant theoretical and methodological heterogeneity, representing an important limitation to understand the relation between EFs and work. There is a robust association between EFs and return to work after brain injury. Findings in this systematic review raise the need for further research on the role of specific EF profiles in the process of returning to work after brain damage. [ABSTRACT FROM AUTHOR]

This paper aims to develop some specific theoretical themes, which could be useful for HR personnel in adopting and implementing blockchain technology in the HR department. Total 126 published documents during the time interval 2016–2021 from the Scopus and Web of Science databases were explored to classify the relevant 25 records using the PRISMA flow diagram. Complete bibliometric information has been synthesised concerning titles, abstracts, and keywords of each of those 25 publications. VOSviewer was used to generate term co-occurrence network maps based on assembled bibliometric information. Four thematic clusters were evolved from the network maps and based on the thematic clusters; two theoretical themes were developed through associations. Two theoretical themes, i.e., Employee-Systems Interaction (ESI) and Blockchain Framework (BcF) for HR, were identified to become the prime movers for adopting and implementing blockchain in the domain of HRM. Later, for justifying the two theoretical themes and testing the robustness of the results, we reported the key terms thoroughly and critically going through the 25 publications. ESI and BcF for HR will add tremendous theoretical contributions to the existing body of knowledge in the fields of blockchain and strategic HRM. Directions for future research have been mentioned. [ABSTRACT FROM AUTHOR]

The optimal cycle of neoadjuvant chemotherapy (NAC) for muscle-invasive bladder cancer (MIBC) remains controversial. This study aimed to compare the efficacy of three and four cycles of NAC in the treatment of MIBC through a systematic review and meta-analysis of the literature. Relevant studies were systematically collected and reviewed in PubMed, Medline, Embase, Web of Science Databases, and the Cochrane Library. Relative ratios (RRs), Hazard ratios (HRs) and their 95% confidence intervals (CIs) were used to estimate outcome measures. Studies comparing the pathological response and prognosis of three versus four cycles of NAC for MIBC were included. Five studies were included in this meta-analysis, including 2190 patients, of whom 1016 underwent three cycles of NAC and 1174 underwent four cycles of NAC. All studies were retrospective cohort studies. We found that 4 cycles of NAC had significantly better cancer-specific survival than 3 cycles (HR = 1.31, 95%CI,1.03–1.67, p = 0.029). There was no significant difference in overall survival between patients who received 3 and 4 cycles of chemotherapy (HR = 1.18, 95%CI = 0.83–1.69, p = 0.345). Similarly, no significant difference was observed in pathological objective response (RR = 0.95, 95%CI= 0.81–1.11, p = 0.515) and complete response rates (RR = 0.87, 95%CI = 0.69–1.11, p = 0.256) in MIBC after 3 or 4 cycles of NAC. Three and four cycles of NAC had similar pathological responses and prognosis for MIBC, although the cancer-specific survival rate of four cycles was better than that of three cycles. The pathological response rate and overall survival of three and four cycles of neoadjuvant chemotherapy for muscle-invasive bladder cancer were similar. Four cycles of neoadjuvant chemotherapy may improve the cancer-specific survival of patients with muscle-invasive bladder cancer It is reasonable and feasible for clinicians to use three or four cycles of neoadjuvant chemotherapy. [ABSTRACT FROM AUTHOR]

vitamin D deficiency is a worldwide health problem. However, the prevalence of vitamin D deficiency in Asian populations is unclear. The aims of our study were to investigate the prevalence of vitamin D deficiency and its association with different health outcomes in Asia. Searches for studies published from January 2009 to January 2021 were performed in the MeDLiNe (via PubMed), eMBASe, and web of Science databases. This study was registered in the PROSPeRO database (CRD42021229841). in total, 472 studies with 746,564 subjects were included in the meta-analysis. The mean serum 25-hydroxyvitamin D (25[OH]D) concentration was 49.39 nmol/L; 20.93% of the participants had 25(OH)D levels <25 nmol/L, 22.82% had levels <30 nmol/L, 57.69% had levels <50 nmol/L, and 76.85% had levels <75 nmol/L. This review found that the prevalence of vitamin D deficiency in Asia is high. The factors significantly related to vitamin D deficiency were gender, age, altitude, region, and specific diseases (diabetes, cancer, fracture, systemic lupus erythematosus [SLe], fatty liver disease, osteopenia, thyroiditis, anemia, hepatitis, metabolic diseases, and dermatitis). These findings may serve as the foundation for more detailed public health strategies and policies on this issue. [ABSTRACT FROM AUTHOR]

As an emerging minimally invasive technology, endoscopic ultrasound (EUS) has been reported to treat pelvic abscess instead of surgical or image-guided percutaneous drainage (PCD) under certain conditions. The aim of this study was to assess the efficacy and safety of EUS-guided drainage for patients with pelvic abscesses. We conducted a comprehensive literature search on PubMed, Embase, Cochrane Library, and Web of Science databases (inception–March 2022). The main outcomes were technical success, clinical success, and complications. Comprehensive meta-analysis software was used to calculate the pooled event rate. Twelve studies containing 272 patients were included. These pelvic abscesses most frequently developed after abdominal and pelvic surgery (n = 180, 66.2%), inflammatory bowel disease (n = 32, 11.8%), and other inflammatory conditions. Respectively, the pooled technical and clinical success rate was 100% and 88.7% [95% confidence interval (CI): 83.8–92.2%, I2 = 1.0%, p < 0.001]. After excluding an individual study, the pooled rate of complications changed from 11.5% (95% CI: 7.4–17.4%, I2 = 38.8%, p < 0.001) to 8.2% (95% CI: 5.0–13.3%, I2 = 0, p < 0.001). EUS-guided drainage of the pelvic abscess was feasible, effective, and safe. Further randomized-controlled studies with large-sample sizes were required in the future. [ABSTRACT FROM AUTHOR]

Recurrent aphthous stomatitis (RAS) is the most common ulcerative lesion of the oral mucosa. The management of RAS is quite challenging with no definitive cure. The present systematic review aimed to summarize the available evidence regarding the efficacy of curcumin in the management of RAS. PubMed, Scopus and Web of Science databases were searched in June 2020 for all relevant studies. Clinical trials that assessed the efficacy of curcumin for the management of RAS were included. The primary outcomes were pain and/or clinical improvement. Eight studies involving 439 subjects were included. The efficacy of curcumin was compared with 1% triamcinolone in four studies, glycerin vehicle in one study, placebo in one study, and honey in one study. Overall, the included studies reported a good efficacy of curcumin in reducing pain and ulcers size in patients with RAS. Four studies found curcumin as effective as triamcinolone in relieving signs and symptoms of RAS. Three studies reported superior results with curcumin as compared with control groups. The limited available evidence suggests that curcumin have potential benefits in alleviating pain and accelerating healing in patients with RAS. Further well-designed clinical trials with standardized curcumin formulations are highly recommended. [ABSTRACT FROM AUTHOR]

Environmental labeling is a valuable communication and marketing tool used to enlarge the visibility and disclosure of environmental attributes of products, processes, and services. Therefore, scientists worldwide are investigating the use of environmental labeling and its possible compliance with technical and economic standards. This paper has examined the scientific output on environmental labeling over the past twenty-two years, reviewing the literature in three scientific databases. A total of 1,246 articles indexed out of 580 magazines were retrieved. The USA contributed most publications on environmental labels. European countries, such as Italy and Sweden, discussed labeling in the food industry, transportation, and forest certification. Brazil is leading Latin America in publications, including the food industry and civil construction. Type I ISO labeling has been the most used, followed by a growing number of publications on Type III ISO labels in recent years. The results display a tendency in aquaculture and food applications in Europe and South America, exhibiting a panorama of advancing scientific and practical strength of environmental labeling in such areas. Finally, we recommend simple, step-by-step activities for consumers to obtain additional benefits by choosing more sustainable products based on the information available on environmental labels. [ABSTRACT FROM AUTHOR]

The skin is a physical barrier that protects the body from the external environment. Through its immune system, it limits the attack of environmental threats. Unregulated immune reactions, however, can cause chronic inflammatory skin diseases, requiring that effective treatment routes be sought. Turmeric, a root originated from Southeast Asia, has a number of therapeutic benefits, including anti-inflammatory activity. The aim of this review was to evaluate the effects of turmeric oral supplementation in the treatment of chronic inflammatory skin diseases. Through PubMed, Scopus, and Web of Science databases, clinical studies examining the relationship between turmeric, curcumin, and skin health in humans until September 2019 were systematically searched. Evidence analysis were performed using robust tools to evaluate the risk of bias (RoB 2.0), (ROBINS-I) and methodological quality (GRADE) of the included studies. A total of eleven studies were included. The skin conditions examined include psoriasis, pruritus, oral lichen planus, facial redness, as well as types of skin cancers. Overall, therapeutic benefits for skin health have been observed through oral turmeric supplementation. The current published studies, nevertheless, are limited, requiring continuity and improvement in the intervention methodology employed. [ABSTRACT FROM AUTHOR]

To synthesize current knowledge of the impact of pediatric neuropsychological evaluations on child functioning, we conducted a systematic review of the literature on parents' overall satisfaction with their child's evaluation and perceptions of how helpful the evaluation was for understanding their child's abilities and how useful the evaluation was for providing actionable information to elicit change. Parent satisfaction is important in this context because studies on healthcare consumption indicate a substantial relationship between patient satisfaction with services and implementation of recommendations and follow-up care. We followed PRISMA guidelines to conduct a systematic review of the literature on parent perception of pediatric neuropsychological evaluations for children aged 3–21 years. Using a set of predefined search terms, we identified 1,163 abstracts across PubMed, PsycINFO, Cochrane Library, and Web of Science electronic databases and included 12 studies in our qualitative synthesis. In general, parents reported high levels of satisfaction with their child's evaluation. Feedback from the evaluation was helpful for understanding their child's pattern of strengths and weaknesses and included useful information for obtaining support. Although parents did report improvement in their child's functional participation in home, school, and community settings, they tended to rate the usefulness of the evaluation for eliciting change lower than their overall satisfaction with the evaluation or how helpful the evaluation was for understanding their child's abilities. Additional effort appears to be needed for pediatric neuropsychological evaluations recommendations to result in durable, meaningful change in child functioning. [ABSTRACT FROM AUTHOR]

The purpose of this study was to reveal the relationship between new fasting hormone asprosin, obesity, and acute–chronic exercise. The prisma guidelines were followed in forming the methodological model of this review. The articles between 2016 and 2020 (including March) were identified by scanning Google Scholar, Pub Med, and Science Direct databases. Thirty-five articles were defined from 188 articles. Three cross-sectional, and 1 prospective cohort design studies in adults, and 3 cross-sectional studies in children were found. Three randomised-control group designed studies which examined the effect of acute exercise on serum asprosin levels in obese individuals. Asprosin may be a new therapeutic biomarker to be considered in the development, but long-term and deep-rooted researches are needed, and increasing the number of studies examining the effect of exercise on asprosin in the future might help us to identify the mechanisms underlying the decrease or increase in asprosin after exercise. [ABSTRACT FROM AUTHOR]

This systematic review and meta-analysis were made to evaluate the bond strength behavior and failure mode of zirconia surfaces treated by laser irradiation and to highlight the main characteristics and parameters of each laser system. The PubMed, the Scopus, and the Web of Science databases were searched for articles without limit on year of publication, in accordance with the PRISMA guidelines. Forty-three in vitro studies were included and meta-analyses were performed to compare the bond strength values found after the use of lasers, and to quantify the percentage of failures. When compared to untreated groups, the bond strength values found for the lasers ranged from 1.4 to 30.16MPa for CO2; 1.18 to 40.33MPa for Nd:YAG; 0 to 22.72MPa for Er:YAG; and 0.5 to 34.92MPa for Er,Cr:YSGG. Statistical analysis indicated high heterogeneity inbetween the comparisons of different lasers (p = 0.05). When compared to other treatments, the results of the meta-analysis were favorable for tribochemical silica coating (TSC) and airborne-particle abrasion (APA) (p = 0.05), except for the CO2 laser. Adhesive failures were predominant (68.28% for CO2; 65.23% for Nd:YAG; 76% for Er:YAG and 71.91% for Er,Cr:YSGG laser), followed by mixed and cohesive failures. Based on the results of this study, the conditioning of zirconia surfaces through laser irradiation increases the bond strength values when compared to untreated surfaces, regardless of the type of laser used. However, except for CO2 laser, TSC and APA still show superior bond strength results. [ABSTRACT FROM AUTHOR]

Large Interactive Displays (LIDs), such as tabletops or interactive walls, are promising innovations, which are increasingly used to support co-located collaboration. Yet the current evidence base on the impact of LID use on collaborative processes and outcomes, and associated influencing factors, is fragmented, particularly in comparison with other media. To address this gap, a systematic review was carried out in the databases Web of Science, Psych.Info, ACM, Elsevier, JSTOR and Springer and in the ACM CHI conference database. A corpus of 38 articles with experimental study designs met the eligibility criteria and was analyzed in-depth. With regard to collaboration processes, the findings suggest a relatively clear advantage of the use of LIDs over classic forms of collaboration, in particular over single-user environments (e.g. laptops). With attention to collaborative outcomes, positive effects of LIDs were identified for knowledge gains and social encounters, and mixed effects for task-related outcomes. The analysis further shows relevant influencing factors of LID, such as the separation of personal and joint work spaces and the deployment of horizontal instead of vertical displays. Conceptual and practice implications are discussed. [ABSTRACT FROM AUTHOR]

This paper aims to investigate the synergy between the innovation and lean philosophy in the services context. The research is composed of a systematic literature review (SLR) on critical success factors (CSFs) related to innovation and lean initiatives applied to services. From this extensive review, 16 common CSF were identified. This analysis is limited to peer review articles from Scopus, ISI Web of Science and SciELO databases. Then, a survey was applied to evaluate the perception of professionals working in services, on the relevance of these factors in the context of innovation and lean initiatives in services. The results show that there is synergy between the CSFs of innovation in services and CSFs of lean initiatives. The selected factors cover organisational aspects, people management, processes and customer. This paper offers interesting implications for managers, pointing out which factors should be prioritised for synergies between lean and innovation, thus achieving more competitive advantage and the success of the organisation. Therefore, it is the first SLR on synergies between CSFs for innovation and CSFs of lean philosophy applied to services; it also provides practical analyses of the current state of these synergisms by the perception of professionals who work in services. [ABSTRACT FROM AUTHOR]

To determine the safety and effectiveness of current pharmacotherapies consisting of long-acting beta2-agonist (LABA) and/or inhaled corticosteroids (ICS) in patients with asthma–COPD overlap. A systematic search was conducted using the PubMed, EMBASE, and Web of Science databases up to June 2018. Only studies comparing the safety and effectiveness of LABA and/or ICS in patients with asthma–COPD overlap were included. A meta-analysis was performed to calculate risk ratio (RR) and 95% confidence interval (CI) using Inverse Variance Random-effects model. From a total of 3382 articles retrieved, three randomized controlled trials (RCTs), six cohort studies (CS), one nested case control study fulfilled the inclusion criteria for three independent meta-analyses representing 181,603 participants. Three CS results show LABA was associated with decreased risk of myocardial infarction (combined RR: 0.80, 95% CI 0.74–0.87) versus non-LABA use; ICS/LABA was associated with a lower risk of death or hospitalization (combined RR: 0.82, 95% CI 0.75–0.90) compared to no use. Results from RCTs, no clear difference in lung function decline in FEV1 was found (combined mean difference: 0.08, 95% CI 0.15–0.32) in patients receiving ICS and/or LABA compared to placebo. However, due to lack of data, exacerbations, fractures and nontuberculous mycobacterial pulmonary disease outcomes were not meta-analyzed. Among patients with asthma–COPD overlap, LABA is associated with decreased risk of myocardial infarction; and the combination therapy of ICS/LABA appears to reduce the risk of death or hospitalization. More studies of quality data and larger number of patients are needed. PROSPERO (CRD42018090863). [ABSTRACT FROM AUTHOR]

Background: Childbirth is considered a significant experience in women's life. Different models of care and interventions without pharmacological approaches have been used to enhance women's positive childbirth experiences, but the most effective interventions have not been clearly identified.Objective: To assess the effectiveness of nonpharmacological approaches in improving women's childbirth experiences.Methods: We searched Cochrane Library, Medline, Web of Science, Embase, Scopus, ProQuest, Google Scholar, and Persian databases (Magiran, Scientific Information Database, and Barakat) from inception until December 2017. Randomized controlled trials and quasi-randomized controlled trials comparing interventions designed to improve women's childbirth experiences with standard cares were included in this review. Pharmacological interventions were excluded from the study. The outcome measure was women's childbirth experience. Heterogeneity was determined using the Cochrane's test and I2 index. The standardized mean differences were pooled based on random effect models.Results: We included 19 studies (10,141 women) in the review. Results of the meta-analysis of 18 studies (8487 women) demonstrated that all the interventions with nonpharmacological approaches improved childbirth experiences (standardized mean difference: 0.49; 95% confidence interval: 0.33-0.66). But, subgroup meta-analysis showed that different models of midwifery care, support during labor and natural therapies were the most effective interventions in improving women's childbirth experience.Conclusions: Nonpharmacological interventions that enable women to feel supported, safe and respected can lead to improved childbirth experiences. However, there is a need for further studies with larger sample sizes and standardized tool to better assess the effectiveness of specific interventions on women's childbirth experiences. [ABSTRACT FROM AUTHOR]

To synthetize the available evidence concerning efficacy and safety of imatinib mesylate, a tyrosine kinase inhibitor, in systemic sclerosis (SSc). A systematic search following the PRISMA-statement in PubMed/MEDLINE, Cochrane CENTRAL, and Web of Science databases up to 7 February 2020 was conducted. Considering the substantial heterogeneity expected, a random-effects model to pool data from selected studies was adopted. After a treatment period ranging from 6 to 12 months, the pooled analysis revealed that imatinib mesylate significantly improved modified Rodnan skin score (mRSS) (mean difference [MD] = −3.091, 95%CI −6.081 to −0.102, p = 0.043), whereas health-related assessment questionnaire (HAQ) remains unchanged (−0.096; 95 CI −0.197 to −0.006). Data regarding change in pulmonary function tests were insufficiently consistent to be considered eligible for meta-analysis. Finally, regarding safety, the authors found a pooled dropout rate due to all adverse events of 22% and a rate of serious adverse events of 17%. The significant change within the range of clinical relevance of mRSS suggests the possible use of imatinib mesylate in SSc, whereas it is still not possible to draw firm conclusions regarding the efficacy of the drug on lung involvement. Specifically designed and powered studies are needed to investigate imatinib mesylate therapy in SSc. [ABSTRACT FROM AUTHOR]

This study is asystematic review conducted in July, 2017. Related studies were searched in scientific databases of Biomed central, PubMed, Sciencedirect, Science of the Web, and Scopus according to the search method of Cochrane with related keywords since the creation of the desired databases. Among the studies, 4 studies did not achieve any of the outcomes, two studies had achieved all the desired outcomes and one study achieved some of the outcomes. Although, the use of antioxidants has reduced the risk of cancer or improved the patient's condition in all the studies, these effects are not statistically significant generally. [ABSTRACT FROM AUTHOR]

A number of studies have assessed the association between vitamin D and premenstrual syndrome (PMS) in different populations, but the findings have been inconclusive. Herein, we systematically reviewed available observational and interventional evidence to elucidate the overall relationship between vitamin D and PMS. PubMed, Cochrane Library, ScienceDirect, Scopus, Google Scholar, and ISI Web of Science databases were searched for all available articles until September 2018. The Newcastle-Ottawa quality assessment scale and Jadad scale were used to assess the quality of the observational and interventional studies, respectively. A total of 16 studies out of 196 met our inclusion criteria and were included in the final analysis. Although no significant association between serum 25(OH)D and PMS (weighted mean difference (WMD) = 3.35; 95% confidence interval, -7.80 to 1.11; p = 0.14) was indicated in observational studies, vitamin D supplementation was effective in ameliorating PMS symptoms based upon findings from interventional studies. These results add to the existing literature supporting the fact that nutrition, especially vitamin D, plays an important role in women's health. Additional well-designed clinical trials should be considered in future research to develop firm conclusions on the efficacy of vitamin D on PMS. KEY TEACHING POINTS 5-8% of women experience severe PMS. Nutrition especially vitamin D plays an important role in the women's health. Vitamin D could exert significant clinical effects on PMS symptoms. This is a systematic review and meta-analysis in this regard. [ABSTRACT FROM AUTHOR]

This investigation aimed to conduct a systematic review of the literature and meta-analysis to determine whether exposure to the herbicide paraquat was associated with the development of Parkinson's disease (PD). Observational studies that enrolled adults exposed to paraquat with PD as the outcome of interest were searched in the PubMed, Embase, LILACS, TOXNET, and Web of Science databases up to May 2019. Two authors independently selected relevant studies, extracted data, and assessed methodological quality. The evidence certainty was assessed by the GRADE approach, which served as basis for a tentative causality assessment, supplemented by the Bradford Hill criteria when necessary. Results from nine case–control studies indicated that PD occurrence was 25% higher in participants exposed to paraquat. The only cohort investigation included demonstrated a non-significant OR of 1.08. Results from subgroup analyses also indicated higher PD frequency in participants that were exposed to paraquat for longer periods or individuals co-exposed with paraquat and any other dithiocarbamate. Data indicate apositive association between exposure to paraquat and PD occurrence, but the weight-of-evidence does not enable one to assume an indisputable cause–effect relationship between these two conditions. Better designed studies are needed to increase confidence in results. Systematic Review Registration: PROSPERO CRD42017069994. [ABSTRACT FROM AUTHOR]

A scientifically sound assessment of the potential hazards associated with a substance requires a systematic, objective and transparent evaluation of the weight of evidence (WoE) for causality of health effects. We critically evaluated the current WoE framework for causal determination used in the United States Environmental Protection Agency's (EPA's) assessments of the scientific data on air pollutants for the National Ambient Air Quality Standards (NAAQS) review process, including its methods for literature searches; study selection, evaluation and integration; and causal judgments. The causal framework used in recent NAAQS evaluations has many valuable features, but it could be more explicit in some cases, and some features are missing that should be included in every WoE evaluation. Because of this, it has not always been applied consistently in evaluations of causality, leading to conclusions that are not always supported by the overall WoE, as we demonstrate using EPA's ozone Integrated Science Assessment as a case study. We propose additions to the NAAQS causal framework based on best practices gleaned from a previously conducted survey of available WoE frameworks. A revision of the NAAQS causal framework so that it more closely aligns with these best practices and the full and consistent application of the framework will improve future assessments of the potential health effects of criteria air pollutants by making the assessments more thorough, transparent, and scientifically sound. [ABSTRACT FROM AUTHOR]