There has been a growing interest in the gastrointestinal system and its significance for autism spectrum disorder (ASD), including the significance of adopting a gluten-free and casein-free (GFCF) diet. The objective was to investigate beneficial and safety of a GFCF diet among children with a diagnosis of ASD. We performed a systematic literature search in Medline, Embase, Cinahl, and the Cochrane Library up to January 2020 for existing systematic reviews and individual randomized controlled trials (RCTs). Studies were included if they investigated a GFCF diet compared to a regular diet in children aged 3 to 17 years diagnosed with ASD, with or without comorbidities. The quality of the identified existing reviews was assessed using A Measurement Tool to Assess Systematic Reviews (AMSTAR). The risk of bias in RCTs was assessed using the Cochrane Risk of Bias Tool, and overall quality of evidence was evaluated using Grades of Recommendation, Assessment, Development, and Evaluation (GRADE). We identified six relevant RCTs, which included 143 participants. The results from a random effect model showed no effect of a GFCF diet on clinician-reported autism core symptoms (standardized mean difference (SMD) −0.31 (95% Cl. −0.89, 0.27)), parent-reported functional level (mean difference (MD) 0.61 (95% Cl −5.92, 7.14)) or behavioral difficulties (MD 0.80 (95% Cl −6.56, 10.16)). On the contrary, a GFCF diet might trigger gastrointestinal adverse effects (relative risk (RR) 2.33 (95% Cl 0.69, 7.90)). The quality of evidence ranged from low to very low due to serious risk of bias, serious risk of inconsistency, and serious risk of imprecision. Clinical implications of the present findings may be careful consideration of introducing a GFCF diet to children with ASD. However, the limitations of the current literature hinder the possibility of drawing any solid conclusion, and more high-quality RCTs are needed. The protocol is registered at the Danish Health Authority website.

OBJECTIVE To estimate the effectiveness of physical activity monitor (PAM) based interventions among adults and explore reasons for the heterogeneity. DESIGN Systematic review and meta-analysis. STUDY SELECTION The electronic databases MEDLINE, Embase, SPORTDiscus, CINAHL, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched on 4 June 2021. Eligible randomised controlled trials compared interventions in which adults received feedback from PAMs with control interventions in which no feedback was provided. No restrictions on type of outcome measurement, publication date, or language were applied. DATA EXTRACTION AND SYNTHESIS Two reviewers independently extracted data and assessed risk of bias. Random effects meta-analyses were used to synthesise the results. The certainty of evidence was rated by the Grading of Recommendations Assessment and Evaluation (GRADE) approach. MAIN OUTCOME MEASURES The three primary outcomes of interest were physical activity, moderate to vigorous physical activity, and sedentary time. RESULTS 121 randomised controlled trials with 141 study comparisons, including 16743 participants, were included. The PAM based interventions showed a moderate effect (standardised mean difference 0.42, 95% confidence interval 0.28 to 0.55) on physical activity, equivalent to 1235 daily steps; a small effect (0.23, 0.16 to 0.30) on moderate to vigorous physical activity, equivalent to 48.5 weekly minutes; and a small insignificant effect (-0.12, -0.25 to 0.01) on sedentary time, equal to 9.9 daily minutes. All outcomes favoured the PAM interventions. CONCLUSIONS The certainty of evidence was low for the effect of PAM based interventions on physical activity and moderate for moderate to vigorous physical activity and sedentary time. PAM based interventions are safe and effectively increase physical activity and moderate to vigorous physical activity. The effect on physical activity and moderate to vigorous physical activity is well established but might be overestimated owing to publication bias.

The Danish Health Authority develops clinical practice guidelines to support clinical decision-making based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system and prioritizes using Cochrane reviews. The objective of this study was to explore the usefulness of Cochrane reviews as a source of evidence in the development of clinical recommendations. Evidence-based recommendations in guidelines published by the Danish Health Authority between 2014 and 2021 were reviewed. For each recommendation, it was noted if and how Cochrane reviews were utilized. In total, 374 evidence-based recommendations and 211 expert consensus recommendations were published between 2014 and 2021. Of the 374 evidence-based recommendations, 106 included evidence from Cochrane reviews. In 28 recommendations, all critical and important outcomes included evidence from Cochrane reviews. In 36 recommendations, a minimum of all critical outcomes included evidence from Cochrane reviews, but not all important outcomes. In 33 recommendations, some but not all critical outcomes included evidence from Cochrane reviews. Finally, in nine recommendations, some of the important outcomes included evidence from Cochrane reviews. In almost one-third of the evidence-based recommendations, Cochrane reviews were used to inform clinical recommendations. This evaluation should inform future evaluations of Cochrane review uptake in clinical practice guidelines concerning outcomes important for clinical decision-making.

Background and purpose: Hip precautions are routinely prescribed to patients with osteoarthritis to decrease dislocation rates after total hip arthroplasty (THA) using a posterior approach. However, recommendations have been based on very low certainty of evidence. We updated the evidence on the influence of hip precautions on early recovery following THA by this systematic review.Materials and methods: We performed systematic searches for randomized controlled trials (RCT) and non-randomized (NRS) studies in MEDLINE, Embase, PEDro, and CINAHL published from 2016 to July 2022. 2 reviewers independently included studies comparing postoperative precautions with minimal or no precautions, extracted data, and assessed the risk of bias. Random effects meta-analyses were used to synthesize the results. The certainty of the evidence was rated by the Grading of Recommendations Assessment and Evaluation approach. The critical outcome was the risk of hip dislocations within 3 months of surgery. Other outcomes were long-term risk of dislocation and reoperation, self-reported and performance-based assessment of function, quality of life, pain, and time to return to work.Results: 4 RCTs and 5 NRSs, including 8,835 participants, were included. There may be no or negligible difference in early hip dislocations (RCTs: risk ratio [RR] 1.8, 95% confidence interval [CI] 0.6–5.2; NRS: RR 0.9, CI 0.3–2.5). Certainty in the evidence was low for RCTs and very low for NRSs. Finally, precautions may reduce the performance-based assessment of function slightly, but the evidence was very uncertain. For all other outcomes, no differences were found (moderate to very low certainty evidence).Conclusion: The current evidence does not support routinely prescribing hip precautions post-surgically for patients undergoing THA to prevent hip dislocations. However, the results might change with high-quality studies.

Editors and peer reviewers of research articles may have conflicts of interest that impact their evaluations. We aimed to characterize medical journals' conflict of interest policies for editors and peer reviewers. In this cross-sectional study, we randomly sampled 277 medical journals from Clarivate Journal Citation Reports. Two authors independently retrieved public conflict of interest policies and disclosures for editors and peer reviewers from journal websites and retrieved publishers' policies when journals also referred to them (January to June 2024). We used content analysis to analyze policies and multivariable mixed-effects logistic regressions to estimate the associations between journal characteristics and having a policy. After excluding 27 journals, we included 250 medical journals in English, of which 177 (71%) had a conflict of interest policy for editors and 174 (70%) for peer reviewers. Of journals with a policy, 137 (77%) and 129 (74%) described disclosure requirements, 160 (90%) and 163 (94%) described management strategies, 124 (70%) and 106 (61%) described policy enforcement strategies, and 17 (10%) and 15 (9%) described processes for appealing decisions. All 4 concepts were addressed in 16 (9%) policies for editors and in 11 (6%) for peer reviewers. Having a policy for editors was associated with higher journal impact factor (adjusted odds ratio (OR): 1.28; 95% confidence interval (CI): 1.05-1.56) and Committee on Publication Ethics membership (OR: 3.50; 95% CI: 1.42-8.65). Having a policy for peer reviewers was associated with higher journal impact factor (OR: 1.16; 95% CI: 0.97-1.37) and open access journal (OR: 4.59; 95% CI: 1.11-18.93). For a subgroup of journals referring to their publishers' policy, the content was concordant for 5 (11%) of 45 journals for editors and 4 (9%) of 47 journals for peer reviewers. Of 250 journals, 14 (6%) had public declarations of interest from editors, and 3 (1%) from peer reviewers. More than two-thirds of medical journals have conflict of interest policies for editors and reviewers; however, policies vary in comprehensiveness. There is potential to improve the content of conflict of interest policies and the transparency of interests in medical journals. Before a scientific study is published as a research paper in a medical journal, it is evaluated by the journal editors and other researchers, known as peer reviewers. This process is used to assess and ensure the quality and trustworthiness of the research and to assist editors in deciding whether to publish the paper. Editors and peer reviewers, however, are not necessarily neutral and may have personal interests that can influence their opinions. For example, they may have personal relationships with the study authors or have financial relationships with a company whose product is investigated in the study, which could result in conflicts of interest. Although most journals have policies addressing study authors' conflicts of interest, little is known about the practices and policies of medical journals concerning editors' and peer reviewers' conflicts of interest. In our study, we randomly selected 250 medical journals and examined their public conflict of interest policies for editors and peer reviewers, as well as whether these policies aligned with their publishers' policies. In addition, we assessed whether the interests of editors and peer reviewers were publicly disclosed. We estimated the proportion of journals with available policies, assessed which journal characteristics were associated with having a policy, and analyzed the content of policies. Of the 250 medical journals, we found that 177 (71%) journals had a conflict of interest policy for editors and 174 (70%) for peer reviewers, but their interests were very rarely publicly disclosed. The policies often contained limited information and were often only described in detail in the publishers' policies, and sometimes information in the journal's and the publisher's policies was in disagreement. Finally, policies rarely describe how journal staff assess interests, how these assessments may influence the journal's editorial process, and how journals enforce the consequences of policy violations. There is substantial potential for medical journals to improve their conflict of interest policies for editors and peer reviewers, as well as the transparency of their interests in medical journals.

Background Peer review may improve the quality of research manuscripts and aid in editorial decisions, but reviewers can have conflicts of interest that impact on their recommendations. Objectives The objective was to systematically map and describe the extent and nature of empirical research on peer reviewers’ conflicts of interest in biomedical research. Design Scoping review Methods In this scoping review, we included studies investigating peer reviewers’ conflicts of interest in journal manuscripts, theses and dissertations, conference abstracts, funding applications and clinical guidelines. We searched MEDLINE, Embase, The Cochrane Methodology Register, Google Scholar (up to January 2024) and other sources. Two authors independently included studies and extracted data on key study characteristics and results, and we organised data by study domain (eg, journal manuscripts) and study aims. We included studies directly investigating peer reviewers’ conflicts of interest in our primary analysis, and studies investigating other questions (eg, reasons for retraction), but reporting relevant data on peer reviewers’ conflicts of interest, were solely included in a supplementary analysis. Results After screening 44 353 references, we included 71 studies, of which 41 were included in our primary analysis. The 41 studies were published between 2005 and 2023, and 34 (83%) were journal publications. 30 (73%) studies investigated journal manuscripts, 1 (2%) conference abstracts, 4 (10%) funding applications and 6 (15%) clinical guidelines. No studies investigated theses or dissertations. 37 (90%) studies used quantitative research methods, 2 (5%) qualitative and 2 (5%) mixed methods. 21 (51%) studies investigated both financial and non-financial interests, 6 (15%) solely financial interests, 5 (12%) solely non-financial interests and 9 (22%) did not report the type of interest. We organised included studies based on study aims, with some studies having multiple aims: impact on recommendations (one study), occurrence of peer reviewers’ conflicts of interest (11 studies), stakeholders’ experiences (13 studies) and policy and management (22 studies). One (2%) study investigated the impact of peer reviewers’ personal connections with authors on reviewers’ recommendations. Nine (22%) studies estimated prevalences of conflicts of interest among peer reviewers, ranging from 3%–91%. Two (5%) studies both reported that conflicts of interest were a reason for declining to review in 1% of cases. 13 (32%) studies investigated stakeholders’ experiences with peer reviewers’ conflicts of interest, primarily using questionnaires of reviewers, editors and researchers. 16 (39%) studies estimated prevalences of having conflict of interest policies for peer reviewers, ranging from 5%–96%, among journals, conferences and clinical guideline organisations. Finally, six (15%) studies estimated prevalences of public availabilities of reviewers’ conflicts of interest declarations, ranging from 0%–71%. Conclusions Most studies addressed conflicts of interest in peer review of journal manuscripts, primarily through surveys of journal policies or questionnaires of researchers, editors and peer reviewers. The impact of peer reviewers’ conflicts of interest on recommendations and their prevalence is still poorly understood. Our results can guide future studies and be used to align policies and management of peer reviewers’ conflicts of interest. Study registration Open Science Framework (DOI: 10.17605/OSF.IO/9QBMG).