Non-Cochrane · intervention · PM35768801
Effectiveness of primary school-based interventions in improving oral health of children in low- and middle-income countries: a systematic review and meta-analysis.
Akera Peter, Kennedy Sean E, Lingam Raghu, et al. · BMC oral health · 2022 · PubMed · doi:10.1186/s12903-022-02291-2
Full textEvery question was extracted from the full text, figures and supplements by two independent LLM extractors, disagreements adjudicated. Rows cite where in the review the value comes from.
Questions
21
current version
GRADE rated
7
No studies
0
Included studies
54
linked below
No studies 0 · 0%Ungraded 14 · 66.7%Very low 7 · 33.3%Low 0 · 0%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Children aged 3-16 years attending primary school in LMICs (post hoc widened age limits) | 34 included studies (n=6766 max meta-analysis); children aged 3-16 in LMICs; 18 Southeast Asia, 6 Africa, 5 the Americas, 2 Europe, 3 eastern Mediterranean |
| Intervention | Primary school-based interventions (school health policy; oral health education; healthy school environment; access to oral health services; community involvement), schools as focal delivery site | School-based interventions (n=34): mostly oral health education programs; 5 exclusively plaque visualisation/daily tooth brushing/fissure sealants/zinc supplementation; 3 based on WHO health-promoting-schools concept |
| Comparison | No intervention or usual practice | Schools receiving no intervention or continuing usual activities |
| Outcomes | Primary: dental caries by dmft(s)/DMFT(S) scores. Secondary: plaque, gingival disease, oral health knowledge, attitude and behaviour scores | Meta-analyzed (7): DMFT, net increment DMFT, DMFS, net increment DMFS, caries prevalence (dmft/DMFT/S>1), plaque, gingival scores. Narrative only: oral health knowledge, attitude, behaviour, quality of life; adverse events (none reported) |
| Study designs | Experimental and observational studies | 24 cluster randomised controlled trials, 2 non-randomised trials, 4 quasi-experiments, 4 cohort studies (30 experimental, 4 observational) |
| Timing | Published 1995 to December 2021 (English only) | Intervention durations a few minutes to 7 years; 19 between 1 month and 1 year; 4 over 3 years |
Search date: 2020-04-08 to 2020-06-07 (updated via automatic alerts; publication window 1995 to December 2021). Databases: MEDLINE, Embase, Global Health, CINAHL, Emcare, Scopus, Web of Science, WHO website, Google Advanced, Google Scholar; plus hand-searching reference lists of included studies and automatic alerts
Questions and results
Primary school-based interventions (one or more of: school health policy, oral health education, healthy school environment, access to oral health services, community involvement) vs No intervention or usual practice/activities
Population: Primary school children (aged 3-16 years) attending primary school in low- and middle-income countries (LMICs)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Dental caries measured by DMFT scores Post-intervention; follow-up varied across studies (interventions ranged from <2 years to >=2 years and longer) · Age 6-8 years Among children aged 6-8 years, DMFT scores were significantly reduced (SMD -0.11); subgroup not separately GRADE-rated. Source: Results (Subgroup analysis) · same question in other reviews | SMD -0.11 [-0.17, -0.04] | NR | Ungraded |
Dental caries measured by net increment in DMFS scores Post-intervention; follow-up varied across studies (interventions ranged from <2 years to >=2 years and longer) · Intervention type: oral health education Oral-health-education interventions significantly reduced net increment in DMFS (SMD -1.05); no significant subgroup difference vs other interventions (P=0.74). Source: Results (Subgroup analysis) · same question in other reviews | SMD -1.05 [-2.03, -0.08] | 3 studies | Ungraded |
Dental caries measured by DMFT scores <2 years · Intervention duration <2 years Interventions lasting <2 years showed no significant effect on DMFT scores (SMD 0.01); subgroup not separately GRADE-rated. Source: Results (Subgroup analysis); Fig. 2 (subgroup 2.2.1) · same question in other reviews | SMD 0.01 [-0.16, 0.18] | 3 studies | Ungraded |
Dental caries measured by DMFT scores Post-intervention; follow-up varied across studies (interventions ranged from <2 years to >=2 years and longer) · Age 8-15 years Among children aged 8-15 years, DMFT scores were significantly reduced (SMD -0.41), a larger effect than in 6-8 year-olds. Source: Results (Subgroup analysis) · same question in other reviews | SMD -0.41 [-0.50, -0.32] | NR | Ungraded |
Dental caries measured by net increment in DMFS scores Post-intervention; follow-up varied across studies (interventions ranged from <2 years to >=2 years and longer) · Intervention type: other (daily tooth brushing) Other interventions (daily tooth brushing) significantly reduced net increment in DMFS (SMD -1.23). Source: Results (Subgroup analysis) · same question in other reviews | SMD -1.23 [-1.46, -1.00] | 1 study | Ungraded |
Dental caries measured by DMFT scores >=2 years · Intervention duration >=2 years Interventions lasting >=2 years significantly reduced DMFT scores (SMD -0.49); subgroup difference by duration was significant (P=0.004). Source: Results (Subgroup analysis); Fig. 2 (subgroup 2.2.2) · same question in other reviews | SMD -0.49 [-0.79, -0.19] | 4 studies | Ungraded |
Dental caries measured by net increment in DMFT scores Post-intervention; follow-up varied across studies (interventions ranged from <2 years to >=2 years and longer) · Age 5-8 years Among children aged 5-8 years, net increment in DMFT was not significantly reduced (SMD -0.36); no significant subgroup difference by age. Source: Results (Subgroup analysis) · same question in other reviews | SMD -0.36 [-0.76, 0.04] | 5 studies | Ungraded |
Dental caries measured by DMFS scores Post-intervention; follow-up varied across studies (interventions ranged from <2 years to >=2 years and longer) The effect of school-based interventions on DMFS scores is uncertain and not statistically significant (SMD -0.26; very low certainty). Source: Abstract; Results (DMFS scores); Fig. 4; Table 4 (SoF) · same question in other reviews | SMD -0.26 [-0.70, 0.18] | 5 studies · 3506 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Dental caries measured by net increment in DMFS scores Post-intervention; follow-up varied across studies (interventions ranged from <2 years to >=2 years and longer) · WHO health-promoting-schools framework Interventions based on the WHO health-promoting-schools framework showed no significant effect on net increment in DMFS (SMD -0.57). Source: Results (Subgroup analysis) · same question in other reviews | SMD -0.57 [-1.56, 0.42] | 2 studies | Ungraded |
Dental caries measured by net increment in DMFS scores Post-intervention; follow-up varied across studies (interventions ranged from <2 years to >=2 years and longer) · Non-WHO-framework interventions Non-WHO-framework interventions significantly reduced net increment in DMFS (SMD -1.88); no significant subgroup difference vs WHO-framework (P=0.11). Source: Results (Subgroup analysis) · same question in other reviews | SMD -1.88 [-3.15, -0.60] | NR | Ungraded |
Dental caries measured by DMFS scores Post-intervention; follow-up varied across studies (interventions ranged from <2 years to >=2 years and longer) · <=3 intervention activities Interventions with <=3 activities showed no significant effect on DMFS scores (SMD -0.58); no significant subgroup difference by number of activities. Source: Results (Subgroup analysis) · same question in other reviews | SMD -0.58 [-1.62, 0.45] | NR | Ungraded |
Dental caries prevalence measured by dmft or DMFT/S score greater than one <2 years · Intervention duration <2 years Interventions lasting <2 years showed no significant effect on caries prevalence (RR 0.95); subgroup not separately GRADE-rated. Source: Results (Subgroup analysis); Fig. 6 (subgroup 2.4.1) · same question in other reviews | RR 0.95 [0.75, 1.21] | 2 studies | Ungraded |
Oral hygiene measured by plaque scores Post-intervention; follow-up varied across studies (interventions ranged from <2 years to >=2 years and longer) School-based interventions may reduce dental plaque scores (SMD -0.32, favouring intervention), but the certainty of evidence is very low. Source: Abstract; Results (plaque scores); Fig. 7; Table 4 (SoF) · same question in other reviews | SMD -0.32 [-0.46, -0.18] | 7 studies · 3339 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Oral hygiene measured by mean gingival scores Post-intervention; follow-up varied across studies (interventions ranged from <2 years to >=2 years and longer) The effect of school-based interventions on gingival scores is uncertain and not statistically significant (SMD 0.12; very low certainty). Source: Abstract; Results (gingival scores); Fig. 8; Table 4 (SoF) · same question in other reviews | SMD 0.12 [-0.32, 0.55] | 3 studies · 1573 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Dental caries measured by DMFT scores Post-intervention; follow-up varied across studies (interventions ranged from <2 years to >=2 years and longer) Primary school-based interventions may reduce dental caries measured by DMFT scores (SMD -0.33, favouring intervention), but the certainty of evidence is very low. Source: Abstract; Results (Dental caries measured by DMFT scores); Fig. 2; Table 4 (SoF) · same question in other reviews | SMD -0.33 [-0.56, -0.10] | 7 studies · 6766 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Dental caries prevalence measured by dmft or DMFT/S score greater than one Post-intervention; follow-up varied across studies (interventions ranged from <2 years to >=2 years and longer) School-based interventions may reduce the prevalence of dental caries (RR 0.70, favouring intervention), but the certainty of evidence is very low. Source: Abstract; Results (Dental caries prevalence); Fig. 6; Table 4 (SoF) · same question in other reviews | RR 0.70 [0.53, 0.94] 60.2% (553/919, control) vs 42.5% (871/2049, intervention) | 4 studies · 2968 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Dental caries measured by net increment in DMFT scores Post-intervention; follow-up varied across studies (interventions ranged from <2 years to >=2 years and longer) The effect of school-based interventions on net increment in DMFT scores is uncertain and not statistically significant (SMD -0.34; very low certainty). Source: Abstract; Results (net increment in DMFT scores); Fig. 3; Table 4 (SoF) · same question in other reviews | SMD -0.34 [-0.69, 0.02] | 5 studies · 5492 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Dental caries prevalence measured by dmft or DMFT/S score greater than one >=2 years · Intervention duration >=2 years Interventions lasting >=2 years significantly reduced caries prevalence (RR 0.58); subgroup difference by duration was significant (P=0.03). Source: Results (Subgroup analysis); Fig. 6 (subgroup 2.4.2) · same question in other reviews | RR 0.58 [0.40, 0.84] | 2 studies | Ungraded |
Dental caries measured by DMFS scores Post-intervention; follow-up varied across studies (interventions ranged from <2 years to >=2 years and longer) · >3 intervention activities Interventions with >3 activities showed no significant effect on DMFS scores (SMD 0.02). Source: Results (Subgroup analysis) · same question in other reviews | SMD 0.02 [-0.13, 0.17] | NR | Ungraded |
Dental caries measured by net increment in DMFT scores Post-intervention; follow-up varied across studies (interventions ranged from <2 years to >=2 years and longer) · Age 9-12 years Among children aged 9-12 years, net increment in DMFT was not significantly reduced (SMD -0.20). Source: Results (Subgroup analysis) · same question in other reviews | SMD -0.20 [-0.44, 0.04] | 1 study | Ungraded |
Dental caries measured by net increment in DMFS scores Post-intervention; follow-up varied across studies (interventions ranged from <2 years to >=2 years and longer) School-based interventions may reduce the net increment in DMFS scores (SMD -1.09, favouring intervention), but the certainty of evidence is very low. Source: Abstract; Results (net increment DMFS scores); Fig. 5; Table 4 (SoF) · same question in other reviews | SMD -1.09 [-1.91, -0.27] | 4 studies · 3755 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
AMSTAR 2 appraisal
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | No | no |
| 3Choice of study designs explained | No | No | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | No | No | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | Yes | Yes | yes |
| 8Included studies described in detail | Yes | Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: Yes | NRSI: Yes · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: No | NRSI: Yes · RCT: Yes | no |
| 12Impact of risk of bias on the pooled results | Yes | Yes | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | No | Yes | no |
| 16Conflicts of interest reported | No | No | yes |
| Overall | Critically Low | Low | no |
Included primary studies 54
Open as a trial list| Study | Also included by | Outcomes it informs here | Trial PICO | Results |
|---|---|---|---|---|
| Duijster et al. 2017 'Fit for school' - a school-based water, sanitation and hygiene programme to improve child health: Results from a longitudinal study in… PMID:28381246 | 1 other review | not stated | not extracted yet | not extracted yet |
| Gholami et al. 2015 A Brief Self-Regulatory Intervention Increases Dental Flossing in Adolescent Girls. PMID:25549910 | 1 other review | not stated | not extracted yet | not extracted yet |
| Haleem et al. 2012 School-based strategies for oral health education of adolescents--a cluster randomized controlled trial. PMID:23249443 | 1 other review | not stated | not extracted yet | not extracted yet |
| Nammontri et al. 2013 Enhancing oral health via sense of coherence: a cluster-randomized trial. PMID:23018820 | 1 other review | not stated | not extracted yet | not extracted yet |
| Petersen et al. 2004 Effect of a school-based oral health education programme in Wuhan City, Peoples Republic of China. PMID:15005471 | 1 other review | not stated | not extracted yet | not extracted yet |
| Tai et al. 2009 Assessing the effectiveness of a school-based oral health promotion programme in Yichang City, China. PMID:19624698 | 1 other review | not stated | not extracted yet | not extracted yet |
| van Palenstein Helderman et al. 1997 Effect evaluation of an oral health education programme in primary schools in Tanzania DOI:10.1111/j.1600-0528.1997.tb00943.x | 1 other review | not stated | not extracted yet | not extracted yet |
| Yekaninejad et al. 2012 Effect of a school-based oral health-education program on Iranian children: results from a group randomized trial. PMID:22985001 | 1 other review | not stated | not extracted yet | not extracted yet |
| Chachra et al. 2011 The most effective and essential way of improving the oral health status education DOI:10.4103/0970-4388.85825 | this review only | not stated | not extracted yet | not extracted yet |
| Chachra et al. 2011 The most effective and essential way of improving the oral health status education. PMID:21985877 | this review only | not stated | not extracted yet | not extracted yet |
| Chauhan et al. 2016 School Based Intervention Programme on Gingival Health of 10–12 Years Old Government Aided School Children of Basavangudi in Bangalore… DOI:10.5958/0976-5506.2016.00070.x | this review only | not stated | not extracted yet | not extracted yet |
| Chounchaisithi et al. 2014 Use of a disclosed plaque visualization technique improved the self-performed, tooth brushing ability of primary schoolchildren. PMID:25518180 | this review only | not stated | not extracted yet | not extracted yet |
| de Farias et al. 2009 A Health Education Program for Brazilian Public Schoolchildren: The Effects on Dental Health Practice and Oral Health Awareness DOI:10.1111/j.1752-7325.2009.00127.x | this review only | not stated | not extracted yet | not extracted yet |
| de Farias et al. 2009 A health education program for Brazilian public schoolchildren: the effects on dental health practice and oral health awareness. PMID:19453867 | this review only | not stated | not extracted yet | not extracted yet |
| de Sousa et al. 2002 DOI:10.1111/j.1875-595x.2002.tb00877.x | this review only | not stated | not extracted yet | not extracted yet |
| de Sousa et al. 2002 Caries reductions related to the use of fluorides: a retrospective cohort study. PMID:12418598 | this review only | not stated | not extracted yet | not extracted yet |
| Esan et al. 2015 Effect of a school‐based oral health education programme on use of recommended oral self‐care for reducing the risk of caries by children… DOI:10.1111/ipd.12143 | this review only | not stated | not extracted yet | not extracted yet |
| Esan et al. 2015 Effect of a school-based oral health education programme on use of recommended oral self-care for reducing the risk of caries by children… PMID:25413008 | this review only | not stated | not extracted yet | not extracted yet |
| Frencken et al. 2001 Effectiveness of an oral health education programme in primary schools in Zimbabwe after 3.5 years DOI:10.1034/j.1600-0528.2001.290403.x | this review only | not stated | not extracted yet | not extracted yet |
| Frencken et al. 2001 Effectiveness of an oral health education programme in primary schools in Zimbabwe after 3.5 years. PMID:11515638 | this review only | not stated | not extracted yet | not extracted yet |
| Gholami et al. 2015 A Brief Self-Regulatory Intervention Increases Dental Flossing in Adolescent Girls DOI:10.1007/s12529-014-9459-6 | this review only | not stated | not extracted yet | not extracted yet |
| Hartono et al. 2002 Effectiveness of primary school-based oral health education in West Java, Indonesia DOI:10.1111/j.1875-595x.2002.tb00618.x | this review only | not stated | not extracted yet | not extracted yet |
| Hartono et al. 2002 Effectiveness of primary school-based oral health education in West Java, Indonesia. PMID:12090263 | this review only | not stated | not extracted yet | not extracted yet |
| Hebbal and Nagarajappa 2005 Does School‐Based Dental Screening for Children Increase Follow‐Up Treatment at Dental School Clinics? DOI:10.1002/j.0022-0337.2005.69.3.tb03926.x | this review only | not stated | not extracted yet | not extracted yet |
| Hebbal and Nagarajappa 2005 Does school-based dental screening for children increase follow-up treatment at dental school clinics? PMID:15749950 | this review only | not stated | not extracted yet | not extracted yet |
| Hebbal et al. 2011 Evaluation of knowledge and plaque scores in school children before and after health education. PMID:22135690 | this review only | not stated | not extracted yet | not extracted yet |
| Jaime et al. 2015 Oral Health Education Program on Dental Caries Incidence for School Children DOI:10.17796/1053-4628-39.3.277 | this review only | not stated | not extracted yet | not extracted yet |
| Jaime et al. 2015 Oral Health Education Program on Dental Caries Incidence for School Children. PMID:26208075 | this review only | not stated | not extracted yet | not extracted yet |
| Kapadia et al. 1999 Evaluation of a curriculum for dental health in 3rd grade school children in Mumbai, India. PMID:10863494 | this review only | not stated | not extracted yet | not extracted yet |
| Lai et al. 2016 Long‐term effectiveness of school‐based children oral hygiene program on oral health after 10‐year follow‐up DOI:10.1111/cdoe.12207 | this review only | not stated | not extracted yet | not extracted yet |
| Lai et al. 2016 Long-term effectiveness of school-based children oral hygiene program on oral health after 10-year follow-up. PMID:26691608 | this review only | not stated | not extracted yet | not extracted yet |
| Monse et al. 2013 The Fit for School Health Outcome Study - a longitudinal survey to assess health impacts of an integrated school health programme in the… PMID:23517517 | this review only | not stated | not extracted yet | not extracted yet |
| Naidu and Nandlal 2017 Evaluation of the Effectiveness of a Primary Preventive Dental Health Education Programme Implemented Through School Teachers for Primary… PMID:28462175 | this review only | not stated | not extracted yet | not extracted yet |
| Nammontri et al. 2013 Enhancing Oral Health <i>via</i> Sense of Coherence DOI:10.1177/0022034512459757 | this review only | not stated | not extracted yet | not extracted yet |
| Nyandindi et al. 1996 Impact of oral health education on primary school children before and after teachers' training in Tanzania DOI:10.1093/heapro/11.3.193 | this review only | not stated | not extracted yet | not extracted yet |
| Pakhomov et al. 1997 Effect of an Amine Fluoride Dentifrice on Dental Caries Used in a Community‐based Oral Health Education Program DOI:10.1111/j.1752-7325.1997.tb02971.x | this review only | not stated | not extracted yet | not extracted yet |
| Pakhomov et al. 1997 Effect of an amine fluoride dentifrice on dental caries used in a community-based oral health education program. PMID:9383758 | this review only | not stated | not extracted yet | not extracted yet |
| Peng et al. 2004 Can school‐based oral health education and a sugar‐free chewing gum program improve oral health? Results from a two‐year study in PR China DOI:10.1080/00016350410010036 | this review only | not stated | not extracted yet | not extracted yet |
| Peng et al. 2004 Can school-based oral health education and a sugar-free chewing gum program improve oral health? Results from a two-year study in PR China. PMID:15848976 | this review only | not stated | not extracted yet | not extracted yet |
| Petersen et al. 2004 Effect of a school-based oral health education programme in Wuhan City, Peoples Republic of China DOI:10.1111/j.1875-595x.2004.tb00250.x | this review only | not stated | not extracted yet | not extracted yet |
| Saied-Moallemi et al. 2009 School‐based intervention to promote preadolescents’ gingival health: a community trial DOI:10.1111/j.1600-0528.2009.00491.x | this review only | not stated | not extracted yet | not extracted yet |
| Saied-Moallemi et al. 2009 School-based intervention to promote preadolescents' gingival health: a community trial. PMID:19694774 | this review only | not stated | not extracted yet | not extracted yet |
| Simpriano and Mialhe 2017 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Swe et al. 2021 Effectiveness of oral health education on 8- to 10-year-old school children in rural areas of the Magway Region, Myanmar. PMID:33388030 | this review only | not stated | not extracted yet | not extracted yet |
| Tai et al. 2009 Assessing the effectiveness of a school‐based oral health promotion programme in Yichang City, China DOI:10.1111/j.1600-0528.2009.00484.x | this review only | not stated | not extracted yet | not extracted yet |
| Tomazoni et al. 2019 Can a School-Based Intervention Improve the Oral Health-Related Quality of Life of Brazilian Children? DOI:10.1177/2380084418816984 | this review only | not stated | not extracted yet | not extracted yet |
| Tomazoni et al. 2019 Can a School-Based Intervention Improve the Oral Health-Related Quality of Life of Brazilian Children? PMID:30931715 | this review only | not stated | not extracted yet | not extracted yet |
| Uckardes et al. 2009 The effect of systemic zinc supplementation on oral health in low socioeconomic level children. PMID:20112596 | this review only | not stated | not extracted yet | not extracted yet |
| van Palenstein Helderman et al. 1997 Effect evaluation of an oral health education programme in primary schools in Tanzania. PMID:9332807 | this review only | not stated | not extracted yet | not extracted yet |
| van Wyk et al. 2004 Evaluation of a Fissure Sealant Program as Part of Community‐Based Teaching and Training DOI:10.1002/j.0022-0337.2004.68.1.tb03734.x | this review only | not stated | not extracted yet | not extracted yet |
| van Wyk et al. 2004 Evaluation of a fissure sealant program as part of community-based teaching and training. PMID:14761173 | this review only | not stated | not extracted yet | not extracted yet |
| Yekaninejad et al. 2012 Effect of a school‐based oral health‐education program on <scp>I</scp>ranian children: results from a group randomized trial DOI:10.1111/j.1600-0722.2012.00993.x | this review only | not stated | not extracted yet | not extracted yet |
| Yusof and Jaafar 2013 Health promoting schools and children's oral health related quality of life. PMID:24325653 | this review only | not stated | not extracted yet | not extracted yet |
| Zacharias et al. 2019 Effectiveness of Randomized Controlled Field Trial Instructing Parents to Supervise Children on Tooth Brushing Skills and Oral Hygiene DOI:10.2174/1874210601913010076 | this review only | not stated | not extracted yet | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match).