Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 45 appraisals
Current opinion in pediatrics
Clinical implementation of artificial intelligence in adolescent mental healthcare
PURPOSE OF REVIEW: This review aims to summarize recent literature on artificial intelligence (AI) tools for adolescent mental health, including the types of tools available, their clinical applications, effectiveness, and safety, as well as relevant ethical considerations. RECENT FINDINGS: For clinicians, AI can facilitate clinical documentation, enhance therapy, and support the diagnosis process. Adolescents show interest in using AI for their mental healthcare and can benefit from AI-guided therapy apps and chatbots. Most studies that show effectiveness focus on depression treatment. Many tools are only in the prototyping stage, not tested on clinical samples, or lack safety measures, highlighting the need for further safety evaluation before specific app recommendations can be made. SUMMARY: AI is increasingly being implemented in pediatric health systems and adolescents' daily lives. Adolescent medicine practitioners should recognize the growing potential for certain AI applications to enhance access and support adolescents, review and utilize those applications that have empirical support of efficacy, and that provide guardrails for safe and ethical use.
1 Aug 2026
Read appraisal →JMIR formative research
Development of a User-Informed Decision Aid for Contraceptive Decision-Making Among Adolescents and Young Adults: Qualitative Study
BACKGROUND: Adolescents and young adults seeking contraceptive care face many considerations related to differences in contraceptive indications and knowledge, which are often overlooked and can lead to contraceptive nonadherence or nonuse as well as adverse health outcomes. OBJECTIVE: This study aimed to develop a digital decision aid that meets the contraceptive decisional needs of adolescents and young adults from diverse backgrounds. METHODS: We developed a web-based decision aid using a user-centered design framework and the International Patient Decision Aid Standards. The design and development process was informed by a literature review and consultations with scientific experts, health informatics specialists, clinicians experienced in adolescent reproductive health, and a diverse group of adolescent and young adult advisors. We gathered feedback on the decision aid's content and functionality from clinicians, adolescents, and young adult stakeholders during focus group interviews conducted across 2 user testing cycles. Each focus group was recorded and transcribed, and the data were analyzed using a focus group guide to identify key attributes, patterns, and perspectives among users. Two qualitative researchers used rapid qualitative analysis to explore and summarize findings across 4 key domains, which contributed to the refinement of the decision aid content and the improvement of its functionality. RESULTS: Twenty-four clinicians, adolescents, and young adult participants from diverse backgrounds shared their perspectives on the decision aid's content, relevance, design, and usability across 2 user testing cycles conducted from February 2023 to June 2024. The decision aid includes a survey, a decision algorithm that generates a summary of contraceptive method recommendations, infographics, and a health care provider summary view. The decision algorithm applies a weighted scoring system ranging from +1 or -1 to +10 or -10 for each method, reflecting the user's primary indication for seeking contraception, contraceptive use preferences, and relevant health history. CONCLUSIONS: This approach allowed us to capture rich perspectives from a diverse group of stakeholders that accounted for the unique contraceptive decision-making needs of adolescents and young adults, resulting in a functional, youth-informed decision aid prototype, MyPlanMyChoice, ready for pilot and feasibility evaluation in a clinical setting.
22 July 2026
Read appraisal →JMIR research protocols
A Health Promoting School Intervention in 10th Grade ('My Life - I Decide'): Protocol for a Pragmatic Controlled Trial
BACKGROUND: Health promoting school (HPS) interventions have the potential to improve adolescent health and well-being, but evidence regarding implementation and system-level impact in real-world school settings remains limited. "My Life - I Decide" (My Life) is a systems-oriented HPS intervention developed to strengthen positive mental and physical health, school well-being, and health-promoting school practices among 10th-grade students in Denmark. OBJECTIVE: This study aims to describe the intervention, study design, and evaluation framework of the "My Life" intervention and its pragmatic controlled trial, including effectiveness, process, and system-level evaluations. METHODS: The intervention is informed by the World Health Organization HPS framework and combines curriculum-based health education, action-oriented teaching, life-psychological approaches, and education outside the classroom. The intervention includes four phases: (1) preparation through cross-sectoral collaboration between health and education sectors; (2) planning and local adaptation; (3) delivery of a health education program; and (4) anchoring of health-promoting practices at the school level. Effectiveness is evaluated using a pragmatic controlled waiting-list trial design. Four intervention schools (11 classes) were matched with 4 control schools (15 classes), including approximately 416 students aged 15-17 years. Primary outcomes include social and emotional competences, self-efficacy, mental well-being, health literacy, school connectedness, and student interpersonal relations. Student survey data are collected at baseline, postintervention, and follow-up, and effectiveness will be analyzed using multilevel mixed models. System-level impacts are assessed using a mixed-methods design, including school staff surveys, interviews with school and municipal stakeholders, and student focus groups. A realist-informed multimethod process evaluation examines implementation fidelity, acceptability, contextual factors, and mechanisms of impact across intervention schools. Data sources include observations, interviews, student registration, and postsession surveys completed by health consultants after each teaching session. RESULTS: The study will generate quantitative and qualitative data on student outcomes, implementation processes, intersectoral collaboration, and development of health-promoting practices within schools. Findings from the effectiveness, process, and system-level evaluations will be triangulated to test and refine the initial program theory of the intervention. Recruitment of schools and student enrollment have been completed, and baseline data collection commenced in September 2025. Follow-up assessments are being conducted according to the study timeline. Qualitative data collection for the process and system-level evaluations were completed in June 2026. CONCLUSIONS: The "My Life" study will contribute knowledge on the implementation and evaluation of complex HPS interventions in real-world educational settings. The findings may inform future HPS initiatives and provide methodological insights into combining effectiveness, process, and system-level evaluations in adolescent health promotion research.
19 July 2026
Read appraisal →JMIR mHealth and uHealth
Perceived Sensitivity of Sensor-Based Digital Health Data: Qualitative Interview Study
BACKGROUND: Digital health tools are increasingly used in mental health care to passively collect patient data and analyze health status outside of clinical settings. While technologies such as digital phenotyping, affective computing, and computational behavioral analysis offer new insights into symptom manifestation in daily life, they generate large volumes of potentially sensitive data that raise significant data privacy concerns, requiring high levels of patient awareness and consent. Empirical research is lacking on stakeholder understandings toward the sensitivity of these data and expectations for data stewardship, perspectives that are critical for developing robust informed consent and data protection policies for digital health data use. OBJECTIVE: This study aimed to explore key stakeholder perspectives on the sensitivity of computer perception (CP) data, trust in existing data protections, willingness to share CP data externally, and desire for transparency of CP data transactions outside of the clinical space. METHODS: As part of a larger, multisite study, we conducted qualitative interviews (n=40) via Zoom (Zoom Communications, Inc) with 20 adolescents (aged 12-17 years) familiar with CP tools and their caregivers (n=20). Interviews consisted of a series of open-ended questions regarding stakeholders' perspectives on privacy, data security, and the use and exchange of CP data. We developed a qualitative codebook to identify and label thematic patterns in responses to questions addressing the topics above, using thematic content analysis to identify themes inductively. Each interview was coded by merging work from at least two separate coders, and several team members contributed to qualitative analysis. RESULTS: Most adolescents and caregivers viewed CP data as highly sensitive and expressed a reluctance to share these data beyond their clinical teams. While many participants expressed trust in existing data protections to protect CP data, they often misunderstood or overestimated the extent of protections to safeguard CP data. CONCLUSIONS: Our findings underscore the critical need for clear and effective patient communication and education about the risks, benefits, and protections associated with CP data through informed consent protocols. To promote greater transparency, understanding, and trust, we recommend 5 strategies: educating patients about data protection; studying secondary data exchange and reidentification risks; strengthening transparency regulations; improving data traceability mechanisms, such as distributed ledger technologies, to enhance data traceability and auditability; and adopting dynamic consent models.
11 July 2026
Read appraisal →Psychiatric services (Washington, D.C.)
Psychiatric Risk Associated With Large Language Model Chatbots: An Emerging Concern
Large language model chatbots such as ChatGPT have been adopted by millions of users, yet their psychiatric implications are poorly understood. Recent media reports describe 26 apparent instances of psychosis and two instances of depression and suicide in the context of heavy chatbot use, often marked by delusions seemingly reinforced by the model. Because chatbots simulate conversation but are statistical systems optimized for agreement, they may amplify distorted beliefs. Research is needed to determine whether these reports represent a genuine pattern of risk and to identify vulnerable populations. Clinicians should screen for chatbot use and discuss these systems with patients.
2 July 2026
Read appraisal →African journal of reproductive health
A systematic review of unintended pregnancy among adolescents living with HIV in Africa
Adolescent pregnancy remains a significant public health concern across Africa, with Eastern and Southern regions experiencing the highest burden. Among adolescents living with HIV(ALHIV), the challenge is intensified by socio-economic, cultural, and healthcare factors that increase vulnerability to unintended pregnancy. This systematic review examined the prevalence of unplanned pregnancy and associated factors among adolescents living with HIV in Africa. Following PRISMA guidelines and registered in PROSPERO (CRD42024564479), a search of Medline, EMBASE, and CINAHL identified relevant studies published between 2011 and 2023. Of the 550 retrieved articles, only three met the inclusion criteria. Reported prevalence rates varied widely, ranging from 18.8% in South Africa to 60.0% and 73.9% in Kenya, indicating a substantial and uneven burden across settings. Factors associated with unintended pregnancy included involvement with boyfriends or acquaintances rather than spouses, reflecting limited agency and structural vulnerabilities. Documented adverse outcomes included miscarriage, stillbirth, and abortion, although one study did not specify outcomes. Overall, the review highlights persistently high rates of unplanned pregnancy among adolescents living with HIV and underscores the need to integrate sexual and reproductive health services into HIV care, address stigma, and strengthen context-specific interventions. Les grossesses adolescentes demeurent un problème majeur de santé publique en Afrique, les régions de l'Est et du Sud étant les plus touchées. Chez les adolescentes vivant avec le VIH (AVVIH), ce défi est exacerbé par des facteurs socio-économiques, culturels et liés aux soins de santé qui accroissent leur vulnérabilité aux grossesses non désirées. Cette revue systématique a examiné la prévalence des grossesses non planifiées et les facteurs associés chez les adolescentes vivant avec le VIH en Afrique. Conformément aux directives PRISMA et enregistrée dans PROSPERO (CRD42024564479), une recherche dans Medline, EMBASE et CINAHL a permis d'identifier les études pertinentes publiées entre 2011 et 2023. Sur les 550 articles recensés, seuls trois répondaient aux critères d'inclusion. Les taux de prévalence rapportés variaient considérablement, allant de 18,8 % en Afrique du Sud à 60,0 % et 73,9 % au Kenya, ce qui témoigne d'une prévalence importante et inégale selon les contextes. Parmi les facteurs associés aux grossesses non désirées figurait le fait d'avoir des relations avec des petits amis ou des connaissances plutôt qu'avec des conjoints, reflétant un manque d'autonomie et des vulnérabilités structurelles. Les issues défavorables documentées incluaient les fausses couches, les mortinaissances et les avortements, bien qu'une étude n'ait pas précisé ces issues. Globalement, cette analyse met en évidence des taux toujours élevés de grossesses non désirées chez les adolescentes vivant avec le VIH et souligne la nécessité d'intégrer les services de santé sexuelle et reproductive aux soins du VIH, de lutter contre la stigmatisation et de renforcer les interventions adaptées au contexte.
28 June 2026
Read appraisal →Journal of affective disorders
Emotion regulation-targeted interventions initiated during hospitalization for suicidal crisis: a systematic review and exploratory meta-analysis
INTRODUCTION: Suicide is a leading cause of premature death, with risk peaking around psychiatric hospitalization. Emotion dysregulation (ED) is recognized as a key factor contributing to suicidal ideation and behavior across psychiatric diagnoses. The efficacy of interventions that target ED for suicidality reduction remains unclear, so we aimed to assess these interventions in psychiatric inpatients. METHODS: We conducted a PRISMA-compliant, PROSPERO-registered (CRD420251140949) systematic review and meta-analysis of randomized and non-randomized trials evaluating interventions targeting emotion regulation (ER) for psychiatric inpatients with suicidal ideation and/or behavior. Searches covered PubMed, Embase, and PsycINFO to September 18, 2025. Standardized mean differences (Hedges' g) were pooled under random-effects models and heterogeneity was assessed (Q, I2, τ2). Exploratory meta-regressions examined age, sex, and study quality; small-study effects were explored with funnel plots. RESULTS: Twelve studies met inclusion (n = 1708), spanning dialectical behavior therapy (DBT), mindfulness-based interventions, acceptance and commitment therapy (ACT), and other ER-related protocols. Across modalities, feasibility and acceptability were high and interventions consistently improved suicide-related outcomes in transdiagnostic adolescents and adult populations. Suicide attempts and ideation met outcome criteria for exploratory meta-analyses, and, for both, ER-targeted interventions outperformed usual care, despite heterogeneity and small samples. Exploratory meta-regressions were non-significant; funnel plots did not suggest marked publication bias, though power was limited. CONCLUSIONS: ER-targeted interventions delivered during psychiatric hospitalization are feasible and show promising benefits on suicide-related outcomes. Given heterogeneity and limited sample sizes, larger, well-powered randomized trials using standardized suicidality endpoints are needed to establish efficacy, refine inpatient protocols, and inform acute care pathways.
16 June 2026
Read appraisal →PloS one
Effects of a school-based ACT program on motivation, physical activity participation, motor competence, and physical performance in physically inactive female adolescent students
Adolescents face internal barriers like low self-confidence and psychological discomfort that limit physical activity. Adolescence offers a key window to enhance intrinsic motivation. Acceptance and Commitment Therapy (ACT) may effectively improve physical activity and motor competence through psychological flexibility and value-based behavior. This study examined the effects of an ACT-based intervention on physical activity participation, motivation, motor competence, and physical fitness in physically inactive adolescent girls. A randomized controlled trial involved 132 inactive girls aged 13-18, randomly assigned to either an ACT intervention or a control group. Intervention included seven sessions targeting six core ACT processes. Pre-and post-intervention assessments used standardized questionnaires and tests for physical activity participation, motivation, physical activity, motor competence, and fitness. ACT group showed significant improvements in intrinsic motivation, identified regulation, autonomy, and reduced amotivation and external regulation (p ≤ 0.05). Introjected regulation did not show a significant change (p > 0.05). Physical activity participation and fitness performance also improved significantly, along with both perceived and actual motor competence (p ≤ 0.05). ACT-based intervention effectively enhanced motivation, physical activity engagement, motor competence, and fitness. These findings support integrating ACT into school or community programs to promote sustainable physical activity habits in adolescent girls.
13 June 2026
Read appraisal →Human vaccines & immunotherapeutics
Safety and immunogenicity of 4CMenB and MenACWY-CRM meningococcal vaccines when administered concomitantly in healthy adolescents: A phase 3b, randomized, observer-blind study.
Meningococcal vaccination of adolescents/young adults is recommended in various countries, including the United States (US). This phase 3b, observer-blind study (NCT04318548) evaluated the safety, reactogenicity, and immunogenicity of serogroup B vaccine, 4CMenB, and quadrivalent conjugate vaccine, MenACWY-CRM, when co-administered to healthy individuals aged 16-18 y, as per US Advisory Committee on Immunization Practices recommendations. Adolescents, who had received MenACWY vaccination ≥4 y previously, were randomized (N = 940; 1:1:1) to one of three groups to assess co-administration versus 4CMenB and MenACWY-CRM administered alone. Co-primary objectives were to demonstrate the non-inferiority of antibody responses after concomitant administration to antibody responses after 4CMenB (two doses administered 2 months apart) and MenACWY-CRM (single dose), as measured by human serum bactericidal assay (hSBA). Vaccine safety and reactogenicity were assessed as another primary objective. The co-primary endpoints were met: the lower limit of 2-sided 95% confidence intervals for all between-group ratios of hSBA geometric mean titers was >0.5 for the concomitant administration group versus 4CMenB group and MenACWY-CRM group. hSBA data after two 4CMenB doses and one MenACWY-CRM dose showed comparable between-group geometric mean ratios versus baseline, and percentages of participants with 4-fold rises in titers and titers ≥lower limit of quantitation. The safety profile of 4CMenB co-administered with MenACWY-CRM was comparable with that of 4CMenB administered alone. In conclusion, 4CMenB and MenACWY-CRM co-administration was well tolerated in adolescents aged 16-18 y and immune responses were comparable versus administration of each vaccine alone, which is consistent with a previous study of co-administration in infants. Invasive meningococcal disease, caused by the bacterium Neisseria meningitidis, poses a life-threatening risk but can be prevented through vaccination. Effective vaccines are available against the most common disease-causing meningococcal serogroups, A, B, C, W, and Y. Evidence from clinical studies and immunization programs over the last decade with the 4-component meningococcal serogroup B vaccine, 4CMenB, and serogroups A, C, W, and Y vaccine, MenACWY-CRM, confirms the effectiveness of both vaccines in population age groups at higher risk of meningococcal disease, including infants and adolescents. It was previously shown that the administration of 4CMenB and MenACWY-CRM to healthy infants at the same visit induced good immune responses and was well tolerated by young children. Adolescent vaccination with 4CMenB and MenACWY-CRM is recommended in various countries, including in the United States. We conducted a study to test the safety of concomitant administration and its ability to induce immune responses in 945 healthy adolescents aged 16–18 y; 834 from the United States and 111 from Italy. We found that most reactions to the 4CMenB and MenACWY-CRM injections were mild or moderate, and were similar whether the vaccines were given together or separately, with no unexpected side effects. Co-administration to adolescents induced robust immune responses against serogroup B and serogroups A, C, W, and Y. These results support the use of concomitant meningococcal vaccinations in adolescent immunization programs.
11 June 2026
Read appraisal →BMJ paediatrics open
Impact of flash glucose monitoring versus capillary blood glucose monitoring on glycaemia in Indian youth with type 1 diabetes: a randomised crossover study
BACKGROUND: Data relating to flash glucose monitoring (FGM) use in low-resource settings are limited. Our study investigated the impact of FGM versus self-monitoring of blood glucose (SMBG) on glycaemia in Ahmedabad, India. METHODS: A randomised crossover study of FGM versus SMBG was undertaken. Participants aged 10-25 years (type 1 diabetes (T1D)>1 year) were randomised 1:1 to either Freestyle Libre 1 FGM use (intervention) for 6 months, followed by SMBG≥4 times/day (local care standard) for 6 months; or SMBG≥4 times/day, followed by FGM. After 12 months, everyone entered a 6-month observation period using the monitoring method choice. Insulin and dietary adjustments were undertaken as per local care standards. Glycated haemoglobin (HbA1c) was measured at 0, 3 and 6 months (period 1) and 9 and 12 months (period 2). Analyses included use of linear mixed-effects analysis of covariance, a paired Wilcoxon signed-rank test, and cumulative link mixed tests and model. RESULTS: Of 106 participants, 91 (86%) completed 12 months follow-up (47.3% female). At baseline, mean±SD age was 17.8±3.8 years, diabetes duration 9.9±5.0 years and HbA1c 8.6±1.9% (70±21 mmol/mol).HbA1c decreased when using FGM versus SMBG (difference -0.44% (4.8 mmol/mol); p=0.006), with greater reduction in those with higher baseline HbA1c (p=0.003). In the FGM→SMBG group, HbA1c initially decreased from 8.6±2.2% (70±24 mmol/mol) to 7.9±1.1% (62±12 mmol/mol) at 3 and 6 months (both p<0.05). After SMBG crossover, HbA1c was unchanged (7.9±1.1% (63±12 mmol/mol) at 9 months and 8.1±1.3% (65±14 mmol/mol) at 12 months). In the SMBG→FGM group, HbA1c was initially stable (8.6±1.4% (70±15 mmol/mol) at baseline; 8.8±1.7% (73±19 mmol/mol) at 6 months), but decreased after crossover to FGM (8.4±1.4% (68±15 mmol/mol) at 9 months; 8.3±0.9% (67±10 mmol/mol) at 12 months; p=0.023). CONCLUSION: This study provides evidence of improvement in glycaemic outcomes while using FGM in youth living with T1D in India. TRIAL REGISTRATION NUMBER: Clinical Trial Registry of India (CTRI/2022/02/020175).
1 June 2026
Read appraisal →African journal of reproductive health
How school-community cultural norms shape young people's reproductive health behaviors: Evidence from educational and behavioral research in China
This study systematically examines how school-community cultural norms shape young people's reproductive health behaviors in China. Using the PRISMA 2020 framework, a systematic review of empirical studies published between 2010 and 2022 was conducted to synthesize evidence from educational and behavioral research. Multiple international and Chinese databases were searched to identify qualitative, quantitative, and mixed-methods studies examining the influence of cultural norms within school and community settings on youth reproductive health knowledge, attitudes, and behaviors. Thematic synthesis, guided by the Social Ecological Model, was employed to integrate findings across studies. The review reveals that school-community cultural norms-particularly norms of silence, stigma, and gendered expectations-play a critical role in shaping reproductive health behaviors and in moderating the effectiveness of school-based interventions. Schools function both as reinforcers of prevailing community norms and as potential agents of change when culturally sensitive education is implemented. The findings underscore the need for context-specific, community-engaged reproductive health interventions tailored to the Chinese socio-cultural environment. Cette étude explore la relation complexe entre les normes culturelles et les comportements en matière de santé reproductive chez les jeunes en Chine, en se concentrant sur l'impact des environnements culturels école-communauté dans la formation de ces comportements. Elle examine comment les valeurs traditionnelles et les attentes sociales influencent les attitudes, les décisions et les actions des jeunes liées à la santé reproductive. En utilisant une approche de recherche qualitative, l'étude s'appuie sur des données secondaires à travers une revue approfondie de la littérature existante et de recherches antérieures, employant l'analyse de contenu pour extraire des insights détaillés. Les résultats soulignent que les normes culturelles école-communauté façonnent significativement les comportements en matière de santé reproductive, imposant souvent des effets restrictifs, les valeurs traditionnelles influençant profondément les décisions et les résultats de santé. L'étude met en lumière le besoin urgent d'interventions culturellement sensibles et spécifiques au contexte, conçues pour les jeunes Chinois. Elle souligne que les solutions efficaces doivent considérer l'interaction nuancée entre les normes culturelles, les contextes éducatifs et les pratiques de santé. En définitive, la recherche appelle à des programmes sur mesure capables de traiter ces complexités afin d'améliorer le soutien et les résultats en santé reproductive pour les jeunes en Chine.
31 May 2026
Read appraisal →African journal of reproductive health
The role of information technology in promoting sexual and reproductive health awareness among young people in Lahore: A comparative study with Shanghai.
Information technology (IT) has transformed access to health information, yet its impact on sexual and reproductive health (SRH) awareness varies across contexts. This study investigates IT's influence on youth SRH awareness in Lahore, Pakistan, using primary data, and provides a comparative analysis with secondary data from Shanghai, China. Using a cross-sectional design in Lahore (n=250), structured questionnaires, PLS-SEM, logistic regression, and ANOVA assessed relationships between IT use, digital health literacy, trust in digital sources, cultural barriers, and awareness outcomes. Results indicate IT use (β=0.42), digital health literacy (β=0.38), and trust (β=0.26) significantly enhance awareness in Lahore, while cultural barriers exert a strong negative influence (β=-0.31). Significant mean differences (p<0.001) were found between cities. Shanghai demonstrated higher digital literacy, trust, awareness, and use of structured platforms, while Lahore exhibited substantially higher cultural barriers. Model comparisons showed stronger predictive pathways in Shanghai (R²=0.74) than Lahore (R²=0.68), reflecting advantages of institutionalized sex education and government-certified digital health applications. Overall, while IT holds considerable potential, its effectiveness is shaped by cultural norms, digital infrastructure, and institutional trust. The findings underscore Pakistan's need to develop culturally appropriate, reliable, and institutionally supported digital health platforms to improve youth access to accurate SRH information. La technologie de l'information (TI) a transformé l'accès à l'information sanitaire, mais son impact sur la sensibilisation à la santé sexuelle et reproductive (SSR) varie selon les contextes. Cette étude examine l'influence des TI sur la sensibilisation des jeunes à la SSR à Lahore, au Pakistan, avec une analyse comparative de Shanghai, en Chine. En utilisant un design transversal à Lahore (n=250), des questionnaires structurés, la PLS-SEM, la régression logistique et l'ANOVA ont évalué les relations entre l'utilisation des TI, la littératie numérique en santé, la confiance dans les sources numériques, les barrières culturelles et les résultats de sensibilisation. Les résultats indiquent que l'utilisation des TI (β=0,42), la littératie numérique en santé (β=0,38) et la confiance (β=0,26) améliorent significativement la sensibilisation à Lahore, tandis que les barrières culturelles exercent une forte influence négative (β=-0,31). Des différences moyennes significatives (p<0,001) ont été constatées entre les villes. Shanghai a démontré une littératie numérique, une confiance, une sensibilisation et une utilisation de plateformes structurées plus élevées, tandis que Lahore présentait des barrières culturelles substantiellement plus fortes. Les comparaisons de modèles ont montré des voies prédictives plus solides à Shanghai (R²=0,74) qu'à Lahore (R²=0,68), reflétant les avantages de l'éducation sexuelle institutionnalisée et des applications de santé numériques certifiées par le gouvernement. Globalement, bien que les TI aient un potentiel considérable, leur efficacité est façonnée par les normes culturelles, l'infrastructure numérique et la confiance institutionnelle. Les conclusions soulignent la nécessité pour le Pakistan de développer des plateformes de santé numériques culturellement adaptées, fiables et soutenues institutionnellement pour améliorer l'accès des jeunes à des informations précises sur la SSR.
31 May 2026
Read appraisal →Psychological medicine
Effectiveness of 13-week dialectical behavior therapy skills training for non-suicidal self-injury: a multi-center randomized clinical trial in China
BACKGROUND: Dialectical behavior therapy skills training (DBT-ST) has received empirical evidence for treating non-suicidal self-injury (NSSI). However, its effectiveness in Chinese contexts remains understudied. This study aims to explore the effectiveness of DBT-ST for NSSI in a clinical sample of individuals with NSSI. METHODS: We conducted a multicenter, randomized clinical trial in China to evaluate the effectiveness of a 13-week DBT-ST compared with social support group therapy (SSGT). A total of 196 individuals with mental disorders and NSSI were recruited. The primary outcome was the frequency of NSSI thoughts and behaviors, assessed using the Ottawa Self-Injury Inventory. RESULTS: Participants were randomized to the DBT-ST group (n = 97) or the SSGT group (n = 99). DBT-ST was significantly more effective than SSGT in reducing the frequency of NSSI behaviors. It also showed superior effects on borderline symptoms and multiple domains of psychological functioning, including emotion dysregulation, impulsivity, alexithymia, mindfulness, psychological resilience, and emotional intelligence. Both groups exhibited significant reductions in the frequency of NSSI thoughts, suicidal ideation and attempts, and depression, with no significant between-group differences in these outcomes. CONCLUSIONS: These findings confirm that the 13-week DBT-ST intervention is an effective treatment for Chinese patients with NSSI in clinical settings.
29 May 2026
Read appraisal →JMIR mHealth and uHealth
Effects, Acceptability, and Use of a Dynamically Tailored Mobile What Do You Drink Intervention to Reduce Excessive Drinking Among Adolescents and Young Adults in the Netherlands: Randomized Controlled Trial
BACKGROUND: Excessive alcohol consumption among adolescents and young adults is a serious health problem. Dynamically tailored interventions could reduce their excessive drinking. We therefore developed "What Do You Drink" (WDYD), a 17-week dynamically tailored mHealth (mobile health) intervention providing personalized support on alcohol consumption. OBJECTIVE: We aim to evaluate the effectiveness, acceptability, and use of WDYD in reducing alcohol consumption of adolescents and young adults at risk. METHODS: We conducted a 2-arm, parallel-group randomized controlled trial using ecological momentary assessments. Recruitment was via an educational alcohol program, an online lifestyle monitor, social media advertisements, or news items on websites. Participants downloaded the standalone WDYD app, and when having given active informed consent, were randomized to the intervention or control group. Participants in the intervention group received dynamically tailored feedback sessions on alcohol consumption (wk 0-5, 7, 9, 13, and 17) and goal-monitoring reminders. Both groups completed an online baseline survey, 2 follow-up surveys (wk 9 and 33), and various ecological momentary assessments (7 daily assessments during wk 1, 7, 13, 19, 25, 31, and 33). Participants provided consent before randomization, in which they were informed that 2 study groups existed. After randomization, no disclosure of group assignment was provided, although participants could potentially infer it from receiving tailored sessions vs no tailored sessions. Primary outcomes were excessive drinking, binge drinking, and weekly alcohol consumption. Secondary outcomes were intrinsic motivation, self-confidence, and mood. Acceptability of WDYD was measured by survey questions; use was tracked via app data logs. RESULTS: Analyses were based on data from 1767 participants; 720 in the intervention group and 1047 participants in the control group. Almost half of them were female (2276/4795, 47.5%), and most (3471/4595, 72.4%) participants were aged 18-24 (median 19.40, IQR 2.92) years. The dropout rate was high, up to 96% (4603/4795) in the final 33rd week. No significant effect of WDYD was found on primary outcomes and mood, except for week 1 (excessive drinking: standardized β=-0.35, SE 0.15; 95% CI -0.64 to -0.05; binge drinking: standardized β=-0.36, SE 0.16; 95% CI -0.68 to -0.04; mood: standardized β=0.20, SE 0.06, 95% CI 0.08 to 0.32). Both groups reduced their alcohol consumption. Significant positive effects were found for intrinsic motivation and self-confidence up to 25 weeks (wk 25: standardized β=0.54, SE 0.24; 95% CI 0.06 to 1.02 for motivation; standardized β=0.72, SE 0.26; 95% CI 0.22 to 1.23 for self-confidence). Participants evaluated WDYD as acceptable and usable. CONCLUSIONS: WDYD did not significantly reduce excessive drinking compared to control, but improved motivation and self-confidence. High dropout rates highlight challenges in sustaining engagement in long-term mHealth interventions. Future research should explore strategies to enhance retention and optimize dynamic tailoring.
28 May 2026
Read appraisal →BMJ open
Prevalence of teenage pregnancy and associated factors in Uganda: a meta-analysis and systematic review
OBJECTIVE: Teenage pregnancy is a major public health problem with huge consequences for maternal health and pregnancy outcomes. This calls for a concerted effort from different stakeholders involved in issues of teenagers' sexual reproductive health to achieve the SDG target of 2030 on the reduction of maternal mortality. The objective of this systematic review was to estimate the prevalence of teenage pregnancy and its associated factors in Uganda. DESIGNS: We conducted a systematic review and random-effects meta-analysis according to Preferred Reporting Items for Systematic Review and Meta-analysis standards. DATA SOURCES: After prospective registration (PROSPERO CRD42023486460), a literature search was conducted in PubMed, African Journals Online and Google Scholar in December 2023. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Observational studies that reported the prevalence of teenage pregnancy among teenagers were included. DATA EXTRACTION AND SYNTHESIS: Articles were screened for relevance at the title, abstract and full-text levels by multiple reviewers. The quality of studies was independently appraised using the Joanna Briggs Institute Critical Appraisal Checklist and Newcastle-Ottawa Scale. Any discrepancies were resolved by reaching a consensus. The process of extracting data included study information, geographical categorisation, type of studies, population, sample size, results/outcomes and prevalence of teenage pregnancy. The risk of bias was determined by Egger's test. The results were pooled using random-effects models to calculate the prevalence of teenage pregnancy with a CI of 95% and I² statistic. RESULTS: Of 918 records screened, 10 studies (4143 participants) were included. The pooled prevalence of teenage pregnancy was 25.5% (95% CI 13.7% to 39.5%; I²=98.9%), with individual study estimates ranging widely from 3.0% to 56.4%, reflecting substantial heterogeneity across study settings, populations and periods of data collection. Higher estimates were observed in the Central-Eastern region (31.7%, 95% CI 19.5% to 45.1%). The overall certainty of evidence was rated as very low using the Grading of Recommendations, Assessment, Development and Evaluation framework, primarily due to very serious inconsistency across included studies (I²=98.9%). CONCLUSIONS: Pooling studies of mixed quality revealed a slightly higher prevalence of teenage pregnancy in Uganda. This review provides valuable insight for policymakers and healthcare providers in developing interventions and policies to reduce the burden of teenage pregnancy from disadvantaged backgrounds. PROSPERO REGISTRATION NUMBER: CRD42023486460.
28 May 2026
Read appraisal →Blood advances
Pediatric-inspired regimens and HSCT for adolescents and young adults with acute lymphoblastic leukemia
The best frontline treatment for acute lymphoblastic leukemia (ALL) in adolescents and young adults (AYAs) is unclear. To support a clinical practice guideline, we systematically reviewed and meta-analyzed evidence on (1) asparaginase-based (pediatric) vs non-asparaginase-based (adult) regimens and (2) allogeneic hematopoietic stem cell transplantation (HSCT) vs no HSCT for AYAs (aged 15-39 years) with ALL in first complete remission. Data sources were PubMed, CINAHL, and PsycINFO from inception to 29 November 2023. Eligible studies compared regimens or the use of HSCT and reported survival, remission, toxicity, or quality of life in AYAs. We included 19 studies (14 comparative, 5 single-group; N = 3607) comparing regimens and 7 studies (N = 7492) comparing HSCT and no HSCT. Studies were mostly of poor quality, with sparse randomized controlled trials (RCTs), yielding low-certainty findings. Pediatric regimens were associated with higher 5-year overall survival (OS; relative risk [RR], 1.40; 95% confidence interval [CI], 1.18-1.65), event-free survival (RR, 1.80; 95% CI, 1.13-2.85), disease-free survival (DFS; RR, 1.55; 95% CI, 1.32-1.82), and lower treatment-related mortality (TRM; RR, 0.29; 95% CI, 0.09-0.90). HSCT was associated with lower 5-year OS (RR, 0.72; 95% CI, 0.61-0.84) and DFS (RR, 0.78; 95% CI, 0.68-0.90) and higher nonrelapse mortality (RR, 2.70; 95% CI, 1.18-6.18) and TRM (hazard ratio, 6.88; 95% CI, 3.02-15.70). Relapse risk varied by time point. In AYAs with Philadelphia chromosome-negative ALL, pediatric regimens may improve survival; toxicity-related evidence remains limited. HSCT may lead to inferior OS and DFS. With a dearth of RCTs, low-certainty evidence highlights the need for high-quality studies and subanalyses of AYAs.
26 May 2026
Read appraisal →Journal of medical Internet research
Toward Participatory Precision Health With Co-Designed Recommendations: Systematic Review of Just-in-Time Adaptive Interventions in Adolescents and Young Adults
BACKGROUND: The transition from adolescence to young adulthood (age 10-25 years) constitutes a sensitive developmental period marked by rapid biological, psychological, and social change, during which preventive health interventions can shape long-term outcomes. Mobile health tools offer accessible opportunities for tailored support for this population, but often adapt poorly to dynamic contexts, resulting in inconsistent engagement and effects. Just-in-time adaptive interventions (JITAIs), which tailor support in real time using ongoing data, are increasingly explored as precision health strategies. However, how these mechanisms are designed, implemented, and evaluated for adolescents and young adults (AYAs) has not been systematically reviewed. OBJECTIVE: This review aimed to synthesize the evidence on JITAIs developed for AYAs, examine how their adaptive mechanisms have been designed to support specific health goals and changing AYA contexts, and assess methodological reporting quality to inform future precision health intervention development. METHODS: We conducted a systematic review in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and SWiM (Synthesis Without Meta-Analysis) reporting guidelines. Twelve databases were searched for peer-reviewed studies published from 2013 to 2025. Eligible studies focused on participants aged 10 to 25 years and reported real-time adaptive mobile health interventions consistent with JITAI design principles. Two reviewers independently conducted screening, data extraction, and methodological quality appraisal using the Joanna Briggs Institute checklists. AYA coauthors contributed to all phases. Due to substantial heterogeneity in study populations, intervention content, adaptive mechanisms, comparators, and outcome measurements, findings were synthesized narratively, and no meta-analysis was conducted. RESULTS: A total of 61 unique interventions were included. JITAIs for AYAs addressed substance use (n=24, 39.3%), mental health (n=23, 37.7%), and physical health or chronic conditions (n=14, 23%). JITAI tailoring mechanisms relied predominantly on self-reported behavioral data. Decision rules were typically symptom threshold-based, and decision points were commonly daily or event-triggered. Methodological concerns with reporting on intervention administration, participant selection, and outcome measurement reliability were pervasive across all studies, limiting the interpretability of observed effects and cross-study comparisons. Ethical considerations, including researcher positioning and reflexivity, alongside the depth of reporting around participatory AYA engagement in design and implementation, were also inconsistent. CONCLUSIONS: This review contributes a novel perspective to AYA digital health by moving beyond intervention outcomes to examine how core adaptive mechanisms are operationalized for AYAs across multiple health domains, while also integrating AYA perspectives into the interpretation of findings and recommendations. Unlike prior reviews focused primarily on adults or specific conditions, it identifies broader contextual, methodological, and ethical considerations relevant to AYA precision health. These findings highlight the need for more transparent, contextually responsive, and youth-centered adaptive interventions, alongside more rigorous designs for evaluating adaptive intervention components in daily life contexts.
23 May 2026
Read appraisal →Current cardiology reports
Bridging Pediatric to Adult Care: A Scoping Review on Transitional Care for Individuals with Congenital Heart Disease Using Data Mining Techniques to Identify Key Topics
BACKGROUND: Adolescents and young adults with congenital heart disease (CHD) face significant challenges when transitioning from pediatric to adult care. Despite growing recognition of its importance, transitional care remains inconsistently implemented across healthcare systems, and a summary of published literature in this regard is still missing. This scoping review aims to systematically map the literature on CHD transitional care and identify key topics and trends. METHODS: Following Joanna Briggs Institute guidelines, we conducted a comprehensive search across seven electronic databases using the Population, Concept, and Context framework. A total of 73 studies were included. Data were extracted and analyzed using Latent Dirichlet Allocation to identify core topics, and Multiple Correspondence Analysis was applied to explore thematic relationships and validate topic structure. Lexicometric analysis assessed the linguistic complexity and specificity of the literature. RESULTS: Three major themes emerged: (1) Education, Self-Management, and Structured Support, (2) Timing, Knowledge Transfer, and Developmental Needs, and (3) Transition Program Implementation and Coordination. These themes reflect an increasing focus on structured educational strategies, developmentally tailored care, and system-level program delivery. Education-focused interventions were more frequently found in recent, high-quality experimental studies. In contrast, studies addressing timing and developmental needs and those focused on implementation were more common in earlier-phase or heterogeneous research contexts. CONCLUSION: Transitional care for individuals with CHD requires more standardized, evidence-based approaches. Improved documentation when reporting transitional care is essential to enhance fidelity, scalability, and long-term impact. This review provides a foundation for developing outcome-focused research and supports designing individualized, high-quality transition programs.
23 May 2026
Read appraisal →JMIR research protocols
A Large, Diverse, Urban Cardiovascular Health e-Cohort in Childhood and Adolescence: Protocol for the Young Hearts Study
BACKGROUND: Cardiovascular health (CVH), defined as a composite of 8 health factors and behaviors ranging from body composition to sleep duration, is strongly associated with the risk for future cardiovascular events in adults. However, there is little data on CVH among contemporary, diverse cohorts of children and adolescents. OBJECTIVE: This protocol describes the completed recruitment of a diverse pediatric e-cohort based in Chicago. We include details about ongoing longitudinal data collection for CVH behaviors, as well as neighborhood and environment-based socioeconomic factors, and linkage to electronic health records (EHRs) for direct capture of CVH factors. METHODS: Young Hearts (YH) uses a longitudinal cohort design, linking participant responses to annual electronic surveys to EHRs. Parents/guardians of children aged 0-17 years and adolescents aged 18 years are asked to complete surveys at 3 e-visits, completed annually in consecutive years. Adolescents aged 12-17 years are invited to complete surveys at each e-visit to provide self-reports of their data in addition to their parents/guardians. As adolescents reach the age of majority, they re-consent and complete their remaining e-visit data. Participants' clinical data are abstracted from EHRs at 6 health systems in Chicago and linked to their survey data. The main study outcome is the CVH score, adapted from the Life's Essential Eight framework for use in pediatric populations. We will also study component CVH behaviors and factors, each assessed using developmentally-appropriate measures, including body mass index, blood pressure, lipids, glycemic control, diet, physical activity, sleep, and smoking exposure. Our innovative study design will allow us to model trajectories of pediatric CVH from birth through 20 years of age. Funding for this study was provided by the National Heart, Lung, and Blood Institute (R01HL155864). RESULTS: The YH study, funded in March 2021, recruited, enrolled, and consented 7114 children and adolescents aged 0-18 years between April 2022 and February 2025. Baseline surveys have been completed by 6651 participants, of whom 3259 (49%) were female, and the mean age was 7.4 (SD 5.4) years. Data collection is still in progress, with completion anticipated in February 2027. We aim to publish results beginning in 2026. CONCLUSIONS: This study will define the epidemiology of cardiovascular risk factors in a diverse, contemporary cohort of US children and adolescents and identify behavioral and structural individual- and area-level economic, psychosocial, and lifestyle factors associated with identified disparities. We anticipate that the YH cohort will become an ongoing resource for pediatric CVH research.
23 May 2026
Read appraisal →BMC psychiatry
Olanzapine effectiveness on weight gain in anorexia nervosa patients: systematic review and meta-analysis
BACKGROUND: Anorexia nervosa (AN) is a complex psychiatric disorder marked by extreme caloric restriction, intense fear of weight gain, and distorted body image perception. Not only influence physical health, but it also creates serious psychological burdens. Treatment of AN is especially daunting due to its multi-dimensional nature. Recent research indicates that a pharmacological approach, such as the prescription of atypical antipsychotics like Olanzapine, may help treat both the nutritional deficiency and psychological distress related to the disorder. By allowing an individual gain weight and potentially reducing comorbid depression and anxiety, Olanzapine can be a valuable add-on to standard treatments. AIM: This study aims to investigate the effectiveness of Olanzapine in causing weight gain among anorexia nervosa patients. Based on comparisons of results in a number of clinical trials, the study aims at establishing the effect of Olanzapine on weight restoration and investigating any accompanying shift in the psychological state of the patients. METHOD: A comprehensive literature search was performed on Medline, ClinicalTrials.gov, Scopus, and the Cochrane Database of Systematic Reviews for all records from the earliest date available through to August 22, 2024. Randomized controlled trials of olanzapine treatment in anorexia nervosa were included. Studies were screened, and data were extracted. Risk of bias was assessed with the Cochrane risk-of-bias tool. Records for meta-analysis were combined in a random-effects model to calculate effect sizes, and heterogeneity was quantified with the I2 statistic. RESULT: 207 records were found, 159 of which were excluded after title and abstract screening. After full-text review, seven RCTs were found. These trials involving 152 patients assessed the impact of olanzapine on weight gain in anorexia nervosa. Meta-analysis of 4 studies (91 patients) showed a mean difference in BMI of 1.68 kg/m² (95% CI: 0.82, 4.18) in favor of olanzapine but not statistically significant (p = 0.19), with high heterogeneity (I² = 94%). Sensitivity analysis reduced the heterogeneity to 28% but not the effect size. CONCLUSION: Although olanzapine showed a numerically greater weight gain compared to control conditions, the pooled effect did not reach statistical significance and was associated with substantial heterogeneity. Therefore, current evidence remains inconclusive. Olanzapine may be considered in selected cases, particularly where psychological comorbidities are prominent, but larger and methodologically robust trials are needed before routine clinical use can be recommended. CLINICAL TRIAL NUMBER: Not Applicable.
21 May 2026
Read appraisal →Archives of disease in childhood
Effects of metformin on anthropometric indices and hormones and adipocytokine concentrations in children with overweight or obesity: a systematic review and meta-analysis of randomised controlled trials
OBJECTIVE: The aim of this systematic review was to assess the effect of metformin on anthropometric indices, hormones and adipocytokine concentrations in children with overweight or obesity. METHODS: Eligible studies were searched via PubMed, Scopus, Cochrane Central Register of Controlled Trials, alongside clinical trial registries and the reference lists of included studies, from inception to October 2024. Screening was carried out independently by two reviewers, involving title-abstract screening for relevance, followed by full-text review for eligibility confirmation. Data extraction was performed by two independent investigators using an identical Excel spreadsheet. A meta-analysis was conducted using the random-effects model. RESULTS: A total of 19 original studies were deemed eligible for this systematic review. Metformin was more effective than placebo in improving Body Mass Index (BMI), BMI-Z score, body weight, fasting insulin and leptin concentrations (mean difference (MD) -1.07 kg/m2, 95% CI -1.62 to -0.52; MD -0.09, 95% CI -0.13 to -0.05; MD -3.20 kg, 95% CI -4.21 to -2.19; MD -3.38 μU/mL, 95% CI -6.00 to -0.75; MD -3.73 ng/mL, 95% CI -6.28 to -1.18, respectively). There was no difference between metformin and placebo on adiponectin and resistin concentrations, as well as adiponectin to leptin ratio. CONCLUSION: Metformin may have a role as an adjuvant therapy in managing overweight and obesity among the paediatric population. Regarding the concentrations of adipokines and hormones, the results are inconclusive. More randomised controlled trials with rigorous methodology and homogeneity in population and intervention characteristics are needed to shed light on this topic. TRIAL REGISTRATION NUMBER: PROSPERO CRD42023401732.
20 May 2026
Read appraisal →Gut and liver
Global Prevalence of Functional Abdominal Pain Disorder among Children and Adolescents According to the Rome III and IV Criteria: A Systematic Review and Meta-Analysis
BACKGROUND/AIMS: Despite the global burden of functional abdominal pain disorder (FAPD) and its four subtypes (irritable bowel syndrome [IBS], functional dyspepsia [FD], abdominal migraine [AM], and functional abdominal pain not otherwise specified [FAP-NOS]), studies involving an estimation of FAPD prevalence based on the Rome III or IV criteria are limited. Therefore, we aimed to estimate the prevalence of FAPD and its four subtypes. METHODS: A comprehensive literature search was conducted in PubMed/MEDLINE, Embase, Google Scholar, and the Cochrane Library. Studies that were performed with the general population and applied Rome III or IV diagnostic criteria were included. Data were extracted to estimate the prevalence of FAPD using a random-effects model with 95% confidence intervals (CIs). Heterogeneity was assessed using the I2 statistic. The study protocol was preregistered with PROSPERO (CRD420251004116). RESULTS: The overall prevalence of FAPD was 10.89% (95% CI, 9.51% to 12.48%), with pooled prevalence rates of 11.84% (10.29% to 13.61%) with the Rome III criteria and 8.42% (6.10% to 11.62%) with the Rome IV criteria. With the Rome III criteria, IBS had the highest prevalence, while FD had the lowest. In contrast, with the Rome IV criteria, the prevalence of IBS, AM, and FAP-NOS decreased, whereas FD became the most prevalent, affecting approximately one in 23 individuals, compared to one in 51 individuals affected by IBS, one in 68 individuals affected by AM, and one in 115 individuals affected by FAP-NOS. Additionally, females exhibited higher prevalence rates of FAPD and all its subtypes than males. CONCLUSIONS: The diagnostic criteria of Rome IV are stricter than those of Rome III, which likely affects the estimated prevalence of FAPD and its subtypes.
18 May 2026
Read appraisal →European respiratory review : an official journal of the European Respiratory Society
Evolution of body image across treatment eras: a systematic review in young people and adults living with cystic fibrosis
OBJECTIVES: Advancements in treatments for cystic fibrosis (CF) have improved prognosis, but variant-specific therapies have also driven weight gain. Traditional challenges to maintain weight are now less prevalent, with new body image concerns potentially emerging. This review aims to synthesise quantitative and qualitative evidence on body image in adults and young people (aged ≥16 years) with CF. METHODS: Systematic search of MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health, the Allied and Complementary Medicine Database and the Cochrane Library (January 2011 to August 2025) using CF-related keywords including body image and physical appearance. RESULTS: Searches retrieved 29 eligible studies (26 quantitative, two qualitative, one mixed methods). The Cystic Fibrosis Questionnaire - Revised (CFQ-R) and Cystic Fibrosis Quality of Life Questionnaire (CFQoL) questionnaires assessed body image quantitatively (0-100). 15 studies reported CFQ-R body image scores (58±19 to 78±23) and five reported CFQoL body image scores (21±26 to 76). Pre-modulator era (≤2012) scores ranged from 64±27 to 70±27; initial rollout phase (2012-2019) scores ranged from 58±19 to 81 (post-ivacaftor); and in the widespread modulator era (2020 to present) were 63±32 to 67 (31). Gender effects were inconsistent. Higher body mass index, weight, and body fat were linked to better body image in some studies; psychological wellbeing and lower anxiety/depression consistently correlated with body image. Ivacaftor and life coaching improved body image, while elexacaftor/tezacaftor/ivacaftor, cognitive behavioural therapy, and self-management programmes showed no effect. Functional health was strongly linked to body image.Qualitative findings highlighted influences of gender, weight change, functional and mental health, social support, early eating experiences, and limited clinician-initiated body image discussions. CONCLUSION: This is the first systematic review of body image in CF since new drug regimens emerged. Emerging body image disturbance patterns highlight the need for clinical strategies to screen for and address body image issues in CF care.
15 May 2026
Read appraisal →Journal of Korean medical science
Cardiovascular Risk Stratification in Youth-Onset Type 2 Diabetes Using Machine Learning
BACKGROUND: The rising incidence of youth-onset type 2 diabetes mellitus (T2DM), along with the risk of early cardiovascular complications, is concerning. Brachial-ankle pulse wave velocity (baPWV) and carotid intima-media thickness (cIMT) are noninvasive markers of arterial stiffness and atherosclerosis. They serve as important markers for cardiovascular risk assessment. This study aimed to apply machine learning models to identify high-risk individuals who may benefit from early and targeted cardiovascular screening. METHODS: This retrospective study included 129 patients with youth-onset T2DM who underwent baPWV and cIMT measurements between January 2018 and July 2024. High-risk groups were defined as having values of ≥ mean + 1 standard deviation for baPWV (arterial stiffness) and cIMT (atherosclerosis). Clinical predictors were evaluated using linear, logistic regression, and machine learning analyses. Multiple machine learning models were trained using oversampling and cross-validation techniques to enhance prediction performance. RESULTS: Among the models tested, the gradient boosting model with adaptive synthetic sampling oversampling achieved the best performance in predicting both arterial stiffness (accuracy 0.81) and atherosclerosis prediction (accuracy 0.92). Age and hypertension were consistently identified as the most important factors for arterial stiffness. For atherosclerosis risk, traditional analysis identified dyslipidemia, male sex, and duration of illness as relevant factors; machine learning more clearly emphasized low-density lipoprotein cholesterol and triglyceride levels as key predictors of increased cIMT. CONCLUSION: Hypertension and age were consistent predictors of arterial stiffness, while atherosclerosis risk factors were further clarified with lipid parameters by machine learning analysis. These findings suggest that conventional and machine learning analyses offer complementary strengths. Their combined use may enable earlier to detect nuanced cardiovascular risk patterns and support early and targeted vascular screening in youth-onset T2DM.
14 May 2026
Read appraisal →Physics in medicine and biology
A novel deep-learning approach for monitoring gastrointestinal air variation during radiotherapy in young patients using radiographs
Objective.To develop deep-learning (DL) predictive models of internal gastrointestinal (GI) gas from radiographs, a surrogate for dose degradation in abdominal proton beam therapy (PBT).Approach.DL architectures (convolutional neural networks and U-Nets) were trained to predict GI air local path length and/or global volume from radiographs. Frontal/lateral radiographs with paired volume and path length labels were simulated from CTs and GI gas segmentations using the Tomographic Iterative GPU-based Reconstruction (TIGRE) toolbox. CTs from The Cancer Imaging Archive Paediatric-CT-SEG dataset (N= 349, 0-16 year, North America) were used for model development and internal evaluation; variation in GI filling, organ motion and body size were simulated for augmentation. External evaluation utilised data from two international radiotherapy institutions: one consisting mostly of children and young people (CYP) (N= 21, 2-19 year, Europe); the other predominantly of teenagers and young adults (TYAs) (N= 14, 10-24 year, Asia). Finally, real-life use case was demonstrated on two subjects treated with PBT.Main results.The optimal configuration was the dual U-Net, accurately predicting both volume (mean absolute error (MAE) = 24.0 ± 32.9 ml) and path length (MAE = 0.80 ± 0.59 mm) on the held-out Paediatric-CT-SEG dataset, while also generalising well to external radiotherapy datasets (volume MAE = {18.9 ± 22.4, 34.6 ± 35.2} ml, and path length MAE = {0.52 ± 0.38, 0.67 ± 0.55} mm on the CYP and TYA datasets, respectively). We found a lower Dice similarity coefficient for gas segmentations in TYA vs Paediatric-CT-SEG and CYP (0.56 ± 0.24 vs 0.87 ± 0.09 and 0.84 ± 0.16, respectively), reflecting cohort-specific gas morphology differences. When applied longitudinally, the network detected both monotonic and realistic intrasubject GI gas variation. Proof-of-concept evaluation on clinical radiographs showed promising performance (volume MAE = 29.5 ± 25.9 ml, and path length MAE = 1.10 ± 0.75 mm).Significance.DL-powered radiographs quantified internal GI gas changes with promising performance and generalisability to diverse ages and demographics. This was the first step towards a novel personalised image-guided radiotherapy traffic-light workflow for abdominal PBT with the goal of reducing the need for CBCT to required fractions.
14 May 2026
Read appraisal →Oral health & preventive dentistry
Prevalence and Risk of Dental Erosion Linked to Carbonated Drinks in Adolescents: A Systematic Review and Meta-Analysis
PURPOSE: To determine the prevalence of dental erosion due to carbonated beverage consumption among adolescents and the association between both variables through a systematic review and meta-analysis. METHODS AND MATERIALS: This study was conducted in accordance with the preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines for systematic reviews. A comprehensive literature search was performed in PubMed, Scopus, Web of Science, LILACS, and SciELO. Observational studies were included, and the PEO framework was used to identify dental erosion and non-erosion (outcome) and intake of carbonated beverages (exposure) in adolescents (population). The prevalence of dental erosion and odds ratio (OR) with 95% confidence interval (95%CI) to determine the risk of carbonated beverages were estimated with MedCalc V.23.0.2 and Review Manager (RevMan V.5.4.1) software, respectively. A P value 0.05 was considered to indicate statistical significance. RESULTS: A total of 24 studies met the eligibility criteria. The pooled sample included 21,541 adolescents, and the overall erosion prevalence was 37.6% (95%CI 26.3, 49.7%). The meta-analysis revealed a significant association between carbonated beverage consumption and dental erosion (OR = 1.98, 95%CI: 1.42-2.77; 7785 participants; I2 = 80%; P 0.0001). CONCLUSION: Dental erosion is a prevalent condition among adolescents, with a pooled prevalence of 37.6%. Carbonated beverage consumption among adolescents is associated with a 98% increased risk of dental erosion.
13 May 2026
Read appraisal →Vaccine
Factors affecting human papillomavirus vaccination: A review of individual, interpersonal, and structural factors affecting vaccine uptake among adolescents.
BACKGROUND: Human papillomavirus (HPV) related cancers, particularly cervical cancer, remain a major public health challenge in low- and lower-middle-income countries (LLMICs), which bear a disproportionate share of global HPV-attributable mortality. Despite the availability of safe and effective vaccines for nearly two decades, vaccination coverage remains low in LLMICs. Several barriers ranging from health misinformation to systemic delivery challenges have hindered efforts to scale up vaccination programs in these settings. OBJECTIVES: This systematic review aims to identify and synthesize the behavioral and structural factors influencing HPV vaccine uptake among adolescents in LLMICs. Guided by a multi-level behavioral health framework, findings were categorized across: individual, interpersonal, and structural domains. METHODS: A comprehensive search of seven databases identified 639 records, of which 34 empirical studies met inclusion criteria. Eligible studies focused on HPV vaccination uptake among adolescents in World Bank-defined LLMICs and were assessed for thematic relevance. Data extraction emphasized barriers and facilitators to uptake. RESULTS: Individual-level barriers included limited awareness, misconceptions about HPV and the vaccine, and fear of side effects. Interpersonal dynamics-particularly parental consent, gendered norms, and community endorsement-shaped adolescent vaccine decision-making. Structural barriers included vaccine stock-outs, weak delivery infrastructure, and limited reach among out-of-school youth. School-based delivery models, trusted healthcare workers, and community sensitization emerged as key facilitators. CONCLUSIONS: Improving HPV vaccine coverage in LLMICs requires coordinated, multi-level interventions that simultaneously address behavioral and structural determinants. Findings highlight the critical role of community engagement, flexible delivery models, and long-term sustainability planning to ensure effective implementation. These insights have direct implications for national immunization policy, health system strengthening, and achievement of global cervical cancer elimination targets in resource-limited settings. Tailoring implementation to the contextual realities of LLMICs will be essential to advancing equity in HPV-related cancer prevention.
13 May 2026
Read appraisal →Tobacco control
Impact of Instagram and TikTok influencer marketing on perceptions of e-cigarettes and perceptions of influencers in young adults: a randomised survey-based experiment
BACKGROUND: Pairing e-cigarettes with healthy lifestyle contexts in influencers' promotional social media posts may increase e-cigarette use risk among young adults. This study examined the effects of e-cigarette and healthy lifestyle content on young adults' perceptions of influencer credibility, harm perceptions of, and susceptibility to use, e-cigarettes. METHODS: In this survey-based online, repeated-measures experiment (2023), California young adults (N=1494, Mage=23 (SD=1.8); 63% female, 51% Hispanic) were randomly shown 10 (total) Instagram and TikTok videos, featuring influencers promoting e-cigarettes alongside healthy lifestyle activities (experimental group), or a healthy lifestyle activity alone (control). After watching each video, participants rated perceived influencer credibility (eg, honesty). After watching all videos, harm perceptions of e-cigarettes were assessed among all participants and susceptibility to e-cigarette use was assessed among e-cigarette never-users. Harm perceptions and susceptibility outcomes were compared between groups (experimental vs control) and between participants who perceived influencers as credible versus non-credible, using binomial generalised linear mixed effects models. RESULTS: Participants in the experimental group were more likely to report lower harm perceptions (adjusted OR (AOR) 1.12; 95% CI 1.03; 1.21) and higher susceptibility to e-cigarette use (AOR 1.22, 95% CI 1.11; 1.34), than participants in the control condition. Similar results were found when influencers were perceived as credible, but not when they were perceived as non-credible. CONCLUSIONS: Social media influencers' posts promoting e-cigarette use along with healthy activities may contribute to young adult e-cigarette use. Decreasing perceived credibility of influencers could decrease the negative effects of their promotional posts. TRIAL REGISTRATION NUMBER: NCT06433466.
12 May 2026
Read appraisal →International health
Systematic narrative review on Menstrual health and hygiene (MHH) in Nigeria, Ghana, Liberia and The Gambia
Menstrual health and hygiene (MHH) are critical components of women's well-being, yet they continue to be overlooked in many low-resource settings. Addressing MHH issues in West Africa is crucial due to their widespread impact on education, health and gender equality, particularly among adolescent girls and women of reproductive age. This systematic narrative review consolidates the existing literature on MHH practices, knowledge, barriers and interventions in Nigeria, Ghana, Liberia and The Gambia. A comprehensive search was conducted across four databases (PubMed, Scopus, CINAHL Plus and Africa Journals Online) for studies published from 2000 to 2024. The search terms were related to menstruation, hygiene and the four West African countries. Both peer-reviewed articles and grey literature (Google Scholar, policy documents) were included to capture a broad spectrum of findings. Studies were selected based on their relevance to MHH in the target countries and data were extracted and analysed thematically. Of 345 articles identified, 26 studies met the inclusion criteria. Key findings highlighted the widespread lack of adequate MHM resources, such as sanitary products and functional sanitation facilities. Socio-economic disparities, cultural stigma and insufficient educational resources were major barriers to effective MHM. The review also found a strong link between inadequate MHM and adverse outcomes, including school absenteeism, psychological distress and increased vulnerability to infections. This review underscores the pressing need for comprehensive interventions to address MHH as a public health and human rights issue in Nigeria, Ghana, Liberia and The Gambia. Ensuring access to sanitary products, improved sanitation facilities and robust educational programs can help empower girls and women to manage menstruation with dignity, thereby improving their health, education and social participation.
12 May 2026
Read appraisal →The Journal of dermatological treatment
Comparative efficacy and safety of oral azithromycin versus doxycycline in moderate-to-severe Acne vulgaris: a systematic review and meta-analysis
BACKGROUND: Acne vulgaris is a chronic inflammatory disease and is one of the leading causes of dermatological morbidities among young adults. Doxycycline is widely recommended as first-line therapy for moderate to severe acne; however, its use is limited. OBJECTIVE: To systematically compare the efficacy and safety of oral azithromycin pulse therapy versus doxycycline in patients with moderate to severe acne vulgaris. METHODS: This systematic review and meta-analysis followed PRISMA guidelines. A comprehensive literature search on different databases was performed. Two reviewers independently screened studies, extracted data, and assessed risk of bias. Mean differences (MDs) and risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using random-effects models based on heterogeneity. RESULTS: A total of 23 comparative studies comprising 2,769 patients were included. Pooled analysis demonstrated a statistically significant improvement in global acne severity favoring azithromycin (GAGS reduction: MD 1.81; 95% CI 1.28-2.34; I2 = 0%). Azithromycin achieved a significantly greater reduction in non-inflammatory lesion counts (MD -7.56; 95% CI -14.33 to -0.79). No significant differences were observed in inflammatory lesion reduction (MD 1.08; 95% CI -0.03 to 2.18). CONCLUSION: Oral azithromycin pulse therapy appears to have similar efficacy, better tolerability, and fewer side effects as compared to doxycycline.
11 May 2026
Read appraisal →European journal of pediatrics
The effect of motivational interviewing on internet addiction and digital game addiction in adolescents: a randomized controlled trial
UNLABELLED: The purpose of this study was to measure the effect of motivational interviewing on both reducing internet addiction and digital game addiction in adolescents. A parallel-group randomised controlled trial was adopted. The study population consisted of ninth-grade (14-15 years of age) high school students in a city in Turkiye. The study was completed by 88 participants (experimental: 44; control: 44). The data were collected using a Personal Information Form, the Young Internet Addiction Test, and the Digital Game Addiction Scale. The experimental group received a preparatory session and five weekly motivational interviewing sessions. Instruments were administered to both groups before (pre-test) and after the intervention (post-test), and at follow-up tests 3 and 6 months after the final session. The data were analysed using the two-way mixed design and the Bonferroni Comparison Test. The mean scores of internet addiction and digital game addiction decreased significantly after the motivational interviewing in the experimental group compared to the control group (p < 0.001) in both the post-test and follow-up tests. CONCLUSION: The present study concluded that motivational interviewing may be associated with reductions in mitigating symptoms of internet addiction and digital game addiction behaviours among adolescents. Motivational interviewing could be implemented to reduce internet addiction and digital game addiction behaviours. Trial registration: The study was registered on a clinical trial database (NCT06721702). The study started on December 11, 2023 (actual date on which the first participant was enrolled). WHAT IS KNOWN: • Internet addiction and digital game addiction are two increasingly important problems among adolescents. • Digital games and online activities negatively affect adolescents' physical, social, and psychological health. WHAT IS NEW: • Motivational interviewing was an effective technique to reduce online gaming and internet addiction. • A motivational interviewing program comprising at least six sessions could be implemented to promote behavioural change in adolescents.
10 May 2026
Read appraisal →European journal of pediatrics
Metaphorical perceptions of secondary school students regarding the concept of generative artificial intelligence
UNLABELLED: The rapid integration of generative artificial intelligence (GenAI) tools, such as ChatGPT, into educational contexts has raised important questions regarding how adolescents conceptualize and make sense of these technologies. Understanding students' perceptions is essential for developing age-appropriate, ethical, and pedagogically sound approaches to AI use in secondary education. This descriptive qualitative study employed a phenomenological approach and metaphor analysis to explore secondary school students' perceptions of generative artificial intelligence. The study sample consisted of 332 students aged 14-18 years from four secondary schools in Türkiye. Data were collected using an open-ended prompt ("Generative artificial intelligence is like … because …") and analyzed through content analysis. Metaphors were categorized based on shared semantic and conceptual features, and inter-rater reliability was established using Cohen's kappa (κ = 0.92). Analysis revealed ten metaphor categories clustered under five overarching themes: generative artificial intelligence as (1) a source of knowledge, (2) a teaching and guiding entity, (3) a supportive and assisting tool, (4) a reflection of human intelligence, and (5) a dual-purpose (beneficial-risky) technology. Students most frequently conceptualized GenAI as a comprehensive knowledge source (e.g., book, encyclopedia) and as a human-like cognitive entity (e.g., brain, wise person). At the same time, metaphors reflecting ethical awareness and potential risks, such as misuse and overreliance, were also identified. The findings indicate that secondary school students hold multifaceted and nuanced perceptions of generative artificial intelligence, encompassing both educational opportunities and ethical concerns. These results highlight the importance of integrating AI literacy into secondary education in ways that promote critical thinking, responsible use, and awareness of GenAI's limitations alongside its potential benefits. CONCLUSION: It was determined that secondary school students perceive generative artificial intelligence ambivalently as both a useful tool and a source of ethical and emotional concern, highlighting the need for developmentally appropriate artificial intelligence literacy approaches. WHAT IS KNOWN: • GenAI tools such as ChatGPT are increasingly integrated into educational contexts and have the potential to support personalized learning, information access, and student engagement. • Existing research has primarily focused on educators' perspectives or higher education settings, while studies examining adolescents' perceptions of GenAI remain limited. WHAT IS NEW: • This study provides empirical evidence on secondary school students' metaphorical perceptions of generative artificial intelligence within a K-12 context. • Findings reveal that adolescents conceptualize GenAI in multifaceted ways, including as a knowledge source, teaching and guiding entity, supportive tool, reflection of human intelligence, and a dual-purpose (beneficial-risky) technology.
10 May 2026
Read appraisal →PloS one
Global folate deficiency among adolescent girls: A systematic review and meta-analysis
INTRODUCTION: Adolescents have higher nutrient requirements than adults, as this stage accounts for approximately 40% of total adult weight gain, 45% of skeletal mass and about 15% of adult height. Adequate micronutrient intake is particularly essential for adolescent girls to support growth, reproductive health, and cognitive development. Adolescent folate deficiency disrupts hematopoiesis, causing megaloblastic anemia, and hinders growth, cognition, and immune function and becoming a major public health concern. OBJECTIVE: This global systematic review and meta-analysis aims to address the gap in comprehensive evidence on the prevalence of adolescent folate deficiency. METHODS: This systematic review was conducted and reported according to PRISMA guidelines. We conducted a systematic literature search in PubMed, HINARI, Science Direct, DOAJ, Google, and Google Scholar for studies reporting the prevalence of folate deficiency among adolescent girls up to August 2025. Study quality was assessed using the Newcastle-Ottawa Scale, and evidence certainty was evaluated using GRADE. Pooled prevalence estimates with 95% confidence intervals were calculated using a random-effects model (DerSimonian-Laird method). Heterogeneity was assessed with Cochrane Q and I² statistics. Publication bias was evaluated through visual inspection of funnel plots and Egger's regression test, and adjusted estimates were calculated using the trim-and-fill method. Meta-regression analyses were conducted to explore potential sources of heterogeneity. Sensitivity analyses were performed to assess the robustness of pooled estimates. RESULTS: The search strategy identified 1,498 records, of which 26 studies met the eligibility criteria and were included in this systematic review and meta-analysis. The pooled global prevalence of folate deficiency among adolescent girls was 26.9%(95% CI: 20.5-33.2), with substantial heterogeneity observed between studies (I² = 99.99%, p < 0.001). On average across included studies, approximately one-quarter of adolescent girls were classified as folate deficient, though the true prevalence varied markedly between settings.. The pooled prevalence of folate deficiency among adolescent girls varied across regions, with the highest rate observed in Africa at 35.5%. CONCLUSION: These findings revealed folate deficiency as a substantial global public health concern among adolescent girls with a disproportionately high burden in low-resource settings. Region-specific strategies are urgently needed to prevent folate deficiency among adolescent girls, particularly in low-resource settings. Implementing targeted nutritional interventions and public health policies is essential to reduce its associated health consequences in this vulnerable population.
22 Apr 2026
Read appraisal →JMIR formative research
Development of iGET Living, a Digital Graded Exposure Intervention for Youth With Chronic Pain: Multiphase User-Centered Design and Pilot Study
BACKGROUND: Pediatric chronic pain affects up to one-third of youth and is associated with significant disruptions in social, emotional, and behavioral functioning. Although behavioral treatments are effective, access remains limited due to geographic, financial, and systemic barriers. Digital behavioral health interventions offer a promising solution, but many lack user-centered design, iterative refinement, and implementation-informed development strategies that support usability and scalability. OBJECTIVE: This study aimed to develop and iteratively refine iGET Living, a digital graded exposure intervention for youth with chronic pain, using a combined user-centered and implementation-informed framework, and to evaluate its preliminary acceptability, feasibility, and user-perceived success. METHODS: Guided by the Consolidated Framework for Implementation Research (CFIR) and the mHealth (mobile health) Agile Development and Lifecycle model, intervention development proceeded through 3 phases. Phase 0 translated an evidence-based in-person graded exposure treatment (GET Living) into an initial digital prototype. Phase 1 involved iterative user-centered refinement across 3 cycles of qualitative development sessions with youth with chronic pain (n=15), incorporating think-aloud usability testing, Likert-rated feedback, and rapid qualitative analysis mapped to CFIR constructs to guide real-time modifications to content, design, and functionality. Phase 2 piloted the refined intervention with a new sample of youth (n=38, n=30 completers) recruited from a tertiary pediatric pain clinic to evaluate feasibility, acceptability, treatment credibility and expectancy, and user-perceived functional improvements. Quantitative outcomes were summarized descriptively, and qualitative exit interview data were analyzed using rapid qualitative analysis. RESULTS: Across development cycles, youth feedback informed substantive refinements to the intervention, including reducing text density, incorporating animated educational videos, enhancing interactive features, and improving navigation and layout. These changes resulted in progressive improvements in clarity, satisfaction, and acceptability across prototypes. In the Phase 2 pilot study, participants reported moderate-to-high treatment credibility (mean of 19.71 out of 30) and expectancy (mean of 17.96 out of 30), as well as high satisfaction (mean of 46.12 out of 60). Acceptability ratings across domains of the Theoretical Framework of Acceptability were favorable. Qualitative exit interviews highlighted the interventions' perceived role in helping youth re-engage in valued activities. CONCLUSIONS: Using a combined CFIR and agile development approach, iGET Living emerged as a feasible, acceptable, engaging digital graded exposure intervention for youth with chronic pain. These findings highlight the value of integrating implementation frameworks and participatory design early in digital intervention development and support further evaluation in a preliminary efficacy trial.
18 Apr 2026
Read appraisal →PloS one
Ultra-processed food consumption and the risk of overweight and obesity in adolescents: A systematic review and meta-analysis
INTRODUCTION: Overweight and obesity during early life increase the risk of premature morbidity and mortality. Adolescent obesity raises the likelihood of developing cardiovascular risk factors, including prediabetes, type 2 diabetes, dyslipidemia, hypertension, liver disease, and metabolic syndrome. Sedentary lifestyles and unhealthy diets are major contributors, with one of the fastest-growing unhealthy eating patterns being the consumption of ultra-processed foods (UPFs). No systematic review and meta-analysis has specifically examined the association between UPF consumption and overweight/obesity in adolescents. OBJECTIVE: To systematically review and conduct a meta-analysis of available evidence on the association between UPF consumption and overweight or obesity among adolescents. METHODS: We searched PubMed, ScienceDirect, HINARI, Google, and Google Scholar for primary studies reporting UPF consumption and overweight/obesity outcomes in adolescents, without restrictions on language or study period. Study quality was assessed using the Newcastle-Ottawa Scale. Heterogeneity was evaluated using Cochrane's Q test and the I² statistic. Publication bias and small-study effects were assessed using Egger's regression test (p < 0.05). A random-effects model estimated pooled associations. RESULTS: Twenty-three studies involving 155,000 adolescents were included. Adolescents with higher UPF consumption had 63% greater odds of overweight or obesity compared with those with lower intake (OR = 1.63; 95% CI: 1.36-1.95). CONCLUSION: High UPF consumption is associated with an increased risk of overweight and obesity among adolescents. Public health strategies targeting reduced UPF intake and promotion of healthier diets should be prioritized to prevent adolescent overweight/obesity and associated health risks.
16 Apr 2026
Read appraisal →JMIR formative research
Designing Psychologically Grounded Artificial Intelligence for Supporting Bystander-Based Cyberaggression Intervention: Mixed Methods Exploratory Study
BACKGROUND: Cyberaggression poses a growing threat to mental health, contributing to increased distress, reduced self-esteem, and other adverse psychosocial outcomes. Although bystander intervention can mitigate the escalation and impact of cyberaggression, individuals often lack the confidence, strategies, or language to respond effectively in these high-stakes online interactions. Advances in generative artificial intelligence (AI) present a novel opportunity to facilitate digital behavior change by assisting bystanders with contextually appropriate, theory-informed intervention messages that promote safer online environments and support mental well-being. OBJECTIVE: This mixed methods design study aimed to explore the feasibility of using generative AI to support bystander intervention in cyberaggression on social media. Specifically, we examined whether AI can generate effective responses aligned with established intervention strategies and how these responses are perceived in terms of their potential to de-escalate online harm and foster behavior change. METHODS: We collected 1000 real-world cyberaggression examples from public social media datasets and generated bystander intervention responses using 3 distinct prompt strategies: a generic policy reminder, a baseline GPT prompt, and a theory-driven GPT prompt (AllyGPT). To evaluate the responses, we conducted computational linguistic analyses to assess their psycholinguistic features and carried out a mixed methods evaluation. Three trained coders rated each message on favorability, conversational impact, and potential to change behavior and later participated in semistructured interviews to reflect on their evaluation process and perceptions of intervention effectiveness. RESULTS: Linguistic analyses revealed that baseline GPT responses exhibited more emotionally positive and authentic language compared to AllyGPT responses, which showed a more analytical and assertive tone. Policy reminder messages were linguistically rigid and lacked emotional nuance. Human evaluation results showed that AllyGPT responses received the highest effectiveness ratings for low-incivil cyberaggression cases in 2 dimensions (favorability and changing behavior), and baseline GPT works better for mid and high levels for all effectiveness dimensions. For medium- and high-incivility aggressions, baseline GPT responses received the highest ratings across all 3 dimensions of effectiveness (favorability, discussion-shifting potential, and likelihood of changing bullying behavior), followed by AllyGPT, with policy reminders rated lowest. Qualitative feedback further emphasized that baseline GPT responses were perceived as natural and inclusive, while AllyGPT responses, although grounded in psychological theory, were sometimes viewed as overly direct. Policy reminders were considered clear but lacked persuasive impact. CONCLUSIONS: Our work showed that designing effective AI-generated bystander interventions requires a deep sensitivity to platform culture, social context, and user expectations. By combining psychological theory with adaptive, conversational design and ongoing feedback loops, future systems can better support bystanders, delivering interventions that are not only contextually appropriate but also socially resonant and behaviorally impactful. As such, this work serves as a foundation for scalable, human-centered AI systems that promote safer online spaces and users' mental well-being.
16 Apr 2026
Read appraisal →Biological psychiatry
From Snapshots to Stable Outcomes: Resting-State Functional Magnetic Resonance Imaging-Based Prognosis of Functioning in Patients With Psychosis Risk or Recent-Onset Depression
BACKGROUND: Early recovery of functioning is critical for favorable outcomes in psychotic and affective disorders. Transdiagnostic brain activity patterns may capture pathways for poor outcomes before clinical manifestation, thereby supporting timely prevention and intervention. METHODS: Using machine learning, we evaluated the transdiagnostic prognostic value of resting-state functional magnetic resonance imaging fractional amplitude of low-frequency fluctuations (fALFF) (slow-5 and slow-4 sub-bands) for functional outcomes in patients at clinical high risk for psychosis (n = 217) or with recent-onset depression (n = 198) from the multisite PRONIA (Prognostic Tools for Early Psychosis Management) study. Leave-site-out cross-validation assessed the geographic generalizability of models across disability and symptom domains, with outcomes defined as snapshots at 9- or 18-month follow-up or across both time points. We examined diagnosis-specific performance, generalization to recent-onset psychosis (n = 140), and negative symptoms and the added value of fALFF over clinical prognostication. RESULTS: Transdiagnostic models predicting stable good functioning across follow-ups showed up to 10% higher balanced accuracy (BAC) than snapshot models. Decreased slow-5 fALFFs in the default mode network, executive control network (ECN), and dorsal attentional network (DAN) and increased fALFF in the salience network, ECN, and DAN predicted impairment with BAC = 67% (sensitivity = 65%, specificity = 70%, p < .001). This model generalized to recent-onset psychosis (BAC = 62%, sensitivity = 64%, specificity = 59%, p < .001) and predicted (BAC = 65%, sensitivity = 66%, specificity = 65%, p < .001) and was mediated by negative symptoms. Slow-5-based models improved prognostic accuracy over expert ratings in disability (BACraters = 66%, BACraters+slow-5 = 75%, W = 1680, p < .001) and symptom (BACraters = 61%, BACraters+slow-5 = 71%, W = 1444, p < .001) domains. CONCLUSIONS: We highlighted the prognostic value of fALFF for functional impairment in psychosis risk and early depression. Leveraging trajectorial information, we identified candidate imaging biomarkers to improve prognostication, thereby supporting personalized prevention and recovery strategies.
16 Apr 2026
Read appraisal →Tobacco control
Generative AI in a new era of computer model-informed tobacco research: a short report
BACKGROUND: Social media influencers who promote e-cigarettes on Instagram or TikTok for tobacco brands use marketing tactics to increase the appeal of their promotional content, for example, depicting e-cigarettes alongside healthy lifestyle or entertainment imagery that could decrease youths' risk perceptions of e-cigarettes. Monitoring the prevalence of such content on social media using computer vision and generative AI (artificial intelligence) can provide valuable data for tobacco regulatory science (TRS). METHODS: We selected 102 Instagram and TikTok videos posted by micro-influencers in 2021-2024 who promoted e-cigarettes alongside posts featuring four themes: cannabis, entertainment, fashion or healthy lifestyle. We used OpenAI's GPT-4o multimodal large-scale visual linguistic model to detect the presence of nicotine vaping, cannabis vaping, fashion, entertainment and healthy lifestyle. The model did not require any additional training and improved its performance as we modified the text prompt. RESULTS: The model's accuracy was 87% for nicotine vaping, 96% for cannabis vaping, 99% for fashion, 96% for entertainment and 98% for healthy lifestyle. CONCLUSIONS: Generative AI can achieve accurate object detection with zero-shot learning (no additional training of the pretrained model). This model can be applied to big data-scale sample sizes of images and videos to detect e-cigarette-related and other substance-related promotional content and contexts (eg, healthy lifestyle) used for the promotion of these products on social media, providing valuable data for TRS.
15 Apr 2026
Read appraisal →JMIR cancer
Physical Activity Monitoring in Adolescents and Young Adults With Cancer: Observational Feasibility Study
BACKGROUND: There is a growing interest in characterizing the relationship between long-term physical activity (PA) habits and cancer-related outcomes such as treatment-related toxicities, recurrence, and complications. Wearable devices can provide critical information to achieve this goal; however, inferences are significantly influenced by device wear adherence. OBJECTIVE: This study aimed to assess the feasibility of using wearable devices to monitor short- and long-term PA in adolescent and young adult (AYA) patients with sarcoma during and after chemotherapy in a free-living environment and evaluate the ability to accurately capture changes in PA over 3 years. METHODS: A total of 63 AYA patients with sarcoma were provided with a Fitbit Charge 3 to track daily steps, sedentary time, and heart rate for up to 3 years. RESULTS: On average, during the first 30 days of follow-up, 57.1% (36/63) of patients wore their device at least 10 hours per day, and only 23.8% (15/63) of patients wore their devices thereafter. Patients spent a mean of 80% (SD 11%) of their day in a sedentary state. Despite low adherence, daily step count trends increased over time. CONCLUSIONS: This study highlights the adherence challenges met with longitudinal PA monitoring in AYA patients with sarcoma. Wearer discomfort, lost devices, and lack of data uploading compliance contributed to data missingness and attrition. Caution is warranted when relying on wearable activity trackers to inform program decisions, accurately assess PA outcomes, and monitor program adherence longitudinally without consideration of wearer bias. Alternative methods that would be more broadly accepted by AYA patients for effective long-term monitoring should be considered.
15 Apr 2026
Read appraisal →Vaccine
Increasing HPV vaccine uptake using a "start at 9" strategy: A pilot program
BACKGROUND: Human papillomavirus (HPV) vaccine completion rates by 13 years remain suboptimal. Earlier HPV vaccination may result in improved timely completion rates. We aim to describe the impact of recommending HPV vaccine at 9 years of age on vaccine completion rates. METHODS: We implemented a multi-level program (including policy development, provider and office personnel education, electronic health record changes, and use of vaccine promotional items) to facilitate routine HPV vaccine recommendation at 9 years at 2 pediatric practices. Monthly chart reviews were performed 6 months before through 18 months after program implementation. Outcome measures included rates of HPV vaccination and documentation of HPV vaccine during the visit. Quarterly data (age, HPV vaccination status, gender, race, ethnicity, insurance, and primary care provider type) were obtained from the electronic health records of 9-12-year-olds served by the practice from baseline through 18 months after program implementation. RESULTS: Following program implementation, the median percentage of HPV vaccine uptake among 9-10-year-olds increased from 8% to 41% at the urban practice and from 3% to 23% at the suburban practice. Similarly, HPV vaccine completion rates among 9-12 year olds increased from 9% to 14%, p < 0.001 and from 6% to 16%, p < 0.001, respectively. Documentation of provider vaccine recommendation strongly correlated with HPV vaccination. CONCLUSION: Implementation of a multi-level program to routinely recommend the HPV vaccine at 9 years of age is feasible and effective in increasing in HPV vaccine completion by 13 years of age.
12 Apr 2026
Read appraisal →JMIR human factors
Evaluation of Wellby, a Cocreated Mobile App and Wearable to Support Stress Management and Overall Well-Being: Mixed Methods Acceptability and Usability Study
BACKGROUND: Digital well-being support tools can offer adolescents tailored interventions embedded in their digital environments. However, there is a lack of high-quality, evidence-based digital interventions specifically designed for young people's well-being needs. Wellby is a mobile app and wearable device cocreated with Irish secondary school students to support stress management and overall well-being. OBJECTIVE: This study aimed to evaluate the acceptability and usability of the Wellby system using the technology acceptance model, focusing on ease of use, perceived usefulness, and behavioral intention among Irish secondary school students. METHODS: A mixed methods acceptability and usability study was conducted with Irish secondary school students (n=43) across 3 schools: 2 mainstream secondary schools and 1 Youthreach center for early school leavers. Students accessed the Wellby mobile app for 8 weeks and received the custom wearable device for the final 4 weeks (April-May 2024). Wellby included mood tracking, to-do lists, educational resources, text-based health coaching, and heart rate variability biofeedback with guided breathing exercises. Acceptability and usability were evaluated using the user version of the Mobile App Rating Scale (uMARS), structured focus groups, and app engagement analytics. Secondary measures included baseline well-being questionnaires (Perceived Stress Scale, Pittsburgh Sleep Quality Index, and EPOCH Measure of Adolescent Well-Being). RESULTS: Among survey respondents (n=29), uMARS subscale scores were high: information quality (mean 4.2/5.0), functionality (4.1/5.0), and aesthetics (4.1/5.0). The perceived impact subscale showed the highest scores for well-being awareness (3.8/5.0) and help-seeking intention (3.9/5.0). Of survey respondents who participated in prior co-design sessions, 88% (21/24) and 83% (20/24) felt the wearable and app, respectively, aligned with their co-design feedback. App engagement more than doubled following the introduction of the wearable and revealed that the wearable tab was most accessed (643/1688, 38% of interactions), followed by the home (430/1688, 25%), resources (338/1688, 20%), and coaching (277/1688, 16%) tabs. Focus group feedback highlighted the mood tracker as the most valued feature and identified technical improvements, including better battery life, enhanced Bluetooth connectivity, and more personalization options. CONCLUSIONS: This study demonstrates that cocreated digital well-being tools can achieve high acceptability and usability with Irish secondary school students. Applying the technology acceptance model effectively captured student experience through mixed methods feedback. Students particularly valued self-tracking and personalization features over coaching or educational features. These findings highlight the importance of aligning digital technologies with adolescents' needs and preferences, such as features that encourage increased autonomy and identity formation. Future iterations of Wellby should address the technical limitations while continuing the involvement of students to adapt to their developmental needs and maintain high acceptability.
11 Apr 2026
Read appraisal →The Tohoku journal of experimental medicine
Age-Specific Trends and Health Status of Children Aged 12-19 Years with Specified Chronic Pediatric Diseases in Japan - Insights from a National Database Study
Japan has a national financial assistance program called the "Specified Chronic Pediatric Diseases of Japan" (SCPDJ; also called "Shouman" in Japanese) for children with chronic diseases designated by the Japanese Ministry of Health, Labour and Welfare. The information of registrants in the system is digitized for research. We utilized the database to clarify the characteristics of children with diseases designated by the SCPDJ program. Analysis was performed with a particular focus on patients aged 12-19 years, which are considered the important ages for transition support from pediatric to adult medical care. The data included 69,061 cases aged 0 to 19 years from April 2016 to March 2017. The number of registrants showed a cumulative increase from 2 years toward adulthood. There were four distribution patterns for registered age and age at onset by disease category: 1) both age and age of onset peaked at age 0; 2) age distribution was mostly flat, while the most common age of onset was age 0; 3) age distribution peaked in older age groups, while age of onset of 0 was most common; and 4) both age and age of onset peaked at older ages. Approximately half of the patients aged 12-19 years were diagnosed after reaching school age. Although the disease condition of most patients remained good, some aged 12-19 years experienced exacerbation. The database was analyzed to provide an overview of children with diseases designated by the SCPDJ program and issues related to transition to adult care systems.
10 Apr 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Transitioning to adolescent and young adult or adult cancer survivorship care: A systematic review of contemporary guidelines and trials
BACKGROUND: Health service transitions of child, adolescent, and young adult cancer survivors between paediatric and adult cancer care services are pervasively fragmented, resulting in poor coordination, reduced satisfaction, and adverse outcomes for cancer survivors and significant others (e.g., caregivers and family members). Numerous trials and clinical guidelines have been developed to support care transitions, but their convergence, divergence, and methodological quality remain unclear. To advance clinical practice and quality research about care transitions, a synthesis of trials and guidelines on child, adolescent, and young adult care transition across age-appropriate cancer services is required to inform future research, practice, guideline, and policy development. METHODS: A systematic review (CRD420251029796) was conducted. Studies were identified from searches of six bibliographic databases, four trial registers, and grey literature. Inclusion criteria focused on clinical guidelines or trials published between January 2020 and April 2025 that addressed age-related transitional cancer care. RESULTS: A total of 3706 records were identified. After screening, 18 records met the inclusion criteria: 10 clinical guidelines, 4 completed trials, and 4 ongoing trials with registrations. While general recommendations between guidelines were consistent, they diverged in detail relating to their local contexts. Only two ongoing trials, and no completed studies, included independent control groups. CONCLUSION: Completed trials were limited and highly variable in approach, components, and outcome measures, suggesting regionally specific guidelines enhance relevance, applicability, and transition practices. Future research should develop core outcome sets for care transition trials to facilitate comparison of outcomes and should develop robust study designs, including control groups.
9 Apr 2026
Read appraisal →JMIR research protocols
Targeted Real-Time Assessment of Chronic Pain (TRAC-Pain) in Youth: Protocol for a Digital Biosignature Development Through a Prospective Observational Cohort Study
BACKGROUND: Approximately 1 in 5 children and adolescents live with chronic pain, with musculoskeletal (MSK) pain being one of the most prevalent subtypes. Unfortunately, some studies show that less than half of youth (<18 years) experience improvements with existing evidence-based treatments. Self-report measures-the current gold standard for monitoring the pain experience-are limited in their use as a single point-of-care assessment and their vulnerability to recall bias. The ubiquitous adoption of wearable technology presents a promising solution for improved monitoring of the pain experience via real-time tracking through a multisystemic lens. OBJECTIVE: The purpose of this study is (1) to develop a digital biosignature of the pain experience in youth with chronic MSK pain and (2) to assess the feasibility, acceptability, and appropriateness of the captured data for future applications. METHODS: All aspects of this study were designed in partnership with people with lived experience and patient advocacy partners. This is a longitudinal observational cohort study, with all study activities taking place remotely over a 12-week period. Up to 500 youth (between 14 and 24 years old) with chronic MSK pain will be enrolled through a multipronged recruitment strategy to ensure a representative sample. The participants will wear an Apple Watch throughout the study to continuously monitor physiological, sleep, and physical activity metrics. In addition, participants will complete brief "daily check-in" surveys that include gold-standard measures of the pain experience (eg, pain interference, mood, fatigue) and the option to report a "pain flare" (ie, a temporary but noticeable worsening of the usual pain symptoms). Participants will also complete a modified online Trier Social Stress Test and a 30-second sit-to-stand task to capture individual responses to standardized challenges. Traditional machine learning and deep representation learning methods will be used to develop a digital biosignature of the pain experience. The accuracy of the biosignature will be assessed through measures of model performance as compared to gold-standard self-reports. RESULTS: This study was funded in September 2024, with data collection beginning in March 2025. As of December 15, 2025, 190 participants are enrolled, with data collection and analysis ongoing. CONCLUSIONS: This is the first study to leverage wearable health technology for real-time monitoring of the pain experience in youth with chronic MSK pain. The resulting digital end points are expected to heighten the rigor of clinical trials and provide opportunities for individually tailored interventions. The second phase of this study will investigate the implementation of "wellness alerts" triggered by abnormal smartwatch readings. Alerts would empower users toward preemptive self-management strategies, thereby enhancing self-efficacy in those living with chronic MSK pain. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/84781.
8 Apr 2026
Read appraisal →PloS one
Identifying minimal risk factors for adolescent suicidal ideation and suicide attempts: A machine learning-optimized approach.
This study aimed to develop and validate a machine learning (ML) model to identify the minimal risk factors for adolescent suicidal behaviors, including suicidal ideation and suicide attempts. Data from the Korea Youth Risk Behavior Web-based Survey (2022-2023), including 90,813 adolescents aged 12-18 years, were analyzed. Using multidimensional risk factors spanning sociodemographic, physical and mental health, and behavioral domains, we applied a Random Forest model combined with recursive feature elimination to identify a minimal subset of risk factors (optimal features). Model performance for identifying suicidal ideation and predicting suicide attempts was evaluated via area under the curve (AUC), sensitivity, specificity, and accuracy metrics across the validation datasets. Sadness, loneliness, anxiety, and stress were identified as optimal features, achieving a high AUC, sensitivity, specificity, and accuracy in identifying suicidal ideation and predicting suicide attempts. Additional factors further improved the ML model's predictive performance for suicide attempts, achieving an AUC of 97.28%, sensitivity of 93.49%, specificity of 90.21%, accuracy of 91.85%, a PPV of 90.52%, and an NPV of 93.26%. This study demonstrated the efficacy of ML-driven approaches in identifying critical risk factors for adolescent suicidal behaviors. The findings highlight the potential of ML frameworks to transform suicide prevention strategies and improve mental health outcomes in adolescents.
7 Apr 2026
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