Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 3 appraisals
BMC psychology
Single-exposure messages for child sexual abuse prevention: a randomized controlled online trial testing educational and humanizing approaches
BACKGROUND: Child sexual abuse and exploitation, including online material depicting such acts, constitute a major public health concern. Prevention efforts likely benefit from public understanding and destigmatization, yet communication strategies on this topic face persistent misconceptions and strong emotional reactions. This randomized controlled online study examined whether brief educational and humanizing communication interventions influenced knowledge, attitudes, and behavioral intentions related to prevention, while avoiding adverse emotional or ethical effects. METHODS: A total of 2,019 adults from Spain and Portugal were recruited via an online panel and randomly assigned to one of four conditions: an educational message, a humanizing message with empathy focus, a humanizing message with prevention focus, or a neutral control message. Each intervention consisted of a short video and accompanying text presented as part of a health information campaign. Measures included affective state, stigma-related attitudes, literacy about therapeutic options, openness toward the topic, and behavioral intention to seek information. RESULTS: Exposure to any intervention message led to short-term changes in affective responses, with lower positive valence and slightly higher arousal compared to the control group (medium effect for valence, small for arousal). No significant differences emerged for stigma dimensions, knowledge, openness, or behavioral intentions. All three intervention formats performed similarly. The study did not identify measurable short-term adverse or rebound effects on stigma. Dropout rates did not differ across conditions, but languages. CONCLUSIONS: Brief communication interventions elicited short-term affective responses without evidence of increased stigma or avoidance on the measured outcomes. While the present single exposures appear insufficient to change attitudes or behavior, such formats may serve as a foundation for repeated, multi-channel prevention messaging integrated into broader educational efforts. TRIAL REGISTRATION: German Clinical Trials Register (DRKS), DRKS00038927, retrospectively registered on 09/01/2026.
25 May 2026
Read appraisal →BMJ paediatrics open
Does osteogenesis imperfecta predispose infants to metaphyseal fractures? A systematic review.
OBJECTIVE: The notion that osteogenesis imperfecta (OI) predisposes children to metaphyseal fractures is controversial. This review aimed to ascertain the prevalence of metaphyseal fractures in children with OI less than 2 years of age. MATERIALS AND METHODS: Medline, CINAHL and Web of Science were searched for studies reporting metaphyseal fractures in children with OI less than 2 years of age. Articles not retrievable, not published in English, or where 'metaphyseal' fracture was not defined/illustrated, were excluded. Article quality was independently assessed using the Critical Appraisal Skills Programme and Case Reports tools. RESULTS: Of 298 retrieved abstracts, 82 were duplicates: 216 articles were screened by title and abstract, excluding 186. Hand search of the remaining 30 articles identified two further articles. Only four articles were included: (1) 4/41 children with OI aged between 1 day and 3 years with 'metaphyseal' fractures; (2) a case series including a 16-month-old boy with three 'metaphyseal' fractures. Abuse concerns remained despite a type IV OI diagnosis (not genetically confirmed); (3) a 7-month-old girl with two 'corner' fractures suspected to have OI and to have been abused; and (4) a pair of siblings with 'metaphyseal' fractures and type XI OI (FKBP10 mutation). CONCLUSIONS: There is limited evidence that OI predisposes infants and young children to metaphyseal fractures. The two diagnoses are not mutually exclusive and until further large studies are conducted, physical abuse should always be considered in infants and young children with metaphyseal fractures, even in those with confirmed OI.
9 Apr 2026
Read appraisal →BMJ paediatrics open
Mapping the global prevalence and socioecological drivers of child sexual abuse: a systematic review and synthesis
INTRODUCTION: Child sexual abuse (CSA) is a widespread global health concern with lasting impacts. CSA is multifactorial and layered, and interventions to tackle CSA require an analysis of the key contributing factors. The main objective of this study was to explore global prevalence estimates of CSA and key contributing factors. METHODS: We systematically searched PubMed, Scopus and Web of Science for studies reporting lifetime prevalence of contact (eg, inappropriate touching or sexual acts) and non-contact (eg, exposure to sexual content or ill-intended conversations) CSA. Of 5493 articles screened, 332 met inclusion criteria. Prevalence data were stratified by population, region and abuse type. Risk factors were synthesised thematically using a socioecological framework. RESULTS: Median prevalence of reported non-contact CSA was 57.0% (range: 31.1%-80.0%). Contact CSA prevalence was higher among females (median: 14.9%, range: 2.2%-40.2%) than males (median: 6.0%, range: 0.6%-21.2%). Regional variations were notable, with sub-Saharan Africa reporting the highest contact CSA prevalence (median: 25.5%) and Latin America and the Caribbean the lowest (median: 8.5%). Vulnerable groups, including Indigenous children (median: 39.2%), orphans (37.9%) and the incarcerated (31.1%), faced higher risk. Risk factors spanned individual (shame, stigma), familial (poor supervision, dysfunction), institutional (lack of safeguards) and societal (weak legal frameworks, normalisation of abuse) levels. CONCLUSIONS: Prevalence of CSA was globally high, with 14 in 100 females reporting having experienced CSA. Multilevel interventions, particularly strengthening family supervision and institutional safeguarding, legal accountability and community awareness, are critical for the prevention of CSA.
4 Apr 2026
Read appraisal →