Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 17 appraisals
European journal of pediatrics
Telemedicine in pediatrics: a critical narrative review of innovations, limitations, and future priorities
UNLABELLED: This narrative review synthesizes recent technological and organizational developments in pediatric telemedicine, maps their principal clinical applications, and critically discusses implementation, safety, equity, and future priorities. This narrative review used a transparent, non-systematic literature-search approach in PubMed/MEDLINE, Scopus, and Google Scholar, considering publications available through April 2026. Searches were intended to identify and contextualize relevant literature across pediatric settings rather than to provide an exhaustive, reproducible systematic evidence synthesis. No formal risk-of-bias assessment, meta-analysis, or certainty-of-evidence grading was undertaken; therefore, findings are interpreted cautiously and according to the maturity and consistency of the available evidence. Evidence suggests that telemedicine can support follow-up, access to specialist care, and family engagement in several pediatric chronic-care pathways, particularly diabetes and asthma. However, the evidence base is heterogeneous across specialties, frequently relies on observational or implementation studies, and is less mature for acute assessment, neonatal and rehabilitation uses, wearables, and AI-enabled tools. CONCLUSION: Telemedicine should be considered a complementary component of pediatric healthcare rather than a replacement for in-person assessment. Hybrid models may support accessibility, continuity, and sustainability when embedded in structured, patient-centered, equitable, and clinically appropriate pathways. WHAT IS KNOWN: • Telemedicine expanded rapidly in pediatrics during the COVID-19 pandemic and is now used across many specialties. • It can improve access, continuity of care, remote monitoring, and family engagement, especially in chronic and complex conditions. WHAT IS NEW: • This review summarizes recent technological and organizational innovations, including wearables, mHealth, EHR integration, AI, and hybrid care models. • It highlights current limits and future requirements for safe, equitable, and sustainable integration into routine pediatric care.
2 Aug 2026
Read appraisal →Preventing chronic disease
Reducing Rates of Cesarean Delivery in Rural US Communities: A Systematic Review of Interventions and Approaches to Care
INTRODUCTION: Cesarean deliveries are the most common major surgery in the US, with rates rising disproportionately in rural communities. While sometimes medically necessary, unnecessary cesarean births increase risks for maternal death, long-term complications, and intergenerational health effects that contribute to the burden of chronic disease. This systematic review examined studies describing interventions and approaches to care that reported outcomes related to reducing cesarean delivery rates in rural US communities. METHODS: We searched 4 databases in September 2025. Studies were eligible if they were conducted in rural US settings and reported cesarean-related outcomes associated with an intervention or care approach. We categorized interventions as patient level, provider level, or health system level. Two reviewers independently screened articles for inclusion, extracted data, and assessed study quality using the Newcastle-Ottawa Scale and the Joanna Briggs Institute checklist. RESULTS: Nine studies met inclusion criteria. Of the 2 patient-level interventions, psychosocial education was associated with lower cesarean delivery rates (21% in intervention vs 40% in control), whereas a mobile health application showed only a marginal difference (27.1% among application users vs 27.7% among nonusers). None were categorized at the provider level. Seven interventions tested system-level models, primarily comparing hospitals with different staffing patterns; family medicine-led hospitals had lower rates of low-risk nulliparous, term, singleton, vertex cesarean delivery than hospitals staffed by both family medicine physicians and obstetricians (23% vs 28%), certified nurse-midwife-managed births had lower cesarean delivery rates than family medicine physician-managed births (8% vs 14%), and collaborative maternity care models integrating midwives, nurses, and obstetricians were associated with cesarean delivery rates declining from 26.2% to 11.2%. CONCLUSION: System-level approaches, particularly those that restructure maternity care teams, emphasize family medicine physician-led models, and integrate midwifery and culturally grounded childbirth practices, are more consistently associated with lower cesarean delivery rates in rural US settings than patient-level interventions alone. Future efforts to reduce unnecessary cesarean deliveries should prioritize strategies tailored to the variability of rural care capacity.
31 July 2026
Read appraisal →International journal of yoga therapy
Randomized Controlled Trial on the Effect of Yoga on Anxiety Severity, Quality of Life, and Biomarkers in Individuals with Anxiety Disorder
Anxiety disorders are highly prevalent mental health conditions characterized by physiological dysregulation that includes heightened stress responses, low-grade systemic inflammation, and metabolic imbalance, which together contribute to impaired quality of life. Although yoga-based interventions are increasingly used as complementary therapies, evidence isolating the effects of slow pranayama (yoga breathing) and savasana (corpse pose) on psychological outcomes and biochemical markers in anxiety disorders remains limited. This randomized controlled study evaluated the effects of slow pranayama and savasana, implemented as adjuncts to routine psychiatric care, on anxiety severity, quality of life, and selected biochemical markers in individuals with anxiety disorders. A total of 150 people diagnosed with anxiety disorders were allocated to either routine psychiatric care alone (control group) or routine care plus slow pranayama and savasana (intervention group) for 8 weeks. We assessed anxiety severity using the Hamilton Anxiety Rating Scale, quality of life using the World Health Organization Quality of Life-Brief questionnaire, and biochemical markers such as serum cortisol, brain-derived neurotrophic factor (BDNF), inflammatory markers, and metabolic parameters. Outcomes were analyzed using mixed-design analysis of covariance with Bonferroni correction, and correlational analyses were performed between psychometric, quality-of-life, and biochemical variables. Of the enrolled participants, 112 completed the study. Significant Group × Time interactions were observed for anxiety severity scores and the physical, psychological, and environmental domains of quality of life, with improvements noted only in the pranayama group. Serum cortisol levels decreased and BDNF levels increased significantly in the intervention group compared with controls. Inflammatory and metabolic parameters did not show statistically significant changes after correction, although favorable directional trends were observed. Anxiety severity and quality-of-life scores demonstrated significant correlations with cortisol, BDNF, and inflammatory and metabolic markers. Slow pranayama and savasana appear to be safe, feasible, and effective adjuncts to standard psychiatric care, improving anxiety severity and quality of life while favorably modulating stress-related physiological markers in people with anxiety disorders.
31 July 2026
Read appraisal →Human vaccines & immunotherapeutics
Factors influencing vaccine uptake during pregnancy: A systematic literature review.
A systematic literature review was conducted to build a comprehensive evidence base of qualitative/quantitative studies to identify barriers and enablers influencing maternal immunization (MI). Searches of seven databases on 20/10/2023 and 26/10/2023 yielded 87,367 records. Two reviewers performed full-text screening of 484 records. English-language articles from countries that had national recommendations for pertussis-containing maternal vaccines and reported on maternal vaccine acceptance, trust, and hesitancy were eligible. Overall, 184 studies were included. Barriers involving individual and group influences like lack of knowledge and reduced awareness of MI, pre-existing anti-vaccination beliefs and attitudes, and perceived concerns about vaccine safety and efficacy were the most prominent. Proactive communication and recommendations from healthcare professionals and public health authorities were major enablers, alongside trusting the information provided by healthcare professionals. Our results show that vaccine hesitancy is a complex phenomenon. Addressing both practical and perceptual barriers to MI might increase vaccination coverage among pregnant individuals. What is the context? Vaccines administered during pregnancy help protect both mother and newborn from serious infections. Yet, some expectant mothers hesitate to receive such vaccines.What is new? We systematically searched the available scientific literature to identify the factors that positively and negatively influence vaccine acceptance among expectant mothers.We analyzed data from 184 studies from countries across Europe, North America, Oceania, Asia, and South America that have national recommendations for vaccines against whooping cough.We found that vaccine refusal was mainly driven by personal perceptions of the vaccine or influences of the social environment.Convincing recommendations from healthcare professionals, fair access to prenatal care, increased trust in healthcare authorities and vaccines, and clear communication with the expectant mother were identified as promoters of vaccine acceptance.What is the impact? Addressing the identified issues might increase vaccine uptake among expectant mothers, which might have a serious impact on reducing infectious disease severity in newborns.
23 July 2026
Read appraisal →European journal of pediatrics
Probiotics in pediatric functional abdominal pain disorders: a systematic review and meta-analysis
UNLABELLED: Functional abdominal pain disorders (FAPDs), currently referred to as abdominal pain-related disorders of gut-brain interaction (AP-DGBIs), are characterized by recurrent abdominal discomfort in children that cannot be fully explained by an identifiable organic disorder. Probiotics are increasingly used as microbiota-targeted treatments, although their true clinical benefit remains uncertain. The objective of this study is to evaluate the efficacy and safety of probiotic supplementation compared with placebo in children with AP-DGBIs. PubMed, Embase, Web of Science and Scopus were searched from the start of each database to April 2026; the review followed PRISMA guidelines. Randomized controlled trials in patients < 18 years with FAPDs (IBS, FAP-NOS, functional dyspepsia, abdominal migraine) diagnosed by Rome II-IV, in which probiotic supplementation was evaluated. Two reviewers independently extracted data and assessed risk of bias using RoB2 tool. Meta-analyses and network meta-analyses were used to synthesize the data; the certainty of the evidence was evaluated using GRADE and CINeMA. This review covers 21 trials (2005-2025) with 1899 patients treatments completed. Probiotics modestly reduced pain intensity and weekly pain episodes, and modestly increased the rate of complete symptom resolution compared with placebo. Treatment with probiotics was associated with complete symptom resolution in 35.3% versus 22.8% of placebo-treated patients, corresponding to a number needed to treat (NNT) of 7 (95%CI = 3.97-29.04). However, the certainty of evidence was rated as low to moderate across outcomes. Moreover, from a clinical perspective, when success was defined as an improvement in symptoms according to an author-defined threshold, probiotic supplementation was not associated with different response rates compared with placebo. CONCLUSION: Probiotics provide modest symptom relief in pediatric FAPDs and may be considered a safe adjunctive therapy rather than a stand-alone treatment. While these findings are in line with the ESPGHAN/NASPGHAN 2025 guidelines, larger standardized trials are required to define optimal strain selection, dosage and treatment duration. TRIAL REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251149947 , identifier CRD420251149947. WHAT IS KNOWN: • AP-DGBIs (formerly FAPDs) are common childhood disorders characterized by recurrent abdominal pain without identifiable organic disease. • Probiotics are increasingly used to restore gut microbial balance, but their clinical benefit remains uncertain. WHAT IS NEW: • Our meta-analysis showed that probiotic supplementation reduced pain intensity and weekly pain episodes and increased symptom resolution versus placebo. • Benefi ts were modest, with substantial heterogeneity across studies and low-to-moderate certainty of evidence.
21 July 2026
Read appraisal →Pediatric surgery international
Pediatric colonic diverticulitis: clinical presentation, management, and review of the literature
Colonic diverticulitis is rare in the pediatric population and often presents with nonspecific symptoms that may be misdiagnosed as other causes of acute abdominal pain, such as appendicitis, leading to diagnostic uncertainty and variability in management. We report a case of pediatric colonic diverticulitis and present a systematic review to characterize its clinical presentation, diagnostic challenges and management. Clinical data for the index patient were retrospectively reviewed, and parental consent was obtained. A structured literature search was performed using PubMed, Scopus, and Embase. Studies reporting patients younger than 18 years were included. A 16-year-old male presented with right lower quadrant pain. CT suggested cecal diverticulitis. Worsening symptoms prompted diagnostic laparoscopy, revealing an inflamed diverticulum adjacent to a normal appendix. The postoperative course was uneventful. The review identified 27 studies including 101 patients. Median age was 14 years (IQR 12-16; range 3-17), with 57% male preponderance. Most cases involved a solitary right-sided diverticulum. CT correctly identified diverticulitis in 85%. Complicated disease occurred in 17%. In conclusion, in the pediatric age diverticulitis often arises from a solitary cecal diverticulum and can closely mimic appendicitis. Awareness may improve diagnosis, and uncomplicated cases can be treated conservatively with careful follow-up and appropriate clinical monitoring.
21 July 2026
Read appraisal →European journal of nutrition
The effect of system-level intervention in early childhood education and care on children's dietary intake and environmental impact of the diet
PURPOSE: Food systems have a large impact on human health and environmental sustainability. Early childhood education and care is an ideal setting for systemic change. We performed a cluster-randomised trial aiming at climate-friendly and healthy sustainable diet at 23 daycare centres in four Finnish municipalities in 2022 and evaluated system-level intervention effects on food consumption and nutrient intake, and climate and biodiversity impacts of the diet. METHODS: The intervention was initially designed by the research group and refined through co-creation workshops with food service and daycare professionals, and municipal decision makers. The 10-month intervention comprised a modified menu towards more plant-based food supply, and food education. Children's (n = 111) diet was assessed at baseline, mid-term, and/or at the end of the intervention by food frequency questionnaires. The climate and biodiversity impacts per megajoule were assessed using previously specified coefficients for the foods. Multilevel linear mixed models were used in the analysis. RESULTS: During the intervention, children's consumption of legumes and legume products and fish from nearby areas increased, while that of red meat, sausages, and other meat products decreased (Bonferroni-corrected p < 0.001). The changes in food consumption were substantial, with effect sizes ranging from 0.9 to 2.69. Nutrient intake was not affected by the intervention. Intervention decreased climate and biodiversity impacts of food provided at daycare (Bonferroni-corrected p < 0.001, p = 0.003, respectively). CONCLUSION: This study demonstrated that well-planned systemic change in meal provision and food education at daycare resulted in healthier and more climate-friendly diets among children.
20 July 2026
Read appraisal →Journal of ethnopharmacology
Efficacy of Wendan Decoction combined with conventional medicine for depression: a systematic review and meta-analysis
ETHNOPHARMACOLOGICAL RELEVANCE: Wendan Decoction is well-known traditional Chinese medicine formula commonly used in China for the treatment of gastrointestinal disorders and mood disorders related to phlegm-dampness and spleen deficiency. In clinical practice, depending on different symptoms, additional herbs may be included, resulting in a modified formula known as modified Wendan Decoction. AIM OF THE STUDY: To evaluate the efficacy of modified Wendan Decoction plus conventional medicine in the treatment of depression. MATERIALS AND METHODS: We independently conducted a meta-analysis of studies on the efficacy of modified Wendan Decoction for depression from inception to February 28, 2025, using electronic databases, including PubMed, Embase, Cochrane, Web of Science, Wanfang, VIP and SinoMed. Data from randomized controlled trials were extracted to evaluate treatment outcomes based on depression scales. RESULTS: A total of 402 articles were identified through database searches, and 13 studies, encompassing 1117 patients, were included. The initial pooled analysis revealed a significant treatment effect of the experimental group, yielding a standardized mean difference (SMD) of -4.84 (95% CI: -7.54 to -2.14), with high heterogeneity (I2 = 99%). Sensitivity analysis, excluding studies with high risk of bias, demonstrated an SMD of -4.18 (95% CI: -5.26 to -3.10) with moderate heterogeneity (I2 = 83%). Notable regional differences were found, with the study in Southern region exhibiting greater efficacy (SMD = -4.81, 95% CI: -6.38 to -3.23) compared to the study in Northern region (SMD = -3.03, 95% CI: -3.73 to -2.32). CONCLUSIONS: Our meta-analysis supports the efficacy of combining modified Wendan Decoction with conventional medicine for treating depression. Exploratory subgroup results suggest slightly greater improvements in Southern China, though this finding requires cautious interpretation and confirmation in future high-quality trials. PROSPERO Registration ID: CRD420251015690.
15 July 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Psychosocial interventions for families with minor children affected by parental cancer: An umbrella review
PURPOSE: Research on psychosocial interventions for families with minor children affected by parental cancer has expanded over recent decades; however, the evidence remains fragmented across multiple systematic reviews. This umbrella review aims to gather and synthesize the existing systematic reviews, with a particular focus on intervention characteristics, implementation, effectiveness, methodological limitations, and implications for future research and clinical practice. METHODS: A comprehensive search of CINAHL, MEDLINE, PubMed, Web of Science, Scopus, PsycINFO, PsycArticles, Epistemonikos, and the Cochrane Database of Systematic Reviews was conducted in September 2025, including gray literature. Eligible reviews were published between 1990 and 2025 in English, Portuguese, or Spanish and had full-text availability. Methodological quality was assessed using AMSTAR-2. The review was registered in PROSPERO (ID 1139397). RESULTS: Eight systematic reviews met inclusion criteria and were synthesized narratively due to substantial clinical and methodological heterogeneity. Across these reviews, 46 distinct psychosocial interventions were identified. Overall, interventions were associated with preliminary beneficial outcomes for children, adolescents, parents, and families, particularly in improving children's understanding of parental illness, enhancing family communication and functioning, strengthening parenting skills, and promoting psychological well-being. However, confidence in these findings was limited by the generally low methodological quality of the included reviews and the high overlap of primary studies. CONCLUSIONS: Current evidence suggests that psychosocial interventions may support families with minor children affected by parental cancer, but conclusions remain tentative due to methodological limitations. There is a clear need for the development and rigorous evaluation of developmentally and disease-stage-sensitive interventions, supported by high-quality research and institutional collaboration. Strengthening the evidence base in this area is essential to inform clinical practice, guide supportive care services, and support policy development in psycho-oncology.
13 July 2026
Read appraisal →JMIR mHealth and uHealth
Safer Sleep Guidance in Standalone UK Smartphone Apps for Parents of Newborns and Infants: Systematic mHealth App Review
BACKGROUND: Parents are increasingly using smartphone apps to help guide decision-making around aspects of caregiving, including safer sleep. However, it remains unclear whether the guidance provided aligns with best practice guidelines. OBJECTIVE: This review aimed to identify smartphone apps that provide safer sleep guidance and to assess their content, technical features, functionality, and quality. A secondary aim was to make recommendations on the improvements that existing and future apps can make to provide safer sleep guidance. METHODS: In January 2026, we searched the UK Google Play Store and Apple App Store for safer sleep guidance apps for parents and caregivers of newborns and infants (babies aged ≤12 months). Information regarding content, technical features, and functional features was extracted and summarized descriptively. Each app was evaluated by 2 raters using the Mobile App Rating Scale (MARS) and the IMS Institute for Healthcare Informatics functionality score. Adherence to best practice sleep guidance was assessed using bespoke criteria. Interrater reliability was calculated. RESULTS: A total of 1345 apps were identified, with 12 meeting the inclusion criteria. All were free to download, with 42% (5/12) containing in-app purchases. Only 17% (2/12) were affiliated with a professional health, medical, clinical, or government body. All 12 apps contained some information regarding safer sleep practices, although this was addressed and named differently (eg, calling it cot death, sudden infant death syndrome, or safe sleep). Of the 9 criteria relating to safer sleep best practice guidance, the apps mentioned an average of 6.75 (SD 1.71; range 3-9) criteria. Some promoted unsafe sleep practices (ie, around swaddling and cosleeping). The apps included an average of 5.4 of the 11 IMS functionality criteria (SD 2.5; range 2-9). The mean MARS score was 3.7 out of 5 (SD 0.43; range 2.92-4.13), and most (11/12, 92%) had a minimum acceptability score of 3 or above. Two had been formally trialed or tested. Although the language used was considered accessible (easy to understand), none of the apps allowed the language to be changed (beyond English), and very few (3/12, 25%) enabled users to change to night/dark mode, which would be considered essential when using these apps at night. CONCLUSIONS: Several apps about safer baby sleep exist. Few discuss safer sleep guidance comprehensively or raise awareness about sudden infant death syndrome and its links with unsafe sleep. All the reviewed apps met the minimum acceptability criteria for quality; however, not many were formally trialed or tested. More long-term research should be conducted on the effectiveness of safer sleep apps on adherence to safer sleep guidance. We recommend that apps relating to infant and baby safety in general include information on realistic safer sleep practices that are informed by best practice guidelines and take a risk minimization approach.
11 July 2026
Read appraisal →PloS one
Optimizing treatment for depressed parents of children with emotional and behavioral disorders: A multi-site feasibility trial.
BACKGROUND: Behavioral parent training (BPT) programs are effective for reducing disruptive behavior of many children with emotional and behavioral disorders (EBD) and improving skills and competencies of their parents. However, these interventions are not sufficiently effective for parents who themselves have depression. This study assessed the feasibility of the Addressing Depression and Positive Parenting Techniques (ADAPT) Program-a novel BPT that includes aspects of cognitive behavioral therapy and dialectical behavior therapy. We identified whether recruitment was possible, attendance was acceptable, participants were satisfied, and facilitators adhered to the protocol. Additionally, we measured trends in changes in parent and child outcomes with intervention. METHODS: Participants were 28 parents and their children with EBD, referred to two hospital-based clinics. Parents were eligible if they (1) had a child aged 6-10 experiencing emotional and behavioral difficulties and (2) were experiencing elevated depressive symptoms. ADAPT took place virtually over 10 weeks. Participants completed measures before, weekly and after treatment. Clinicians recorded attendance and completed weekly treatment fidelity checklists. RESULTS: We found that recruitment was possible, the intervention showed high parental satisfaction, and facilitators reported high program fidelity. Further, secondary outcome measures showed evidence of sensitivity to change in the intended direction. CONCLUSION: Given that a priori progression criteria were met and we found preliminary indication of efficacy, we conclude that an RCT of ADAPT to determine efficacy is warranted.
11 July 2026
Read appraisal →JMIR dermatology
The Rise in Homemade Sunscreen Trends and Future Impacts on Skin Cancer Risk: Systematic Review
BACKGROUND: The trend of homemade sunscreen recipes has rapidly gained popularity over the last decade, being largely fueled by social media influencers, natural health blogs, and the growing mistrust of large health organizations like the US Food and Drug Administration (FDA). Consumers are increasingly drawn to products labeled "natural," "organic," "vegan," and "cruelty-free," often conflating these terms with safety and effectiveness. However, when applied to sun protection, these assumptions can be dangerously misleading. According to the FDA, there is no verified mathematical formula that can be used to determine an accurate sun protection factor (SPF) rating for the amount of zinc oxide used in many of the recipes found online. OBJECTIVE: The objective of this review is to examine the rising popularity and efficacy of homemade sunscreens compared to commercial sunscreens and highlight the potential public health implications of skin cancer risk related to homemade sunscreen use. METHODS: Multiple databases were searched to find current and relevant literature analyzing the social media impact relating to homemade sunscreens and the efficacy of homemade sunscreens compared to commercially available products. Digital content that included or discussed homemade sunscreen recipes was included as well to provide examples of information trending online. RESULTS: One study analyzing social media trends found that many strong, unverified claims relating to homemade sunscreen versus commercial sunscreen use are being presented in the media, potentially influencing public knowledge. Additional studies analyzing the components of homemade sunscreen recipes compared to components in commercially available products found that homemade sunscreens offer little to no sun protection, therefore increasing the risk of UV damage for individuals using homemade products. CONCLUSIONS: Based on the presented evidence, the adoption of unregulated homemade sunscreens presents a substantial threat to public health. Misinformation spread through social media and influencer culture may unintentionally contribute to an increase in UV-related skin cancers. Greater efforts are needed from health care professionals, regulatory bodies, and online platforms to educate the public and promote the use of scientifically validated sun protection methods.
4 July 2026
Read appraisal →European journal of nutrition
The effectiveness of a plant-based milk with fermented brown rice on constipation symptoms via gut microbiota modulation: a double-blind randomized controlled trial
PURPOSE: To evaluate the effects of a plant-based milk with fermented brown rice on constipation symptoms in patients with functional constipation and to identify post-intervention gut microbial alterations that may underlie potential mechanisms. METHODS: This is a randomized controlled trial among 100 participants with functional constipation. Participants were randomly assigned to the intervention group (plant-based milk with fermented brown rice, 2 bottles/day, 500 ml in total), or the control group (an isocaloric plant protein milk, equivalent dose) for 3 weeks. The primary outcome is complete spontaneous bowel movement (CSBM) rate, while secondary outcomes include score of individual symptoms assessment of constipation, bowel movement frequency (BMF), and gut microbial changes (metagenomics). RESULTS: A total of 99 participants completed the intervention. CSBM and BMF increased, and GSRS scores decreased over time in both groups, with no significant between-group differences. The plant-based milk with fermented brown rice relieved constipation symptoms more than the control group did, with significant between-group differences in straining, bloating and abdominal pain (all P < 0.05). The intervention group showed increases in 8 species, including three beneficial species in the genus Blautia, associated with relief of abdominal pain after the intervention. Meanwhile, machine learning models identified gut microbiota features predicting intervention responders. CONCLUSION: Our study did not find between-group difference in CSBM, while the plant-based milk with fermented brown rice showed greater effectiveness in relieving constipation symptoms and optimizing gut microbiota. Functional species benefiting intestinal health in response to the intervention were also identified. CLINICAL TRIAL REGISTRY: This study has been registered in the Chinese Clinical Trial Registry (https://www.chictr.org.cn/, ChiCTR2400088688).
30 June 2026
Read appraisal →Journal of medical Internet research
Digital Interventions Targeting Parents to Improve Early Childhood Movement, Nutrition, and Sleep Behaviors: Systematic Review
BACKGROUND: Early childhood (0-5 years) is key for shaping health behaviors, yet optimal behaviors are rarely achieved. Digital health promotion interventions offer scalable support for families; however, most research has focused on childhood more broadly, leaving limited evidence for the early childhood period. OBJECTIVE: The primary aim of this systematic review was to examine whether autonomously delivered digital interventions targeting parents are effective at increasing physical activity, reducing sedentary behavior, improving nutrition (breastfeeding, feeding practices), and/or optimizing sleep among children aged 0-5 years. The secondary aim was to review the reporting of co-design practices, user engagement, and process evaluation, and to assess how engagement influences intervention effectiveness. METHODS: Seven databases were searched for randomized controlled trials (RCTs) evaluating autonomously delivered digital interventions targeting one or more of the following behaviors: physical activity, sedentary behavior, nutrition, or sleep among children (published to January 2026). Study quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for RCTs. Findings were narratively synthesized by target age-group and behavior, and the direction of effect was summarized in structured tables. RESULTS: Of the 14,352 identified records, 38 interventions (33 RCTs, 4 pilot RCTs, and 1 feasibility RCT) were included. Most studies focused on pregnancy to infancy (n=24; 0-1 y), followed by preschoolers (n=8; 3-5 y) and toddlers (n=6; 1-2 y). Intervention duration ranged from 2 weeks to 1000 days, and various digital formats were used (apps n=11, SMS text messaging n=10, web- or internet-based platforms n=6, WeChat [Tencent] n=3, tablet-based program n=2, a combination of app and SMS text messaging n=1, website and emails n=1, emails and SMS text messaging n=1, automated voice calls n=1, Facebook Messenger Chatbot [Meta] n=1, and online videos n=1). Interventions spanning pregnancy to infancy reported mixed findings for breastfeeding and feeding practices. Studies targeting toddlers showed improvements in sleep, mixed findings for diet and screen time, and no differences in physical activity. Most studies targeting preschoolers reported significant improvements for feeding practices and diet, but no differences in physical activity, sedentary behavior and sleep, and mixed findings for screen time. Most studies reported co-design or engagement (n=24), but few examined the impact of engagement on intervention effectiveness (n=6), and those that did reported mixed findings. Interpretation was limited by heterogeneous designs, inconsistent outcome measures, and mixed risk-of-bias ratings across studies. CONCLUSIONS: This review advances the field by synthesizing evidence on scalable digital interventions that support parents in promoting healthy lifestyle behaviors across the first 2000 days, together with key design and implementation factors that have rarely been reported in previous reviews. Unlike prior work, it focuses exclusively on autonomously delivered digital interventions in early childhood. Findings show heterogeneous designs and mixed effectiveness, and highlight 3 priority evidence gaps: limited studies in toddlers and preschoolers, incomplete reporting of engagement, and limited understanding of how engagement influences outcomes. These findings define priorities for future research to strengthen the evidence for scalable digital interventions in early childhood.
28 June 2026
Read appraisal →PloS one
Long-term effects following prenatal cocaine exposure: A systematic review.
Cocaine use represents a global public-health concern, and children's exposure to this substance is receiving growing attention. Despite the importance of this phenomenon, efforts to isolate cocaine-specific long-term effects are affected by the limited availability of human cohorts followed into adulthood and by the influence of environmental factors and co-exposures. Addressing ongoing debates in the literature, this systematic review synthesizes human evidence on long-term outcomes following prenatal cocaine exposure (PCE), from infancy to early adulthood. A comprehensive search of PubMed and Scopus from inception to August 2025 identified 26 eligible studies. Results suggest that across maturational stages, PCE is consistently associated with early developmental effects (including smaller head circumference and motor delays), deficits in visuospatial, language and executive functions, focal neuroimaging alterations (white-matter microstructure and task-related functional recruitment), growth deficits, and elevated externalizing behaviours. However, evidence is characterised by heterogeneity in exposure assessment, frequent prenatal polysubstance exposure, socioeconomic confounding, caregiving instability and small neuroimaging samples. Overall, this review suggests that PCE is linked to a broad spectrum of detrimental effects and that some biological vulnerabilities associated with PCE may persist. Nonetheless, supportive postnatal environments may mitigate developmental disadvantages and promote better trajectories for affected children. These findings underscore the need for integrated public-health and clinical strategies that combine prevention of prenatal substance use with family-focused postnatal supports.
28 June 2026
Read appraisal →PloS one
Factors associated with resilience among parents of children with autism spectrum disorder: A systematic review
Parents of children with autism spectrum disorder (ASD) experience ongoing caregiving demands and challenges that may contribute to their general well-being. Research has shown that resilience enables parents to adapt to these challenges; however, existing evidence on associated factors toward resilience among these parents remains fragmented. This systematic review aimed to identify factors associated with resilience among parents of children with ASD. We conducted a PRISMA 2020-guided systematic review on studies published between January 2019 and May 2025 using Web of Science, Scopus, and PubMed by applying predefined search terms and Boolean operators. Studies examining factors associated with resilience among parents of children with ASD aged under 18 years were included in this review. We also used the Mixed Methods Appraisal Tool 2018 to assess the quality of these studies. Findings were synthesised narratively using thematic analysis. From the 13 selected studies, five themes were identified as determinants of resilience among parents, i.e., sociodemographic and economic factors; child-related characteristics; parenting well-being and distress; psychological factors and coping styles; and social support and family relationships. Most included studies were cross-sectional and utilised different measurement tools, which may limit causal inference and comparability. As a conclusion, parental resilience was found to be influenced by psychological, social, and contextual factors. Strengthening coping resources and social support may enhance parental adaptation and family well-being. Along these lines, multi-level and culturally sensitive interventions are thus needed to inform strategies to foster resilience among parents of children with ASD. The review was registered with PROSPERO (CRD420251034348). The author(s) received no specific funding for this work.
23 June 2026
Read appraisal →Current psychiatry reports
Artificial Intelligence in Child and Adolescent Psychiatry: A Narrative Review of Recent Clinical Applications and Ethical Considerations
PURPOSE OF REVIEW: This narrative review examines recent literature of artificial intelligence (AI) in child and adolescent psychiatry. With increasing mental health disorders in young people along with persistent workforce shortages, AI has emerged as a potential tool to improve efficiency and support clinical decision making. However, using AI raises important ethical concerns which are summarized in our review. RECENT FINDINGS: Most AI applications in child and adolescent psychiatry remain early in development and are not ready for routine clinical use. AI scribes are likely impractical in many child psychiatry settings because of multiparty visits, consent concerns, and sensitive clinical discussions. Many multimodal diagnostic tools using machine learning still require further testing and can be impractical when relying on costly diagnostics like neuroimaging. Similarly, AI-assisted therapeutics requiring physical hardware like robotics and virtual or augmented reality devices can also be prohibitively expensive. One of the few exceptions includes AI-enabled video and eye-tracking approaches for autism diagnosis. Chatbots and robot companions may provide modest improvements for depression, but evidence remains limited in the pediatric population with risk of serious harm. Concerns of AI include misinformation, algorithmic biases, privacy risks, crisis mismanagement, and excessive emotional attachments to chatbots. AI may eventually support child and adolescent psychiatry, but current evidence supports cautious, supervised use rather than broad clinical adoption. Clinicians should help families understand AI's limits, encourage digital literacy, and ensure that AI remains an adjunct to human care rather than a substitute.
22 June 2026
Read appraisal →