Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 40 appraisals
PloS one
Integrating smoking cessation into HIV care settings: A systematic review and meta-analysis of effectiveness and the evidence gap in cost-effectiveness.
The prevalence of smoking among people living with HIV (PLWH) is higher than in the general population, and PLWH who smoke are at increased risk of both smoking- and HIV-related comorbidities. As most PLWH reside in low- and middle-income countries (LMICs), there is a need for effective and cost-effective smoking cessation interventions in resource-constrained settings. We systematically reviewed and meta-analyzed the effectiveness of smoking cessation interventions for PLWH and looked for economic evaluations. Four databases (PubMed, Cochrane, Scopus, Web of Science) were searched up to March 23rd, 2026. Interventional and quasi-experimental studies evaluating smoking cessation interventions for PLWH were included. Risk of bias was assessed using Cochrane's risk-of-bias tool for randomized studies and the Effective Public Healthcare Panacea Project tool for non-randomized studies. Thirty-two articles met the inclusion criteria. Most evidence originated from high-income countries, with three randomized controlled trials conducted in LMICs (Kenya, South Africa and Vietnam). No economic evaluations were identified. Smoking cessation interventions varied in type, duration, intensity, and mode of delivery. Overall, studies had low to moderate risk of bias. GRADE assessments indicated moderate-certainty evidence that pharmacological interventions (RR 1.86, 95% CI 1.42-2.45) and tailored, intensive behavioral support (RR 1.34, 95% CI 1.05-1.71) increase smoking abstinence compared with standard care. This review indicates that pharmacological and tailored, intensive behavioral support interventions can support smoking cessation among PLWH, including emerging evidence from LMICs, but the absence of economic evaluations limits guidance for resource-constrained settings. Future research should prioritise implementation strategies and economic evaluations to support scalable integration into routine HIV care. (PROSPERO Registration no: CRD42022313630).
1 Aug 2026
Read appraisal →BMJ open ophthalmology
Screening for diabetic retinopathy with artificial intelligence in a primary care setting: a comparative cost analysis
OBJECTIVE: Cost analysis of autonomous artificial intelligence (AI)-based screening of diabetic retinopathy (DR) for adults with diabetes at a primary care clinic. METHODS AND ANALYSIS: This study provides a comparative cost analysis of actual results using AI-based DR screening with counterfactual results based on all patients going through the physician-based referral system. A cost analysis is conducted using cost data from published sources, provincial billing codes, statistical sources, and patient characteristics from a clinical study to compare autonomous AI-based screening for DR versus physician-based screening. Costs considered include direct costs of operating the AI system, physician fees, and indirect costs to patient time. Along with total cost comparisons, a cost per DR case detected is estimated and a sensitivity analysis based on variations in AI costs is provided. RESULTS: Over the study period, 202 participants were screened for DR using autonomous AI. The majority (93.6%, n=189) of AI-based DR screening exams were completed successfully. The AI-based scenario results in total direct costs of $C7919.04 and indirect costs of $C5728.80, resulting in total costs of $C13 647.84 per 100 patients. The traditional physician-based approach results in total direct costs of $C8240 and indirect costs of $C19 998.09, resulting in total costs of $C28 238.09 for 100 patients. When costs are converted to costs per unit outcome, the total cost per diagnosed DR case is $C620.36 for the AI-based approach and $C1283.55 for the physician-based approach; the AI-based cost per diagnosed case was 52% lower. CONCLUSION: Given the lower cost per diagnosed case of the AI-based approach, there are advantages to the implementation of AI-based screening for DR.
1 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 →PloS one
Analysis of swimming teaching programs, aquatic competencies and specific skills in school settings from early childhood to secondary education: A systematic review.
The teaching of swimming in school contexts has become increasingly important due to the benefits in the integral development of students and the prevention of aquatic accidents.This study analyses, by means of a systematic review, the aquatic teaching programmes and Competencies implemented in school settings over the last 25 years, from infant to secondary education. The Methodological approach was based on the PRISMA guidelines, with searches in scientific databases (PubMed, Scopus, Sport Discus and Web of Science) and secondary sources. Sixteen studies were selected according to the PICOS model, assessed with the STROBE and TREND tools. The results show a predominance of technical-utilitarian approaches focused on specific swimming skills, with little curricular integration and limited involvement of PE teachers. Most of the studies focused on infant and primary school, being scarce in secondary school. A high variability in duration, frequency, Contents and Assessment instruments was evidenced. The studies highlight the need for greater inclusion of swimming in school curricula, with more comprehensive pedagogical approaches adapted to each stage. It is concluded that although progress has been made, systematic implementation is still limited, requiring greater institutional support, teacher training and methodological coherence.
25 July 2026
Read appraisal →Journal of medical ethics
AI interventions in cancer screening: balancing equity and cost-effectiveness
This paper examines the integration of artificial intelligence (AI) into cancer screening programmes, focusing on the associated equity challenges and resource allocation implications. While AI technologies promise significant benefits-such as improved diagnostic accuracy, shorter waiting times, reduced reliance on radiographers, and overall productivity gains and cost-effectiveness-current interventions disproportionately favour those already engaged in screening. This neglect of non-attenders, who face the worst cancer outcomes, exacerbates existing health disparities and undermines the core objectives of screening programmes.Using breast cancer screening as a case study, we argue that AI interventions must not only improve health outcomes and demonstrate cost-effectiveness but also address inequities by prioritising non-attenders. To this end, we advocate for the design and implementation of cost-saving AI interventions. Such interventions could enable reinvestment into strategies specifically aimed at increasing engagement among non-attenders, thereby reducing disparities in cancer outcomes. Decision modelling is presented as a practical method to identify and evaluate these cost-saving interventions. Furthermore, the paper calls for greater transparency in decision-making, urging policymakers to explicitly account for the equity implications and opportunity costs associated with AI investments. Only then will they be able to balance the promise of technological innovation with the ethical imperative to improve health outcomes for all, particularly underserved populations. Methods such as distributional cost-effectiveness analysis are recommended to quantify and address disparities, ensuring more equitable healthcare delivery.
25 July 2026
Read appraisal →PloS one
AI-based color vision screening and educational counseling for high school students: An experimental study
Color vision deficiency (CVD) can negatively affect students' learning experiences and career choices; however, combined screening and educational counseling remain challenging in school settings, particularly in low-resource contexts. Conventional paper-based color vision tests are time-consuming, difficult to standardize, and rarely linked to individualized educational or career guidance. This study aimed to design, implement, and validate an Android-based mobile application that integrates CVD screening with artificial intelligence (AI)-assisted educational and career counseling for high school students. A cross-sectional study was conducted with 527 high school students in Danang, Viet Nam. The application incorporated a digital Ishihara-based screening module and an AI-assisted counseling component. Screening outcomes were compared with conventional Ishihara testing to evaluate agreement, while students' perceptions of usability, usefulness, and counseling relevance were assessed using a validated questionnaire. Statistical analyses included descriptive statistics, independent-samples t-tests, reliability analysis using Cronbach's alpha, and exploratory factor analysis. Seventeen students (3.23%) were identified as having CVD, including red-green, protan, deutan, and achromatopsia (complete CVD). The mobile application demonstrated high concordance with conventional screening results. No statistically significant differences were observed between students with and without CVD in overall system evaluation scores (p > 0.05). The questionnaire showed good internal consistency (Cronbach's alpha = 0.857) and a clear multi-factor structure reflecting students' acceptance of AI-assisted educational and career counseling. These findings indicate that the proposed mHealth application offers a feasible and scalable approach for school-based CVD screening combined with personalized educational and career guidance. The system may serve as a supportive decision-making tool for students and counselors, while further validation under diverse real-world conditions and across different mobile devices is recommended.
24 July 2026
Read appraisal →Current obesity reports
A Systematic Review of Community-based Interventions to Promote Physical Activity or Reduce Sedentary Behavior among Adults in Low- and Middle-Income Countries
PURPOSE OF REVIEW: Community-based interventions (CBIs) are widely used to address behavioral risk factors for non-communicable diseases, yet evidence of their effectiveness in low- and middle-income countries (LMICs) remains limited. This study systematically reviewed evidence on the effectiveness of CBIs promoting physical activity (PA) and/or reducing sedentary behavior (SB) among community-dwelling adults in LMICs. We searched PubMed, Embase, Scopus, and the Cochrane Library (2000-2024) for CBIs in LMICs. Primary outcomes were changes in PA and/or SB. Descriptive and graphical depictions were used to draw inferences. RECENT FINDINGS: We selected 24 studies (11 RCTs) from 15,396 for review. Most studies (n = 16) reported significant improvements in PA outcomes. Changes were observed in Metabolic Equivalents (+ 100 - +2,700), moderate-to-vigorous PA (+ 7 to + 60 min/week), and steps/day (+ 3,000). Broadly, interventions were delivered using digital/technology format (n = 10), peer-led/community health worker-facilitated (n = 8), and Environmental restructuring (n = 6), with the digital interventions depicting the most consistent significant improvements. Two studies directly measured SB as a primary outcome. Short- (≤ 6 months; n = 11) and medium-duration (6-12 months; n = 4) interventions more frequently reported significant PA improvements than long-duration interventions (> 12 months; n = 9). PA/SB-focused CBI demonstrated proportions of significant effects similar to those of broader lifestyle interventions (88.9% and 53.3%, respectively). CBIs can be effective in improving PA in LMICs, although evidence is heterogeneous and SB is less addressed. Digital interventions show more consistent positive signals, but high heterogeneity in studies precludes firm conclusions. The impact of duration on effectiveness looks counterintuitive but underscores the need for more rigorous evaluation of longer-duration interventions and SB outcomes. PROSPERO registration number: CRD42024579461.
23 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 →Depression and anxiety
Reducing Public Stigma Toward Suicide-Loss Survivors Through Brief Video Interventions: A Randomized Controlled Trial
BACKGROUND: Suicide-loss survivors (SLSs) experience substantial and often enduring psychological burden. These difficulties are compounded by public stigma, underscoring the need for scalable approaches to shift attitudes at the population level. In this study, we examined whether brief survivor-narrative videos can reduce public stigma of SLSs. METHODS: In a randomized controlled trial, 1351 adults (18-50) completed baseline measures and were allocated to view either a brief SLS narrative or a psychoeducational control. Public stigma toward SLSs and trait impressions were assessed at baseline and postexposure. RESULTS: Relative to control, the SLS video arm showed clear improvements immediately and at 30 days: stigma scores were lower and trait impressions more favorable, with attenuation over time. Item-level analyses indicated sizable immediate reductions for "Disconnected" (-24%) and "Cowardly" (-16%), and smaller but significant decreases for "Immoral" and "Irresponsible" (-12% each). CONCLUSIONS: Brief survivor-narrative videos can shift public attitudes toward SLSs and maintain part of that change over 1 month. As a low-cost, scalable complement to postvention, brief video contact offers a practical lever to improve the social climate surrounding SLSs. Deployed widely and reinforced over time, it can move communities from blame to empathy, strengthen everyday support, and advance survivors' recovery.
23 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 →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 →International journal of technology assessment in health care
Consideration of intersectoral costs and benefits in health economic evaluations of pneumococcal conjugate vaccines: a systematic review.
OBJECTIVES: This systematic review explores which intersectoral costs and benefits (ICBs) are considered in the economic evaluation of pneumococcal conjugate vaccines (PCVs) across different age groups and the related impacts on the results of economic evaluations. METHODS: Seven databases were searched from 2009 to 2024 for full economic evaluations (Ees) of PCVs from a societal perspective. ICBs were presented narratively and in tabular form. Studies were appraised on quality, and PRISMA guidelines were followed. RESULTS: In all, 57 studies were included. ICBs were captured in the following sectors: patient and family, paid labor (productivity), nonpaid productivity, other sectors (education, leisure, consumption), unspecified sectors for ecological effects (herd immunity, serotype replacement, cross-protection), and equity. In cases where the comparator was no vaccination, 10 studies reported that PCVs were dominant when ICBs were included. After excluding dominant analyses, the median QALY-based incremental cost-effectiveness ratio (ICER) reduction ranged from -3.25 percent (for patient/family costs and productivity loss) to -46.02 percent (in children with ecological effects). Among DALY-based studies, the inclusion of ecological effects reduced the median ICER by -22.97 percent. In head-to-head comparisons, 16 studies reported that PCVs were dominant when ICBs were included. CONCLUSION: Inclusion of ICBs, except for serotype replacement, showed favorable cost-effectiveness results. This study provides a framework for identifying the intersectoral costs and benefits for the health economic evaluation of PCVs in children and adults.
19 July 2026
Read appraisal →Acta odontologica Scandinavica
Obstructive sleep apnea and periodontitis: a systematic review with considerations on CPAP therapy
OBJECTIVE: To evaluate the association between obstructive sleep apnoea (OSA) and periodontitis and to assess the available evidence on the effects of continuous positive airway pressure (CPAP) therapy on periodontal status. MATERIALS AND METHODS: This review was conducted in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 guidelines. Comprehensive literature searches were performed in Cochrane, PubMed, Scopus, and Web of Science. Study selection and data extraction were carried out independently by two reviewers. A total of 20 original studies met the inclusion criteria. Methodological quality was assessed using the Joanna Briggs Institute critical appraisal tool. RESULTS: Fourteen of the 20 studies (70%) reported a significant association between OSA and periodontitis. However, only two studies fulfilled all methodological quality criteria, indicating an overall moderate to low quality of evidence. Data on the effects of CPAP therapy on periodontal outcomes were limited, and the available studies generally showed no significant impact. CONCLUSIONS: Current evidence supports an association between OSA and periodontitis, suggesting that OSA may contribute to periodontitis. Robust, well-designed studies with larger sample sizes and rigorous methodology are needed to clarify the nature of this relationship and to determine whether CPAP therapy influences periodontal health.
17 July 2026
Read appraisal →Food chemistry
Decoding the neural mechanisms of salty peptide perception via electroencephalography and machine learning
Excessive sodium intake poses major public health risks, driving the search for salt substitutes that preserve desirable flavor. Salty peptides have emerged as promising low-sodium alternatives, yet their neural perception, distinct from the ion-dependent mechanism of sodium chloride, remains poorly understood. This study integrated electroencephalography (EEG) and machine learning to elucidate the neurophysiological mechanisms of salty peptide perception. By extracting temporal, spectral, and spatial EEG features and combining them with source localization, the study identified delta-band predominance and a hierarchical cortical activation cascade extending from the prefrontal to the insular and parietal cortices, reflecting both primary gustatory processing and higher-order integration. Among the tested classifiers, XGBoost achieved the highest performance (AUC = 0.815), demonstrating that EEG features effectively distinguish neural responses between salty and non-salty peptides. These findings provide electrophysiological evidence for salty perception and offer a neural framework for reduced-sodium food design.
16 July 2026
Read appraisal →BMC medical research methodology
Digital focus groups in healthcare interventions: A reflexive methodological analysis of how socio-technical and relational factors co-produce qualitative data.
BACKGROUND: Digital focus groups are increasingly used in health research, yet their methodological implications within complex interventions remain insufficiently examined. When conducted with pre-existing cohorts, digital focus groups may function not only as evaluative tools but also as relational and socio-technical encounters that shape the generation of qualitative data. The goal of the present study was to examine how digital focus groups operate within this context. METHODS: This study presents a methodological re-analysis of focus group material originally collected for the evaluation of a hybrid psychosocial prevention intervention, examining how digital focus groups operate within this context following the perspective of Situational Analysis. Digital focus groups were conducted with participants who had completed the hybrid intervention together in fixed cohort groups, meaning participants were already acquainted with one another prior to the focus group sessions. For the analysis, the transcripts were examined using descriptive, inductive coding. Verbatim quotations were used as methodological markers to illustrate how relational, emotional and technological factors shaped the data. RESULTS: Pre-existing cohort cohesion strongly influenced how participants engaged in the digital setting, fostering emotional safety, peer-supported learning, motivational reinforcement and opportunities for self-regulation. Digital platforms structured visibility, turn-taking and synchronization, while differences in devices, connectivity and digital literacy affected participation and the stability of group interaction. The researcher role expanded to include facilitation, technical troubleshooting and emotional anchoring, making the research team part of the socio-technical infrastructure. At times, the focus groups elicited supportive or motivational effects that echoed elements of the intervention itself, blurring the line between evaluation and unintended interventional effects. CONCLUSIONS: Focus groups in intervention research operate as relational encounters rather than neutral data-collection tools. This applies particularly to Digital Focus Groups. Recognizing how pre-existing relationships, technological environments and researcher involvement shape interaction is essential for methodological transparency and rigorous interpretation. The findings highlight the importance of reflexivity, attention to digital differences, and awareness of unintended interventional dynamics when designing and interpreting digitally mediated qualitative methods in healthcare contexts. Furthermore, the findings indicate that the choice between digital and in-person FGs should not be guided by pragmatic considerations alone, but by the relational, technological and institutional conditions of the research situation. TRIAL REGISTRATION: DRKS-ID: DRKS00033080 (registration date: December 7, 2023).
13 July 2026
Read appraisal →Depression and anxiety
A Systematic Review of Community Pharmacy-Led Depression Services: Service Components, Outcomes, and Implementation Barriers and Facilitators
BACKGROUND: Depression is the most common mental ill health condition, and its prevalence is increasing. Despite this, its treatment is variable often due to a lack of capacity within healthcare systems to support this vulnerable population. Community pharmacy staff could offer additional support. This systematic review identifies depression services led by community pharmacy staff, their service components, outcomes, and barriers/facilitators to their implementation. METHODS: Four bibliographic databases were searched (Medline, EMBASE, PsycINFO, and CINAHL) from 2000 onwards. Title/abstract and full-text screening was conducted. Data on the service components were mapped to the Template for Intervention Description and Replication (TIDieR). Clinical, humanistic, economic, and service outcomes were charted. Barriers and facilitators were mapped to the Consolidated Framework for Implementation Research (CFIR). Quality assessment was performed using the Quality Assessment with Diverse Studies (QuADS) tool. RESULTS: Fifty studies were included. Seventeen studies identified general attitudes regarding community pharmacy services for depression, which were generally supportive. The majority (n = 33) explored an implemented depression service focusing on depression advice/education (n = 15), screening (n = 12), medication adherence (n = 4), medication review (n = 1), and disease therapy management (DTM) (n = 1). Clinical outcomes were the most commonly reported types of outcomes, with varied results. Key facilitators were linked to the pharmacy 'inner setting', including accessibility of community pharmacies, the use of private consultation rooms, and skills/training of staff. Barriers to service delivery related often to the external 'outer setting', especially societal stigma, low public awareness of pharmacy roles, funding constraints, and limited collaboration with other healthcare professionals. CONCLUSION: This international review identified a range of different services that community pharmacy staff can deliver to support people with depression, ranging from supporting diagnosis, health literacy, and management plans. The accessibility of community pharmacies for depression service delivery warrants further investigation. However, limited empirical evidence of clinical and economic outcomes and reported implementation barriers may complicate broader implementation.
13 July 2026
Read appraisal →Vaccine
Mobile health strategies to improve HPV vaccination uptake among parents of adolescent girls: a scoping review
BACKGROUND: Human papillomavirus (HPV) vaccination is a highly effective primary prevention strategy against cervical cancer. However, despite strong evidence of vaccine efficacy and safety, uptake among adolescent girls remains suboptimal globally, particularly in low- and middle-income countries. Mobile health (mHealth) technologies have emerged as promising tools to address parental concerns, reduce vaccine hesitancy, and strengthen parental engagement in vaccination decision-making. OBJECTIVE: This scoping review aimed to synthesize evidence on the types of mHealth strategies implemented to improve HPV vaccine uptake among parents of adolescent girls and to examine the outcomes of these interventions. METHODS: A systematic search of major databases identified studies evaluating mHealth interventions targeting parental decision-making regarding HPV vaccination. Eligible interventions included text messaging, mobile applications, chatbots, web-based educational platforms, and other digital health tools. Data were charted and synthesized narratively. KEY FINDINGS: mHealth interventions were associated with significant improvements in HPV vaccine uptake across multiple settings. SMS-based interventions consistently increased vaccination rates, while chatbot, web-based, and mobile app interventions improved parental knowledge, vaccine literacy, intention to vaccinate, and, in several studies, actual vaccine uptake. However, intervention effectiveness varied by socioeconomic context, digital access, and cultural factors. CONCLUSION: mHealth technologies represent cost-effective and scalable strategies to improve HPV vaccine uptake by enhancing parental knowledge, reducing hesitancy, and supporting informed decision-making. Future implementation should prioritize culturally tailored, equity-focused approaches and integrate digital interventions with community-based engagement to maximize impact.
12 July 2026
Read appraisal →PloS one
Edge-intelligent safelink-V2X: A low-latency cooperative framework for real-time vulnerable road user protection.
The protection of Vulnerable Road Users (VRUs) remains a major challenge in modern transportation safety, as onboard line-of-sight and adverse weather conditions limit conventional onboard sensors. Existing systems that rely solely on vehicle-based sensing or on isolated communication struggle to provide timely, accurate alerts in dynamic urban environments. To address these shortcomings, this paper introduces SafeLink-V2X, a comprehensive Vehicle-to-Everything Cooperative Warning Framework designed to enhance safety for pedestrians, cyclists, and scooter riders. SafeLink-V2X employs Cellular Vehicle-to-Everything (C-V2X) and Dedicated Short-Range Communications (DSRC) protocols to enable direct data exchange of location, velocity, and heading between connected vehicles, smart infrastructure, and VRUs via smartphones or wearable tags. By applying sensor fusion and machine learning-based conflict prediction, the system identifies potential collision points and issues real-time, context-aware warnings through vehicle HMIs and VRU devices, promoting immediate evasive action. Evaluation on urban intersection simulations (detailed in Section 5) demonstrates that SafeLink-V2X reduces simulated collision probability by up to 91.4%, increases situational awareness measures by 44%, and lowers end-to-end alert latency by 30% compared to baseline onboard-only and communication-only systems under the same conditions.
12 July 2026
Read appraisal →Vaccine
Interventions to improve pre-school vaccination timeliness: a systematic review.
BACKGROUND: Improving the timeliness of pre-school vaccinations (children aged 0 to 5 years) is an important public health goal to prevent outbreaks and maximise protection during early childhood. Multiple studies have highlighted the need for effective public health interventions to improve timely vaccination, and consequently the overall effectiveness of vaccination programmes. We aim to synthesise evidence on vaccination timeliness interventions and subsequently provide recommendations to improve pre-school vaccination timeliness in England. METHODS: We conducted a systematic review of randomised controlled trials (RCTs) and non-randomised studies. Studies were eligible if they were conducted in high-income countries and evaluated an intervention to improve timeliness of any pre-school vaccination on the United Kingdom (UK) national childhood vaccination schedule. Five databases and grey literature were searched to February 2025. Risk of bias was assessed using Cochrane risk of bias tools. Data were analysed using random-effects meta-analyses and synthesis without meta-analysis (using effect direction plots). RESULTS: Of the 10,385 records from database searches and 1490 records from citation searches, 33 studies were eligible (15 RCTs, 18 non-randomised studies). Most studies were conducted in the USA (n = 24) and reported on the timeliness of multiple pre-school vaccines (n = 23). Twelve studies (36%) were judged as serious or critical risk of bias, eleven at moderate and ten at low risk. Various intervention groups were identified: call-recall (n = 10), quality improvement (n = 9), education (n = 5), multicomponent (n = 5), combination vaccines (n = 2), communication (n = 1) and vaccination schedule change (n = 1). We found limited evidence from a small number of studies of a potential beneficial effect of combination vaccines, communication, quality improvement, education and schedule change interventions. CONCLUSION: We identified several possible interventions to improve pre-school vaccination timeliness. However, we found limited quantity and quality of evidence on this topic. We recommend further high-quality studies evaluating interventions to improve vaccination timeliness in England, and application of consistent vaccination timeliness definitions.
12 July 2026
Read appraisal →BMJ open
Determinants of cervical screening in Ghana: a systematic review
BACKGROUND: Cervical cancer remains a leading cause of morbidity and mortality among women in Ghana, yet screening coverage is extremely low and organised national programmes are limited. Although several studies have examined determinants of screening, no comprehensive synthesis has summarised the evidence to guide effective policy and intervention design. OBJECTIVE: To synthesise existing evidence on determinants of cervical screening in Ghana and identify opportunities to strengthen national screening strategies. DESIGN: This is a systematic review conducted following Aromataris and Pearson's methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches across PubMed Central, CINAHL, Web of Science, Scopus and grey literature (January 2000-July 2025) identified studies reporting barriers and facilitators of cervical screening in Ghana. Risk of bias was assessed using standard appraisal tools. SETTING: This study was conducted in the context of Ghana. RESULTS: Of 7833 records screened, 32 studies met inclusion criteria. Barriers to cervical screening spanned individual, interpersonal, health system, socio-cultural and structural factors, including poor knowledge, fear, limited access, financial constraints and social norms. Facilitators included knowledge and awareness, provider recommendation, social support, positive health perceptions, healthcare access and cost-related enablers. Overall, 23 studies were rated low risk of bias, while nine were rated moderate risk of bias. CONCLUSION: Cervical screening behaviour in Ghana is influenced by structural, cultural, psychological and informational factors. The reviewed evidence suggests that these determinants do not operate in isolation but interact in ways that may vary across contexts and populations. OSF REGISTRATION NUMBER: https://doi.org/10.17605/OSF.IO/M4XKT.
11 July 2026
Read appraisal →Journal of medical Internet research
The Association Between eHealth Literacy and Health Behaviors During and Since the COVID-19 Pandemic: Systematic Review and Meta-Analysis
BACKGROUND: Since COVID-19, health information seeking, service navigation, and routine care have become increasingly digitally mediated. It remains unclear whether the association between eHealth literacy and health behaviors is consistent across behavioral domains, populations, and analytic frameworks. OBJECTIVE: This systematic review and meta-analysis synthesized COVID-19 and post-COVID-19 evidence on the association between eHealth literacy and health behaviors and examined variation across study contexts. METHODS: We conducted a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020-compliant, PROSPERO-registered review (CRD420251009048). PubMed, Embase, Web of Science Core Collection, CINAHL Ultimate, and Scopus were searched from January 1, 2020, through March 27, 2026. Eligible observational studies assessed eHealth literacy and reported analyzable associations with health behavior outcomes collected in 2020 or later. Health behaviors were classified as health decision-making, health-promoting, or health management behaviors. Correlation coefficients, grouped odds ratios (ORs), and continuous ORs were synthesized separately using random-effects models with Knapp-Hartung adjustment. Certainty was assessed using the Grading of Recommendations Assessment, Development, and Evaluation framework. RESULTS: In total, 19 studies were included: 10 contributed correlation coefficients, 6 grouped ORs, and 3 continuous ORs. In the correlation-based synthesis, higher eHealth literacy was associated with more favorable health behaviors (pooled r=0.43, 95% CI 0.36-0.51; 95% prediction interval 0.22-0.61), with substantial heterogeneity (I2=80.50%). In the grouped OR synthesis, higher eHealth literacy was also associated with more favorable health behaviors (pooled OR 2.12, 95% CI 1.47-3.05; 95% prediction interval 1.11-4.06), with moderate heterogeneity (I2=46.33%). In the continuous OR synthesis, all 3 studies showed positive associations, but the pooled effect was not statistically significant (pooled OR 1.07, 95% CI 0.89-1.30; 95% prediction interval 0.84-1.37), with very high heterogeneity (I2=97.98%). Subgroup analyses showed a significant difference only by geriatric status in the grouped OR synthesis. Certainty was low for the grouped OR synthesis and very low for the other 2 syntheses. CONCLUSIONS: Higher eHealth literacy was generally associated with more favorable health behaviors in the correlation-based and grouped OR syntheses, whereas evidence from the continuous OR synthesis was inconclusive. Given the predominantly cross-sectional evidence base, heterogeneity, risk-of-bias concerns, and low to very low certainty, the association should be interpreted as contextual and associative rather than causal or uniform. This review is innovative in synthesizing COVID-19 and post-COVID-19 evidence, applying a functional classification of health behaviors, and analyzing distinct effect measures separately. Unlike previous reviews that summarized the association more broadly, it avoids a single mixed pooled effect and provides a cautious, context-specific interpretation. In practice, interventions should pair eHealth literacy improvement with trustworthy digital services, clinician support, and behavior-specific conditions that help translate digital information into sustained health-related action.
10 July 2026
Read appraisal →BMJ open
Development and acceptability of gist-based decision aids for prostate and breast cancer screening: a two-phase qualitative interview study in an online setting.
BACKGROUND: Traditional approaches to designing decision aids have focused on providing completeness of information and quantitative detail. An alternative approach based on psychological research emphasises understanding the essence or 'gist' of the decision. Few gist-based decision aids exist. The objective of this study was to develop novel gist-based decision aids for prostate and breast cancer screening and evaluate their acceptability. METHODS: Men aged 40-60 years and women aged 40-49 years eligible for prostate or breast cancer screening were recruited from ResearchMatch (National Institutes of Health) and a public hospital located in New York City. Three rounds of semistructured interviews were performed to determine self-reported comprehensibility and acceptability, with iterative modifications after each phase, including: Phase 1: initial feedback; Phase 2, Round 1: evaluating our modifications; and Phase 2, Round 2: confirming final content. RESULTS: A total of 80 participants were involved in the two-phase qualitative interview process; Phase 1 and Phase 2 included 32 and 48 participants, respectively. Racial distribution was 50% white, 30% black and 10% Asian; 9% of participants were Hispanic or Latino. Most participants were highly educated. Interview themes established content validity of the final decision aids. In a quantitative analysis of the final decision aids using a questionnaire with fixed response options, acceptability was high, with two-thirds finding the length and amount of information of the decision aid to be optimal. The majority found the decision aid visually appealing, easy to read and easy to get through, and indicated that it held their interest and did not require much mental effort to read. One-quarter said the tool made them feel somewhat nervous, and three-quarters not at all. Most participants could understand and relate to the images, graphs and patient stories in the decision aid. After Phase 2, 45 of the 48 participants (94%) said they would find the decision aid helpful when making a decision. CONCLUSION: This study describes the iterative development and pilot testing of a novel gist-based decision aid for cancer screening, demonstrating high acceptability. Our findings provide a foundation for randomised trials comparing gist-based and traditional tools.
10 July 2026
Read appraisal →Psychological medicine
Extreme heat and mental health: systematic review and qualitative investigation of risk and protective factors
BACKGROUND: Extreme hot weather poses increasing risks to mental health. Yet, factors affecting vulnerability are under-researched. This mixed-method study integrates a systematic review and qualitative investigation to identify risk and protective factors for heat-related mental health issues, leading to the co-development of a screening tool. This could inform future research and, pending validation in clinical settings, support mental health professionals in assessing vulnerability among service users. METHODS: We searched PubMed and Web of Science for publications on extreme heat, mental health, and risk/protective factors. In addition, we conducted six focus groups with 21 people with lived experience of heat and/or mental illness and 12 healthcare professionals. Transcripts were analyzed using thematic content analysis and informed the co-development of the screening tool. RESULTS: Out of 764 articles identified by the systematic review, 47 were included. Evidence emerged for age, sex, existing mental illness, ethnicity, and socioeconomic status as risk factors. However, findings were inconsistent between studies, likely due to differences in study population and methodology. Protective effects included good physical health, social support, and exposure to green spaces. Our qualitative investigation identified additional risk and protective factors related to: (1) behavioral adaptability, (2) personal heat sensitivity, and (3) disparities in heat exposure. The resulting screening tool, HEAT-MH (Heat Exposure Assessment Tool for Mental Health), contains 15 questions on previous experiences of heat, general health, and lifestyle. CONCLUSIONS: The mental health impacts of extreme heat depend on a range of risk and protective factors, including demographic, socioeconomic, health, and lifestyle characteristics.
8 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 →BMJ health & care informatics
Detection of cancer recurrence from Thai-English electronic medical records using sentence embeddings.
OBJECTIVE: This study developed and validated monolingual and bilingual sentence-bidirectional encoder representations from transformers (SBERT) models for detecting cancer recurrence within Thai-English electronic medical records (EMRs) from Thai cancer hospitals. METHOD: A multicentre dataset of 32 436 documents from 1250 patients was used for model development. External validation involved an independent dataset of 9244 documents from 384 patients across two Thai cancer hospitals. Performance was benchmarked against a fine-tuned PubMedBERT (MetBERT). RESULTS: The development dataset included breast (43.9%), colorectal (12.1%), cervical (28.0%) and head and neck (16.0%) cancers. MetBERT achieved the highest area under the precision-recall curve (AUPRC) for locoregional versus no recurrence (11.1%) and locoregional versus distant recurrence (91.7%), while monolingual-SBERT excelled at distant versus no recurrence (32.0%). External validation demonstrated MetBERT superiority for locoregional versus no recurrence (9.30%-21.50%). For distant versus no recurrence, bilingual-SBERT performed best with AUPRC 17.55%-24.39%. While MetBERT led in distinguishing locoregional versus distant recurrence (88.30%-94.70%), bilingual-SBERT demonstrated robust external validation performance (AUPRC 85.25%-91.80%). DISCUSSION: Low AUPRC values (9%-32%) reflect the extreme class imbalance in real-world data (~1% recurrence prevalence). Despite this, fine-tuned MetBERT achieved highest performance, while bilingual-SBERT demonstrated superior robustness during external validation. This validates sentence embedding models for handling mixed Thai-English medical records in multilingual clinical environments. CONCLUSION: Sentence embedding frameworks provide a practical, generalisable solution for detecting cancer recurrence within multilingual EMRs. Despite text-length constraints, these models are suitable for clinical integration as a screening tool for cancer registry workflows.
4 July 2026
Read appraisal →Telemedicine journal and e-health : the official journal of the American Telemedicine Association
Implementation and Evaluation of Virtual Care in Canadian Health Care Systems: A Scoping Review
OBJECTIVE: This scoping review examined available evidence in implementation and evaluation of virtual care in Canada. Virtual care saw recent uptake due to the COVID-19 pandemic; however, to ensure quality of care, rigorous implementation and evaluation frameworks are needed. METHODS: Peer-reviewed and gray literature were searched to determine extent, range, and nature of evidence surrounding implementation and evaluation of virtual care based on the guidelines of the Joanna Briggs Institute. Although virtual care can encompass synchronous and asynchronous modalities, this review focused on synchronous virtual care, defined as real-time interactions between patients and providers via videoconferencing or telephone. Search included MEDLINE, EMBASE, Psych Info, and CINAHL databases and national and provincial health system, professional organization, and regulatory websites. Inclusion criteria included videoconferencing or telephone and English and French Canadian sources. Citations were screened by two researchers at title, abstract, and full-text levels. RESULTS: Two hundred and eight (208) manuscripts were included for analysis. High numbers of studies on patient satisfaction, process outcomes, and barriers were identified, with underrepresentation of health and systems outcomes and impact evaluations. There were very few studies examining hybrid care, planetary health, and use of virtual care with equity-deserving groups. DISCUSSION: This scoping review identified areas of importance for future research, including the use of virtual care in rural and remote regions, inpatient, long-term, and emergency settings, hybrid care, economic and planetary health impacts, and artificial intelligence. As well, enhancing standardization of implementation and evaluation guidelines will optimize quality of care and best practice.
3 July 2026
Read appraisal →European journal of pediatrics
Feasibility of image-based 3D avatar anthropometry assessment of pediatric obesity: a pilot study.
UNLABELLED: The purpose of this study is to evaluate the feasibility and validity of 3D avatar-based anthropometry for assessing anthropometric indicators of overweight and obesity in children based on artificial intelligence-derived 3D body reconstruction. This cross-sectional study included 171 children aged 8-10 years from five primary schools in southern Spain. Due to technical constraints of the reconstruction software, 75 children meeting predefined image quality and body weight requirements (≥ 30 kg) were eligible for 3D avatar analysis. Manual anthropometric measurements were obtained following International Society for the Advancement of Kinanthropometry (ISAK) standards and compared with avatar-derived circumferences. Agreement was assessed by using Wilcoxon tests, Spearman correlations, Bland-Altman analyses, and false discovery rate-adjusted comparisons. Avatar-derived circumferences were consistently greater than manual measurements, although waist-to-hip and waist-to-stature ratios demonstrated no significant differences. Avatar and manual circumferences were moderately to strongly correlated (Spearman's ρ = 0.62-0.72; adjusted p < 0.05). However, the mean absolute errors ranged from 6.21 to 7.11 cm, and Bland-Altman analysis revealed systematic overestimation with wide limits of agreement, particularly for waist and hip circumferences. Despite these discrepancies, both methods similarly discriminated between weight status categories. CONCLUSION: Image-based 3D avatar anthropometry is a feasible, noninvasive approach for population-level screening and research in pediatric settings. Although the system reliably captures relative differences and body proportions, its current accuracy is insufficient for individual-level clinical assessment. Further algorithmic refinement and validation in lighter and more diverse pediatric populations are needed before clinical implementation. WHAT IS KNOWN: • Childhood obesity remains a major public health challenge requiring accurate monitoring. • Anthropometric assessment still relies mainly on manual measurements, while AI-based 3D body modeling offers a promising non-invasive alternative. WHAT IS NEW: • Image-based 3D avatar anthropometry is feasible in school settings but is constrained by technical requirements. • Avatar measurements are correlated with manual anthropometry and preserve weight status discrimination but demonstrate systematic overestimation and limited agreement.
29 June 2026
Read appraisal →Journal of special operations medicine : a peer reviewed journal for SOF medical professionals
Prediction Factors Associated with Success in Military Special Operations Courses: A Systematic Review
BACKGROUND: We investigated factors associated with military personnel success in Special Operations courses (course pass or fail). METHODS: A systematic search was conducted across eight databases using the keywords "Special Operations" and "attrition." Sample size and profile data, course characteristics, predictive factors, follow-up, and results were extracted from the studies. We compared the means of the variables associated with success between the groups that completed and did not complete the courses. A meta-analysis was conducted for factors assessed by two or more studies, pooling standardized or weighted mean differences using fixedor random-effects models. RESULTS: A total of 23 studies were included. They were published between 1990 and 2022, included samples from 10 nations, lasted between 5 days and 12 months, and ranged from 11 to 1,138 individuals. VO2max, pull-ups, push-ups, and marching performance showed consistent positive associations with course success, while body fat percentage and sit-up performance did not. Certainty of evidence was rated as low to very low using the Grading of Recommendations Assessment, Development, and Evaluation. CONCLUSION: The factors that increased the probability of success in Special Operations courses were character strengths, recidivism in the course, anthropometric data, performance on physical assessment tests, psychological dissociation, psychosocial resources, blood markers, smoking/alcohol consumption, personality, and psychological strength. These findings support the inclusion of aerobic capacity, muscular endurance, and psychological resilience in early screening and preparatory selection processes.
29 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 →Journal of global health
Habitual physical activity and sarcopenia: a systematic review and meta-analysis of prospective cohort studies
BACKGROUND: Habitual physical activity (HPA) has been associated with a lower risk of sarcopenia by enhancing skeletal muscle protein synthesis and suppressing systemic inflammation. However, the evidence for a long-term protective association remains inconclusive. Therefore, we conducted a systematic review and meta-analysis to quantify the association between HPA and sarcopenia. METHODS: We searched PubMed, the Cochrane Library, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Web of Science, and the China National Knowledge Infrastructure for prospective cohort studies on the relationship between physical activity (PA) and sarcopenia. We selected English and Chinese-language literature published before 6 October 2025, and assessed study quality using the Newcastle-Ottawa Scale. Data were statistically synthesised by calculating pooled relative risks (RRs) and 95% confidence intervals (CIs) using a random-effects model with the generic inverse-variance method. RESULTS: This meta-analysis included nine prospective cohort studies involving 21 265 participants. High levels of HPA were associated with a significantly lower risk of sarcopenia compared to the low levels (RR = 0.55; 95% CI = 0.44-0.67). This protective association remained consistent in subgroup analyses stratified by gender and by compliance with international PA guidelines. Furthermore, moderate HPA was also associated with a reduced risk compared to low HPA levels (RR = 0.73; 95% CI = 0.50-0.96). CONCLUSIONS: Our analysis indicates that moderate to high levels of HPA are independently associated with a lower risk of sarcopenia, serving as a significant protective factor. However, given the methodological heterogeneity in PA measurement, further high-quality prospective studies are needed to clarify the optimal PA dose while accounting for potential reverse causality. REGISTRATION: PROSPERO: CRD420251162529.
28 June 2026
Read appraisal →Public health research & practice
Optimising SMS content for bowel cancer screening participation in Australia: cross-sectional national survey findings.
OBJECTIVES AND IMPORTANCE OF STUDY: This study aimed to identify short message service (SMS) reminder content perceived as most likely to prompt bowel cancer screening, examine differences across sociodemographic subgroups, and explore preferences for timing and frequency. METHODS: Australian residents (N = 1016) aged 50-74 years completed an online survey rating five SMS reminders presented in random order. Outcomes included perceived usefulness, likelihood of encouraging kit return, likelihood of irritation and clarity. Preferences for timing and frequency were also assessed. Bayesian multilevel modelling (cumulative probit) compared ratings across SMS types, with effect sizes expressed as standard deviation (s.d.) differences in perceived likelihood that each SMS would encourage kit return compared with a reminder-only message. Interactions with age, gender, socioeconomic status and screening history were explored. RESULTS: Compared with a 'reminder-only' message, SMS content that encouraged storing the kit near the toilet (s.d. 0.44), conveyed general practitioner endorsement (s.d. 0.32) and gave instructions (s.d. 0.22) was more likely to prompt kit return. Responses varied slightly by age and area-level socioeconomic status. Most participants preferred two to three SMS reminders (mean 2.89, s.d. 6.73). CONCLUSIONS: SMS reminders using behavioural prompts and clear, concise content may support improved screening participation. Tailored SMS messages that reflect public preferences may increase kit return rates, support national screening goals and reduce bowel cancer mortality.
27 June 2026
Read appraisal →JMIR formative research
Supporting Student Mental Health With the Safespace Generative AI Chatbot: Mixed Methods Feasibility Study
BACKGROUND: Generative artificial intelligence (GenAI) chatbots have the potential to provide personalized mental health support to individuals at scale. OBJECTIVE: This study evaluates the feasibility and usage patterns of the Safespace GenAI chatbot, an artificial intelligence (AI)-driven smartphone app that offers a large language model-powered interactive chatbot to support mental health. METHODS: Using a mixed methods approach, we explored baseline attitudes toward GenAI chatbots and chatbot usage patterns, conducted a qualitative content analysis of participants' experiences, and descriptively assessed patterns related to preintervention depressive symptoms. The study included an initial sample of 42 university students, 20 of whom actively used the chatbot over 2 to 4 weeks, generating 286 user-chatbot interactions. RESULTS: Preintervention surveys indicated that the majority of participants anticipated that the chatbot would be helpful (27/42, 64%) and that they trusted its privacy safeguards (39/42, 93%). Usage patterns suggested that the highest levels of interaction occurred early in the morning and late at night, when peer and professional support may be inaccessible. The qualitative analysis indicated that participants appreciated using the chatbot for reflection as a blended-care tool between their counseling sessions, while also naming technical barriers and specific design needs required to sustain engagement. In addition, our exploratory analyses descriptively showed that participants with elevated depression scores engaged in emotional disclosure during 99% (38 sessions with 8 participants) of their sessions, compared to 84% (26 sessions of 12 participants) of those with low symptoms. Due to the small sample size, future adequately powered studies are needed to inferentially examine these observed patterns. CONCLUSIONS: These findings provide initial insights into the usage and engagement dynamics of the Safespace GenAI chatbot and highlight directions for future research to optimize GenAI-driven mental health interventions.
27 June 2026
Read appraisal →Journal of medical Internet research
The Emerging Roles of AI in Self-Directed Stress Management: Systematic Review
BACKGROUND: Stress is widespread and carries substantial mental health, social, and economic burdens. Yet, access to clinician-led stress management remains constrained by service capacity, cost, and stigma. In response, artificial intelligence (AI)-enabled tools have rapidly proliferated as scalable, self-directed options. However, evidence on how these systems support stress management outside formal clinical settings remains fragmented. OBJECTIVE: This systematic review aimed to synthesize empirical evidence on how AI-enabled technologies are used for self-directed stress management. We mapped the emerging functions of these tools, the psychological frameworks informing their design, the populations and settings studied, and the outcomes reported. METHODS: We conducted a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-compliant systematic review of English-language studies published between 2000 and 2025. Six databases were searched (APA PsycINFO, PubMed, MEDLINE, Scopus, Web of Science Core Collection, ProQuest, and Google Scholar). RESULTS: Of 3008 records identified, 35 studies met the inclusion criteria. The methodological quality of included studies was critically appraised using the Mixed Methods Appraisal Tool (version 2018). Findings illustrated that AI-supported stress management can operate through 5 core functions, including psychological intervention, behavioral support, psychoeducation, companionship, and emotional support, and stress monitoring, detection, and triage. Across the reviewed studies, these functions supported self-directed stress management by helping users identify stress, regulate responses, and engage in coping outside formal clinical care. CONCLUSIONS: AI-enabled systems show preliminary promise for supporting self-directed stress management through multiple user-facing functions grounded in established psychological frameworks.
26 June 2026
Read appraisal →Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco
Efficacy of Yoga in Tobacco Cessation: A Systematic Review and Meta-Analysis
INTRODUCTION: Tobacco consumption is a global epidemic with a high relapse rate. A complementary method like yoga, recognized for addressing psychological and behavioral aspects of addiction, was evaluated in this systematic review and metaanlaysis. METHODS: The objective was to comprehensively summarize the current evidence and evaluate the efficacy of yoga in tobacco cessation. This review was registered with PROSPERO (CRD42025643806). A systematic search across four databases identified randomized controlled trials (RCTs) in English up to September 2024. Eligible studies included adults (≥18 years) using any form of tobacco excluding vaping, randomized to yoga as monotherapy or adjunct therapy. The primary outcome was 7-day point prevalence abstinence (7PPA), while the secondary outcomes included quality of life, depression, anxiety, and mood states. Two reviewers independently extracted data and assessed quality using the Cochrane Risk of Bias (RoB2) tool. A meta-analysis was conducted for outcomes assessed in at least two studies. RESULTS: Seven RCTs were included, with five suitable for meta-analysis. The pooled odds ratio for 7PPA at the end of treatment was 1.50 (95% confidence interval = 0.60 to 3.73), suggesting a positive but inconsistent effect. Considerable heterogeneity was observed (I2 = 65%, p = .07; τ2 = 0.7127), indicating substantial variability across studies. Heterogeneity (I2 = 65%) markedly reduced to 16% when high-risk trials were excluded in sensitivity analysis. Studies reported improvements in depression, anxiety, and quality of life. CONCLUSION: This review consolidates the best available evidence on the effects of yoga interventions for tobacco cessation, showcasing the promising potential of yoga in smoking cessation. IMPLICATIONS: Active yoga styles like hatha, vinyasa, and Iyengar improved 7PPA by reducing stress and depression, while pranayama reduced cravings and negative affect. Future research should explore yoga-based cessation programs in diverse settings, especially low- and middle-income countries, to address unique challenges. Standardizing methodologies across populations will enable a more comprehensive evaluation of yoga's role in tobacco cessation and its potential to enhance global public health outcomes.
25 June 2026
Read appraisal →Reviews on environmental health
Air quality and public health co-benefits of national transport policies
INTRODUCTION: Transport is a major contributor to urban air pollution and premature mortality worldwide. This systematic review evaluates the air-quality and public health co-benefits of national and regional transport policies aimed at reducing population exposure to air pollution. CONTENT: Following PRISMA 2020 guidelines, this review synthesized evidence published between 2011 and 2024 on the health and environmental impacts of national or regional transport policies. Ten eligible studies were reviewed, covering diesel vehicle phase-outs, inspection and maintenance programs, electric vehicle incentives, fuel taxation, and promotion of public or active transport. SUMMARY: Across multiple settings, these policies were associated with reductions in PM2.5 concentrations and with avoided premature mortality, respiratory and cardiovascular hospitalizations, and healthcare costs. The largest and most consistent health benefits were observed for integrated policy packages, particularly those combining regulatory and technological measures such as fuel quality improvements, vehicle electrification and diesel phase-out, complemented by behavioral or fiscal instruments. Most available evidence originates from high-income countries, while studies from low- and middle-income regions remain scarce. The limited number of eligible studies and their concentration in specific regions and modeling approaches constrain generalizability, especially to settings with different transport systems, resource availability, and air-quality profiles. OUTLOOK: Embedding health-impact assessment within transport planning and expanding long-term evaluations in low- and middle-income countries are essential to ensure equitable and sustained air-quality and health improvements. Future policy frameworks should prioritize source-oriented regulatory and technological measures such as vehicle electrification, fuel-quality regulation, and diesel phase-out implemented within integrated policy packages to maximize public-health co-benefits.
25 June 2026
Read appraisal →BMJ global health
Lifestyle interventions for dementia prevention in low- and middle-income countries: a systematic review.
INTRODUCTION: By 2050, two-thirds of people with dementia will live in low-and-middle-income countries (LMICs). However, multimodal prevention lifestyle interventions for people at risk are being developed predominantly in higher-income countries. METHODS: We systematically reviewed randomised controlled trials (RCTs) evaluating non-pharmacological interventions in individuals with mild cognitive impairment and subjective cognitive decline in LMICs. We assessed quality using the Mixed Methods Assessment Tool, meta-analysed and synthesised evidence. RESULTS: We included 25 RCTs from six countries (most in China, n=17), involving 1304 participants. In the 15 studies with sufficient data to meta-analyse, we found significant positive effects on cognition favouring interventions (1.49 (standardised mean difference, 95% CI 1.06 to 1.93)). There was significant publication bias. We classified interventions into exercise, multidomain and arts/creative expression. Exercise (1.67, 95% CI 1.24 to 2.11, n=8) and multidomain (1.22, 95% CI 0.22 to 2.21, n=5) had replicated evidence of effectiveness. There was insufficient data to meta-analyse the arts/creative category. CONCLUSION: We propose greater consideration and investment in the development of interventions accounting for specific LMIC contexts from the outset, so they are acceptable and used by local services. PROSPERO REGISTRATION NUMBER: CRD42023403908.
24 June 2026
Read appraisal →Journal of medical Internet research
Solidarity or Segregation? ChatGPT Health and US Health Care Disparities.
ChatGPT Health, an artificial intelligence feature launched by OpenAI in January 2026, integrates personal medical records and consumer health data into a large language model-based chatbot. It positions itself as a digital health tool to help users navigate a fragmented US health care system marked by inaccessible insurance, medical deserts, and workforce shortages. We argue that, rather than closing these gaps, ChatGPT Health risks widening what we call the solidarity gap in health care. By appearing to address unmet needs, it may obscure and entrench the structural conditions that produce health care disparities. We identify specific risks to patient safety, such as the legitimization of dangerous self-rationing and self-medication behaviors, inaccurate triage of clinical emergencies, erosion of effective health communication, and the reinforcement of confirmation and anchoring bias. These risks are particularly acute for individuals facing structural barriers to care. To prevent ChatGPT Health and similar large language model-based health tools from deepening inequities, we propose solidarity-based policy interventions such as upstream reforms that rebuild the institutional foundations of access and health equity and downstream safeguards that embed artificial intelligence tools within accountable, equitable health care infrastructures as complements to rather than substitutes for human care.
24 June 2026
Read appraisal →PloS one
Identifying policy-relevant traffic crash risk factors in Cheongju, South Korea using logistic regression and explainable machine learning
Rapid urbanization and increasing traffic volumes have made the occurrence of traffic crashes and the resulting harm a major public safety concern. This study analyzes traffic crash data from Cheongju, a mid-sized city in Chungcheongbuk-do, to identify key determinants of crash severity and provide evidence-based policy recommendations. Our approach is novel in that it integrates statistical modeling and machine learning methodologies; this dual approach not only overcomes the limitations inherent in using either technique alone but also allows for the identification of consistent risk factors influencing traffic crash severity that may have gone unrecognized otherwise. Marginal effects of explanatory variables were interpreted using ordinal logistic regression, while feature importance in machine learning models-including Support Vector Machine, Random Forest, XGBoost, and LightGBM-was evaluated using SHAP (SHapley Additive exPlanations) values. Both analytical approaches consistently identified traffic signal violations, failure to comply with safe driving obligations, and the absence of a median barrier on undivided roads as significant predictors of crash severity. By leveraging empirical data specific to Cheongju, our research provides regionally tailored insights that distinguish our work from prior studies with broader or less localized focus. These findings highlight the need for stricter enforcement of traffic regulations and structural improvements in roadway infrastructure and can inform policymakers in formulating effective, context-specific measures to enhance road safety.
24 June 2026
Read appraisal →Vaccine
Impact of standing orders on vaccine uptake: A systematic review.
OBJECTIVE: We sought to evaluate the impact of standing orders on vaccine coverage in clinical settings. METHODS: Two reviewers independently screened and included studies that evaluated use of standing orders either alone or in combination with other interventions and collected data on vaccine coverage. We extracted effect sizes for studies that used only standing orders as an intervention and had a comparison group. RESULTS: The search yielded 56 eligible studies, 22 of which evaluated standing orders-only interventions. Standing orders increased vaccine uptake by a median of 13 percentage points (IQR 2-20 percentage points). Eight of these studies had a comparison group including 1 randomized trial; 5 were at low risk of bias. The overall findings were similar those for seasonal influenza vaccine (median increase of 12 percentage points; IQR, 6-24; 7 studies) and pneumococcal vaccines (14 percentage points; 2-20; 5 studies), the two most studied outcomes. Multi-component studies paired standing orders with interventions for providers frequently (34%-63% of studies), patients often (20%-49%), and systems least often (3%-14%). CONCLUSIONS: Standing orders show one of the largest effects among vaccine uptake interventions. Future research should focus on randomized trials, childhood vaccination, and behavioral aspects of implementation in healthcare systems.
21 June 2026
Read appraisal →Current psychiatry reports
Digital Tools to Support Mental Health in Later Life: Scoping Review of Systematic Reviews
PURPOSE OF REVIEW: This scoping review synthesises existing evidence from systematic reviews on the effectiveness and implementation of digital mental health interventions among community-dwelling older adults. RECENT FINDINGS: Twenty-one systematic reviews were included. Results showed that a range of digital tools demonstrate potential to improve common mental health and psychosocial symptoms among older adults, with most evidence concentrating on digital tools to improve depressive symptoms. However, reviews' findings were frequently mixed and accompanied with cautions that primary evidence under-reported key elements such as theoretical underpinnings, intervention design process, participant demographics, intervention acceptability and usability, participant retention, adverse events, and long-term outcomes. More rigorous research and reporting are needed to understand the mechanisms underpinning effective digital mental health interventions for older adults and how they might mitigate the age-related digital divide in mental health services.
19 June 2026
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