Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 10 appraisals
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 →PloS one
Effects of a school-based ACT program on motivation, physical activity participation, motor competence, and physical performance in physically inactive female adolescent students
Adolescents face internal barriers like low self-confidence and psychological discomfort that limit physical activity. Adolescence offers a key window to enhance intrinsic motivation. Acceptance and Commitment Therapy (ACT) may effectively improve physical activity and motor competence through psychological flexibility and value-based behavior. This study examined the effects of an ACT-based intervention on physical activity participation, motivation, motor competence, and physical fitness in physically inactive adolescent girls. A randomized controlled trial involved 132 inactive girls aged 13-18, randomly assigned to either an ACT intervention or a control group. Intervention included seven sessions targeting six core ACT processes. Pre-and post-intervention assessments used standardized questionnaires and tests for physical activity participation, motivation, physical activity, motor competence, and fitness. ACT group showed significant improvements in intrinsic motivation, identified regulation, autonomy, and reduced amotivation and external regulation (p ≤ 0.05). Introjected regulation did not show a significant change (p > 0.05). Physical activity participation and fitness performance also improved significantly, along with both perceived and actual motor competence (p ≤ 0.05). ACT-based intervention effectively enhanced motivation, physical activity engagement, motor competence, and fitness. These findings support integrating ACT into school or community programs to promote sustainable physical activity habits in adolescent girls.
13 June 2026
Read appraisal →PloS one
A systematic review and meta-analysis on achievement emotions, working memory and student-teacher relationship during second language learning in primary school
Learning is a multidimensional process resulting from the interaction between cognitive and emotional factors within the learning context; in this respect the quality of the student-teacher relationship plays a significant role. Although the literature suggests that cognitive processes and emotions experienced during learning and task performing play a central role in academic achievement, it remains unclear how these factors interact with socio-affective factors in explaining academic performance, particularly in second language (L2) learning from primary school. This systematic review and meta-analysis focused on the studies that jointly or individually investigated the role of emotional factors (achievement emotions), socio-affective factors (student-teacher relationship) and cognitive factors (working memory) in L2 learning during primary school. Our sample contained 19 primary studies with 5,340 participants involved in at least one of the factors of our interest. 16 out of 19 studies were included in the meta-analysis. Our results showed a positive correlation between working memory and L2 learning, differentiated effects of achievement emotions, with a significant negative association with anxiety, and a small but positive association with enjoyment. The student-teacher relationship was supported only by qualitative evidence, however, showing a protective effect of emotional closeness to the teacher in the learning process in the presence of negative emotions such as anxiety. Findings support the importance of integrating cognitive, emotional, and relational factors to understand L2 learning in primary school. Further empirical research focusing on positive emotions and relational dynamics in different educational contexts is needed.
28 May 2026
Read appraisal →Medicine
Effect of a sports-medicine-guided football program on physical fitness in adolescents: A controlled school-based trial
Integrating artificial intelligence (AI) with sports medicine principles into school-based physical education may enhance physical fitness and reduce injury risk among adolescents. This study aimed to evaluate whether a 10-week sports-medicine-guided football curriculum augmented with explainable machine-learning feedback produces greater improvements in physical fitness and injury-prevention outcomes than a standard physical-education curriculum. A total of 195 healthy junior high school students (mean age 14.1 ± 0.7 years) participated in a controlled school-based intervention and were allocated to either an AI-supported sports-medicine curriculum (intervention) or a standard curriculum (control). Physical fitness outcomes, including lung capacity, estimated maximal oxygen uptake (VO2max), sprint performance, standing long jump, and middle-distance running performance (800 m girls/1000 m boys), were assessed before and after the 10-week program. Outcomes were analyzed using 2-way mixed analysis of variance to test Group × Time interactions. Injury risk prediction was supported by an explainable machine-learning ensemble model (CatBoost + Gradient Boosting) interpreted using SHAPley Additive explanations. Significant Group × Time interactions were observed for lung capacity (P < .01) and VO2max (P < .01), indicating greater improvements in the intervention group compared with controls. The intervention group also demonstrated superior improvements in sprint performance, middle-distance running, and lower-limb power (P < .05), while no significant between-group differences were observed for upper-body strength (P > .05). A school-based football curriculum integrating sports-medicine principles with explainable AI-driven feedback leads to significantly greater improvements in key physical-fitness outcomes than a standard physical-education curriculum. This approach directly supports individualized training adaptation and injury-risk awareness, offering a scalable model for enhancing adolescent health and safety in school physical education.
25 May 2026
Read appraisal →Journal of affective disorders
Intolerance of uncertainty and depression in children and adolescents: Systematic review and meta-analysis
BACKGROUND: Intolerance of uncertainty (IU) is a development and maintenance factor for depression and anxiety. Previous reviews found that it associated with anxiety in children and adolescents. However, there was insufficient evidence at the time to review its association with depression in this population. METHOD: 20 studies investigating the relationship between IU and depression in children and adolescents were identified. Random effects meta-analysis was used to aggregate cross-sectional associations, with age, gender, and measure as moderators. A narrative review of longitudinal findings from relevant studies (K = 6) was also conducted. RESULTS: Meta-analysis of cross-sectional associations found an overall effect size of r = 0.47. There was limited evidence that age or gender moderated the effect, however there was a significant moderating effect of measure. Namely, when including studies using 'child-friendly' measures (i.e., developed and normed with children as opposed to adults), the effect size was r = 0.37. Another analysis revealed that the inhibitory IU subscale was more strongly associated with depression than prospective IU. Longitudinal findings suggested that the association between IU and depression persists over time. LIMITATIONS: Studies were limited to those published in English and including general population samples (e.g., typically developing, without significant medical needs). CONCLUSIONS: There is a medium-strong association between IU and depression symptoms in children and adolescents. However, it may be overestimated by the use of IU measures that are not child-friendly. Future research can further extend the evidence-base through careful measure selection, as well as longitudinal and experimental designs.
17 May 2026
Read appraisal →Current psychiatry reports
The Type of Providers Delivering Practice Elements Used in Child Mass Trauma Interventions: A Systematic Review
PURPOSE OF REVIEW: This review identified the relative frequency of use of various types of providers delivering practice elements in 130 child mass trauma interventions and compared the use of these providers across events, populations, and settings. RECENT FINDINGS: Mental health professionals (MHPs) more frequently delivered cognitive, self-monitoring, exposure, and narrative elements than other providers while non-specialist providers (NSPs) and teachers and school personnel (TSPs) delivered support networking and social skills training more frequently. MHPs administered interventions to targeted populations more frequently, and TSPs administered interventions to universal populations more frequently. Only MHPs administered interventions at clinical facilities; NSPs delivered a majority of interventions at community sites. Understanding the specific practice elements delivered by providers with different backgrounds and training can inform efforts to enhance the reach and impact of mass trauma services. Future publications should report greater detail about providers and their training and about specific practice elements used.
14 May 2026
Read appraisal →European journal of pediatrics
The effect of motivational interviewing on internet addiction and digital game addiction in adolescents: a randomized controlled trial
UNLABELLED: The purpose of this study was to measure the effect of motivational interviewing on both reducing internet addiction and digital game addiction in adolescents. A parallel-group randomised controlled trial was adopted. The study population consisted of ninth-grade (14-15 years of age) high school students in a city in Turkiye. The study was completed by 88 participants (experimental: 44; control: 44). The data were collected using a Personal Information Form, the Young Internet Addiction Test, and the Digital Game Addiction Scale. The experimental group received a preparatory session and five weekly motivational interviewing sessions. Instruments were administered to both groups before (pre-test) and after the intervention (post-test), and at follow-up tests 3 and 6 months after the final session. The data were analysed using the two-way mixed design and the Bonferroni Comparison Test. The mean scores of internet addiction and digital game addiction decreased significantly after the motivational interviewing in the experimental group compared to the control group (p < 0.001) in both the post-test and follow-up tests. CONCLUSION: The present study concluded that motivational interviewing may be associated with reductions in mitigating symptoms of internet addiction and digital game addiction behaviours among adolescents. Motivational interviewing could be implemented to reduce internet addiction and digital game addiction behaviours. Trial registration: The study was registered on a clinical trial database (NCT06721702). The study started on December 11, 2023 (actual date on which the first participant was enrolled). WHAT IS KNOWN: • Internet addiction and digital game addiction are two increasingly important problems among adolescents. • Digital games and online activities negatively affect adolescents' physical, social, and psychological health. WHAT IS NEW: • Motivational interviewing was an effective technique to reduce online gaming and internet addiction. • A motivational interviewing program comprising at least six sessions could be implemented to promote behavioural change in adolescents.
10 May 2026
Read appraisal →JMIR formative research
Designing Psychologically Grounded Artificial Intelligence for Supporting Bystander-Based Cyberaggression Intervention: Mixed Methods Exploratory Study
BACKGROUND: Cyberaggression poses a growing threat to mental health, contributing to increased distress, reduced self-esteem, and other adverse psychosocial outcomes. Although bystander intervention can mitigate the escalation and impact of cyberaggression, individuals often lack the confidence, strategies, or language to respond effectively in these high-stakes online interactions. Advances in generative artificial intelligence (AI) present a novel opportunity to facilitate digital behavior change by assisting bystanders with contextually appropriate, theory-informed intervention messages that promote safer online environments and support mental well-being. OBJECTIVE: This mixed methods design study aimed to explore the feasibility of using generative AI to support bystander intervention in cyberaggression on social media. Specifically, we examined whether AI can generate effective responses aligned with established intervention strategies and how these responses are perceived in terms of their potential to de-escalate online harm and foster behavior change. METHODS: We collected 1000 real-world cyberaggression examples from public social media datasets and generated bystander intervention responses using 3 distinct prompt strategies: a generic policy reminder, a baseline GPT prompt, and a theory-driven GPT prompt (AllyGPT). To evaluate the responses, we conducted computational linguistic analyses to assess their psycholinguistic features and carried out a mixed methods evaluation. Three trained coders rated each message on favorability, conversational impact, and potential to change behavior and later participated in semistructured interviews to reflect on their evaluation process and perceptions of intervention effectiveness. RESULTS: Linguistic analyses revealed that baseline GPT responses exhibited more emotionally positive and authentic language compared to AllyGPT responses, which showed a more analytical and assertive tone. Policy reminder messages were linguistically rigid and lacked emotional nuance. Human evaluation results showed that AllyGPT responses received the highest effectiveness ratings for low-incivil cyberaggression cases in 2 dimensions (favorability and changing behavior), and baseline GPT works better for mid and high levels for all effectiveness dimensions. For medium- and high-incivility aggressions, baseline GPT responses received the highest ratings across all 3 dimensions of effectiveness (favorability, discussion-shifting potential, and likelihood of changing bullying behavior), followed by AllyGPT, with policy reminders rated lowest. Qualitative feedback further emphasized that baseline GPT responses were perceived as natural and inclusive, while AllyGPT responses, although grounded in psychological theory, were sometimes viewed as overly direct. Policy reminders were considered clear but lacked persuasive impact. CONCLUSIONS: Our work showed that designing effective AI-generated bystander interventions requires a deep sensitivity to platform culture, social context, and user expectations. By combining psychological theory with adaptive, conversational design and ongoing feedback loops, future systems can better support bystanders, delivering interventions that are not only contextually appropriate but also socially resonant and behaviorally impactful. As such, this work serves as a foundation for scalable, human-centered AI systems that promote safer online spaces and users' mental well-being.
16 Apr 2026
Read appraisal →PloS one
Identifying minimal risk factors for adolescent suicidal ideation and suicide attempts: A machine learning-optimized approach.
This study aimed to develop and validate a machine learning (ML) model to identify the minimal risk factors for adolescent suicidal behaviors, including suicidal ideation and suicide attempts. Data from the Korea Youth Risk Behavior Web-based Survey (2022-2023), including 90,813 adolescents aged 12-18 years, were analyzed. Using multidimensional risk factors spanning sociodemographic, physical and mental health, and behavioral domains, we applied a Random Forest model combined with recursive feature elimination to identify a minimal subset of risk factors (optimal features). Model performance for identifying suicidal ideation and predicting suicide attempts was evaluated via area under the curve (AUC), sensitivity, specificity, and accuracy metrics across the validation datasets. Sadness, loneliness, anxiety, and stress were identified as optimal features, achieving a high AUC, sensitivity, specificity, and accuracy in identifying suicidal ideation and predicting suicide attempts. Additional factors further improved the ML model's predictive performance for suicide attempts, achieving an AUC of 97.28%, sensitivity of 93.49%, specificity of 90.21%, accuracy of 91.85%, a PPV of 90.52%, and an NPV of 93.26%. This study demonstrated the efficacy of ML-driven approaches in identifying critical risk factors for adolescent suicidal behaviors. The findings highlight the potential of ML frameworks to transform suicide prevention strategies and improve mental health outcomes in adolescents.
7 Apr 2026
Read appraisal →Journal of global health
Exposure-response association between outdoor activity time and myopia risk in Chinese children and adolescents: a systematic review and meta-analysis
BACKGROUND: The prevalence of myopia among Chinese children and adolescents has increased sharply over recent decades, raising concern about modifiable environmental risk factors. Although outdoor activity is widely recognised as protective, the quantitative exposure-response relationship within the Chinese educational context remains incompletely defined. METHODS: A systematic review and meta-analysis were conducted following PRISMA guidelines. Studies examining the association between daily outdoor activity time and myopia risk among Chinese youth were identified from major English and Chinese databases (Web of Science, PubMed, CNKI, and Wanfang) through October 2025. Random-effects meta-analysis was conducted to pool odds ratios (ORs). Prespecified subgroup and sensitivity analyses examined exposure thresholds, study design, and geographic latitude. RESULTS: We included 31 studies comprising 380 215 participants. Greater outdoor activity was consistently associated with lower myopia risk (pooled OR = 0.75; 95% confidence interval (CI) = 0.71-0.80), although substantial heterogeneity was observed (I2 = 94%). Compared with <1 hour per day, outdoor exposure of 1-2 hours (OR = 0.85; 95% CI = 0.79-0.92), 2-3 hours (OR = 0.86; 95% CI = 0.78-0.95), and > 3 hours (OR = 0.74; 95% CI = 0.63-0.87) was associated with reduced risk. When dichotomised at two hours, exposure >2 hours yielded an OR of 0.74 (95% CI = 0.69-0.80). Findings were directionally consistent across study designs and latitude strata. CONCLUSIONS: Greater outdoor activity time is associated with lower myopia risk among Chinese children and adolescents. An approximate daily exposure of around two hours appears to represent a pragmatic benchmark under current educational conditions.
4 Apr 2026
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