Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 9 appraisals
Sexual health
Digital versus clinic-based sexual health services: patterns of use and equity implications from a UK-based evaluation
BACKGROUND: Digital sexual health services have expanded rapidly in England; yet, concerns remain regarding equitable access among different population groups. We compared demographic characteristics and outcomes between online and clinic-based sexual health service users in Leicester, Leicestershire, and Rutland. METHODS: A retrospective analysis of data (April 2019-June 2023) compared online contacts, via SH:24, a UK online sexual health service providing postal sexually transmitted infection (STI) testing and remote contraception, with in-clinic attendances. Demographic variables included age, gender, ethnicity and Index of Multiple Deprivation (IMD 2019) decile, where Deciles 1-2 represent the most deprived areas. Ethnicity was recoded into Office for National Statistics categories. Reasons for attendance, contraception methods, and STI test outcomes were analysed. Risk ratios with 95% confidence intervals compared proportions between modalities. RESULTS: Online users were younger than clinic attendees (mean age, 25.1 vs 31.4 years). A slightly higher proportion of women accessed online services although gender was unrecorded in 59.1% of online attendances. White and mixed ethnicity groups were more likely to use online services than Black, Asian and 'Other' ethnic groups. Individuals living in the most deprived areas were less likely to access online services. STI testing was more frequent online (56.8% vs 43.3%), while positivity rates for infections were lower. CONCLUSIONS: Complementary to clinic-based sexual health services, online pathways provide accessible STI testing and contraception. Differences in uptake by age, ethnicity and deprivation highlight the importance of monitoring equitable access as digital provision expands. Maintaining both online and face-to-face provision is likely to remain important for equitable sexual health care.
16 June 2026
Read appraisal →African journal of reproductive health
How school-community cultural norms shape young people's reproductive health behaviors: Evidence from educational and behavioral research in China
This study systematically examines how school-community cultural norms shape young people's reproductive health behaviors in China. Using the PRISMA 2020 framework, a systematic review of empirical studies published between 2010 and 2022 was conducted to synthesize evidence from educational and behavioral research. Multiple international and Chinese databases were searched to identify qualitative, quantitative, and mixed-methods studies examining the influence of cultural norms within school and community settings on youth reproductive health knowledge, attitudes, and behaviors. Thematic synthesis, guided by the Social Ecological Model, was employed to integrate findings across studies. The review reveals that school-community cultural norms-particularly norms of silence, stigma, and gendered expectations-play a critical role in shaping reproductive health behaviors and in moderating the effectiveness of school-based interventions. Schools function both as reinforcers of prevailing community norms and as potential agents of change when culturally sensitive education is implemented. The findings underscore the need for context-specific, community-engaged reproductive health interventions tailored to the Chinese socio-cultural environment. Cette étude explore la relation complexe entre les normes culturelles et les comportements en matière de santé reproductive chez les jeunes en Chine, en se concentrant sur l'impact des environnements culturels école-communauté dans la formation de ces comportements. Elle examine comment les valeurs traditionnelles et les attentes sociales influencent les attitudes, les décisions et les actions des jeunes liées à la santé reproductive. En utilisant une approche de recherche qualitative, l'étude s'appuie sur des données secondaires à travers une revue approfondie de la littérature existante et de recherches antérieures, employant l'analyse de contenu pour extraire des insights détaillés. Les résultats soulignent que les normes culturelles école-communauté façonnent significativement les comportements en matière de santé reproductive, imposant souvent des effets restrictifs, les valeurs traditionnelles influençant profondément les décisions et les résultats de santé. L'étude met en lumière le besoin urgent d'interventions culturellement sensibles et spécifiques au contexte, conçues pour les jeunes Chinois. Elle souligne que les solutions efficaces doivent considérer l'interaction nuancée entre les normes culturelles, les contextes éducatifs et les pratiques de santé. En définitive, la recherche appelle à des programmes sur mesure capables de traiter ces complexités afin d'améliorer le soutien et les résultats en santé reproductive pour les jeunes en Chine.
31 May 2026
Read appraisal →African journal of reproductive health
The role of information technology in promoting sexual and reproductive health awareness among young people in Lahore: A comparative study with Shanghai.
Information technology (IT) has transformed access to health information, yet its impact on sexual and reproductive health (SRH) awareness varies across contexts. This study investigates IT's influence on youth SRH awareness in Lahore, Pakistan, using primary data, and provides a comparative analysis with secondary data from Shanghai, China. Using a cross-sectional design in Lahore (n=250), structured questionnaires, PLS-SEM, logistic regression, and ANOVA assessed relationships between IT use, digital health literacy, trust in digital sources, cultural barriers, and awareness outcomes. Results indicate IT use (β=0.42), digital health literacy (β=0.38), and trust (β=0.26) significantly enhance awareness in Lahore, while cultural barriers exert a strong negative influence (β=-0.31). Significant mean differences (p<0.001) were found between cities. Shanghai demonstrated higher digital literacy, trust, awareness, and use of structured platforms, while Lahore exhibited substantially higher cultural barriers. Model comparisons showed stronger predictive pathways in Shanghai (R²=0.74) than Lahore (R²=0.68), reflecting advantages of institutionalized sex education and government-certified digital health applications. Overall, while IT holds considerable potential, its effectiveness is shaped by cultural norms, digital infrastructure, and institutional trust. The findings underscore Pakistan's need to develop culturally appropriate, reliable, and institutionally supported digital health platforms to improve youth access to accurate SRH information. La technologie de l'information (TI) a transformé l'accès à l'information sanitaire, mais son impact sur la sensibilisation à la santé sexuelle et reproductive (SSR) varie selon les contextes. Cette étude examine l'influence des TI sur la sensibilisation des jeunes à la SSR à Lahore, au Pakistan, avec une analyse comparative de Shanghai, en Chine. En utilisant un design transversal à Lahore (n=250), des questionnaires structurés, la PLS-SEM, la régression logistique et l'ANOVA ont évalué les relations entre l'utilisation des TI, la littératie numérique en santé, la confiance dans les sources numériques, les barrières culturelles et les résultats de sensibilisation. Les résultats indiquent que l'utilisation des TI (β=0,42), la littératie numérique en santé (β=0,38) et la confiance (β=0,26) améliorent significativement la sensibilisation à Lahore, tandis que les barrières culturelles exercent une forte influence négative (β=-0,31). Des différences moyennes significatives (p<0,001) ont été constatées entre les villes. Shanghai a démontré une littératie numérique, une confiance, une sensibilisation et une utilisation de plateformes structurées plus élevées, tandis que Lahore présentait des barrières culturelles substantiellement plus fortes. Les comparaisons de modèles ont montré des voies prédictives plus solides à Shanghai (R²=0,74) qu'à Lahore (R²=0,68), reflétant les avantages de l'éducation sexuelle institutionnalisée et des applications de santé numériques certifiées par le gouvernement. Globalement, bien que les TI aient un potentiel considérable, leur efficacité est façonnée par les normes culturelles, l'infrastructure numérique et la confiance institutionnelle. Les conclusions soulignent la nécessité pour le Pakistan de développer des plateformes de santé numériques culturellement adaptées, fiables et soutenues institutionnellement pour améliorer l'accès des jeunes à des informations précises sur la SSR.
31 May 2026
Read appraisal →Sexually transmitted infections
Complex role of digital health literacy in awareness and use of digital sexually transmitted and blood-borne infections testing: a structural equation modelling analysis of the 2022 GetCheckedOnline survey
BACKGROUND: Although digital health literacy (DHL) is recognised as a determinant of access to digital sexually transmitted and blood-borne infection (STBBI) testing, empirical evidence about its contribution to access disparities remains limited. We applied multidimensional DHL measures to examine inequities in awareness and use of GetCheckedOnline, British Columbia's (BC) publicly funded digital STBBI testing service. METHODS: We analysed data from GetCheckedOnline's 2022 community survey of English-speaking BC residents aged ≥16 years who were sexually active in the past year. Outcomes were awareness and use of GetCheckedOnline (yes/no). DHL was measured using latent factors from the eHealth Literacy Scale: Information Navigation, Resource Appraisal and Confidence in Use. Structural equation modelling (SEM) was used to estimate associations and mediation pathways between DHL, sociodemographic characteristics and service outcomes. Model fit was assessed using standard SEM indices. RESULTS: Among 1657 respondents (mean age 33 years, SD 11.77), Information Navigation was positively associated with awareness (β=0.162, p<0.001) and use (β=0.063, p=0.020) of GetCheckedOnline. Confidence in Use was positively associated with awareness (β=0.206, p=0.014) and use (β=0.115, p=0.020). In contrast, Resource Appraisal was negatively associated with awareness (β=-0.263, p=0.006) and use (β=-0.150, p=0.010). DHL factors mediated the effects of age, income, education and digital access on both outcomes. CONCLUSIONS: DHL operates as a multidimensional and socially patterned determinant of access to digital STBBI testing services. While information navigation and confidence in use facilitate access, higher resource appraisal may reduce use, potentially reflecting concerns about service fit, privacy or trust. Findings highlight the need for digital interventions that are not only accessible but also contextually relevant, trusted and responsive to the needs of diverse users.
20 May 2026
Read appraisal →Emerging microbes & infections
Optimizing machine learning-based diagnosis of neurosyphilis in HIV-negative patients: a multicenter, real-world comparison of international diagnostic criteria
Neurosyphilis continues to rise globally, yet diagnosis remains challenging, often requiring multidisciplinary expertise and multiple CSF assays that are difficult to access in resource-limited settings. We developed and compared machine-learning (ML) models tailored to six international diagnostic guidelines and built a free, web-based tool for guideline-adapted decision support. We assembled 1,648 suspected neurosyphilis cases from four centers, using Guangzhou as the training cohort and Beijing, Xiamen (China) and Seattle (USA) as external validation cohorts. Five algorithms (Random Forest, AdaBoost, SVC, NuSVC, XGBoost) were trained with randomized search and three-fold cross-validation; performance was assessed by AUC, PRAUC, calibration, decision-curve net benefit, Brier score, and SHAP for model explainability. Across models and guidelines, neurological symptoms, CSF protein, and CSF white blood cell count consistently ranked as the strongest predictors. All models achieved excellent discrimination (AUC and PRAUC >0.90) with good calibration, reliability, and positive clinical utility, though performance varied modestly by guideline. These findings indicate that the optimal ML approach depends on the diagnostic definition applied. Our freely available online tool operationalizes these models to provide clinicians worldwide with context-adapted support aligned to local criteria.
18 Apr 2026
Read appraisal →BMJ open
Trends and characteristics of syphilis incidence in Japan: a nationwide claims-based analysis of working-age populations and their dependents, 2016-2023
OBJECTIVES: To examine trends and demographic characteristics of syphilis incidence in Japan using a large nationwide claims database with family linkage, with particular focus on differences by sex, age, HIV status and family relationships. DESIGN: Retrospective cohort study. SETTING: JMDC claims database (JMDC Inc, Tokyo, Japan), a nationwide administrative claims database in Japan, using data from 2016 to 2023. PARTICIPANTS: Individuals aged 16-59 years enrolled in the JMDC database, including employees of medium-to-large companies and their dependents (n=12.5 million). OUTCOME MEASURES: Syphilis cases were defined by International Classification of Diseases, 10th Revision (ICD-10) codes (A50-A53) with concurrent treatment with relevant antibiotics. We determined syphilis incidence rates per 100 000 person-years, stratified by sex, age, HIV status and family relationships. We also investigated within-couple concordance patterns and reinfection rates. RESULTS: Among 16.4 million individuals, 9357 syphilis infections were identified among 8881 individuals. Incidence increased markedly during the pandemic, reaching 48.2 (men) and 12.9 (women) per 100 000 person-years in 2023. Men showed consistently high incidence in their 20s-50s, whereas female incidence peaked in the 10s-20s. Among 2 294 184 married couples, dependent women (ie, housewives) showed comparably high incidence to age-matched men (10-20 per 100 000 person-years). In 1286 couples with at least one syphilis case, 12.4% of wives in their 20s were also diagnosed, compared with 2%-3% in older groups. In 20s couples, the proportion of syphilis among wives only and husbands only was similar. Subgroup analysis revealed notably high incidence among unmarried female dependent youths (2022: 66.7 per 100 000 person-years). Individuals living with HIV had substantially elevated incidence (3000-15 000 per 100 000 person-years) and reinfection rates. CONCLUSIONS: Using a large claims database with family linkage, we found that while male syphilis incidence remained dominant, high rates were also observed among dependent women and youths. These findings suggest that syphilis risk may extend beyond traditionally recognised high-risk populations and emphasise the need for targeted screening and preventive strategies in broader demographic groups.
17 Apr 2026
Read appraisal →Cell host & microbe
VIBRANT: A phase 1 randomized trial of multi-strain vaginal L. crispatus live biotherapeutic products in people with bacterial vaginosis
Bacterial vaginosis (BV) is characterized by high microbial diversity. High recurrence rates following antibiotics may stem from poor recolonization by protective Lactobacillus species. This phase 1 randomized trial in the United States and South Africa evaluated two vaginally delivered live biotherapeutic products (LBPs) containing multiple Lactobacillus crispatus strains. After metronidazole treatment for BV, participants received either a placebo or 3 or 7 days of active LBPs. LBP strains were detected by metagenomics in 66.1% (47/71) of participants in the active arms in the first 5 weeks. Among those, nearly half (49%, 23/47) remained colonized at 12 weeks despite the short initial treatment course. Participants were most often colonized by one of three component strains, with no geographic differences in strain colonization observed. LBPs were safe, acceptable, and well tolerated, with no serious adverse events (AEs) reported. These results provide a foundation for the development of transformational interventions aimed at optimizing the vaginal microbiome.
11 Apr 2026
Read appraisal →Cell host & microbe
Vaginal microbiota impacts of a Lactobacillus crispatus live biotherapeutic and predictors of colonization in randomized controlled trial
Bacterial vaginosis (BV) affects >25% of women worldwide and often recurs after standard-of-care metronidazole (MTZ) treatment. LACTIN-V, a live biotherapeutic product (LBP) containing Lactobacillus crispatus strain CTV-05, significantly reduced recurrent BV in a phase 2b clinical trial, but efficacy was incomplete. Here, we characterize microbiota and immune effects using multi-omics and define correlates of treatment success. By week 12, an L. crispatus-dominant microbiota was achieved in 30% of LBP recipients compared with 9% of placebo recipients (benefit ratio: 3.31; p < 0.005). This is primarily due to CTV-05, but native L. crispatus strains are also present and increase over time. Inflammatory cytokines decrease in both arms after MTZ but return to baseline in placebo recipients. Successful L. crispatus colonization is associated with pre-MTZ microbiota, baseline inflammatory profiles, post-MTZ bacterial load, and clinical and behavioral variables. These findings elucidate LBP microbiota effects and identify predictors of treatment success, informing improved intervention strategies to advance women's health.
11 Apr 2026
Read appraisal →Sexual health
Resilience of STI service delivery in community-based organizations during the 2024 armed conflict: insights from Lebanon.
This study explores the potential impact of war on STI services in Lebanon. Programmatic STI service data from Lebanon were analyzed, alongside a targeted review of the literature on conflict-affected settings, using public health databases covering the period 2014-2024. Evidence-based STI service packages for conflict settings remain limited. Drawing insights from the COVID-19 crisis, periods of emergencies are associated with an elevated risk of STI surges among key populations. Programmatic data from the conflict further demonstrated this increased risk, reflected in reductions in prevention and early detection activities compared with pre- and post-conflict periods. Self-care and outreach service packages could be critical in these contexts. Community-based organizations (CBOs) should adapt STI services to the wartime environment and evaluate the effectiveness of these interventions post-conflict. CBOs are encouraged to prioritize the implementation of self-care modalities for STI prevention and early detection, expand the availability of telehealth services, and deploy mobile clinics to maximize service continuity. This editorial analyzes STI service delivery within the specific context of the Lebanese war.
9 Apr 2026
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