Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 10 appraisals
Journal of epidemiology and community health
Incidence of physical non-communicable disease in people who have experienced imprisonment compared with the general population in high-income countries: a systematic review and meta-analysis
BACKGROUND: Non-communicable diseases (NCDs) represent a significant cause of morbidity and mortality globally. Despite a strong evidence base outlining increased risk of communicable diseases and poor mental health in people who have experienced imprisonment, the risk of NCDs has not been quantified in previous reviews. This study aimed to describe the incidence of morbidity and mortality of physical NCDs in people who have experienced imprisonment compared with the general population in high-income countries. METHODS: We searched MEDLINE, Embase, CINAHL and SocINDEX (PROSPERO CRD42024540173) for comparative studies of morbidity or mortality from NCDs. Articles were assessed against predefined criteria to select studies that included people with experience of imprisonment; measured NCD incidence; compared incidence to a general population; and were conducted in a high-income country. Two reviewers conducted independent risk of bias assessment using an adapted version of the Newcastle-Ottawa Scale. Data were synthesised using random-effects meta-analyses and vote counting based on effect direction. Meta-regression and subgroup analysis investigated heterogeneity. RESULTS: Of 3085 articles screened, 32 were included providing 341 datapoints. Meta-analysis showed a higher risk of mortality from several diseases, including respiratory disease (risk ratio (RR) 2.38 (95% CI 1.18 to 4.80), I2=97%), cardiovascular disease (RR 1.80 (95% CI 1.32 to 2.46), I2=99%), liver disease and cirrhosis (RR 2.50 (95% CI 1.08 to 5.77), I2=99%), digestive disease (RR 2.92 (95% CI 1.09 to 7.78), I2=99%), neurological disease (RR 1.94 (95% CI 1.09 to 3.44), I2=92%), head and neck cancer (RR 21.31 (95% CI 4.32 to 105.14), I2=97%), liver cancer (RR 4.07 (95% CI 2.34 to 7.08), I2=94%), cervical cancer (RR 3.95 (95% CI 3.11 to 5.01), I2=0%) and lung cancer (RR 1.95 (95% CI 1.34 to 2.85), I2=0%). Synthesis without meta-analysis also indicated imprisonment was associated with increased morbidity from multiple NCDs. CONCLUSIONS: Several NCDs, including multiple cancers, cardiovascular disease, respiratory disease and liver disease, are substantially more common in people who have experienced imprisonment compared with the general population, highlighting a need for primary prevention and NCD management.
13 June 2026
Read appraisal →Proceedings of the National Academy of Sciences of the United States of America
Systemic electioneering from the evangelical pulpit: Evidence from a computational analysis
Religious institutions' engagement in prohibited electoral advocacy is a growing concern for democratic governance. In the United States, such mobilization has been especially visible within the evangelical movement. We examine this phenomenon using a corpus of 88,546 sermons from predominantly evangelical churches, transcribed from 63,683 h of Sunday services spanning the 2020, 2022, and 2024 election cycles and a nonelection control period. Analysis of this corpus reveals that direct political advocacy and endorsements are widespread: 14.7% of churches engaged in this speech during the three months surrounding the 2024 election. This behavior follows a clear electoral rhythm, peaking on the Sunday before Election Day, when 3.5% of churches mobilized. Geographic analysis indicates that advocacy correlates with county partisan composition but lacks strategic targeting; rates in swing states are indistinguishable from those in safe states. Our results provide large-scale quantification of political speech from American pulpits that constitutes prohibited electioneering under current Internal Revenue Service (IRS) guidelines, revealing a pattern of base mobilization driven by local partisan context rather than national electoral strategy.
27 May 2026
Read appraisal →BMC public health
Interventions against loneliness and social isolation in older adults- a systematic review.
BACKGROUND: Loneliness is a growing health and social challenge. The COVID-19 pandemic boosted feelings of loneliness for many people. To combat loneliness, a wide range of interventions have been developed and evaluated for their efficacy and effectiveness. As a result, many new interventions to alleviate loneliness have been developed, especially technological interventions. Therefore, the objective of this study was to conduct a comprehensive and up-to-date systematic review to identify interventions aimed at loneliness and social isolation among adults, 60 years and older published during or post-pandemic. METHODS: A comprehensive literature search was conducted for studies between 2020 and 2024 across five online databases: MEDLINE via PubMed, Web of Science, Scopus, Cochrane Library, and CINAHL. Title and abstract screening, critical appraisal of the studies, and data extraction were performed by two independent reviewers. A narrative approach was adopted to assess and integrate the diverse findings from the research. RESULTS: Ultimately, 79 studies were included in this systematic review. The results are structured based on the categorization of the interventions, which includes differentiation between analogue interventions, technological interventions and multicomponent (analogue and technological) interventions. The effectiveness of analogue interventions, particularly community-based interventions such as group meetings, social participation programs, and educational or psychological interventions, tended to be superior to that of technological interventions. CONCLUSIONS: The combination of analogue and technological interventions in particular produced promising results regarding a decrease of loneliness. Specific interventions must be tailored to the target group and setting and regularly reevaluated. The aim now should be to implement these interventions comprehensively and monitor their effectiveness over several years. Future research should focus on differentiating the circumstances under which various forms of intervention are effective. TRIAL REGISTRATION: PROSPERO systematic review registration: CRD42024538755.
20 May 2026
Read appraisal →BMJ open
Potential harms of social prescribing: a global umbrella review and dark logic model
OBJECTIVES: Social prescribing has provided a lifeline to people, capturing the importance of quality support offered via community connections. It has not been exempt from difficulties, resulting in low-quality evidence on effectiveness in part due to high drop-out rates and lack of controls. While these have been the focus of recent research, less attention has been paid to the safety implications of social prescribing. This review aims to understand safety implications of social prescribing interventions and to build a dark logic model of how harms are produced. DESIGN: Using review of review (umbrella) methodology, we searched nine databases to June 2024. DATA SOURCES: Medline/Ovid, Embase, PsycINFO, Cochrane Library/Wiley, Web of Science and Scopus) were searched from 1 January 2010 to 3 June 2024. ELIGIBILITY CRITERIA: Included reviews were systematic/scoping/narrative reviews or meta-analyses, which synthesised primary data collected from any person in receipt, involved in delivery or the commissioning of social prescribing interventions. The context of the review was social prescribing interventions/services based in primary healthcare (statutory) or third sector (non-statutory) in any country. Only reviews that were published in English and in peer-reviewed journals were included. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers extracted data from included reviews using the Typology of Harms Framework (which includes five categories of harms associated with interventions: physical, psychological, group/social, equity and opportunity harms) and to build a dark logic model to understand what contributes to these harms. RESULTS: Sixteen reviews were included, reporting on social prescribing research including a link worker. Of the identified harms, we found that opportunity harms (harm related to the cost, inappropriate or ineffective interventions) were most reported. There was also evidence extracted to suggest plausible psychological, equity (impact caused by inequity in provision, delivery or access) and group/social harms (impact that overly or inadvertently excludes a person). No physical harms were identified. CONCLUSIONS: Social prescribing, as with any delivery of care, has the potential to cause harm. We identified a range of potential harms (psychological, group/social, equity or opportunity harm) from social prescribing; however, it is unlikely to be an exhaustive list. We provide two clear outcomes: (1) the need for robust design of social prescribing research, including collection of data on the incidence and prevalence of harms, (2) recognition of the potential for harm from social prescribing and to address these where practicable.
11 May 2026
Read appraisal →Annals of epidemiology
Population-based clustering of co-occurring social determinants: An application of unsupervised machine learning
PURPOSE: This study aimed to develop a cluster-based measure of multiple co-occurring social determinants of health by applying unsupervised machine learning to a population-based cohort, offering a data-driven approach to organize complex social exposures. METHODS: Unsupervised clustering was applied to a population-based cohort of Ontario respondents to six-cycles of the Canadian Community Health Survey (2001-2012) linked to the Canadian census and vital statistics data. Clusters were evaluated using internal metrics, visualization techniques, descriptive analysis and theoretical considerations to determine the optimal number of clusters. Sensitivity analyses were integrated across the iterative clustering process. Premature mortality rates were generated assess validity. RESULTS: Optimal clustering solutions included 4-clusters and 6-clusters. Both cluster solutions revealed distinct social typologies. The 6-cluster solution offered greater granularity and theoretical interpretability. The 4-cluster solution showed greater heterogeneity within certain marginalized groups. Premature mortality rates differed meaningfully across clusters, supporting the clustering approach in capturing risk associated with social exposure. CONCLUSIONS: Unsupervised machine learning methods identified meaningful population subgroups reflecting complex patterns of social exposures. This approach offers a flexible, data-driven method for characterizing social exposures that can be considered alongside theoretical frameworks and used for equity monitoring, intervention planning and policy development.
6 May 2026
Read appraisal →Journal of Korean medical science
Association Between Changes in Socioeconomic Status Before and After Human Immunodeficiency Virus Infection Diagnosis and Mortality Rates in Korea
BACKGROUND: This study investigated changes in medical insurance status as a surrogate marker of socioeconomic status after human immunodeficiency virus (HIV) infection, and their association with mortality among people living with HIV in Korea. METHODS: This study included 13,112 individuals newly diagnosed with HIV between 2004 and 2018, identified from the claims data of the National Health Insurance System-National Health Information Database. Participants' medical insurance status was categorized into National Health Insurance (NHI) and medical aid (MA). Using the Cox proportional hazards model, the association between mortality and changes in medical insurance status before and after HIV infection diagnosis was assessed using hazard ratios (HRs) and confidence intervals (CIs). RESULTS: The insurance coverage rates before HIV diagnosis were 95.1% and 4.9% for NHI and MA recipients, respectively. After diagnosis, the insurance coverage rates were 13.4% and 86.6% for MA and NHI recipients, respectively, demonstrating a threefold increase in the proportion of MA recipients. The conversion rate from NHI to MA was highest in the 35-44 and 45-54-year age groups at HIV infection diagnosis (32.9% and 29.4%, respectively). Compared with NHI recipients, the HR was significantly higher among individuals that transitioned from NHI to MA (HR, 1.66; 95% CI, 1.39-1.97) and individuals that remained on MA (HR, 1.74; 95% CI, 1.40-2.18), suggesting a higher mortality rate in these groups. CONCLUSION: In Korea, where highly active antiretroviral therapy is essentially free of charge, a significant association was observed between a decline in medical insurance status following HIV diagnosis and increased mortality.
23 Apr 2026
Read appraisal →Hernia : the journal of hernias and abdominal wall surgery
The impact of socioeconomic status in hernia treatment: a qualitative systematic review.
INTRODUCTION: Hernias are among the most common surgical conditions worldwide. However, access to optimal treatment remains disproportionately distributed. Socioeconomic disparities play a critical role in determining whether patients receive timely surgical intervention, access to minimally invasive techniques, or suffer from postoperative complications due to delayed or suboptimal care. This study aims to evaluate the impact of socioeconomic disparities on the treatment of ventral hernia repair. METHODS: This systematic review was conducted following PRISMA guidelines. A comprehensive search was conducted using MEDLINE/Pubmed, EMBASE, Web of Science, Cochrane Library, and LILACS, from inception until March 2026 without any filter applied. A search strategy was created using the MeSH terms. Our inclusion criteria comprise studies related to socioeconomic disparities in ventral hernia repair within the United States. Due to heterogeneity in study designs, socioeconomic variables, and outcome definitions, a meta-analysis was not feasible, and findings were synthesized using a narrative synthesis. A qualitative assessment of included studies was made using the Cochrane Risk of Bias tool, ROBINS-I. RESULTS: A total of 28 studies were included, encompassing 2,096,513 patients with ventral hernia. Most were retrospective cohorts, with sample sizes ranging from a few hundred to over 665,000 patients. Across studies, patients with government funded insurance (Medicaid or Medicare) generally experienced higher rates of complications, readmissions, and recurrences compared to commercial insured patients, although the magnitude of association varied. Odds ratios demonstrated increased risks of wound complications, readmission, and recurrence among government funded insured and uninsured patients, while commercial insured and higher-income patients were more likely to undergo advanced surgical approaches and had shorter hospital length of stay. Some studies also highlighted socioeconomic and racial disparities, with vulnerable populations and minority groups showing disproportionately higher complication rates and different patterns of insurance coverage. CONCLUSION: This systematic study demonstrates significant racial and socioeconomic disparities in ventral hernia repair. Government funded insurance holders or lower incomers, faced higher complication rates, more emergent presentations, and worse outcomes, including increased mortality and readmissions. Moreover, they usually have less access to minimally invasive and robotic techniques. These inequities highlight systemic barriers in healthcare access.
18 Apr 2026
Read appraisal →BMJ health & care informatics
Supporting street medicine through medical informatics: a manifesto on research needs
Homeless individuals face major barriers in accessing regular healthcare, leading to the development of street medicine as a distinct humanitarian field. To enhance continuity and quality of care, consistent documentation is crucial. However, electronic health records are rarely used in European street medicine. An interdisciplinary European workshop identified four key research fields for medical informatics in street medicine: (1) Research ethics: The creation of ethical guidelines that promote co-creation and active communication with patients. (2) System development: Designing a secure, anonymous and European Health Data Space-compliant personal Electronic Health and Social Record (pEHSR), establishing standardised health and social care datasets, and implementing dynamic consent management methods. (3) Education and training: Developing targeted programmes to improve digital and health literacy among street medicine clients and training professionals in the effective use of the pEHSR system. (4) Management and evaluation: Creating management structures and evaluation frameworks suited to the unique challenges of street medicine.This manifesto calls for internationally coordinated scientific efforts to build effective, integrated digital health solutions for vulnerable populations. It encourages researchers and practitioners from medical informatics and related fields to engage with these priorities and support innovation that advances equitable healthcare access.
15 Apr 2026
Read appraisal →JMIR cancer
Leveraging Innovative Electronic Health Record Data to Characterize Social Determinants of Health Among Survivors of Cancer in Persistent Poverty Areas: Cross-Sectional Study
BACKGROUND: Residents in persistent poverty areas experience higher cancer mortality due to social determinants of health that negatively affect multiple factors, including health behaviors. OBJECTIVE: This study aimed to characterize demographic, clinical, and social determinant of health factors among survivors of cancer in persistent poverty areas using electronic health record (EHR) data-including an embedded social risk screener and natural language processing (NLP) of social work notes-to inform community-engaged adaptation of lifestyle interventions. METHODS: EHR data from a large multispecialty group practice were extracted for patients with cancer residing in zip codes inclusive of persistent poverty areas targeted for a health behavior intervention and receiving care between January 2018 and November 2023. Self-reported social determinant of health data were obtained using the Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences (PRAPARE) and through NLP of social histories from a social work visit. RESULTS: We identified 2672 unique patients with cancer, of whom 578 (21.6%) had PRAPARE data and 1597 (59.8%) had social history data available for analysis. The most common cancers among survivors (n=1420, 53.1% female; n=1299, 48.6% Black individuals; mean age 65.2, SD 13.7 years) included breast (n=536, 20.1%), prostate (n=400, 15%), and lymphoid or hematopoietic (n=323, 12.1%) cancer. Among survivors in persistent poverty areas (n=509, 19%; all with a high Social Vulnerability Index), 34.6% (176/509) were single, 55.4% (282/509) had Medicare coverage (with only 73/509, 14.3% having private insurance), 36.5% (186/509) had obesity, 63.9% (325/509) had hypertension, and 31.2% (159/509) had diabetes. Of survivors in persistent poverty areas with PRAPARE data, 15.8% (19/120) lacked transportation, 4.2% (5/120) lived with housing insecurity, and 6.7% (8/120) felt unsafe where they lived. CONCLUSIONS: Innovative EHR and NLP approaches identified several socioeconomic and safety-related challenges along with opportunities for health behavior interventions to leverage Medicare coverage and target multiple comorbidities when adapting interventions for survivors of cancer living in persistent poverty areas.
14 Apr 2026
Read appraisal →Global public health
Link between housing and community factors and mental health and psychological well-being of refugee parents and children in high-income countries: A systematic review
Whilst forced migration is known to significantly increase the risk of mental health problems, the influence of post-migration factors for refugee children and parents in high-income countries remains understudied. However, systemic post-migration factors have the potential to be modified by policy and practice to improve outcomes. This systematic review identifies the housing and community factors examined in research and their link to the mental health and psychological well-being of refugee parents and children in high-income countries. Adhering to the PRISMA guidelines, we searched the databases of PubMed, PsycINFO and Embase for studies published in peer-reviewed journals until the 17th of October 2025. Of the 11,588 studies identified, 30 were eligible for inclusion in this review. Our findings particularly suggest favourable mental health outcomes among those living with their families/relatives or foster care as opposed to reception centres, as well as those with social support. Perceived discrimination consistently showed an association with negative mental health outcomes. The findings suggest a gap in the evidence base focusing on parents, education and school-related factors. We recommend that policy makers provide family-based living arrangements and improve access to spaces for social support. Future research in this field will benefit from further sub-group analyses.
8 Apr 2026
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