Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 4 appraisals
African journal of reproductive health
Domestic violence during pregnancy and its maternal and reproductive health consequences in mainland China: A systematic review and meta-analysis
Domestic violence during pregnancy represents a serious public health concern. This study conducted a systematic review of quantitative data to examine its prevalence, factors influencing it, and associated health outcomes in Mainland China. Following PRISMA 2020 guidelines, a meta-analysis of 25 studies was performed using random-effects models, alongside assessments of heterogeneity (I²) and publication bias. The analysis revealed a pooled prevalence of approximately 20%, with psychological violence identified as the most prevalent form. Key contributing factors included socio-economic disadvantage, restricted decisionmaking autonomy, and risky behaviors by partners. Exposure to domestic violence substantially heightened the likelihood of antenatal depression or anxiety, pregnancy complications, and negative birth outcomes such as low birth weight and preterm delivery. Although some heterogeneity was noted, the associations were consistently observed. These findings highlight the significant prevalence and severe health impacts of domestic violence during pregnancy, emphasizing the urgent need for comprehensive maternal healthcare approaches in China. Such strategies should integrate domestic violence screening, mental health services, and initiatives promoting socio-economic empowerment. La violence domestique pendant la grossesse constitue un problème de santé publique grave. Cette étude a réalisé une revue systématique des données quantitatives pour examiner sa prévalence, les facteurs l'influençant et les conséquences sanitaires associées en Chine continentale. Conformément aux directives PRISMA 2020, une méta-analyse de 25 études a été effectuée en utilisant des modèles à effets aléatoires, ainsi que des évaluations de l'hétérogénéité (I²) et du biais de publication. L'analyse a révélé une prévalence globale d'environ 20 %, la violence psychologique étant identifiée comme la forme la plus répandue. Les principaux facteurs contributifs comprenaient les désavantages socio-économiques, une autonomie décisionnelle restreinte et les comportements à risque des partenaires. L'exposition à la violence domestique augmentait considérablement la probabilité de dépression ou d'anxiété anténatales, de complications de la grossesse et d'issues défavorables à la naissance, telles qu'un faible poids de naissance et un accouchement prématuré. Bien qu'une certaine hétérogénéité ait été notée, les associations ont été constamment observées. Ces résultats soulignent la prévalence significative et les impacts sanitaires graves de la violence domestique pendant la grossesse, mettant en évidence le besoin urgent d'approches globales en matière de soins de santé maternelle en Chine. De telles stratégies devraient intégrer le dépistage de la violence domestique, des services de santé mentale et des initiatives favorisant l'autonomisation socio-économique.
16 May 2026
Read appraisal →JMIR formative research
Access to Technology-Mediated Community Mental Health Care Among Low-Socioeconomic Status Consumers With Serious Mental Illness: Qualitative Study
BACKGROUND: Access to mental health care is critical for the effective management of serious mental illness (SMI), but consumers with low socioeconomic status (SES) have lower rates of service usage and worse retention in care. Digital technologies are often lauded as a way to bridge access gaps; however, little is known about how technology-mediated care may influence care access among low-SES consumers and how consumers use technology in care access. OBJECTIVE: This study aimed to examine the applicability of Levesque et al's access framework to technology-mediated care for SMI and analyze how low-SES consumers use technology to facilitate care access. Furthermore, the study assesses whether and how technologies are involved in care access at multiple points within the process of accessing care. METHODS: This study used 2 qualitative methods: ethnographic observations at a mental health treatment court and interviews with low-SES consumers with SMI using community mental health care (n=14) and key informant interviews with health and service providers working with this population (n=14). Observations occurred from July 2022 through September 2023, and interviews occurred between January 2022 and May 2024. Data analysis involved both inductive and deductive coding approaches. Data from both the interviews and observations were analyzed in NVivo and further triangulated through analytic memos. RESULTS: Levesque et al's framework required several extensions to accommodate technology-mediated care related to SMI for low-SES consumers: (1) a cyclical rather than linear trajectory; (2) simultaneous care acquisition from multiple health and service providers; (3) staying in care long-term; (4) identification of both one-time and ongoing health needs; and (5) an emergency pathway for entering care. Consumers often faced challenges related to the varied digital requirements of each provider and a dearth of integrative, patient-facing tools like portals. Within this context, some consumers use mobile apps, communication, and telehealth technologies across various care access stages. Consumers used technology by figuring out how to navigate technology-mediated care, especially by leaning on others, such as case managers, for support. These others provided consumers with temporary technologies, showed them how to use technologies, and accompanied them through the process of using technology for accessing care. CONCLUSIONS: This study highlights that accessing care is iterative and ongoing, involving multiple forms of co-occurring service provision. A theoretical contribution of this work is its extension of Levesque et al's care access framework to better reflect technology-mediated care for SMI among low-SES consumers. This work also underscores ongoing challenges for accessing technology-mediated care and the importance of human support in addressing access difficulties. Clinical implications include incorporating digital readiness assessments and providing comprehensive guidance on how consumers can effectively use technologies for care. Future work should investigate how technology-mediated care can make care access easier rather than harder.
24 Apr 2026
Read appraisal →JMIR aging
"Living Inside the Walls": Systematic Review and Qualitative Meta-Synthesis
BACKGROUND: Social isolation is a prevalent issue among older people in long-term care facilities (LTCFs), with profound negative impacts on their quality of life and mental health. However, the authentic experiences and underlying mechanisms of social isolation among older people in LTCFs remain understudied. A nuanced understanding of these experiences is essential for designing targeted nursing interventions. OBJECTIVE: This study aimed to systematically review and synthesize qualitative evidence to explore the experiences of social isolation among older adults in LTCFs and analyze them in terms of causes, mechanisms, outcomes, and strategies. METHODS: A systematic review and qualitative meta-synthesis were conducted. We searched PubMed, Web of Science, Embase, PsycInfo, Cochrane Library, CINAHL, Scopus, Chinese Biomedical Literature Database, CNKI, Wanfang Data, and Weipu (VIP) with no restriction on the start year, up to February 2025. Two reviewers (WL and ZM) independently screened studies, extracted data using a Microsoft Excel spreadsheet, and assessed study quality with the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research. Qualitative data synthesis was performed following Thomas and Harden's thematic and content analysis method, including line-by-line coding of participant quotes, organizing codes into descriptive themes, and developing analytical themes. RESULTS: A total of 4856 papers were retrieved through systematic searches, and 14 qualitative studies met the inclusion criteria. Four overarching analytical themes were identified: (1) root cause: person-environment mismatch (encompassing 4 interrelated dimensions: imbalance between declining individual capacity and insufficient environmental support, negative self-perception paired with inadequate positive environmental feedback, personal biases conflicting with homogeneous institutional social ecology, and disrupted social roles due to rigid institutional management); (2) overt behavioral patterns: proactive isolation, defensive isolation, and adaptive isolation; (3) inner emotional experiences: feelings of confinement, sorrow, and weariness; and (4) strategies for restoring person-environment match: active engagement in interaction, rational acceptance of coexistence, and passive avoidance and withdrawal. Notably, person-environment mismatch was confirmed as the core mechanism driving the onset and persistence of social isolation in this population. CONCLUSIONS: Person-environment mismatch is the fundamental driver of social isolation among older adults in LTCFs. Interventions should prioritize restoring person-environment alignment-including optimizing physical environments, reconstructing supportive social environments, and enhancing psychological empowerment. Future studies should focus on developing tools to quantify person-environment matching degrees in LTCFs and conduct longitudinal evaluations of targeted interventions to further reduce social isolation and promote active social participation among older people.
18 Apr 2026
Read appraisal →Pediatric surgery international
Anorectal malformation in adulthood: a systematic review of biological, psychological, and sociological outcomes and experiences
PURPOSE: Anorectal malformations are congenital anomalies involving the rectum, anus, genital, and urinary tracts, and occur in approximately one in 5000 live births. A lack of transition from pediatric to adult health services means little is known about how this condition is experienced in adulthood. The purpose of this review was to discover biopsychosocial challenges and supports experienced by adults living with anorectal malformation. MATERIALS AND METHODS: A systematic quantitative literature review was the preferred method to collect and analyze data. Articles included in the review were sorted into purpose-built datasets, with data coded into biopsychosocial themes and patterns. RESULTS: The most frequently reported biological challenge was surgical intervention; the most frequently reported support was positively framed continence management. The most common psychological challenges were psychosexual concerns such as sexual anxiety, and the most common supports were interventions focused on improving self-perception. The most reported sociological challenge was navigating complex health systems, and the most reported support was forming meaningful relationships. CONCLUSION: Biopsychosocial outcomes experienced by adults born with anorectal malformation remain largely unknown. Social work and psychology can provide therapeutic interventions that enhance emotional wellbeing, psychosocial functioning, and patient-led care.
17 Apr 2026
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