A process for systematically reviewing the literature: providing the research evidence for public health nursing interventions

Expanding vaccination provider types and administration sites can increase vaccination uptake: A systematic literature review of the evidence in non-United States geographies

Vaccination is a successful public health intervention; however, vaccine-preventable diseases continue to pose global health risks due to insufficient uptake. Expanding authority for "alternative" or complementary healthcare providers to administer vaccinations, as well as approving additional non-clinical vaccination sites, could improve access to and uptake of vaccines. The value of complementary providers and expanded sites has been documented in the United States; however, there is limited evidence in geographies outside the United States. To address this gap, we conducted a systematic literature review to identify studies that evaluated vaccination by complementary providers and/or at expanded sites outside of the United States. Of 943 identified records, 18 met our inclusion criteria and were conducted in Australia (4), Canada (6), the United Kingdom (3), Peru (2), Cameroon (1), or in multiple geographies (2). All studies demonstrated that expanding provider types and sites could positively impact vaccine uptake and/or provide additional benefits.

Behavior Change Techniques to Reduce Sugars Intake by Adolescents: A Systematic Review

INTRODUCTION

The adolescent diet is high in sugars compared with other age groups. Effective approaches to support sugar reduction by adolescents are needed as part of caries prevention.

OBJECTIVE

To systematically review peer-reviewed evidence (1990 to 2023) to identify effective behavior change techniques (BCTs) for sugars reduction in adolescents aged 10 to 16 y.

METHODS

Nine databases (CINAHL, Cochrane, Dental and Oral Sciences Source, EMBASE, MEDLINE, PubMed, PsycINFO, Scopus, and Web of Science) were searched. Identified articles were screened independently in duplicate for eligibility. Interventions were eligible if they aimed to change adolescent dietary behavior(s) and reported pre- and postsugar-relevant outcome measures. Interventions from included studies were coded using a 93-item BCT Taxonomy (Michie Taxonomy v1). Risk of bias was assessed using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. Evidence synthesis by vote counting (number of studies showing positive versus null or negative effects) was applied to BCTs that were present in more than 5 interventions.

RESULTS

Of 16,271 articles identified, 764 were screened in full, yielding 35 studies (in 43 papers), of which 3 were uncodeable. BCTs coded in interventions covered 11 of 16 BCT clusters and 25 of 93 individual BCTs in the BCT taxonomy. The median number of BCTs applied per study was 3 (interquartile range 2-6). Evidence synthesis indicated that the BCTs most positively associated with a positive reduction in sugars were (with the percentage of strong-/moderate-quality studies applying these techniques that successfully reduced sugars intake in brackets) feedback on behavior (100%), information on social and environmental consequences (100%), problem solving (75%), and social comparison (75%).

CONCLUSION

Notwithstanding limitations in available data, the current evidence most strongly supports the use of BCTs relating to feedback on behavior, providing information on the social and environmental consequences, include problem solving and making social comparisons, to lower sugars intake in adolescents.Knowledge Transfer Statement:The results of this study will enable clinicians to provide more effective dietary advice when supporting dietary behavior change to reduce sugars intake in adolescents. The results may also be used by researchers to guide future directions for research into effective sugars reduction in adolescents.

Nonverbal correlates of paranoid ideation - a systematic literature review

BACKGROUND AND AIM

Insight in nonverbal correlates of paranoid ideation can potentially help improve diagnostic procedures and guide interventions. The aim was to systematically evaluate the scientific evidence investigating nonverbal correlates of paranoid ideation.

METHODS

The review follows the PRISMA guidelines. Databases PsycINFO, PubMed, Web of Science, and Cinahl were searched for studies concerning the use of standardized instruments for both verbal and nonverbal measurements of paranoid ideation in adult participants. Quality of studies was evaluated using the Effective Public Health Practice Project tool. Data were systematically extracted and summarized thematically and narratively. This review was registered with PROSPERO (CRD42022288001).

RESULTS

The search strategy yielded 3962 results of which 22 papers met inclusion criteria. Half (n = 11) of the included articles included patients with a diagnosis on the psychosis spectrum, the other articles (n = 11) studied healthy populations. Identified nonverbal categories were spatial behavior (n = 6), brain region activity (n = 5), visual perception (n = 5), stress physiology (n = 4), information processing (n = 3), and aggression (n = 1). Some studies investigated multiple nonverbal categories.

CONCLUSIONS

Evidence was strongest for spatial behavior and brain region activity as nonverbal correlates of paranoid ideation. Evidence for stress physiology, information processing, and aggression as potential nonverbal correlates was less robust, due to inconsistent findings and small numbers of publications. Using nonverbal methods to assess paranoid ideation requires more investigation and evaluation. The integration of nonverbal assessments might offer new diagnostic possibilities that move beyond traditional verbal methods.

Elements of Return-to-Work Interventions for Workers on Long-Term Sick Leave: A Systematic Literature Review

PURPOSE

The aim of this systematic review is to identify vocational rehabilitation (VR) interventions that are effective to enhance return-to-work (RTW) for people on long-term sick leave (> 90 days) and to identify main elements of these interventions.

METHODS

Six electronic databases were searched for peer-reviewed studies published up to February 2022. Each article was screened independently by two different reviewers. Thereafter, one author performed the data-extraction which was checked by another author. The EPHPP quality assessment tool was used to appraise the methodological quality of the studies.

RESULTS

11.837 articles were identified. 21 articles were included in the review, which described 25 interventions. Results showed that ten interventions were more effective than usual care on RTW. Two interventions had mixed results. The effective interventions varied widely in content, but were often more extensive than usual care. Common elements of the effective interventions were: coaching, counseling and motivational interviewing, planning return to work, placing the worker in work or teaching practical skills and advising at the workplace. However, these elements were also common in interventions that were not effective on RTW compared to usual care and can therefore not explain why certain interventions are effective and others are not.

CONCLUSION

The effective interventions included in this study were often quite extensive and aimed at multiple phases of the RTW-process of the worker. In the future, researchers need to describe the population and the content of the investigated interventions more elaborate to be able to better compare VR interventions and determine what elements make interventions effective.

Psychological Interventions for Sleep Problems Among Medical and Paramedical Students: A Systematic Review

Sleep problems such as poor sleep quality and insomnia are common issues among medical and paramedical students, which may lead to mental health disorders and impaired academic performance. Despite the availability of different sleep programs and psychological interventions, as well as a few reviews exploring their effects on sleep variables in college students, a systematic review comparing their effectiveness in medical students is still lacking. This systematic review aims to investigate psychological interventions to improve sleep quality and address sleep problems in medical students. Four databases (PubMed, SciDirect, Scopus, and PsycNet) were searched to retrieve original research articles written in English and published from January 1, 2000, to September 30, 2023. Outcome measures were sleep quality, insomnia, sleep behavior, sleep quantity, and sleep-related problems. A total of 19 articles met the inclusion criteria, and 4 categories of interventions were identified (1) sleep hygiene, (2) cognitive behavioral therapy (CBT), (3) a combination of sleep hygiene/CBT with other modalities, and (4) other psychotherapeutic interventions such as progressive muscle relaxation, hypnotherapy, aromatherapy yoga, and mindfulness. Ten studies were randomized control trials, two were quasi-experimental, and the remaining seven were pre- and post-intervention designs (one group only and no control). Overall, both individual CBT and sleep hygiene education led to significant improvement in sleep quality and sleep problems among medical students, but CBT was more effective with consistent positive effects on sleep quality. Nevertheless, significant improvements in sleep quality and sleep-related outcomes were observed in studies combining these psychological interventions. Effective comparisons were limited due to the substantial heterogeneity between the studies. Further research is required to elucidate the type of psychological intervention, optimal mode of delivery, duration, and number of contacts of these interventions, including the moderators to improve sleep quality among medical students.

Do burn injury prevention interventions change what people know and how people think? A systematic review investigating the impact on psychological constructs

INTRODUCTION

Burns can result in life-long physical and psychological difficulties. Interventions aimed at preventing burns are therefore important. Behaviour change theories propose that psychological variables (e.g., knowledge, attitudes, beliefs, self-efficacy) are associated with injury prevention behaviour. However, whether or not burn prevention interventions impact psychological variables is uncertain. This systematic review aimed to address this gap in the literature.

METHODS

A systematic review was conducted according to PRISMA guidelines. Electronic databases (CINAHL, MEDLINE, PubMed and Scopus) were searched for randomized control trials (RCTs) of burn prevention interventions which measured at least one psychological construct. Studies were quality assessed using the Effective Public Health Practice Project (EPHPP) quality assessment tool.

RESULTS

Eight studies met inclusion criteria. A narrative synthesis was conducted. Seven RCTs detailed interventions aimed at reducing paediatric burns (five delivered to parents/caregivers and two delivered to children). One RCT was aimed at adults. All RCTs measured burns knowledge, but findings were mixed about whether knowledge changed following interventions. Four RCTs measured self-efficacy, with all finding an increased perceived ability to engage in burn prevention behaviour following interventions. Risk perceptions (e.g., around the perceived severity and susceptibility of burns) were rarely measured.

CONCLUSION

To date, burn prevention RCTs have mainly focused on paediatric burns and most often measured knowledge change. However, the impact of interventions on knowledge is variable. Future burn prevention interventions should measure a range of psychological constructs, as these are likely to be important in burn prevention behaviour.

A systematic review and meta-analysis of factors associated with adolescent substance use in Africa, 2000 to 2020

BACKGROUND AND AIMS

Adolescent substance use is a growing public health concern in Africa, yet little is known about the contextual factors of substance use among young African populations. This systematic review identified factors associated with substance use among adolescents (aged 10-19 years) in Africa.

METHODS

This review was conducted in line with PRISMA guidelines. We searched six databases (from January 2000 to December 2020): PubMed, Cochrane Library, African Journals Online (AJOL), Google Scholar, ScienceDirect and World Health Organization (WHO) African Index Medicus. We included population-based observational studies reporting on factors associated with adolescent substance use across Africa. Study screening was conducted by at least four independent reviewers who resolved discrepancies through discussion and consensus. All included studies were analysed in a narrative synthesis. Studies providing sufficient statistics, i.e. three or more reporting the same outcome and exposure/predictor, were included in meta-analyses.

RESULTS

Sixty-three peer reviewed studies that were full text accessible were included. The majority were cross-sectional surveys. Factors associated with adolescent substance use identified were linked to individual, family, socioenvironmental and non-familial social networks determinants. Results from both the narrative synthesis and meta-analysis revealed that being male and an older adolescent were significantly associated with adolescent substance use. Combined odds ratio (OR) of males who currently smoke compared with females was 1.81 [95% confidence interval (CI) = 1.37-2.39; 6 studies, 13 443 participants, I2 = 59.67%]. Additional meta-analysis outcomes found that having a friend who smokes was associated with tobacco smoking. Combined OR of 'ever-smokers' with a friend who smoked was 4.83 (CI = 2.56-9.10; 3 studies, 18 858 participants, I2 = 79.21%). Having a family member who smokes was associated with smoking initiation (OR = 2.99; CI = 2.67-3.35; 3 studies, 18 858 participants, I2 = 0%) and current smoking (OR = 2.33; CI = 2.23-2.45; 4 studies, 13 282 participants, I2 = 0%).

CONCLUSION

Multiple factors that operate on individual, family and societal levels influence adolescent substance use in Africa. Key factors of adolescent substance use in Africa appear to include being male, being an older adolescent and being exposed to peer substance use.

Intolerance of uncertainty and psychosis: A systematic review

OBJECTIVES

Intolerance of uncertainty, the tendency to interpret and react negatively to uncertainty, is a transdiagnostic risk factor for anxiety, depression and eating-related disorders. Given the high comorbidity between anxiety, depression and schizophrenia-spectrum diagnoses (SSDs), there is potential for intolerance of uncertainty to play a role in modulating psychosis symptoms. To address this gap in our understanding, we conducted the first prospectively registered systematic review on intolerance of uncertainty and psychotic symptoms in both people with SSDs and in the general population.

METHODS

Four databases were searched (PsycINFO, Medline, Web of Science and PubMed), which identified ten studies with a total of 1503 participants that measured intolerance of uncertainty and psychosis symptoms.

RESULTS

Key findings suggest the following: (1) Intolerance of uncertainty was associated with total negative psychotic symptoms with small-medium effect sizes; (2) intolerance of uncertainty was higher in individuals with an 'at-risk' mental state for psychosis compared to controls; (3) higher intolerance of uncertainty was associated with more individual psychotic symptoms related to delusions and paranoia within clinical and nonclinical samples; and (4) there was mixed evidence for a relationship between intolerance of uncertainty and auditory hallucinations and intolerance of uncertainty and total positive symptoms in clinical samples.

CONCLUSIONS

Overall, these findings highlight that intolerance of uncertainty may be an important transdiagnostic dimension and potential treatment target for psychotic symptoms such as delusions and paranoia in people with SSDs.

A Systematic Review of Third-Wave Therapies to Reduce Distress and Improve Wellbeing and Quality of Life in People with Parkinson's Disease

OBJECTIVES

This systematic review assessed use of third-wave psychotherapies in reducing psychological distress and improving psychological well-being and quality of life in people with Parkinson's disease and critically evaluated intervention adaptations.

METHODS

A literature search, conducted across five databases identified randomized controlled trials (RCTs) evaluating third-wave psychotherapies for individuals with Parkinson's disease.

RESULTS

Ten RCTs were identified of which nine evaluated mindfulness-based interventions, and one acceptance and commitment therapy. Methodological quality ranged from moderate to high, but sample sizes were small, and only one study was adequately powered. Five reported on Parkinson's specific adaptations. The trial with the largest sample size reported a significant effect of Mindfulness Yoga on depression and anxiety, psychological well-being and quality of life. Other findings were mixed across all outcomes.

CONCLUSIONS

There was evidence of an effect of Mindfulness Yoga on our pre-defined outcomes. Pilot and feasibility trials showed that mindfulness-based interventions were well received and provided feedback on adaptations. There was a lack of data to draw conclusions regarding non-mindfulness-based therapies.

CLINICAL IMPLICATIONS

Larger trials of mindfulness-based interventions are required to establish the clinical meaningfulness of treatment effects. Further research is needed to adapt and explore on non-mindfulness-based interventions such as acceptance and commitment therapy.

A systematic review of the characteristics of programs and services resulting in competitive employment outcomes for young people with an intellectual disability

BACKGROUND

Transitioning to paid employment is part of the natural progression to adulthood, yet the number of people with an intellectual disability who are competitively employed globally is low. This study systematically reviewed the literature to understand characteristics of programs that support competitive employment outcomes for young people with an intellectual disability.

METHOD

Five databases were searched. Two quality assessment tools were used: the Effective Public Health Practice Project (EPHPP) tool; and the Mixed Methods Appraisal Tool (MMAT). Content analysis was conducted using Braun and Clarke's theoretical thematic analysis framework.

RESULTS

Key findings demonstrated the importance of early career planning, work exposure, post-secondary education and certification, and on-the-job training.

CONCLUSION

Further research, along with the application and adaptation of existing international studies presented in this systematic review, could drive system-wide changes prioritising competitive employment outcomes for young people with intellectual disability, enabling them to experience the benefits of competitive employment.

Tools used to appraise the quality of studies included in systematic reviews and meta-analyses in human genetics: a systematic review

Quality assessment of primary studies is an essential component of systematic reviews (SRs). This methodological review systematically examines the choice, format and utilization of critical appraisal (CA) tools in SRs with or without meta-analyses in the field of human genetics. We searched MEDLINE, Embase, Web of Science, and PubMed up to January 2024. Two reviewers independently performed title, abstract, full-text screening and data extraction. This PROSPERO registered methodological review followed PRISMA guidelines. Meta-analysis and full-scale risk-of-bias assessment of SRs were not relevant. Among 149 randomly selected SRs, 136 mentioned CA tools (156 citations). Nineteen different generic tools constituted 71.2% of citations. NOS, QUADAS and the Cochrane risk-of-bias tool represented 36.5, 11.5, and 8.3% of tools, respectively. Ninety-three reviews stated following reporting guidelines, with 22 PRISMA checklists accessible. Detailed presentation of results was observed for 65.8% of generic and 37.8% of customized tools (p = 0.0013). Results for NOS were less often detailed than for other generic tools (p < 0.0001). Few SRs used CA results for study selection, data analysis, or discussion of findings. In conclusion, this first review of CA tools in human genetics SRs highlights a lack of transparency regarding utilization of CA tools and deficiencies in reporting of CA results.Registration: PROSPERO (CRD42023449349).

High-Intensity Training on Patients with Hypertrophic Cardiomyopathy: A Systematic Review

Hypertrophic cardiomyopathy (HCM) is a common inherited cardiac disorder associated with significant morbidity. The role of high-intensity exercise in HCM remains controversial due to concerns about potential adverse effects. This study aims to conduct a systematic review of experimental and observational studies to evaluate the effects of high-intensity training (HIT) on patients diagnosed with HCM. This systematic review was conducted according to the Preferred Reporting Items in the Systematic Review and Meta-analysis Guidelines 2020. A comprehensive search was performed using Proquest, Pubmed, Scopus, and JSTOR databases to identify relevant studies published up to March 2024. Both experimental and observational studies written in English were included in the study. No restrictions were placed on the year, country of publication, or duration of follow-up. Study quality was evaluated using the Effective Public Health Practice Project (EPHPP) tool. A narrative synthesis was also conducted to summarize the findings. A total of 1418 references were identified through the search strategy. After removing 151 duplicates, 1267 records were screened based on title and abstract, resulting in the exclusion of 1253 studies. The full text of 14 articles was assessed for eligibility, of which ten were excluded. Four papers with a total of 2008 sample sizes were included. Significant differences were observed in several echocardiographic parameters. HCM athletes exhibited higher left ventricular end-diastolic volume (96 ± 33 vs. 76 ± 27 mL; p = 0.001, effect size = 0.682) and stroke volume (58 ± 21 vs. 47 ± 17 mL; p = 0.004, effect size = 0.593) compared to non-athletes. Additionally, significant differences were found in left ventricular outflow tract (LVOT) gradients: both resting (p < 0.001, effect size = - 0.192) and provoked (p < 0.001, effect size = - 0.258) LVOT gradients were significantly lower in the vigorous exercise group compared to the non-vigorous exercise group. In contrast, no significant differences were found between HIT and the comparator group in vital signs and functional aerobic capacity. Moreover, no significant differences were observed in arrhythmias, cardiac arrest, or mortality, suggesting that HIT did not increase the risk of arrhythmias or other adverse events compared to the comparator group. HIT improves cardiac function and exercise capacity in patients with HCM without increasing the risk of severe adverse events. These findings support reconsidering the guidelines on physical activity restrictions for individuals with HCM.

The Impact of Methylphenidate on Sexual Functions: A Systematic Review of Benefits and Risks

Background: Methylphenidate is a psychostimulant that enhances dopamine and norepinephrine neurotransmission through the mechanism of reuptake inhibition at the synaptic cleft. Studies indicate that sexual dysfunction is prevalent among psychiatric patients. The objective of our study was to assess the impact of methylphenidate on patients' sexual health, identify specific types of sexual dysfunction, and analyse the correlations between psychiatric disorders, treatment dosages and durations, and the presence of sexual dysfunction. Additionally, we aimed to evaluate the prevalence of improved sexual function resulting from methylphenidate use. Methods: A systematic literature review was performed using the PubMed database in accordance with PRISMA guidelines. The initial search yielded 186 articles, of which 14 met the inclusion criteria and were analyzed. Clinical studies involving changes in libido, erectile function, ejaculation, semen quality, and sexual behavior due to methylphenidate were reviewed. Results: The findings indicate that methylphenidate can have both negative and positive effects on sexual function. In some patients, particularly those with psychiatric comorbidities, methylphenidate was associated with decreased libido and ejaculation disorders. In other cases, especially in individuals with preexisting dysfunctions or on low doses, it appeared to enhance sexual arousal and performance. Conclusions: Methylphenidate may influence sexual function in complex ways depending on individual patient profiles and treatment variables. Clinicians should be aware of these potential outcomes and consider sexual health as part of the therapeutic discussion when prescribing methylphenidate.

Minor Visual Phenomena in Lewy Body Disease: A Systematic Review

Minor visual phenomena (MVP), such as visual illusions, pareidolias, feeling of presence, and passage hallucinations, are often experienced by patients with Lewy Body Disease (LBD), in addition to complex visual hallucinations (VH), even in the early stages of the disease. This systematic review aimed to provide an up-to-date literature review of the occurrence and prevalence of MVP in LBD and to assess their potential associations both with VH and visuoperceptual and visuospatial deficits. A systematic literature search was carried out in PubMed, Web of Science, APA PsycInfo, Scopus, and Cochrane Library, and a total of 44 articles were included. The included studies showed significant variability in the occurrence of MVP in the LBD population and in the assessment methods used, such as standardized scales (e.g., the noise pareidolia test), semi-structured interviews (e.g., the North-East Visual Hallucinations Interview), and clinical descriptions. Similarly to VH, MVP appears to be highly specific to LBD, helping in differential diagnosis from Alzheimer's Disease. The overall relationship between MVP, VH, and visuoperceptual/visuospatial deficits remains unclear. Some studies found that MVP (especially pareidolic responses and presence of hallucinations) was positively correlated with VH, yet it is challenging to determine whether MVP can be considered a precursor of future VH development. Negative associations were reported between MVP (especially pareidolias) and visuoperceptual/visuospatial abilities. However, it is not clear whether these deficits serve as independent, exclusive factors in MVP occurrence or if they interact with VH as a contributing component. Gaining insight into the occurrence of these phenomena could prove beneficial for differential diagnosis, prognosis, and prediction of treatment outcomes in patients with LBD.

Effects of reminiscence therapy for loneliness in older adults: a systematic review and meta-analysis

BACKGROUND

Loneliness has detrimental effects on the mental well-being of senior citizens. Reminiscence therapies have emerged as a potential intervention to alleviate loneliness. This study aimed to systematically review and quantitatively analyse the effects of reminiscence therapy on loneliness among older adults.

METHODS

A comprehensive search was performed across 11 electronic databases, meta-analyses were used to explore the effectiveness of reminiscence therapy on loneliness among older adults, while multiple subgroup analyses were conducted to explore differences in the effectiveness of different types of reminiscence therapy. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

RESULTS

Twenty-two studies were included in the systematic review meta-analysis. The meta-analysis indicated that reminiscence therapy significantly reduced loneliness in older adults (standard mean difference = -1.52, 95% CI [-2.11, -0.93], P < .01). Subgroup analyses showed significant effects for both simple reminiscence and life review therapy. Group reminiscence therapy was more effective than individual reminiscence therapy, and that reminiscence therapy conducted by professional facilitators was more effective than that led by non-professionals.

CONCLUSIONS

Reminiscence therapy is an effective intervention for reducing loneliness among older adults, highlighting its importance in clinical practice. Future research should explore the best practices for different types of reminiscence therapies, tailored to the personal needs and backgrounds of older adults.

Characterizing predictors of response to behavioral interventions for children with autism spectrum disorder: A meta-analytic approach

A comprehensive understanding of specific factors contributing to variability in responsiveness of children with autism to interventions is paramount for making evidence-based clinical and policy decisions. This meta-analysis examined child and family characteristics, as well as intervention design factors, associated with outcomes of behavioral interventions for children with autism. A systematic review identified 95 studies published between 1987 and 2024, encompassing 6780 children on the autism spectrum and 2150 independent effect sizes. Results indicated that stronger post-intervention effects were observed across intervention approaches for children with higher cognitive, language, and other developmental abilities, greater adaptive functioning, and fewer autism-related features. Additionally, interventions of longer duration and greater total hours were associated with stronger post-intervention outcomes. In contrast, intervention approach (Early Intensive Behavioral Intervention, Naturalistic Developmental Behavioral Interventions, or Developmental Interventions), delivery agent, and child age at intervention onset did not significantly predict the strength of post-intervention outcomes. While study methodology and reporting quality were marginally associated with predictive strength, adjusting for these factors had minimal impact on the reported findings. The insights from this meta-analysis have significant implications for the development of personalized intervention models for children with autism. These models have the potential to optimize outcomes and offer critical guidance for decision-making in both the service and policy levels, ensuring efficient and equitable allocation of resources.

Strategies for increased adherence to the Mediterranean or healthy diet in university food services: a systematic review

The Mediterranean diet (MD) has been recognised as a healthy and sustainable diet model. Despite this, current eating habits diverge significantly from established dietary recommendations, namely the MD among young university students. The eating habits of young people are characterised by a high consumption of energy-dense foods and a low consumption of vegetables and fruit. Thus, university canteen food services are essential in promoting a healthy and sustainable diet. This systematic review aimed to identify the strategies for promoting adherence to the MD and healthy diets in Higher Education food service. This systematic review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Of the 39 studies that were retrieved, all focused on strategies to improve healthy eating, and none specifically used the term "Mediterranean". Studies were conducted in different countries worldwide. Architectural nudges, discounts on healthy food and nutritional information were identified as successful strategies, especially among females and students with higher nutrition education. A combination of nudging strategies in food service is a promising way to promote healthier food habits.

Health-related quality of life, service utilisation and costs for anxiety disorders in children and young people: A systematic review and meta-analysis

BACKGROUND

Anxiety disorders (ADs) are common mental health issues in children and young people (CYP). The literature on its overall economic burden regarding health-related quality of life (HRQoL), service use and costs is limited. This study synthesises the literature on how ADs are associated with these outcomes in CYP (0-24 years) and caregivers.

METHOD

A systematic search was undertaken across six databases from January 2013 to the end of December 2024. Grey literature was also searched. Dual-independent screening and quality assessment were conducted. An adapted version of the Effective Public Health Practice Project tool was used for quality assessment. Narrative synthesis and meta-analysis were conducted.

RESULTS

Of 41,166 studies identified, 24 studies were included. Most were cross-sectional; only four were longitudinal, with 1.5- to 6-year follow-up periods. Studies found poorer HRQoL in CYP with ADs compared to those without ADs or healthy peers. The meta-analysis found a strong effect on the psychological/emotional and social functioning of HRQoL. Comorbid ADs were also associated with poor overall HRQoL, with a particularly very large effect on emotional functioning. Limited studies show that childhood ADs were associated with increased health service use and costs, with mixed findings on caregivers' HRQoL.

CONCLUSION

ADs in CYP were associated with lower HRQoL for CYP and their caregivers, and with increased health service use and costs. This review highlights the need for future research to examine the burden on caregivers and the long-term impact on CYP's HRQoL, service use and costs.

The psychosocial outcomes following cosmetic surgery are largely unknown: A systematic review

INTRODUCTION

Cosmetic surgery is marketed and widely considered to exert positive psychosocial outcomes, particularly in relation to body image, self-esteem, and mental health. The present systematic review aimed to conduct a timely, up-to-date assessment of the existing academic empirical literature, applying stringent inclusion criteria to summarize only the highest quality of evidence in the field.

METHODS

The following databases were systematically searched: EBSCO, Cochrane Library, Scopus, and ProQuest. Screening was completed by two independent reviewers. Prospective studies that utilized a control cohort to examine at least one psychosocial outcome using a validated measure after cosmetic surgery were included. Risk was double assessed using the Effective Public Health Practice Project Quality Assessment Tool.

RESULTS

Seventeen studies met the inclusion criteria. There was considerable heterogeneity across research designs, control groups, measures, and statistical analyses. Overall, the quality of studies was poor. Results suggest short-term improvements in some psychosocial outcomes after cosmetic surgery (particularly in relation to body-area-specific satisfaction, self-esteem, sexual well-being and physical well-being), with limited and inconclusive evidence for outcomes such as mental health, holistic body image, quality of life and social functioning. Very few studies have explored psychosocial outcomes beyond 6-months after the surgery.

CONCLUSION

Current evidence regarding psychosocial outcomes following cosmetic surgery is weak. There is an urgent need to conduct high-quality research that will require collaboration among surgeons, research psychologists, and methodologists. Recommendations include pre-registration, larger sample sizes, longer follow-up duration, and appropriate control group recruitment. Considering the increasing popularity of cosmetic surgery globally, this field of research should assume priority.

Physical activity and exercise interventions in adults with cerebral palsy: a systematic review of quantitative and qualitative studies

PURPOSE

Participating in physical activity may benefit health-related outcomes for adults with cerebral palsy (CP). The aim of this review is to provide a synthesis of the evidence from both qualitative and quantitative studies on the impact of physical activity and exercise interventions in adults with CP.

METHODS

Literature searches were conducted from inception to November 2023 in nine electronic databases. A meta-analysis was carried out to evaluate the efficacy of the interventions on walking speed related outcomes and muscle strength.

RESULTS

Twenty-two studies met the inclusion criteria. The interventions of the nine studies included in the meta-analysis did not improve walking speed over a distance of 10 m (SMD = -0.03, 95% CI: -0.34-0.40, p = 0.88, I2 = 0%) or endurance (distance covered in 2 or 6 min) (SMD = 0.25, 95% CI: -0.10-0.59, p = 0.16, I2 = 0%), but there was an improvement in lower limb muscle strength in favour of the experimental groups (SMD = 0.59, 95% CI: 0.19-0.99, p = 0.004, I2 = 20%). Only a few studies reported on psychosocial outcomes, quality of life, or intervention sustainability.

DISCUSSION AND CONCLUSIONS

Further research is needed to explore the impact on psychosocial outcomes and quality of life in adults with CP and the sustainability of physical activity participation.

Low-Carbohydrate Diets for the Management of Pediatric Obesity: A Systematic Review and Meta-analysis

CONTEXT

Although low-carbohydrate (LC) diets have been shown to be beneficial for weight loss and improvements in cardiometabolic health in adults with obesity, their efficacy in youth has not yet been established.

OBJECTIVES

A systematic review and meta-analysis was conducted to qualitatively and quantitively synthesize the evidence from clinical trials testing the efficacy of LC diets to improve anthropometric and cardiometabolic-related parameters in children and adolescents with obesity.

DATA SOURCES

Searches in Medline, EMBASE, and Cochrane databases were undertaken for LC interventions with or without control comparisons.

DATA EXTRACTION AND ANALYSIS

Data before and after the LC intervention and control comparisons (if applicable) were extracted from 19 studies, 17 of which were pooled in random-effects meta-analyses.

RESULTS

Children on LC diets (Mean = 30 [IQR: 30-60] g/d), for approximately 3 months (IQR: 3-4 months) significantly reduced their weight (mean change [MC] = -7.09 [95% CI: -9.60, -4.58] kg; P < .001), body mass index (BMI) (MC = -3.01 [-3.71, -2.30] kg/m2; P < .001), and BMI z-score (MC = -0.27 [-0.48, -0.06]; P = .020), on average, with concomitant improvements in different metabolic biomarkers, such as serum triglycerides (MC = -29.16 [-45.06, -13.26] mg/dL; P = .002) and insulin (MC = -7.13 [-9.27, -4.99] µU/mL; P < .001). Evidence from 5 out of 7 controlled trials suggests that LC diets without caloric restriction may lead to similar or greater improvements in anthropometric and lipid-related outcomes relative to caloric-restricted or low-fat diets. However, meta-analyses demonstrated high between-study heterogeneity, indicative of a wide variety of methodologies, including intervention duration and degree of carbohydrate restriction.

CONCLUSION

Overall, this review found that short-term LC diets can be beneficial for weight loss and improving cardiometabolic parameters with or without calorie restriction. However, the limited number of controlled trials and the demonstrable diversity in methods prevent firm conclusions regarding their efficacy relative to traditional approaches, such as energy restriction.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42023440835.

An umbrella review of efficacy of digital health interventions for workers

Efficacy of digital health (d-Health) interventions on workers' physical activity (PA), sedentary behavior, and physiological outcomes remains unclear. This umbrella review searched PubMed, Cochrane Library, and Google Scholar up to October 25, 2024. We identified 24 systematic reviews (SRs) and selected 130 individual studies from these SRs for analysis. The AMSTAR 2 tool rated the quality of most SRs as critically low. Narrative syntheses suggested that d-Health interventions could potentially improve all outcomes compared with no intervention. However, whether d-Health interventions outperform non-d-Health interventions remains uncertain. Meta-analyses showed a significantly small effect of d-Health interventions on step counts, sedentary/sitting time, and weight compared with no intervention, while d-Health interventions slightly improved only moderate-to-vigorous PA compared with non-d-Health interventions. Subgroup analyses identified potential sources of heterogeneity (e.g., risk of bias, control conditions), which may vary between outcomes. Further high-quality studies are needed to evaluate the efficacy of d-Health interventions.

Is it beneficial to allow the patient's family to attend cardiac resuscitation: Different cultural perspectives? A scoping review

Background

Family presence during resuscitation (FPDR) is a controversial issue that remains unresolved in contemporary practice. Although there are many research studies on FPDR and several published statements and guidelines supporting FPDR by international organizations, no conclusive position guides clinicians in making a decision. A scoping review was conducted to discuss the different healthcare professionals (HCPs) and cultural perspectives toward family presence during CPR is conducted.

Methods

Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines, we screened 797 studies published between 2000 and 2022 from the databases including Springer Link, MEDLINE, Pro-Quest Central, CINAHL Plus, and Google Scholar. All articles were filtered using inclusion criteria to eliminate redundant, irrelevant, and unnecessary content.

Results

A total of 34 studies that fulfill the eligibility criteria reported that there are multiple perspectives from HCPs and families about FPDR. HCPs felt that their performance had improved during resuscitation and received family support in breaking the bad news of death. Family relatives who attended cardiopulmonary resuscitation (CPR) had less stress, less anxiety, more positive grieving behavior, and enhanced family members' decision-making. Contrastingly, some HCPs were against FPDR because they were concerned about the family's misinterpretation of resuscitation activities, psychological trauma to the family members, increased stress levels among staff, and worry about an unexpected response from the distressed family.

Conclusions

It is important to consider the culture and awareness of families when deciding on FPDR. It is the responsibility of HCPs to assess family members' willingness and the benefits they attain from attending CPR. The decision should be based on the given situation, cultural context and beliefs, and current policy to guide practice.

Evaluating social rehabilitation of aggression for persons with Acquired Brain Injury: a systematic review

PURPOSE

Social rehabilitation of aggression following an Acquired Brain Injury (ABI) is critically important for persons with ABI due to increased vulnerability of criminal behaviour related to post-injury changes in functioning. This review presents findings from studies that evaluated aggression interventions in both community and forensic populations of people with ABI.

METHODS

We searched PsycINFO, EMBASE, SocINDEX, CINAHL and Medline databases for studies published between 1st January 2000 and 15th October 2023.

RESULTS

There were 15 studies (14 community-based, one forensic) that met inclusion criteria. Pharmacological management (6) was largely ineffective and anger management interventions (6) presented with inconsistent effectiveness. Emotion regulation (1) may be effective for externalised aggression. Both mindfulness and transcranial direct current stimulation (1) were effective, and the results of a forensic peer group approach (1) were not tested for statistical significance. There was variability in the measurement of aggression, injury severity, and cognitive impairment.

CONCLUSIONS

Whilst community interventions for aggression in persons with ABI are prevalent, findings for effectiveness have been mixed and there is a paucity of evaluated interventions in forensic samples. Further research is needed to unravel the complex interplay of factors contributing to aggression and develop effective social rehabilitation for persons with ABI.

Rotator Cuff Tendinopathy Diagnosis, Nonsurgical Medical Care, and Rehabilitation: A Clinical Practice Guideline

This evidence-based clinical practice guideline (CPG) aims to guide clinicians with recommendations covering the assessment, treatment, and prognosis of adults with shoulder pain with suspected rotator cuff (RC) tendinopathy, the nonsurgical medical care and rehabilitation of adults with RC tendinopathy, as well as the return to function and sport for elite and recreational athletes. This CPG includes recommendations for managing RC tendinopathy with or without calcifications and partial-thickness RC tears. J Orthop Sports Phys Ther 2025;55(4):235-274. Epub 30 January 2025. doi:10.2519/jospt.2025.13182.

How is Telehealth Used to Increase Access to Specialty Palliative Care? A Systematic Review

CONTEXT

Specialty palliative care remains inaccessible for many with serious illness, especially in rural areas. Telehealth may be one solution.

OBJECTIVES

To describe how telehealth increases access to specialty palliative care, describe facilitators and barriers to its use, and summarize evidence of patient benefits.

METHODS

We conducted a systematic review using database-specific vocabulary and Boolean logic focusing on concepts "telemedicine," "remote consultation," "palliative medicine," and "hospice care." Included articles described original research evaluating a telehealth intervention addressing ≥2 National Consensus Project for Quality Palliative Care domains. Two researchers reviewed and abstracted articles; disagreements were resolved by consensus.

RESULTS

Of 13,928 articles identified, 150 were eligible. Of these, 112 involved telemedicine (direct care from a clinician to a patient); 15 involved tele coaching (connection of non-palliative care clinician with a palliative care specialist to increase primary palliative care skills); 16 involved e-health (an app to monitor symptoms); and 7 involved e-consults (connection to a palliative care clinician to advise on a particular case). About two-thirds (65%) of articles were published since 2020. Common barriers included broadband issues, lack of familiarity with technology, and lack of access to a device. Facilitators included having a technology-skilled assistant and providing a device. Few studies assessed patient outcomes.

CONCLUSION

While telehealth is widely used to increase access to specialty palliative care, more evidence is needed to evaluate effectiveness. Further research is needed to understand how to overcome barriers prominent in rural settings and to optimize integration of multiple modalities of telehealth in specialty palliative care.

Managing egg allergy: A systematic review of traditional allergen avoidance methods and emerging graded exposure strategies

Egg allergy represents a significant and growing health concern, particularly among young children. Consequently, there has been a surge in the development of management strategies to address this issue. While oral immunotherapy presents a promising novel approach, its resource-intensive nature renders it impractical in many countries. This review aims to contrast the traditional method of strict avoidance with emerging, cost-effective alternatives for managing egg allergy at home, such as the gradual introduction via a ladder approach. Studies were identified through the search of medical databases and gray literature, with a focus on studies spanning from 2003 to 2023. Studies were independently screened and appraised by two independent reviewers. One hundred and thirty-four articles were identified. After removing duplicates and screening, 49 underwent full-text review, resulting in 28 included articles. These encompassed various study designs and originated from multiple countries, primarily the USA, Australia and Canada. The interventions mainly focused on managing IgE-mediated egg allergy through graded exposure to denatured/baked egg (n = 20), with an additional six studies exploring allergen avoidance and two studies investigating both management methods. A key observation from this review is the shift in management strategies towards incorporating methods such as graded exposure to denatured/baked egg alongside traditional allergen avoidance methods. Allergen avoidance remains the cornerstone of egg allergy management. However, there is a need for complementary approaches to optimise outcomes for individuals with egg allergy. Factors such as quality of life, including social inclusion and dietary diversity, as well as economic implications are crucial considerations.

Mother-Infant Bed-sharing Is Associated with Increased Breastfeeding: A Systematic Review

Objectives: To review current knowledge of the association between bed-sharing and breastfeeding behaviors during infancy. Methods: A systematic review methodology was employed following the Preferred Reporting Items for Systematic reviews and Meta-Analyses method and utilizing the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies for quality assessment. Inclusion criteria were quantitative or mixed-methods studies published between 1993 and 2022 that provided data on the association between bed-sharing and breastfeeding for postpartum mothers of infants 0-12 months. We excluded studies that utilized breastfeeding as the independent variable and bed-sharing as the dependent variable. Results: A total of 24 studies met the inclusion criteria, 11 of which were prospective/longitudinal and 13 of which were cross sectional. Eight of the longitudinal studies found a significant positive association between bed-sharing and breastfeeding (73%), and nine of the cross-sectional studies (69%) found a positive association. Conclusion: Many postpartum women bed-share with their infants. Bed-sharing is associated with an increase in breastfeeding for most women. There does not appear to be such a relationship between bed-sharing and breastfeeding in U.S. African American women, who have overall lower rates of breastfeeding. Policy Implications: The public health principle of risk reduction could be applied to those who plan to bed-share such as recommending that health care providers educate women about bed-sharing without hazards. Bed-sharing without hazards may be considered one strategy to promote breastfeeding.

Medical education challenges in Mainland China: An analysis of the application of problem-based learning

BACKGROUND

The medical education system in mainland China faces numerous challenges and the lack of learner-centered approaches may contribute to passive learning and reduced student engagement. While problem-based learning (PBL) is common in Western medical schools, its feasibility in China is questioned due to cultural differences. This systematic review aims to summarize the application of PBL in medical education in mainland China based on existing literature, as well as to identify the challenges and opportunities encountered in its implementation.

METHODS

A systematic literature review was conducted using electronic databases, including MEDLINE, Cochrane Library, EMBASE, Web of Science, Wan fang and CNKI databases. Grey literature sources were explored using Google Scholar. The search was limited to articles that include at least one English abstract up to May 1st, 2023. The inclusion criteria were studies that reported the use of PBL in medical education in mainland China.

RESULTS

A total of 21 articles were included in the final analysis. The findings indicate that PBL is a well-adopted and effective learning method in most medical education, especially for developing critical thinking, problem-solving, and teamwork skills. However, the application of PBL in mainland China is limited due to various challenges, including faculty resistance, inadequate resources and cultural barriers. To effectively address these challenges, it is essential to provide faculty training, develop appropriate assessment methods to evaluate student progress within the PBL framework and create conducive spaces and resources that support collaborative learning and critical thinking.

CONCLUSION

The utilization of PBL in mainland China holds potential for enhancing medical education. However, its successful implementation requires significant efforts to address the identified challenges. It is crucial to engage stakeholders in a collaborative effort to promote the application of PBL and ultimately improve the quality of medical education in mainland China.

Effects of social skills training on social responsiveness of people with Autism spectrum disorder: a systematic review with meta-analysis

Social skills training (SST) is a widely proposed intervention to address social impairments in autism spectrum disorder (ASD). SST employs a series of activities aiming to enhance pro-social behaviors. A promising approach to evaluate SST's effects lays on social responsiveness (SR) indicators, which are related to the capacity to respond appropriately to social stimuli. Despite the widespread use of SST, there are no integrative studies evaluating its effects on the SR of ASD people. We performed a systematic review with meta-analysis investigating the effects of SSTs in SR indicators of individuals with ASD. PRISMA guidelines were considered to search through EMBASE, PubMed, PsycINFO, and Scopus without timeframes or language restrictions. Randomized controlled trials (RCTs) were included only. Jamovi (version 1.6) was used to perform the meta-analysis with the standardized mean difference (SMD) between pre and post-intervention scores (∆) as the outcome measure. Twenty-seven papers composed the review and 25 the meta-analysis. The population was predominantly male (80%), with a mean age of 13.03 years. Interventions were mostly conducted in group settings. Meta-analysis indicated the set of interventions as capable of improving SR indicators of ASD people (SMD = 0.57 (CI 95% 0.46-0.67; p < 0.0001). Although our findings cannot support PEERS program as quantitatively superior to other programs, its methodological consistency, treatment adherence and involvement of parents are noteworthy. SST appears to be a viable, versatile, and easily implementable intervention to improve SR of individuals with ASD.

Systematic review of soft-to-hard tissue ratios in orthognathic surgery: 3D analysis-update of scientific evidence

The aim of this research was to determine the soft-to-hard tissue ratio using three-dimensional (3D) analysis in different types of orthognathic surgery and to update the most recent scientific evidence provided in 2017. A systematic search covering the period January 2017-December 2023 was performed in the MEDLINE, Embase, LILACS, Scopus, and Science Direct databases to identify relevant studies. The methodological quality of the included studies was assessed using the method proposed by the Effective Public Health Practice Project. Of 897 articles identified in the database search, 10 were included in this review. These articles included analyses of points or anatomical areas of the face, and all of them used image superimposition for the analysis. The clinical analyses of the perinasal region, upper lip, and chin region produced ambiguous results. The bias in methods and variables, such as the types of surgery, patient variables, and differences in diagnosis may limit the use of the information obtained. There are no data that can be applied to daily clinical practice; the limited evidence that was previously published in 2017 remains.

The association of particulate matter PM2.5 and nitrogen oxides from ambient air pollution and mental health of children and young adults- a systematic review

INTRODUCTION

The developing brain, especially vulnerable during neuroplastic phases, is influenced by environmental and genetic factors. Understanding the impacts of air pollution on children's and young adults' mental health is an emerging research field.

CONTENT

This review systematically examines the adverse associations of ambient air pollutants on mental health. A database search using Scopus, EMBASE, Global Health, and PsycINFO included articles from 2013 onwards, following PRISMA guidelines. Of the 787 identified articles, 62 met the inclusion criteria. Quality was assessed using the EPHPP tool, and Best Evidence Synthesis (BES) evaluated the findings.

SUMMARY

The review found 36 associations between ambient air pollutants and adverse mental health outcomes across seven life-course exposure periods. Strong evidence linked early-life PM2.5 and NO2 exposures to Autism Spectrum Disorder (ASD) and childhood exposures to Attention Deficit Hyperactivity Disorder (ADHD). Significant, though inconsistent, associations were found between air pollutants and cognitive impairments, anxiety, depression, self-harm, and other behavioral problems. The heterogeneity of exposure limits and lack of experimental studies hinder causal assessment.

OUTLOOK

Compelling evidence links early-life and childhood exposure to PM2.5 and NO2 with ASD and ADHD. These findings highlight the need for public health policy changes and further research to explore these associations comprehensively.

Voice Meets Swallowing: A Scoping Review of Therapeutic Connections

PURPOSE

This scoping review aimed to explore the use of volitional voice tasks in assessing swallowing-related outcomes and to evaluate their therapeutic impact on swallowing disorders, including their effects on swallowing biomechanics.

METHOD

This scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. A literature search was performed across multiple databases (PubMed, Web of Science, and Scopus), and additional records were identified through manual searches. After screening and eligibility assessment, 36 studies were included for data extraction and analysis. The Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies was employed to evaluate the quality of the included studies.

RESULTS

The review identified various volitional voice tasks, such as maximum phonation time and pitch glides, as potential assessment tools for predicting swallowing-related outcomes. Additionally, voice tasks targeting pitch modulation, increased vocal loudness, and squeezed voice quality showed promising therapeutic benefits for swallowing disorders across different populations, especially individuals with neurological conditions and head and neck cancer.

CONCLUSIONS

While methodological limitations were found in current literature, volitional voice tasks demonstrate potential as complementary tools for assessing and treating swallowing disorders, leveraging their interconnected neurological and biomechanical mechanisms underlying functions. Further research with more robust methodologies is needed to establish the efficacy of these integrated interventions, facilitate their translation into clinical practice, and test new possibilities.

Cannabis use and suicide in people with a diagnosis of schizophrenia: a systematic review and meta-analysis of longitudinal, case control, and cross-sectional studies

Cannabis use is highly prevalent in people with schizophrenia and is related to adverse clinical outcomes, including relapse and hospitalization. However, the relationship between cannabis and suicide remains inconclusive. This study aimed to systematically review and meta-analyze the relationship between cannabis use and suicide-related outcomes in people with schizophrenia. A comprehensive search of Medline, Embase, and PsycINFO for cross-sectional, case-control, and longitudinal studies was conducted using search terms from database inception to November 2024 inclusive. Computation of odds ratios (ORs) and hazard ratios (HRs) was performed using random effects models with DerSimonian-Laird estimation. All studies were appraised for quality. We also evaluated heterogeneity, publication bias and performed sub-group analyses and meta-regression. Twenty-nine studies comprising 36 samples met eligibility criteria. Cannabis use was not associated with odds of suicide death or suicidal ideation but was associated with risks of suicide death (HR = 1.21, 95% CI = 1.04 - 1.40) and odds of attempted suicide (OR = 1.40, 95% CI = 1.16 - 1.68). While between-sample heterogeneity was moderate in analyses of attempted suicide (I2 = 39.6%, p = 0.03), there was no publication bias. Summary effects remained significant in most sub-groups, but just failed to reach significance in longitudinal studies of attempted suicide (OR = 1.40, 95% CI = 0.97 - 1.68) and studies investigating first episode samples (OR = 1.24, 95% CI = 0.99 - 1.55). Cannabis use is significantly associated with some, but not all, suicide-related outcomes in people with schizophrenia. More work is needed to examine potential mechanisms of significant relationships.

Core beliefs in psychosis: a systematic review and meta-analysis

Increasing interest is growing for the identification of psychological mechanisms to account for the influence of trauma on psychosis, with core beliefs being proposed as a putative mediator to account for this relationship. A systematic review (n = 79 studies) was conducted to summarise the existing evidence base regarding the role of core beliefs/schemas in psychosis, Clinical High-Risk (CHR), and non-clinical samples with Psychotic-Like Experiences (PLEs). Compared to Healthy Controls (HCs), individuals with psychosis experiencing Auditory Hallucinations or Persecutory Delusions had significantly higher scores for negative self and negative other-beliefs and significantly lower scores for positive self and positive other-beliefs. This pattern of core beliefs was also observed for CHR individuals. In contrast, the core belief profile for grandiose delusions was in the opposite direction: higher positive self and positive other-beliefs and lower negative self-beliefs. In non-clinical samples, several factors mediated the relationship between Traumatic Life Events (TLEs) and PLEs, such as greater perceived stress, dissociation, external locus of control, and negative self and negative other-beliefs. Compared to HCs, meta-analyses revealed statistically significant large effects for negative self and negative other-beliefs in Schizophrenia. In CHR, statistically significant large and moderate effects were found for negative self and negative other-beliefs, respectively, along with a moderate negative effect for positive self-beliefs. Core beliefs were found to play a significant role in the development and maintenance of positive symptoms of psychosis. The development of psychosocial interventions that explicitly target negative self and other-beliefs, whilst also enhancing positive self-beliefs are warranted and would innovate CBTp practices.

Interventions to Reduce Loneliness among Community-dwelling Older Adults: A Network Meta-analysis and Systematic Review

OBJECTIVES

This study aimed to evaluate the effectiveness of interventions in reducing loneliness among community-dwelling older adults.

DESIGN

A network meta-analysis (NMA) and systematic review.

SETTING AND PARTICIPANTS

Interventional studies were included if they contained original quantitative data on interventions to reduce loneliness among community-dwelling older adults. Qualitative studies were included if they contained views on loneliness coping strategies or intervention evaluation.

METHODS

Six English databases and 3 Chinese databases were searched for studies published before August 2023. We extracted mean and standard deviation for the NMA to examine the overall effectiveness and efficacy of different interventions on loneliness. Thematic analysis was used to derive perspectives on coping strategies to mitigate loneliness.

RESULTS

Forty-six quantitative studies with 6049 participants and 40 qualitative studies with 1095 participants were included in the analysis. The pooled effect size was large and significant [standardized mean difference (SMD), -0.95; 95% CI, -1.32 to -0.58; P < .001], indicating a strong effect of interventions in reducing loneliness. Subgroup analyses revealed significant differences in effect sizes by study region and health risk. Results of the NMA suggested interventions seem to be most effective when having psychosocial interventions as the content, a combination of individual and group as the delivery mode, and a mixture of face-to-face and online methods as the contact mode. Findings of the qualitative synthesis revealed 2 main dimensions of activities for reducing loneliness, including delivery modes (individual or group or combination) and settings (indoor or outdoor or combination). Strategies for coping with loneliness at the social, cognitive, and behavioral levels were also identified.

CONCLUSIONS AND IMPLICATIONS

The present study identified the most effective components of loneliness interventions in reducing loneliness among older adults. Findings offer important insights for practice and policy-making on potential strategies that can be used to reduce loneliness among community-dwelling older adults.

Optimizing mealtime care and outcomes for people with dementia and their caregivers: A systematic review and meta-analysis of intervention studies

Interventions addressing modifiable personal and environmental factors are critical to optimize dementia mealtime care, caregiving, and outcomes. This review synthesized the characteristics and effects of non-pharmacological interventions on mealtime care and outcomes in people with dementia and their caregivers. Five databases were searched from January 2012 to October 2024. Eligible studies were accessed for study quality and graded for level of evidence. Meta-analyses were performed for studies within the same intervention type that tested the impact on same outcomes. 33 studies were identified and categorized into five intervention types. Five studies were strong, 7 moderate, and 21 weak in quality. The levels of evidence varied from very low to moderate, with most being very low to low. Meta-analyses showed "resident training/therapy" decreased eating difficulties and increased food intake; "Nutritional supplement" improved cognition and depression; "environmental/food modification" increased food intake. Further research using rigorous designs is needed to increase evidence quality and determine effects of multi-component interventions. HIGHLIGHTS: Five intervention types were identified from the 33 included studies: nutritional supplements, resident training/therapy, caregiver training and/or mealtime assistance, environmental/food modification, and multiple component interventions. One-third of the included studies were strong to moderate, and two-thirds were weak in study quality. "Resident training/therapy" showed effects in reducing eating difficulties and increasing food intake. "Environmental/food modification" showed effects in increasing food intake. "Nutritional supplements" showed effects in improving cognitive function and depression.

The effect of breast cancer awareness interventions on young women aged 18-50 years: A systematic review

A scarcity of research has examined the effect of breast cancer awareness (BCA) interventions among young women (18-50 years). This overlooks important differences that may affect BCA levels such as education preferences within this younger cohort. Younger women are more likely than older women to present with aggressive subtypes of breast cancer if they develop the disease, and at a more advanced stage translating into poorer survival. It is therefore worthy to investigate which interventions have a significantly positive effect on BCA within this cohort. Five studies were deemed eligible for review. Despite differing intervention methods, theoretical applications and awareness targets, positive outcomes were reported across all designs. However, the evidence is weak in investigating the effectiveness of BCA interventions on this cohort and is considered as inconclusive with such a small number of available studies to review, highlighting a need for further research in this area.

Mindfulness- and acceptance-based interventions for people with spinal cord injury: a scoping review

STUDY DESIGN

Scoping review.

OBJECTIVE

To synthesize the effects of mindfulness- and acceptance-based interventions (MABIs) on health-related outcomes of individuals with spinal cord injury.

SETTING

The included studies were conducted across four countries: The United States, Iran, China, and The United Kingdom.

METHODS

This review followed the Arksey and O'Malley framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guideline. Seven databases were searched until November 2024 to identify studies published in English-language that evaluated MABIs' effects on health-related outcomes in people with spinal cord injury. Literature screening, data extraction, and quality assessment were conducted by two reviewers independently. A narrative data synthesis was conducted.

RESULTS

Of 2389 records, nine studies were included with designs of randomized controlled trials (n = 4), quasi-experimental studies (n = 3), and case studies (n = 2). Acceptance commitment therapy (n = 4) and mindfulness-based interventions (n = 5) were employed. MABIs demonstrated significant improvements in psychological health outcomes (depression, n = 3; anxiety, n = 3; stress, n = 2) with medium-to-large effect sizes (η p 2 = 0.112 - 0.223 ) and other health-related outcomes (chronic pain, n = 1; functional independence, n = 1; engagement in meaningful activities, n = 1; and quality of life, n = 1). Participants found the MABIs to be acceptable and satisfactory. Study quality varied from weak (n = 6) to strong (n = 2).

CONCLUSIONS

The findings generally support the acceptability and effectiveness of MABIs for improving the overall well-being of individuals with SCI. Future research directions regarding designing MABIs and exploring effectiveness mechanisms were recommended for maximizing its benefits.

Psychotherapy in patients with long/post-COVID - A systematic review on the feasibility, acceptability, safety, and efficacy of available and emerging interventions

BACKGROUNDS

There is an urgent need for effective treatments for patients with long/post-COVID. Current recommendations for management favor a multimodal approach including psychotherapy and emphasize that interventions should also consider the mental health impact of living with long/post-COVID. This systematic review synthesizes psychotherapeutic interventions that currently target long/post-COVID complaints and summarizes data on the feasibility, acceptability, safety, and efficacy of psychotherapy for patients with long/post-COVID.

METHODS

This systematic review was conducted according to the PRISMA statement. Studies were retrieved from three databases (PubMed, PsycInfo, Web of Science) and independently assessed by two raters. Studies investigating patients of any age suffering from long/post-COVID were included if the intervention involved psychotherapeutic treatment and changes in long/post-COVID symptoms were reported. The review has been pre-registered on PROSPERO.

RESULTS

A total of 12 studies were included in the analysis. Of these, 10 were multimodal approaches with integrated psychotherapeutic interventions, and two were studies on stand-alone psychotherapy. The majority of studies were uncontrolled and demonstrate pre-post improvements in a range of long/post-COVID symptoms. Only one RCT could be identified, which supports the benefit of CBT for COVID-related fatigue. It was not possible to draw general conclusions regarding the efficacy of psychotherapy for long/post-COVID. However, data on feasibility, acceptability, and safety support the potential of psychotherapy as a treatment approach for long/post-COVID.

CONCLUSION

Future studies investigating the potential of psychotherapy approach for long/post-COVID which go beyond the pilot stage are needed to systematically assess feasibility, acceptability, safety, and efficacy in large-scale confirmatory trials.

Nutrition Interventions to Improve the Military Nutrition Environment Positively Impact Service Members

INTRODUCTION

This systematic review examines dietary interventions in the military nutrition environment (MNE) to support the health and performance of service members (SM).

METHODS

Articles that implemented a dietary intervention for active duty SMs on military installations were included in this analysis (from 2010 to 2013). Of the 723 articles yielded in screening through Covidence, 6 studies qualified to be included in this review.

RESULTS

Study interventions were grouped into color coding, food choice architecture, and menu modifications. All studies indicated increased nutrient intake. One study reported enhanced diet quality using the Healthy Eating Index. Two studies received positive customer feedback, and all selected studies demonstrated positive behavior modification among SM.

DISCUSSION

All studies demonstrated improvement in diet-related outcomes, and behavior modification. Many barriers exist within MNE that need to be addressed to make meaningful changes. The heterogeneity in study designs and interventions poses challenges in reaching definitive conclusions.

IMPLICATIONS FOR RESEARCH AND PRACTICE

These results highlight the need for a more extensive examination of the military food environment across all venue types. Replication of standardized nutrition practices throughout the diverse military landscape can further impact the health, readiness, and performance of SM.

Contemporary media campaigns for musculoskeletal pain: A systematic review and meta-analysis with social marketing benchmarking

Musculoskeletal pain is a global public health problem. Social marketing aims to increase adoption of desired behaviours in target audiences and may uncover new strategies to improve uptake of helpful pain-related behaviours at the population-level. We systematically evaluated effects of contemporary mass media campaigns targeting musculoskeletal pain and used social marketing benchmarking to explore strategies associated with campaign success. Published evaluations of campaigns involving an online/digital component and a comparator/control condition were eligible. The primary outcome was population beliefs; secondary outcomes were healthcare provider beliefs, behavioural (e.g., healthcare-related, work-related), clinical (e.g., pain), and economic outcomes. Decision-rules and meta-analyses (random-effects models) were used to synthesise findings. Eight databases and grey literature were searched from inception to May 2024. Thirteen eligible publications evaluated eight campaigns (N = 5 back pain, N = 2 rheumatic pain; N = 1 work-related pain) from eight Western/high-income countries. All evaluations reported historical control data (interrupted time-series/before-and-after designs); three also compared selected outcomes to an unexposed geographical region (quasi-experimental designs). Risk of bias was weak-moderate for all evaluations. Population beliefs improved from baseline vs. final follow-up (1.5-10yrs) for items related to 'staying active' [RR = 1.38 (95%CI: 1.14-1.67), N = 4 campaigns, n = 12,568 participants] and 'rest' [RR = 1.35 (95%CI: 1.14-1.60), N = 5 campaigns, n = 14,571 participants] for pain management, however, certainty of evidence was very low. Other outcomes were not pooled due to heterogeneity, and evidence was mixed. Greater numbers of social marketing benchmarks were associated with successful campaign outcomes. Future campaigns should implement social marketing strategies beyond education alone, including behaviour change support, to facilitate adoption of desired pain-related behaviours. REGISTRATION: PROSPERO registration number: CRD42023400456; Open Science Framework (detailed Social Marketing Benchmarking analysis plan): https://osf.io/npyck/. PERSPECTIVE: We systematically evaluated contemporary mass media campaigns targeting musculoskeletal pain. Promising improvements in population beliefs about pain supports continued investment into campaigns. Our review provides critical new information including social marketing strategies to ensure future campaign efforts shift population-level pain-related behaviours, towards reducing the societal burden of pain.

Addressing dishonesty in nursing education: A systematic review of intervention effectiveness

AIM

This systematic review evaluates the effectiveness of educational interventions to reduce academic and clinical dishonesty among nursing students. It examines these interventions' objectives, content, instructional methods, duration and assessment outcomes to identify gaps and opportunities for fostering ethical behavior.

BACKGROUND

Academic and clinical dishonesty among nursing students threatens professional integrity and patient safety but remains under-researched, especially in clinical settings.

METHODS

Following PRISMA guidelines, a systematic search was conducted in EMBASE, EBSCO, PROQUEST, PubMed and Scopus for peer- review studies published between 2010 and 2024. Three researchers independently performed the selection and data extraction process. The quality of the studies was assessed using the Public Health Effectiveness Project tool, which was adapted for interventional studies. The study protocol was registered in PROSPERO [Registration Number CRD42024595490].

RESULTS

Only four studies met the inclusion criteria, originating from the USA, Iran and Australia. All educational interventions focused exclusively on academic dishonesty, with an emphasis on plagiarism. The educational content ranged from theoretical understanding to practical skills, such as citation and paraphrasing. However, none of the interventions addressed clinical dishonesty, highlighting a critical gap in nursing education. The effectiveness of these educational interventions was predominantly assessed through self-reported improvements in knowledge and attitudes.

CONCLUSIONS

The systematic review highlights significant gaps in educational interventions for preventing dishonesty among nursing students. The focus on plagiarism, without addressing clinical dishonesty, underscores the need for comprehensive curricula. A systematic approach integrating academic and clinical dishonesty is vital to strengthen professional identity and ethical standards.

Smoking Cessation Programs for Women in Non-reproductive Contexts: A Systematic Review

BACKGROUND

Women's smoking and cessation behaviors are influenced by various sex- and gender- (SaG) related factors; however, most smoking cessation programs that do not target pregnant women follow a gender-neutral approach. We aimed to systematically review the literature on smoking cessation programs for women outside reproductive contexts to assess their effectiveness and how they address SaG-related barriers.

METHODS

We selected experimental studies published between June 1, 2009, and June 7, 2023, that describe smoking cessation interventions designed exclusively for women. Two independent reviewers extracted study characteristics, intervention effectiveness, strategies to address SaG-related factors, and the studies' approach to gender equity using the gender integration continuum. We searched multiple databases to comprehensively identify relevant studies for inclusion. The protocol was registered with PROSPERO #CRD42023429054.

RESULTS

Twenty-five studies were selected and summarized using a narrative synthesis. Of these, nine (36%) found a greater reduction in smoking in the intervention group relative to the comparison group. Nine studies addressed women's concerns about post-cessation weight gain; however, in only one of these did the intervention group show a greater likelihood of quitting smoking relative to the comparison group. In contrast, three of four studies tailored for women facing socioeconomic disadvantage, and three of four studies designed for women with medical comorbidities, reported a greater reduction in smoking behaviors in the intervention relative to the comparison group. Ten studies relied solely on counseling and did not provide participants with smoking cessation pharmacotherapy. Overall, studies addressed individual and community-level barriers to quitting, including post-cessation weight gain, lack of social support, psychological distress, and cultural influences. All but one study avoided using harmful gender norms to promote cessation.

CONCLUSIONS

Strategies that address SaG-related barriers to quitting may improve cessation outcomes among women, particularly when tailored to meet the unique needs of specific groups such as those facing socioeconomic disadvantage. Future studies should combine best practices in smoking cessation treatment-behavioral counseling and pharmacotherapy-with new knowledge on how SaG factors influence motives for smoking and barriers to quitting. Such an approach could lead to more effective and equitable smoking cessation interventions for women.

Problematic Sexual Behavior Among Children: A Meta-Analysis of Demographic and Clinical Correlates

Problematic sexual behavior (PSB) are behaviors that involve sexual body parts and that are developmentally inappropriate or potentially harmful among children ages 12 and younger. PSB has been associated with different types of maltreatment as well as clinical difficulties, albeit inconsistently. The aim of this meta-analysis was to summarize the current research on correlates of PSB, specifically child demographic factors (i.e., gender, age), maltreatment history (i.e., childhood sexual abuse [CSA], childhood physical abuse [CPA]), and comorbid clinical symptoms (i.e., externalizing and internalizing problems). A total of 47 samples (n = 15,562 children) were included. Males and younger children were slightly more likely to exhibit PSB (g = .12 and -.21, respectively). CSA was associated with PSB (g = .71); however, the strength of this relationship differed by caregiver gender and publication year. CPA was also related to PSB (g = .32), but was more strongly associated when PSB was limited to the interpersonally intrusive subtype of PSB (g = .46). Externalizing (g = .95) and internalizing (g = .63) symptoms were also linked with PSB, with externalizing difficulties evincing the strongest association of all of the correlates. These results are discussed in the context of advancing research on PSB, specifically addressing several limitations in the current literature. These include inconsistent assessment of PSB and CSA, as well as the pressing need to develop a more robust measure of PSB. Finally, a more comprehensive assessment of the correlates of PSB is needed to address significant common method variance.

Interventions aimed at preventing suicide in the healthcare workforce: a systematic review

Healthcare workers are exposed to various factors in the workplace that may put them at an increased risk of suicide, but there is a lack of evidence reviewing interventions put in place by employers that may modify this risk. The authors undertook a systematic review to identify and assess organisational interventions aimed at preventing suicide in the healthcare workforce. Databases were systematically searched between January 2022 and August 2022. Eligibility for inclusion in the review was determined using a population, intervention, comparison, outcome framework, and 12 studies met the inclusion criteria. Studies were summarised using narrative synthesis and interventions included education, screening, modification of the workplace, referrals for support and/or therapy and peer support. Outcomes included: uptake, satisfaction, pre-training and post-training knowledge, symptoms, risk of suicide and economic costs. It was identified that various suicide prevention interventions are feasible in healthcare organisations and likely to have positive effects for staff. However, there is a lack of robust evaluation of these interventions, so further research is warranted.

The cognitive model of negative symptoms: a systematic review and meta-analysis of the dysfunctional belief systems associated with negative symptoms in schizophrenia spectrum disorders

BACKGROUND

The hypothesized cognitive model of negative symptoms, proposed nearly twenty years ago, is the most prevalent psychological framework for conceptualizing negative symptoms in schizophrenia spectrum disorders (SSDs). The aim of this study was to comprehensively validate the model for the first time, specifically by quantifying the relationships between negative symptom severity and all related dysfunctional beliefs.

METHODS

A systematic search was conducted using MEDLINE and PsychINFO, supplemented by manual reviews of reference lists and Google Scholar. Eligible studies were peer-reviewed with data on the direct cross-sectional association between negative symptoms and at least one relevant dysfunctional belief in SSD patients. Screening and data extraction were completed by independent reviewers. Random-effects meta-analyses were performed to pool effect size estimates of z-transformed Pearson's r correlations. Moderators of these relationships, as well as subset analyses for negative symptom domains and measurement instruments, were also assessed.

RESULTS

Significant effects emerged for the relationships between negative symptoms and defeatist performance beliefs (k = 38, n = 2808), r = 0.23 (95% CI, 0.18-0.27), asocial beliefs (k = 8, n = 578), r = 0.21 (95% CI, 0.12-0.28), low expectancies for success (k = 55, n = 5664), r = -0.21 (95% CI, -0.15 - -0.26), low expectancies for pleasure (k = 5, n = 249), r = -0.19 (95% CI, -0.06 - -0.31), and internalized stigma (k = 81, n = 9766), r = 0.17 (95% CI, 0.12-0.22), but not perception of limited resources (k = 10, n = 463), r = 0.08 (95% CI, -0.13 - 0.27).

CONCLUSIONS

This meta-analysis provides support for the cognitive model of negative symptoms. The identification of specific dysfunctional beliefs associated with negative symptoms is essential for the development of precision-based cognitive-behavioral interventions.

Prevalence of mental health conditions, substance use disorders, suicidal ideation and attempts, and experiences of homelessness among Veterans with criminal-legal involvement: A meta-analysis

Veterans with histories of criminal-legal system involvement are considered high-priority within Veterans Health Administration (VHA) and criminal-legal settings. Over several decades, a large literature has accumulated to study these Veterans' needs. To consolidate findings, this meta-analysis provides aggregated prevalence estimates of common mental health conditions, substance use disorders, suicidal thoughts and behaviors, and experiences of homelessness among Veterans with current or prior involvement with the United States criminal-legal system. A total of 79 samples encompassing over 1.2 million Veterans were analyzed. Results estimate 8 in 10 Veterans with criminal-legal involvement experience a mental health condition, 7 in 10 a substance use disorder, 1 in 10 a history of suicidal ideation, and 4 in 10 a history of homelessness. Veterans with current (versus prior) criminal-legal involvement had higher rates of alcohol use, drug use, and current homelessness. Samples consisting of Veterans with a history of incarceration and samples collected in non-VHA settings tended to have lower rates of psychosocial difficulty relative to samples consisting of Veterans with other forms of criminal-legal involvement or collected in VHA settings, respectively. Remaining gaps in the literature include research on criminal-legal involved Veterans under community supervision, and/or from demographic minority groups.

A meta-analysis of the effect of visiting zoos and aquariums on visitors' conservation knowledge, beliefs, and behavior

Zoos and aquariums are well placed to connect visitors with the issues facing biodiversity globally and many deliver interventions that seek to influence visitors' beliefs and behaviors with respect to conservation. However, despite primary studies evaluating the effect of such interventions, the overall effect of engaging with zoos and the factors that influence this effect remain unclear. We conducted a systematic review to investigate the effect of zoo-led interventions on knowledge, beliefs (attitudes, intentions, self-efficacy, and social norms), and behavior among zoo visitors. These outcomes were identified using the Theory of Planned Behavior as a theoretical lens. We identified and described the nature of zoo-led interventions in 56 studies and used the behavior change technique (BCT) taxonomy to identify 6 specific BCTs used in interventions to date. Multilevel meta-analyses revealed a small to medium positive effect of engaging with zoo-led interventions on outcomes (d+ = 0.40, 95% confidence interval = 0.28-0.51). Specifically, visitors were more knowledgeable about conservation issues, held more favorable attitudes toward conservation, and reported being more likely to act for the benefit of biodiversity. No evidence of publication bias was present. Effect sizes were, however, heterogeneous and subgroup analyses revealed that the nature of the intervention or type of outcome did not explain this variance. Larger effects were, however, found in studies conducted at a single institution relative to research at multiple institutions and studies that used within-participant designs relative to between-participant designs. Taken together, these findings demonstrate how behavior change frameworks can be used to describe zoo-led interventions and supports the assertion that zoos and aquariums can promote changes in beliefs and behaviors that may help protect biodiversity.

Evaluating the effectiveness of intensive family preservation services: A multi-level meta-analysis

BACKGROUND

Intensive Family Preservation Services (IFPS) are an important part of child welfare. They are short-term, in-home treatment programs aimed at preventing imminent out-of-home placements, however, today, their overall effectiveness remains unclear.

OBJECTIVE

This study aims to conduct a comprehensive review of IFPS effectiveness, evaluate a wide range of outcomes, and analyze the impact of various factors on its success.

METHODS

A three-level meta-analysis was conducted on 33 controlled trial studies comprising 226 effect sizes to test whether the effectiveness of IFPS was influenced by study, program, target, sample, and outcome characteristics.

RESULTS

Analyses showed that IFPS did have a modest overall effect on treatment outcomes (g = 0.18), with notable variations across different outcome measures, showing small and positive effects on out-of-home placement (g = 0.31), family functioning (g = 0.19), juvenile delinquency (g = 0.19), and parental psychopathology (g = 0.34). Greater program intensity was associated with smaller effects, and follow-up assessment yielded larger effects than post-test assessments, indicating that positive intervention effects increased over time.

CONCLUSIONS

The findings suggest a rather limited effectiveness of IFPS, indicating that both practice and policy should take this into account. Recommendations for future research are provided to further enhance understanding and improvement of IFPS interventions.