Effective Public Health Practice Project Research Articles

Review of national nutrition standards with salt-related criteria for publicly funded institutions around the world.

Creating healthy food environments through nutrition standards for publicly funded institutions (eg, schools, workplaces, and hospitals) provides an important opportunity to improve population diets. This study aimed to identify countries with national nutrition standards for publicly funded institutions that included salt-related criteria and to describe and summarize these initiatives. Peer-reviewed and grey literature was searched to December 2019, including MEDLINE, CENTRAL, Embase, TRoPHI, LILACS, Web of Science, Cochrane Public Health Group Specialised Register, and Effective Public Health Practice Project Database. In addition, a questionnaire was sent to country contacts and salt-reduction experts, and a targeted search on relevant government websites was conducted. Key characteristics of the national nutrition standards for publicly funded institutions were extracted, including name, governance, institution type, implementation status, and details of food and nutrient criteria. Nutrition standards were analyzed by World Health Organization region, World Bank income level, institution type, type of criteria, regulatory approach, and method of application. Sixty-six countries were identified as having national nutrition standards that included salt-related criteria for at least one publicly funded institution. Standards were more prevalent in the European Region, high-income countries, and schools compared to other regions, income levels, and institution types, respectively. Most standards were mandatory and contained nutrition criteria pertaining to both foods and nutrients. Nutrition standards have the potential to significantly improve diets, but there is considerable scope to develop and implement nutrition standards more effectively using the new World Health Organization Action Framework.

Effects of reducing sedentary behaviour duration by increasing physical activity, on cognitive function, brain function and structure across the lifespan: a systematic review protocol

IntroductionGreater engagement in sedentary behaviours has been related to poorer cognitive functions in epidemiological research. However, the effects of reducing sedentary behaviour duration on cognitive function, brain function, and structure...

Effects of school-based interventions on Food and Nutrition Literacy (FNLIT) in primary-school-age children: a systematic review.

This study systematically reviewed the evidence on interventions seeking to improve Food and Nutrition Literacy (FNLIT) functional, interactive and critical skills in primary school-aged children. Electronic databases, including PubMed/MEDLINE, SCOPUS, Web of Science, Cochrane, Pro-Quest and Google Scholar were systematically searched. Randomised and non-randomised controlled trials, pre-/post-test and case-control designs were included. The primary outcomes were three levels of FNLIT: functional, interactive and critical. All citations, full-text articles and abstract data were screened by two independent reviewers. Any conflicts were then resolved through discussion. The quality of the included studies was individually evaluated using the Effective Public Health Practice Project (EPHPP) quality assessment tool. Two reviewers extracted data from the included studies, and a descriptive analysis was performed. The quality of all eligible studies (n 19) was rated as moderate/weak. A wide variety of skill-building activities were introduced by programmes, including recipe skills/food preparation, food label literacy, food tasting, gardening harvesting, and supporting cultural practices and ethnic foods. Only four studies measured food literacy (FL) (food label literacy) via a valid measure. Most interventions focused on the functional level of FL, except for two programmes (one scored weak and one scored moderate). In most of the studies, delivery of intervention content was facilitated by teachers (n 15). Promising interventions were tailored to the needs and interests of students, incorporated into the existing curriculum and facilitated by teachers. The successful intervention strategies led to improvements in functional, partly interactive and critical skills. Future interventions should focus, holistically, on all aspects of FNLIT, especially interactive and critical skills.

Recovery expectations can be assessed with single-item measures: findings of a systematic review and meta-analysis on the role of recovery expectations on return-to-work outcomes after musculoskeletal pain conditions.

The objective of this systematic review is to quantify the association between recovery expectations and return-to-work outcomes in adults with musculoskeletal pain conditions. In addition, this review has the second objective to compare the predictive utility of single-item and multi-item recovery expectation scales on return-to-work outcomes. Relevant articles were selected from Embase, PsycINFO, PubMed, Cochrane, and manual searches. Studies that assessed recovery expectations as predictors of return-to-work outcomes in adults with musculoskeletal pain conditions were eligible. Data were extracted on study characteristics, recovery expectations, return-to-work outcomes, and the quantitative association between recovery expectations and return-to-work outcomes. Risk of bias was assessed using the Effective Public Health Practice Project. Odds ratios were pooled to examine the effects of recovery expectations on return-to-work outcomes. Chi-square analyses compared the predictive utility of single-item and multi-item recovery expectation scales on return-to-work outcomes. Thirty studies on a total of 28,741 individuals with musculoskeletal pain conditions were included in this review. The odds of being work disabled at follow-up were twice as high in individuals with low recovery expectations (OR = 2.06 [95% CI 1.20-2.92] P < 0.001). Analyses also revealed no significant differences in the predictive value of validated and nonvalidated single-item measures of recovery expectations on work disability (χ 2 = 1.68, P = 0.19). There is strong evidence that recovery expectations are associated with return-to-work outcomes. The results suggest that single-item measures of recovery expectations can validly be used to predict return-to-work outcomes in individuals with musculoskeletal pain conditions.

Does persistent precarious employment affect health outcomes among working age adults? A systematic review and meta-analysis

ObjectiveTo evaluate the impact of persistent precarious employment (lasting 12+ months) on the health of working age adults, compared with more stable employment. Persistent precarity reflects a shift towards less...

Impact of smoking bans and other smoking cessation interventions in prisons, mental health and substance use treatment settings: A systematic review of the evidence

We conducted a systematic review to examine whether smoking bans alone are effective in achieving smoking cessation in people released from prison, and patients discharged from mental health or substance use settings. We searched health, criminology and social science databases. Detailed search strings were used to combine terms related to smoking bans and cessation interventions in prison, mental health and substance use treatment settings. We used backward and forward snowballing and manual hand searching to find additional studies. Studies were included if they: were published between 1 January 2000 and 25 February 2022; included a complete smoking ban; measured people released from prison and/or mental health and/or substance use patients smoking post-release/discharge from a smoke-free facility; and reported smoking cessation intervention and/or smoking ban outcomes. Methodological quality was assessed using the Effective Public Health Practice Project's Quality Assessment Tool for Quantitative Studies and reviewed by two authors. People released from prison, mental health and substance use in-patients who experience a smoking ban while incarcerated or in in-patient settings often relapse to smoking shortly after release or discharge. We found that although smoking bans alone do not promote cessation, multi-component interventions in combination with smoking bans can significantly increase cessation rates post-release/discharge provided they support participants during this time. There is limited evidence to suggest tobacco bans alone in prison, mental health and substance use treatment settings are effective in achieving long-term smoking cessation. This review suggests that combining smoking bans and cessation interventions including pre- and post-release/discharge support can be effective in achieving smoking cessation.

Content and Effectiveness of Web-Based Treatments for Online Behavioral Addictions: Systematic Review.

BackgroundVery few people seek in-person treatment for online behavioral addictions including gaming and gambling or problems associated with shopping, pornography use, or social media use. Web-based treatments have the potential to address low rates of help seeking due to their convenience, accessibility, and capacity to address barriers to health care access (eg, shame, stigma, cost, and access to expert care). However, web-based treatments for online behavioral addictions have not been systematically evaluated.ObjectiveThis review aimed to systematically describe the content of web-based treatments for online behavioral addictions and describe their therapeutic effectiveness on symptom severity and consumption behavior.MethodsA database search of MEDLINE, Embase, PsycInfo, Web of Science, Cochrane Central Register of Controlled Trials, and Google Scholar was conducted in June 2022. Studies were eligible if the study design was a randomized controlled trial or a pre-post study with at least 1 web-based intervention arm for an online behavioral addiction and if the study included the use of a validated measure of problem severity, frequency, or duration of online behavior. Data on change techniques were collected to analyze intervention content, using the Gambling Intervention System of CharacTerization. Quality assessment was conducted using the Effective Public Health Practice Project Quality Assessment Tool.ResultsThe review included 12 studies with 15 intervention arms, comprising 7 randomized controlled trials and 5 pre-post studies. The primary focus of interventions was gaming (n=4), followed by internet use inclusive of screen time and smartphone use (n=3), gambling (n=3), and pornography (n=2). A range of different technologies were used to deliver content, including websites (n=6), email (n=2), computer software (n=2), social media messaging (n=1), smartphone app (n=1), virtual reality (n=1), and videoconferencing (n=1). Interventions contained 15 different change techniques with an average of 4 per study. The techniques most frequently administered (>30% of intervention arms) were cognitive restructuring, relapse prevention, motivational enhancement, goal setting, and social support. Assessment of study quality indicated that 7 studies met the criteria for moderate or strong global ratings, but only 8 out of 12 studies evaluated change immediately following the treatment. Across included studies, two-thirds of participants completed after-treatment evaluation, and one-quarter completed follow-up evaluation. After-intervention evaluation indicated reduced severity (5/9, 56%), frequency (2/3, 67%), and duration (3/7, 43%). Follow-up evaluation indicated that 3 pre-post studies for gaming, gambling, and internet use demonstrated reduced severity, frequency, and duration of consumption. At 3-month evaluation, just 1 pre-post study indicated significant change to mental health symptoms.ConclusionsWeb-based treatments for online behavioral addictions use an array of mechanisms to deliver cognitive and behavioral change techniques. Web-based treatments demonstrate promise for short-term reduction in symptoms, duration, or frequency of online addictive behaviors. However, there is limited evidence on the effectiveness of web-based treatments over the longer term due to the absence of controlled trials.

The Safety and Efficacy of Psychosocial Adherence Interventions in Young People with Early Psychosis: A Systematic Review.

Background: The role of antipsychotic medication in supporting young people in their recovery from early psychosis is complex and controversial. It is common for young people, often given antipsychotic medication for the first time, to express a choice to stop treatment, potentially increasing the risk of relapse and admission to hospital. Our systematic review aimed to evaluate the safety and effectiveness of psychosocial interventions to enhance antipsychotic medication adherence in young people with early psychosis. Methods: We reviewed studies using any experimental design of psychosocial interventions specifically focused on enhancing adherence with antipsychotic medication in young people with early psychosis. Cochrane CENTRAL Register, Medline, Embase, PsychINFO and CINAHL were searched on 19 November 2021 without time restriction. Studies were assessed for quality using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. Results: Our initial search identified 3469 documents. Following title, abstract and full-text screening, we included three published studies and one unpublished experimental study that met our inclusion criteria. Outcome data were available for three studies that tested adherence–coping–education, adherence therapy, and a health dialogue intervention, all having a positive effect on medication adherence. None of the trials reported data on the safety of the experimental interventions. Conclusion: There is a paucity of evidence from high-quality randomized controlled trials that establish the safety and effectiveness of any type of psychosocial intervention to enhance medication adherence in young people with early psychosis. Further high-quality trials are warranted. This review was registered on the Open Science Framework prior to undertaking out initial searches.

Dysphagia in Alzheimer's disease: a systematic review.

The objective of this study was to identify the specific characteristics, progression, and prevalence of dysphagia in AD. Publications were searched in the PubMed (MEDLINE), EBSCO, ScienceDirect, and BASE databases. Critical appraisal and evidence-level analysis were conducted using the Joanna Briggs Institute and Effective Public Health Practice Project's (EPHPP) tools. A total of 26 studies were reviewed. Symptoms begin in the early stage of AD, as oral phase impairments, and progress to pharyngeal symptoms and swallowing apraxia in the later stages of AD. Dysphagia progresses, as AD, along a continuum, with severity depending on individual variability. There were no studies found on prevalence. Dysphagia is a complex and important comorbidity in AD that impacts the quality of life. No recent publications on prevalence may imply that is not being coded as a potential cause for pneumonia deaths in AD.

Effectiveness of interventions to improve health behaviours of health professionals: a systematic review

ObjectiveTo evaluate the effectiveness of interventions designed to improve the health behaviours of health professionals.DesignSystematic review.Data sourcesDatabase searches: Medline, Cochrane library, Embase and CINAHL.Review methodsThis systematic review used Preferred Reporting...

Review of the role of additional treatments including oseltamivir, oral steroids, macrolides, and vitamin supplementation for children with severe pneumonia in low- and middle-income countries.

BackgroundPneumonia is a major cause of death in children aged under five years. As children with severe pneumonia have the highest risk of morbidity and mortality, previous studies have evaluated the additional benefit of adjunctive treatments such as oseltamivir, oral steroids, macrolides, and vitamin supplementation that can be added to standard antibiotic management to improve clinical outcomes. The study reviewed the evidence for the role of these additional treatments for children with severe pneumonia in low- and middle-income countries (LMICs).MethodsFour electronic databases were searched for English-language articles between 2000 to 2020. Systematic reviews (SRs) with meta-analyses, comparative cohort studies, and randomised controlled trials (RCTs) from LMICs that reported clinical outcomes for children with severe pneumonia aged between one month to 9 years who received adjunct treatment in addition to standard care were included. Risk of bias of included SRs was assessed using AMSTAR 2, and of individual studies using the Effective Public Health Practice Project (EPHPP) quality assessment tool for quantitative studies.ResultsOverall, the search identified 2147 articles, 32 of which were eligible, including 7 SRs and 25 RCTs. These studies evaluated zinc (4 SRs, 17 RCTs), Vitamin D (1 SR, 4 RCTs), Vitamin A (3 SRs, 1 RCT), Vitamin C (1 SR, 2 RCTs) and micronutrients (1 RCT). Most studies reported clinical outcomes of time to improvement, length of stay, and treatment failure (including mortality). No studies of oseltamivir, steroids, or macrolides fulfilling the inclusion criteria were identified. For zinc, pooled analyses from SRs showed no evidence of benefit. Similarly, a Cochrane review and one RCT found that Vitamin A did not improve clinical outcomes. For Vitamin D, an RCT evaluating a single high dose of 100 000 international units (IU) of vitamin D found a reduction in time to improvement, with 38%-40% documented vitamin D deficiency at baseline. However, two other studies of 1000 IU daily did not show any effect, but vitamin D status was not measured. For vitamin C, two studies found a reduction in time to symptom resolution in those with severe disease, with one reporting a shorter length of hospital stay. However, both studies were of weak quality. Most studies excluded malnourished children, and studies which included these children did not report specifically on the effect of micronutrients.ConclusionsThis review found that adjunctive zinc and vitamin A, in addition to standard care, does not improve clinical outcomes in children with severe pneumonia in LMICs (strong evidence). However, a reduction in time to symptom resolution was reported with high dose vitamin D supplementation in children with documented vitamin D deficiency (strong evidence from one study) and vitamin C (weak evidence), although further research is needed, especially in underweight children.

Cognitive and Academic Outcomes of Fundamental Motor Skill and Physical Activity Interventions Designed for Children with Special Educational Needs: A Systematic Review.

This systematic review aimed to investigate the methodological quality and the effects of fundamental motor skills and physical activity interventions on cognitive and academic skills in 3- to 7-year-old children with special educational needs. The review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) statement. A literature search was carried out in April 2020 (updated in January 2022) using seven electronic databases, including ERIC, Scopus, Web of Science, PsycINFO, CINAHL, PubMed, and SPORTDiscus. The methodological quality of the studies was assessed with Effective Public Health Practice Project (EPHPP) Quality Assessment Tool. Cohen’s d effect sizes and post-hoc power analyses were conducted for the included studies. Altogether 22 studies (1883 children) met the inclusion criteria, representing children at-risk for learning difficulties, due to family background (nstudies = 8), children with learning difficulties (nstudies = 7), learning disabilities (nstudies = 5), and physical disabilities (nstudies = 2). Two of the included 22 studies displayed strong, one moderate, and 19 studies weak methodological quality. The intervention effects appeared to be somewhat dependent on the severity of the learning difficulty; in cognitive and language skills, the effects were largest in children at-risk due to family background, whereas in executive functions the effects were largest in children with learning disabilities. However, due to the vast heterogeneity of the included studies, and a rather low methodological quality, it is challenging to summarize the findings in a generalizable manner. Thus, additional high-quality research is required to determine the effectiveness of the interventions.

Is micronucleus assay in oral exfoliated cells a useful biomarker for biomonitoring populations exposed to pesticides? A systematic review with meta-analysis.

The systematic review (SR) with meta-analysis aimed to infer if micronucleus assay using oral mucosal cells a useful biomarker for biomonitoring populations continuously exposed to pesticides (EP). The SR has been made in accordance with the PRISMA-P guidelines. The PICOS strategy has focused to answer the following question: "Does exposure to pesticides cause genetic damage in oral cells?" The literature search was made in the following scientific databases: Web of Science, PubMed/Medline, and Scopus. The approach was defined as follows: standardized mean difference (SMD) and 95% confidence intervals (CI). The quality assessment of manuscripts was obtained by the EPHPP (Effective Public Health Practice Project). The GRADE tool was chosen for assessing the quality of evidence. A total of 108 articles were selected in this setting. After screening abstracts and titles, 23 manuscripts were evaluated for eligibility. After reviewing the studies, two were considered weak and 22 were classified as moderate or strong. The meta-analysis data pointed out statistically significant differences in volunteers exposed to EP (SMD = 1.23, 95% CI, 0.69 to 1.77, p < 0.001), with a Tau2 = 1.44; Chi2 = 566.38, and p < 0.001, so that the selected manuscripts were considered heterogeneous and the I2 of 97% indicated high heterogeneity. Taken together, this review was able to validate the micronucleus assay in oral exfoliated cells as a useful biomarker in individuals continuously exposed to EP because the studies categorized as moderate and strong have demonstrated positive response related to mutagenesis.

Access to Family Planning Services Following Natural Disasters and Pandemics: A Review of the English Literature.

Background: When natural disasters strike, there is a sudden decrease in access to care due to infrastructure loss and displacement. A pandemic has the similar ability to acutely limit access to care. The relationship between decreased access to care and natural disasters has been previously explored.Objective: The purpose of this article is to present a focused review of the available and emerging literature regarding the overall impact of natural disasters and pandemics on unintended pregnancy and decreased care in this setting.Methods: A literature search was conducted on PubMed, Cochrane, Google Scholar, and Embase databases. The search was restricted to studies that were population-based, prospective or retrospective. Only peer-reviewed articles were considered. The search was further restricted to manuscripts in English or officially translated manuscripts. All qualifying papers from which data were extracted were subjected to a quality assessment conducted by two independent investigators (SK and AA). Each investigator reviewed all nine papers relevant to data collection using the Effective Public Health Practice Project (EPHP). MeSH terms were utilized across various databases. Studies were selected that were population-based, prospective or retrospective. Case reports and case series were not used. The primary outcomes were the rates of unintended pregnancy. Secondary outcomes included the use of contraception, short interval pregnancy, and access to reproductive services.Results: An initial search yielded 74 papers, of which nine papers were reviewed for qualitative data, examining the subjects affected by natural disasters or pandemics. An additional two papers regarding theoretical data and COVID-19 were analyzed. Although there seems to be a rise in unintended pregnancy and more difficulty accessing care following natural disasters and pandemics, there are variations in the rates based on region and event.Conclusions: The full effects of the COVID-19 pandemic on the rates of unplanned pregnancies will become apparent in the months and years to come. As obstetrician-gynecologists, we must communicate openly with our patients regarding the use of available contraception, sexual education, and family planning services at times of natural disasters and pandemics.

Associations between Light Rail Transit and physical activity: a systematic review

ABSTRACT Investment in public transport is on the rise as many cities around the world aim to reduce their carbon footprint and improve population health. One such investment is building or extending Light Rail Transit (LRT). Focusing on studies in the USA, Canada, Australia, and New Zealand, this paper reports the results of a systematic review on the associations between LRT and physical activity. This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Twenty studies were identified through a search of five bibliographic databases (Web of Science, Transport Research International Documentation (TRID), Scopus, Medline, and SPORTDiscus) (n=5,866) and a systematic Google search (n=446). At least two reviewers conducted the search and reviewed the titles and abstract of each identified article to include in the review. Standardized data extraction forms were used to document information from each selected article. The forms included a risk of bias assessment tool. Two reviewers completed the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies. Our findings show that moderate certainty of evidence exists for the relationship between LRT and walking behaviour. Here, all studies, most of which were natural experiments (n = 6), found a positive association between LRT and walking behaviour, with LRT leading to an increase of 7–40% in walking in most studies (n = 7 out of 8). A positive relationship between LRT and moderate-to-vigorous intensity physical activity (MVPA) and between LRT and cycling was also often identified; however, results were inconsistent, and certainty of evidence is low for MPVA, and very low for cycling. Further, some studies (n = 3) identify differences in physical activity participation at different LRT stations, suggesting that station design, surrounding land use, and built environment play important roles in promoting physical activity around LRT. Given this, practitioners can be relatively confident that LRT investments will result in increased walking behaviour.

Identifying obesity and COVID-19 overlapping risk-factors: Protocol for a systematic review and meta-analysis.

This systematic review main goal is to identify the common risk factors of obesity and COVID-19 overall, and highlight the ones related to urban settings specifically, using a syndemic framework. COVID-19 highlighted the interaction between infectious diseases and non-communicable diseases. We hypothesise that obesity and COVID-19 share determinants, thus our main goal is to identify the overlapping risk factors and their magnitude of association with both health outcomes. Literature search was conducted in Medline and Embase, Cochrane Library and Epistemonikos, Web of Science and Scopus, ASSIA and SocINDEX and, Google Scholar, in June 2021. Covidence will be used to conduct the title and abstract, and full-text screening, considering the following inclusion criteria: (a) study addresses both health outcomes, (b) full-length articles, (c) study focuses on humans and (d) studies in English. The exclusion criteria will be: (a) study addresses one of the outcomes in combination with other pathologies, (b) not full-length article, (c) study focuses on animals, (d) study not written in English, (e) study focuses on treatment (pharmacological or other), testing (prognostic) or specific patients with other pathologies and (f) study focussed in clinical and/or physiological mechanisms associated with obesity and/or COVID-19. The included studies will be assessed for quality using the Effective Public Health Practice Project for quantitative studies and the tool described by Hawker for qualitative studies. Qualitative results will be assessed using thematic analysis methods to synthesise findings and presented in summary tables. Quantitative results – meta-analysis – will be analysed and presented using Q test and Funnel Plot.

Does Physical Activity in Natural Outdoor Environments Improve Wellbeing? A Meta-Analysis.

Organizational initiatives and researchers have argued for the importance of the natural outdoor environment (NOE) for promoting wellbeing. The main aim of this meta-analysis was to synthesize the existing literature to examine the effects of physical activity (PA) in the NOE on wellbeing in adults. The secondary aim was to explore whether wellbeing reported by adults differs as a function of PA context. Electronic databases (PubMed, ProQuest Nursing and Allied Health, PsycINFO, SPORTDiscus and Embase) were searched for English peer-reviewed articles published before January 2019. Inclusion criteria were: (1) healthy adults; (2) PA in the NOE; (3) the measurement of wellbeing; and (4) randomized control trials, quasi-experimental designs, matched group designs. To address the secondary aim, PA in the NOE was compared with that performed indoors. Risk of bias was assessed through the Effective Public Health Practice Project (EHPP) Quality Assessment Tool for Quantitative Studies. Primary studies meeting inclusion criteria for the main (nstudies = 19) and secondary (nstudies = 5) aims were analyzed and interpreted. The overall effect size for the main analysis was moderate (d = 0.49, p < 0.001; 95% CI = 0.33, 0.66), with the magnitude of effect varying depending on wellbeing dimension. Wellbeing was greater in PA in the NOE subgroup (d = 0.53) when compared with the indoor subgroup (d = 0.28), albeit not statistically significant (p = 0.15). Although physical activity in the NOE was associated with higher wellbeing, there is limited evidence to support that it confers superior benefits to that engaged indoors. Researchers are encouraged to include study designs that measure markers of wellbeing at multiple time points, greater consideration to diverse wellbeing dimensions and justify decisions linked to PA and NOE types.

A systematic review of interventions aiming to promote positive body image in children and adolescents

Evidence shows interventions can improve positive body image in adult women. This systematic review examined the evidence of efficacy of interventions that aimed to increase positive body image in children and young people aged under 18 years. The authors followed PRISMA guidelines for the review. Searches of CINAHL Plus, Medline, PsychINFO, Wiley Online Library, SCOPUS and grey literature were conducted up to February 2021 and identified 4171 papers. Thirteen studies evaluating 12 interventions, designed for children/adolescents aged 9–18 years, were eligible and evaluated using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool. The studies evaluated body appreciation, body-esteem, and embodiment. Studies using cognitive dissonance, peer support, and psychoeducation had evidence of improving body appreciation and body-esteem in adolescent girls. However, evidence of efficacy for younger children and boys was lacking and the studies ranged in methodological quality. Further research should rigorously evaluate positive body image interventions using second-generation measures that assess specific components of positive body image and consider how to promote positive body image in young children and boys.

Web-based interventions for pregnant women with gestational diabetes mellitus: a systematic review and meta-analysis protocol

IntroductionGestational diabetes mellitus (GDM) is one of the most prevalent diseases during pregnancy, which is closely associated with many short-term and long-term maternal and neonatal complications and can incur heavy...

The role of perceived criticism in patient and caregiver outcomes in severe mental health disorders: A systematic review

• The role of perceived criticism on patient outcomes in SMI is ambiguous. • Paucity of research on impact of perceived criticism on caregiver outcomes limited consensus and clarity on targets of perceived criticism. • Lack of consistency in the use and reporting of perceived criticism measures. This review aimed to systematically synthesise the evidence on the role of perceived criticism (PC) in patient and caregiver outcomes in severe mental disorders and bridge the gap in current knowledge of existing PC measures. Four databases (EMBASE, Medline, PsycINFO and Web of Science) were searched. The quality of the reviewed studies was evaluated using the Effective Public Health Practice Project (EPHPP) tool. Sixty studies were identified for inclusion in this review. The Perceived Criticism Measure (PCM) and its derivatives were used in over half of these studies. Over a third (35%) of studies focused on anxiety disorders. Only four studies reported on the role of PC in caregiver outcomes. Empirical studies into the contribution of perceived criticism and its direct links with caregiver functioning and outcomes remains scarce. Further research across a broader range of mental disorders, with more ethnically diverse samples is required. To advance scholarly debate on perceived criticism and its relevance to mental health assessment and interventions, consensus on its criteria and measurement tools is called for.