To systematically review and map the evidence on community-based nutrition interventions implemented in humanitarian and emergency settings in low- and middle-income countries (LMIC), focusing on intervention types, outcomes, evidence gaps and implications for humanitarian nutrition systems.

Systematic review and evidence mapping conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eight electronic databases and twenty-six organisational websites were searched for studies published between 2010 and 2024. Studies are mapped by intervention and outcome categories. Findings are synthesised narratively.

Humanitarian and emergency settings in LMIC affected by conflict, fragility, displacement or natural disasters.

Women, infants, children, adolescents, caregivers and households receiving community-based nutrition interventions delivered through community health workers (CHW), volunteers, peer counsellors, care groups or other community platforms.

Fifty-three documents met inclusion criteria, including thirty-nine primary study documents representing thirty-three interventions across twenty countries and fourteen systematic reviews. Most evidence originates from Africa and focuses on community groups, nutrition counselling and community-based management of acute malnutrition. Preventive interventions generally improved infant and young child feeding practices and caregiver behaviours but showed inconsistent effects on anthropometric outcomes. Treatment interventions delivered through CHW and community volunteers improved recovery, programme coverage and treatment performance. However, evidence on dietary intake, food security, caregiver capacity, relapse prevention and longer-term outcomes remains limited.

Community-based nutrition interventions are central to extending nutrition service delivery in humanitarian settings and show strong potential to improve feeding practices and treatment outcomes. More integrated and context-sensitive evaluation frameworks are needed to strengthen evidence for resilient humanitarian nutrition programming.

General practice (GP) training is central to the development of the primary care workforce but is often described as a bounded educational programme rather than a process shaped by clinical work, workplace culture, and wider service conditions.

To examine how GP training is represented in the literature and to develop a complexity-informed conceptual model of GP training.

Systematic review and complexity-informed synthesis of studies relating to GP training in primary care contexts.

Empirical and conceptual studies were identified through systematic searching and analyzed using thematic synthesis, informed by complex adaptive systems and Cohered Emergent Theory.

Three thematic areas were identified: GP–patient interactions, GP–professional interactions, and training intricacies. Four cross-cutting insights emerged: complexity in everyday training, the influence of power and hierarchy, the importance of diversity and adaptability, and the shaping role of wider system pressures. These informed the Cohered GP Training Model, which conceptualizes GP training as a dynamic system in which outcomes emerge from the degree of coherence between trainee formation, educational relationships, patient care encounters, workplace and team ecology, and the wider primary care system.

GP training is best understood as a relational and system-embedded process rather than a discrete educational intervention. The model may help explain variation in training quality across settings and offers a conceptual basis for improving training environments and workforce development.

Existential factors such as loss of meaning play a central role in suicide-related vulnerability, yet most prevention interventions target symptom reduction. We aimed to systematically review the effects of meaning-based interventions on suicide-related outcomes and characterize the mechanisms through which these effects operate.

A systematic review was conducted following PRISMA 2020 guidelines. Six databases (PubMed, Web of Science, CINAHL, PsycINFO, Research Information Sharing Service, and Korean Studies Information Service System) were searched from inception to April 2026. Studies were included if they evaluated meaning-based interventions and reported suicide-related outcomes. Risk of bias was assessed using RoB 2 for randomized trials and RoBANS for nonrandomized studies. Given heterogeneity across populations, interventions, and outcomes, findings were synthesized narratively by domain.

Ten studies were included (7 randomized controlled trials, 2 quasi-experimental studies, and 1 secondary analysis). Meaning-based interventions most consistently improved existential outcomes, including meaning in life, spiritual well-being, and quality of life. Emotional outcomes showed partial and heterogeneous effects. Suicide-related outcomes, including hopelessness, demoralization, and suicidal ideation, generally showed reductions, although effects varied across studies. Mechanistically, most studies showed patterns of indirect pathways, whereby improvements in existential variables co-occurred with reductions in emotional and suicide-related outcomes.

Meaning-based interventions may reduce suicide-related vulnerability primarily by enhancing existential resources rather than directly targeting symptoms. These findings support integrating meaning-centered approaches into suicide prevention strategies and highlight the need for longitudinal and mediation-based studies to examine causal mechanisms.

Adults with a Fontan procedure or total cavo-pulmonary connection (TCPC) have been shown to have abnormalities in their microcirculation (capillary rarefaction) and increased aortic stiffness. These are also a hallmark of essential hypertension. It remains unclear whether the blood pressure of Fontan patients differs from the general population. Therefore, we undertook a systematic review and meta-analysis in Fontan patients comparing blood pressure against healthy controls.

A systematic search of peer-reviewed publications for “Fontan adults” studies, including patients >=16 years of age, with a previous Fontan/TCPC and containing blood pressure data for both Fontan adults and controls, was included. The trial strategy was registered in PROSPERO (CRD42022355781). MEDLINE, Embase, and Cochrane (CENTRAL) database searches yielded 2168 records. Heterogeneity was assessed with Higgins I2 statistic with a value >50% indicative of high heterogeneity and P values based on Cochran’s Q test. A random-effects model was used to calculate the pooled effect size.

Eleven studies contained sufficient blood pressure data from 544 Fontan/TCPC adults. Their weighted mean systolic and diastolic blood pressure was 114 ± 14 mmHg and 69 ± 9 mmHg. Only four (130 patients) studies, were suitable for meta-analysis. Weighted mean difference in systolic BP was −1.36 mmHg (95% CI, −9 to 6.38) and in diastolic BP was +0.89 mmHg (95% CI, −2.92 to 4.70) between Fontan/TCPC patients and controls. A high level of heterogeneity in both SBP (P < 0.00001) and DBP (P < 0.003) was noted.

Neither systolic nor diastolic blood pressure in adults with a Fontan circulation differ from healthy controls. Overall weighted means of blood pressure were comparable for similar age groups. Arterial hypertension does not appear to explain the capillary rarefaction and aortic stiffness found in adults with a Fontan procedure or total cavo-pulmonary connection. Further studies are required to explore other causes of their vascular remodelling.

According to attachment theory, loneliness may be a cause of hoarding symptoms. However, due to mixed findings, it is unclear whether people with hoarding disorder (HD) are lonelier than healthy and clinical controls, whether there is a significant positive association between loneliness and hoarding, and whether loneliness causes more severe hoarding.

We conducted a systematic review and included peer-reviewed quantitative cross-sectional, longitudinal, experimental and intervention research that measured hoarding and loneliness. We excluded hoarding due to other conditions and qualitative, review, and case study research. The final search was conducted on 16 May 2025 on PsycINFO, Medline, and Web of Science. We used the Quality Assessment with Diverse Studies to evaluate study quality and conducted a random effects meta-analysis to examine loneliness-hoarding correlations.

Eleven papers with 13 studies (n = 2715) were included. Four studies compared loneliness in HD relative to controls. Ten studies examined the association between hoarding and loneliness. Only one experimental study examined the causal link. Results showed significantly higher loneliness in HD relative to healthy controls, but findings were mixed when compared with clinical controls. The meta-analysis showed a significant association between loneliness and hoarding, r = .38 [95% CI .33, .44].

Our findings confirm that loneliness is a significant issue in HD. Due to its wide-ranging effects, we recommend that clinicians should assess and address loneliness in HD. Although we are confident that loneliness is positively associated with hoarding, further research is required to establish a causal link.

Psychiatry is a rewarding career, but many medical students have limited exposure to the specialty. Extracurricular enrichment programmes aim to provide early exposure to psychiatry, promote positive attitudes and encourage early career interest.

To systematically review literature on extracurricular psychiatry enrichment programmes for undergraduate medical students.

The review was registered with PROSPERO (CRD420251025990) and followed PRISMA guidelines. Four databases were searched using pre-determined search strings. Records were screened and data extracted independently by two authors. Quality was appraised using the Mixed Methods Appraisal Tool. A narrative synthesis summarised and consolidated findings.

Of 731 articles screened, 65 full reports were assessed for eligibility and 27 were included. These studies were conducted across 10 countries, most commonly the USA and UK. Programme duration and format varied from single-day events (n = 2) to longitudinal mentoring schemes spanning medical school (n = 5). Summer schools were most common (n = 10). Other schemes included mentoring, elective courses, special study modules, student-led clinics and film/media-based activities. Student feedback was positive, particularly for mentoring and film/media initiatives. Most studies reported improved attitudes towards psychiatry and mental illness, with several reporting statistically significant improvements using validated tools. Of 18 studies assessing career intentions, 16 reported increased interest in a career in psychiatry, and six studies reported higher subsequent match rates into psychiatry specialty training.

The available literature on voluntary extracurricular enrichment programmes suggests that they may provide positive student experiences and are associated with improved attitudes and early interest in psychiatry through meaningful learning opportunities. However, the evidence base is limited as most studies were small, self-selected samples with short-term follow-up and predominantly self-reported outcomes.

Title/abstract and full-text screening are among the most time-consuming stages of systematic reviews. Large language models (LLMs) such as ChatGPT can assist in screening, but prior evaluations have largely focused on abstract-level decisions and require coding or application programming interfaces (API) access, limiting practical application. This study developed and evaluated a structured, prompt-based approach that enables LLMs to perform both abstract and full-text screening without programming or API integration.

Using datasets from three completed meta-analyses, we implemented a stepwise training framework involving comprehension checks, criterion-specific feedback, and iterative prompt refinement. Study 1 optimized file format and batch size using 1,000 abstracts and 50 full texts. Studies 2 and 3 validated the approach using independent datasets on teletherapy versus in-person therapy (1,321 abstracts, 82 full texts) and emotion regulation and mental health (1,500 abstracts, 129 full texts), respectively. Human reviewers’ decisions served as the reference standard.

In Study 1, the LLM achieved 98 percent sensitivity and 80.6 percent specificity at abstract screening, with batches of 50 abstracts in plain-text format performing optimally. In Study 2, sensitivity and specificity were 100 percent and 85.6 percent for abstracts, with 82.1 percent full-text accuracy and all eligible studies retained. In Study 3, abstract screening achieved 100 percent sensitivity and 93 percent specificity, while full-text screening achieved 96.2 percent sensitivity and 90.3 percent specificity.

A structured, prompt-based approach enabled LLMs to achieve high sensitivity and specificity across both screening stages without coding or APIs. With human oversight, this accessible workflow can reduce reviewer burden and accelerate evidence synthesis.

Health technology assessment is emerging in Lebanon, with an increased interest in health economic evaluations (EEs). Despite the importance of the methodological quality of EEs, no study has examined this issue in Lebanon.

As only methodologically robust health EE can meaningfully inform decision making, this study systematically reviews and critically appraises published full EEs in Lebanon, formulating recommendations to strengthen the quality and consistency of future evaluations within the Lebanese context.

We searched for full model- and trial-based EEs and cost-minimization analyses (CMAs) on NHSEED, Medline, EMBASE, and CINAHL without language or time restrictions. We followed PRISMA guidelines, narratively synthesized the characteristics, methods, and results of studies, and critically appraised them using CHEC for trial-based evaluations and CMA and CHEC-Extended for model-based evaluations.

Eight studies, published 2012–2025, were included: five model-based, two trial-based, and one CMA. Assessed technologies included screening/vaccination programs, diagnostic tools, nutrition education, e-mental health interventions, and early versus delayed treatment of hepatitis C. Methodological inconsistencies pertained mostly to discounting rates and willingness-to-pay thresholds. Suboptimal quality pertained mainly to model-based evaluations conducted by Lebanese researchers. Common pitfalls included the perspective being unclear; the identification, measurement, and valuation of costs and outcomes; model validation and calibration; sensitivity analyses; and discounting. The trial-based and CMA met more than 80 percent of the criteria.

We identified a limited number of published full EEs in Lebanon and highlighted their major shortcomings. Future work should scale up high-quality EEs in Lebanon, particularly modeling studies, to inform resource allocation.

Populations affected by humanitarian crises, including conflict, disasters and displacement, are frequently exposed to elevated psychological distress, while access to mental health services remains scarce. Problem Management Plus (PM+), a low-intensity psychological intervention developed by the World Health Organization, has shown clinical efficacy. However, evidence on its implementation in humanitarian contexts remains limited. This systematic review aimed to synthesize available evidence on the implementation outcomes of PM+ and its delivery formats (individual, group and digital) in such settings. The review included individual PM+, group PM+ and Step-by-Step.

Following PRISMA 2020 guidelines, we systematically searched four databases (PubMed, Scopus, Web of Science and CENTRAL) for studies published up to June 2025. Eligible studies included populations in humanitarian settings receiving PM+ in any format and reported at least one implementation outcome based on Proctor’s framework (acceptability, adoption, appropriateness, feasibility, fidelity, cost, penetration and sustainability). Data extraction and quality appraisal were conducted independently by two reviewers. The protocol for this systematic review was prospectively registered in PROSPERO (Registration No. CRD42024551943).

Of 2093 records screened, 23 studies met inclusion criteria, representing 5377 participants across diverse humanitarian contexts. Feasibility (70% of studies) and acceptability (65%) were the most frequently assessed outcomes, with consistently positive findings, including adequate recruitment, retention and cultural adaptability of PM+. Evidence was strongest for participant and provider acceptability and feasibility of delivery, whereas system-level outcomes such as sustainability, adoption, penetration and cost were rarely reported. Delivery by trained non-specialist providers was common and supported by supervision structures. Fidelity assessments (43%) demonstrated high adherence to intervention manuals. In contrast, sustainability (9%) and cost evaluations (17%) were infrequently reported. Barriers to implementation included stigma, population mobility and resource constraints, while facilitators included contextual adaptation, community engagement and ongoing supervision.

PM+ demonstrates strong feasibility and acceptability when delivered by trained non-specialist providers in humanitarian contexts. However, gaps remain in evidence on long-term sustainability, cost-effectiveness and policy integration. The limited availability of system-level implementation data constrains conclusions regarding large-scale integration of PM+ in humanitarian settings. Future research should employ standardized implementation science metrics and focus on strategies to enhance scalability and embed PM+ within existing health systems.

Unipolar mania (UM), defined by the occurrence of manic episodes without a history of depression, is a topic of debate within the classification of affective disorders. However, its epidemiological burden remains unclear. This systematic review and meta-analysis aimed to estimate the prevalence of UM among individuals with bipolar type I disorder (BD-I) while exploring potential sources of heterogeneity.

The study protocol was registered in Open Science Framework on 27 March 2025. Embase, MEDLINE and APA PsycInfo were searched. We included observational studies reporting data on UM prevalence rates in adults with BD-I. Pooled prevalence was estimated using the Freeman–Tukey double arcsine transformation, employing a restricted maximum likelihood random-effects model. Subgroup and meta-regression analyses were implemented to explore sources of heterogeneity.

We included 26 studies, encompassing 35 independent samples and 17,716 individuals with BD-I. The pooled prevalence of UM was 21.1% (95% confidence interval: 15.5–27.4%). Although potential publication bias was detected (Egger’s p = 0.010), the trim-and-fill method did not impute any missing studies. No differences were found between clinical and community-based studies (p = 0.966). However, prevalence estimates were influenced by both geographical area (p = 0.020) and study quality (p = 0.014). Rate differences across studies may also be attributable to variations in UM diagnostic definition.

People with UM represent a significant subset of BD-I cases worldwide, warranting greater clinical awareness. The observed rate variability emphasizes the impact of sociocultural and methodological factors on UM diagnosis. Further research is necessary to refine diagnostic criteria and evaluate optimal treatment approaches for individuals with UM.

Cannabinoids are increasingly discussed as adjuncts in addiction treatment, yet whether they improve clinically meaningful substance use disorder (SUD) outcomes beyond short-term symptom relief is unresolved. We determined whether cannabinoid exposure confers directional efficacy across opioid, alcohol, cocaine, tobacco, and methamphetamine use disorders, distinguishing symptomatic targets from sustained therapeutic outcomes.

PubMed and Embase (1975–2025) were searched for human studies evaluating cannabinoid exposure in relation to SUD outcomes. Two reviewers independently screened and extracted data. Risk of bias was assessed using RoB 2 for randomized controlled trials (RCTs), ROBINS-I for cohort studies, and JBI checklists for cross-sectional, case, and qualitative designs. Six prespecified endpoints (treatment retention, relapse, abstinence, craving, withdrawal severity, consumption) were mapped to each target SUD. Following Synthesis Without Meta-analysis (SWiM) guidance, structured narrative synthesis used a design-based weighting scheme (RCT 1.00 to qualitative 0.25). PROSPERO: CRD420251151193.

Ninety-seven studies (41,954 participants) contributed 195 endpoint instances: 89 Beneficial (45.6%), 80 No Significant Effect (41.0%), 12 Mixed/Partial (6.2%), and 14 Harmful/Inferior (7.2%). Short-term symptom targets accounted for most Beneficial findings (76.4%). Sustained outcomes were predominantly No Significant Effect, most pronounced in opioid use disorder. Beneficial symptom findings derived overwhelmingly from weaker study designs (craving 81.5%; withdrawal severity 85.7%; consumption 80.0%).

Cannabinoids confer short-horizon symptomatic benefits but do not demonstrate efficacy for sustained abstinence, relapse prevention, or retention, most clearly in opioid use disorder, where evidence is strongest. Findings for other disorders remain preliminary. Adequately powered adjunctive randomized trials with biochemically verified endpoints are needed.

Adverse childhood experiences are critical contributors to the development of psychiatric disorders. Despite its pervasive impact on mental health, childhood neglect remains underexplored. Here, we performed a first comprehensive synthesis of the association between neglect subtypes and psychiatric disorders.

The primary aim was to quantify the overall association between neglect and psychiatric disorders, by estimating the odds ratios from clinical and control groups. The secondary aim was to examine the association between unspecified, physical and emotional neglect, and specific psychiatric disorders.

Studies were systematically selected from three databases (PubMed, EMBASE and PsycINFO), focusing on adult populations with diagnosed psychiatric disorders and corresponding control groups. Meta-analyses assessed overall associations between neglect and psychiatric disorders, as well as subtypes-specific associations with distinct psychiatric conditions. Multiple meta-regressions were performed to explore moderating factors.

Strong associations were found between neglect and psychiatric disorders across all subtypes (unspecified neglect: odds ratio 3.63, 95% CI 2.19–6.01; physical neglect: odds ratio 3.27, 95% CI 2.51–4.25; emotional neglect: odds ratio 3.36, 95% CI 2.58–4.38). Subgroup analyses showed the strongest associations between unspecified neglect and bipolar disorder, physical neglect and schizophrenia spectrum disorders, and emotional neglect and major depressive disorder. Other associations emerged, although their interpretation was limited by a small number of studies and high heterogeneity levels.

Neglect is significantly associated with psychiatric disorders, with distinct patterns across neglect subtypes and mental health outcomes. These findings highlight the need for early identification and tailored interventions to mitigate neglect’s long-term burden on mental health.