Search Results (47)

Mobile applications are increasingly used for suicide prevention; however, their effectiveness remains unclear. This meta-analysis evaluated the effectiveness of mobile applications for suicide prevention and investigated potential moderators influencing intervention outcomes. Following the PRISMA guidelines, four databases (ProQuest, PubMed, Cochrane Central, and IEEE) were systematically searched for studies published from January 2020 to February 2025. This review was registered with PROSPERO (ID: CRD420251029046). Twenty-two studies were included, comprising 47 effect sizes derived from 6556 participants (3623 in the intervention and 2933 in the control groups). Risk of bias was assessed using RoB 2 (RCTs) and ROBINS-I (NRSs). Effect sizes were synthesized using random-effects meta-analysis with heterogeneity and publication bias evaluated. The overall post-intervention effect size was small to moderate (g = 0.39), with sustained but smaller effects observed at follow-up (g = 0.15). Moderator analyses indicated stronger effects for universal interventions targeting adults, weekly interventions, 12-week programs, and those implemented in efficacy settings. The findings should be interpreted with caution because of substantial heterogeneity. Nevertheless, the effects were statistically significant and provided evidence for the utility of mobile applications in suicide prevention, underscoring the need for further research to refine intervention design and delivery. Full article

This study investigates the effectiveness of designing a gamified Virtual Reality (VR) intervention, grounded in Kolb’s Experiential Learning Theory, in enhancing social reciprocity, affective expression, and daily living skills among Thai children with Autism Spectrum Disorder (ASD). Utilizing the Meta Quest 2 headset, the intervention simulated five real-world contexts—home routines, classroom behavior, street crossing, supermarket shopping, and fast-food interactions. A quasi-experimental pretest-posttest control group design was employed with 33 children aged 6–12, complemented by thematic analysis of caregiver and therapist interviews. Results from the Social Responsiveness Scale, Second Edition (SRS-2), indicated significant improvements in social communication (p = 0.001) and social motivation (p = 0.045), while changes in social awareness (p = 0.233) and repetitive behaviors (p = 0.169) were not statistically significant. However, an ANCOVA analysis controlling for pre-test scores found that the difference in post-test outcomes between the intervention and control groups did not reach statistical significance (p = 0.073), suggesting that observed improvements may be influenced by baseline variability. Qualitative feedback highlighted the program’s engagement value, cultural relevance, and usability, alongside suggestions for increased adaptivity and contextual nuance. These results underscore the potential of VR-based learning while highlighting the need for further research with larger samples and more adaptive systems. These findings offer practical insights for educators, researchers, teachers, and program developers by demonstrating how culturally grounded, gamified VR interventions when guided by experiential learning principles can effectively enhance engagement and support targeted social skill development in children with ASD. Full article

The application of extended reality (XR) in design education has grown substantially; however, empirical evidence on its educational benefits remains limited. This two-year study examines the impact of incorporating a virtual reality (VR) learning module into undergraduate landscape architecture (LA) construction courses, focusing on brick masonry instruction. A conventional learning sequence—lecture, sketching, CAD, and 3D modeling—was supplemented with an immersive VR experience developed using Unreal Engine 5 and deployed on Meta Quest devices. In Year 1, we piloted a preliminary version of the module with landscape architecture students (n = 15), and data on implementation feasibility and student perception were collected. In Year 2, we refined the learning module and implemented it with a new cohort (n = 16) using standardized VR evaluation metrics, knowledge retention tests, and self-efficacy surveys. The findings suggest that when sequenced after a theoretical introduction, VR serves as a pedagogical bridge between abstract construction principles and physical implementation. Moreover, the VR module enhanced student engagement and self-efficacy by offering experiential learning with immediate feedback. The findings highlight the need for intentional design, institutional support, and the continued development of tactile, collaborative simulations. Full article

This study is titled “Success Factors in Transport Interventions: A Mixed-Method Systematic Review (1990–2022)”. The purpose of the systematic review is to (1) identify effective interventions for transitioning individuals from private car reliance to sustainable transport, (2) summarise psychosocial theories shaping transportation choices and identify enablers and barriers influencing sustainable mode adoption, and (3) determine the success factors for interventions promoting sustainable transport choices. The last search was conducted on 18 November 2022. Five databases (Scopus, Web of Science, MEDLINE, APA PsycInfo, and ProQuest) were searched using customised Boolean search strings. The identified papers were included or excluded based on the following criteria: (a) reported a modal shift from car users or cars to less CO₂-emitting modes of transport, (b) covered the adoption of low-carbon transport alternatives, (c) comprised interventions to promote sustainable transport, (d) assessed or measured the effectiveness of interventions, or (e) proposed behavioural models related to mode choice and/or psychosocial barriers or drivers for car/no-car use. The identified papers eligible for inclusion were critically appraised using Sirriyeh’s Quality Assessment Tool for Studies with Diverse Designs. Inter-rater reliability was assessed using Cohen’s Kappa to evaluate the risk of bias throughout the review process, and low-quality studies identified by the quality assessment were excluded to prevent sample bias. Qualitative data were extracted in a contextually relevant manner, preserving context and meaning to avoid the author’s bias of misinterpretation. Data were extracted using a form derived from the Joanna Briggs Institute. Data transformation and synthesis followed the recommendations of the Joanna Briggs Institution for mixed-method systematic reviews using a convergent integrated approach. Of the 7999 studies, 4 qualitative, 2 mixed-method, and 30 quantitative studies successfully passed all three screening cycles and were included in the review. Many of these studies focused on modelling individuals’ mode choice decisions from a psychological perspective. In contrast, case studies explored various transport interventions to enhance sustainability in densely populated areas. Nevertheless, the current systematic reviews do not show how individuals’ inner dispositions, such as acceptance, intention, or attitude, have evolved from before to after the implementation of schemes. Of the 11 integrated findings, 9 concerned enablers and barriers to an individual’s sustainable mode choice behaviour. In addition, two integrated findings emerged based on the effectiveness of the interventions. Although numerous interventions target public acceptance of sustainable transport, this systematic review reveals a critical knowledge gap regarding their longitudinal impact on individuals and effectiveness in influencing behavioural change. However, the study may be affected by language bias as it only included peer-reviewed articles published in English. Due to methodological heterogeneity across the studies, a meta-analysis was not feasible. Further high-quality research is needed to strengthen the evidence. This systematic review is self-funded and has been registered on the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY; Registration Number INPLASY202420011). Full article

Background/Objectives: Virtual reality (VR) is becoming an increasingly popular therapeutic tool, with immersion being a key component that provides users with a sense of spatial presence in virtual environments. However, comprehensive research is lacking on the impact of static versus dynamic VR environments on changes in perceived spatial presence. The aim of this study was to assess the experience of spatial presence in virtual environments and to examine the relationship between spatial presence and users’ emotional responses during exposure to static and dynamic VR scenarios. The study also sought to compare the effects of static and dynamic environments on the occurrence of cybersickness symptoms. Methods: The study included 30 participants aged 18 to 26. Each participant was instructed to view two separate films, with each film lasting 20 min (with a 20 min break between them) in virtual reality using Oculus Meta Quest 2 VR goggles, and to share their experiences. Cybersickness was assessed using the Virtual Reality Sickness Questionnaire (VRSQ), emotional responses were evaluated using the International Positive and Negative Affect Schedule—Short Form (I-PANAS-SF), and spatial presence was measured with the Spatial Presence Experience Scale (SPES). Results: In the group of participants who viewed the dynamic film, a significant decrease in stress levels was observed after the projection as compared to the baseline resting state (p = 0.002), along with an increase in experienced relaxation (p < 0.001). In contrast, in the group that viewed the static film, no significant changes were found in stress levels (p = 0.464) or experienced relaxation (p = 0.455) when compared to baseline. The dynamic environment had the greatest impact on the occurrence of cybersickness symptoms, with all responses indicating a progressive increase compared to the static condition. The static environment produced only minor disturbances. Conclusions: These findings confirm that virtual environments can influence users’ emotional states, particularly highlighting the relationship between spatial presence and emotional experience. Full article

Background/Objectives: Rapid weight loss after bariatric surgery is linked to a higher risk of symptomatic gallstone disease, which could require a cholecystectomy. This meta-analysis aimed to assess the efficacy and safety of conducting laparoscopic cholecystectomy concurrently with sleeve gastrectomy in morbid obese patients. Methods: Scopus, PubMed, ProQuest, Web of Science, and Google Scholar were searched for this review. Quality assessment was conducted using the Newcastle-Ottawa Scale for observational studies and ROB2 for randomized clinical trials. Eight of thirteen studies were high-quality. Pooling for BMI difference and LOS was used to measure efficacy, and the pooled proportion was utilized to assess safety through bleeding, wound infection, and leakage. Heterogeneity was explained via leave-one-out analysis and meta-regression. Results: The pooled standardized mean difference in BMI peri-operation was 3.26 (95% CI: 2.51–4.01, p < 0.01), where the age and initial BMI explained 98% of the heterogeneity through meta-regression. The pooled mean of LOS was 3.18 days (95% CI: 2.23–4.14, I² = 99%, p < 0.001), where age explained 33.22% of the heterogeneity through meta-regression. The pooled proportion of bleeding was 0.03 (95% CI: 0.02–0.04, I² = 2%, p = 0.42). The pooled wound infection was 0.04 (95% CI: 0.02–0.08, I² = 80%, p < 0.001), where age accounted for 99% of the heterogeneity. The pooled biliary/gastric leakage was 0.02 (95% CI: 0.01–0.05, I² = 0, p = 0.52). Conclusions: These findings indicate that the combined procedures can be executed with an acceptable safety profile. The heterogeneity in outcomes underscores the necessity of personalized patient care, standardized perioperative practices, and continuous research to enhance results and mitigate dangers. Full article

Background: this overview of systematic reviews with meta-analysis summarized the epidemiology of suicide in cancer, mainly focused on prevalence, incidence, and risk. Methods: the CINAHL (via EBSCOhost), Embase, PsycINFO (via ProQuest), and PubMed databases were searched from inception to February 2024. AMSTAR 2 evaluated the methodological quality of reviews. The degree of overlap between reviews was calculated. Results: Twelve systematic reviews with meta-analysis were included. The prevalence of suicidal ideation in prostate cancer was 9.85% (95%CI 7.31–12.70%). The relative risk of suicidal ideation in prostate cancer was 2.01 (95%CI: 1.52–2.64) in comparison to controls without this type of cancer during the first 12 months after diagnosis. Furthermore, the risk of suicidal ideation was higher among individuals with bladder cancer in comparison to people without this clinical condition (HR 1.90, 95%CI 1.29−2.81). The crude suicide mortality rate per 100,000 person-years in prostate cancer was 47.1 per 100,000 person-years (95%CI 39.85–54.96). Incidence suicide death per 100,000 person-years was higher in sarcoma (60.99 per 100,000 person-years, 95%CI 17.37–214.19), esophagus (87.71 per 100,000 person-years, 95%CI 27.42–280.54), and pancreas (75.39 per 100,000 person-years, 95%CI 41.80–135.97). Finally, the standardized mortality ratio by suicide was higher in the pancreas (SMR 6.42, 95%CI 1.60–25.76), bone and cartilage (SMR 9.59, 95%CI 1.54–59.77), and mesothelioma (SMR 13.07, 95%CI 1.61–105.80). Conclusions: overall, meta-analyses underlined the relevance of suicide mortality in different cancer sites and geographical regions. Some meta-analyses also found suicidal ideation may be important in prostate or bladder cancer. Full article

Background/Objectives: Shift workers face higher risks of impaired glucose metabolism due to irregular eating habits and circadian misalignment. Time-restricted eating (TRE) could improve glucose metabolism by aligning food intake with the circadian clock, but its effectiveness remains unclear. Methods: Ten electronic databases (PubMed, EMBASE, Cochrane Library, CINAHL, PsycINFO, Scopus, Web of Science, ProQuest Dissertations and Theses, Science.gov, and ClinicalTrials.gov) were searched from journal inception to September 2024. Only randomized controlled trials (RCTs) involving shift workers were included. Meta-analyses with sensitivity analyses were conducted using a random-effects model to pool glucose metabolism and sleep outcomes, with heterogeneity and quality assessments performed. Results: Six RCTs were included. TRE demonstrated positive but non-significant effects on glucose metabolism outcomes: fasting blood glucose (weighted mean difference [WMD]: −0.02 mmol/L, 95% confidence interval [CI]: −0.13 to 0.10, I² = 0%), fasting blood insulin (WMD: −5.77 pmol/L, 95% CI: −85.62 to 74.08, I² = 92%), HOMA-IR (WMD: −0.50, 95% CI: −2.76 to 1.76, I² = 82%), 2 h postprandial glucose (WMD: −0.65 mmol/L, 95% CI: −3.18 to 1.89, I² = 86%), total sleep time (g = 0.07, 95% CI: −0.23 to 0.37, I² = 0%), and sleep efficiency (g = −0.05, 95% CI: −0.63 to 0.53, I² = 62%). Sensitivity analyses yielded similar findings, and overall certainty of evidence was rated ‘very low’. Conclusions: While TRE shows potential for improving the glucose metabolism in shift workers, current evidence remains inconclusive due to small sample sizes and study limitations. Future research should prioritize well-powered TRE RCTs in shift workers that adhere to a 6–10 h eating window. Incorporating early-TRE schedules with sleep hygiene may optimize metabolic outcomes, with circadian biomarkers analyzed to better elucidate the mechanistic pathway implicated. Full article

Autism Spectrum Disorder (ASD) has been associated with disruptions in one-carbon metabolism and vitamin D pathways. Nutritional exposures—particularly vitamin D, vitamin B₁₂, and homocysteine—may influence neurodevelopmental outcomes. However, a comprehensive, lifespan-spanning synthesis of these modifiable nutritional biomarkers has not been conducted. This systematic review and stratified meta-analysis critically synthesized data on vitamin D, vitamin B₁₂, and homocysteine to elucidate their relationships with ASD risk and symptomatology. Our central question was: How do levels of vitamin D, vitamin B₁₂, and homocysteine—measured before and after birth—affect the risk, severity, and potential treatment outcomes for ASD? We conducted a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) compliant systematic review and stratified meta-analysis (2015–2025) of 35 studies (11 randomized controlled trials, 24 observational), examining prenatal, neonatal, and postnatal biomarker levels. Eligibility criteria were defined using the PICOS (Population, Intervention, Comparator, Outcome, and Study Design) framework to ensure scientific rigor and clinical relevance, including studies involving human participants aged 0–18 years with a formal Autism Spectrum Disorder (ASD) diagnosis or prenatal exposures potentially linked to later ASD onset, while excluding animal studies, adult-only ASD populations, and studies lacking ASD cohorts or biomarker data. The search strategy, developed according to PRISMA, and Cochrane best practices, encompassed five major databases (PubMed/MEDLINE, Cochrane Library, Google Scholar, ClinicalTrials.gov, and ProQuest) alongside manual searches of key references, grey literature, and clinical trial registries to ensure comprehensive retrieval of both published and unpublished studies. Study quality was assessed using version 2 of the Cochrane risk-of-bias tool for RCTs (RoB2) and the Newcastle–Ottawa Scale (NOS) for observational studies; certainty of evidence was graded via GRADE (Grading of Recommendations Assessment, Development and Evaluation). Random-effects meta-analyses were stratified by biomarker and study design. Heterogeneity, small-study effects, and publication bias were evaluated using Cochran’s Q, I², Egger’s test, and trim-and-fill. Prenatal vitamin D deficiency was associated with approximately two-fold increased odds of Autism Spectrum Disorder (ASD) in offspring (pooled OR ≈ 2.0; p < 0.05), while excessively elevated maternal B₁₂ concentrations, often co-occurring with folate excess, were similarly linked to increased ASD risk. Meta-analytic comparisons revealed significantly lower circulating vitamin D (SMD ≈ −1.0; p < 0.001) and B₁₂ levels (SMD ≈ −0.7; p < 0.001), alongside elevated homocysteine (SMD ≈ 0.7; p < 0.001), in children with ASD versus neurotypical controls. Early-life vitamin D/B₁₂ insufficiency and elevated homocysteine are important, modifiable correlates of ASD risk and severity. Adequate maternal and child nutritional status could have risk-reducing and symptom-mitigating effects, although causality remains to be confirmed. This evidence supports tailored nutritional interventions as a component of ASD risk reduction and management strategies, within the bounds of overall developmental healthcare. The article processing charges (APC) were supported by “Dunărea de Jos” University of Galati, Romania. No external funding was received for the execution of the research. The review was not prospectively registered in PROSPERO or any other systematic review registry. Full article

Background: Appropriate clinical training for emergencies is a key factor in the quality of healthcare. Advances in technology facilitate the creation of new forms of training, fostering student interaction and engagement. In this respect, augmented and virtual reality approaches in healthcare training are generating great interest. Objectives: to evaluate the effectiveness of virtual and augmented reality in emergency healthcare training. Methods: A randomized controlled trial was conducted with two intervention groups. Intervention group No. 1 (n = 30) received in-class instruction followed by practice with a cardiopulmonary resuscitation (CPR) manikin and using virtual reality with the Meta Quest model (using the VR applications Heart, Lung, and School of CPR). Intervention group No. 2 (n = 31) received the same in-class training but followed by an augmented reality session. In this intervention, the Heart and Lung AR applications were used on an iPhone 15 ProMax. The control group (n = 32) only received in-class instruction and practice with the CPR manikin. Results: The virtual reality and augmented reality interventions improved learning effectiveness and user satisfaction. These results were statistically significant (p < 0.05) for knowledge post-intervention between groups, VR being the highest. However, the results were not significant for satisfaction. Conclusions: VR procedures can be effective for increasing learning effectiveness in emergency training. Full article

Virtual Reality (VR) painting, an emerging form of artistic expression under 5G technology, showcases a broader range of expressive styles and dynamic visual effects compared to traditional computer graphics. The creative process in VR painting enhances spatial depth, exhibiting different spatial abilities and necessitating more physical movements, including hand controllers and foot movements in the virtual space. Furthermore, VR painting in art therapy encourages users to engage in physical activities, contributing to better emotional expression. This study involved digital-native users in VR painting, using Meta Quest 2 to operate Open Brush for their creations. Through observational methods, we examined user operational behaviors and conducted semi-structured interviews post-experiment to explore their painting performance and usage behaviors in the virtual environment. The results of this study indicate that VR painting enhances the sense of space and dynamic expression in creative work and improves users’ emotional and physical engagement, providing new avenues for artistic expression. These findings contribute to improving the usability and application value of VR paintings. Full article

This research paper explores the impact of immersive virtual reality (IVR) on the teaching of conceptual design in engineering and architecture fields, focusing on the use of interactive 3D drawing tools in virtual and augmented reality environments. The study analyzes how IVR influences spatial understanding, idea communication, and immersive 3D sketching for industrial and architectural design. Additionally, it examines user perceptions of virtual spaces prior to physical construction and evaluates the effectiveness of these technologies through surveys administered to mechanical engineering students utilizing VR/AR headsets. A structured methodology was developed for students enrolled in an industrial design course, comprising four phases: initial theoretical instruction on ephemeral architecture, immersive 3D sketching sessions using Meta Quest 2 and Microsoft HoloLens 2 VR/AR headsets, detailed CAD modeling based on conceptual sketches, and immersive virtual tours to evaluate user perception and design efficacy. Ad hoc questionnaires specifically designed for this research were employed. The results indicate a positive reception to IVR, emphasizing its ease of use, intuitive learning process, and effectiveness in improving motivation, academic performance, and student engagement during the conceptual design phase in graphic engineering education. Full article

Virtual reality (VR) technology has gained popularity across various fields; however, its use often induces cybersickness, characterized by symptoms such as dizziness, nausea, and eye strain. This study investigated the differences in cybersickness levels and head movement patterns under three distinct VR viewing conditions: dynamic VR (DVR), static VR (SVR), and a control condition (CON) using a simulator. Thirty healthy adults participated, and their head movements were recorded using the Meta Quest 2 VR headset and analyzed using Python. The Virtual Reality Sickness Questionnaire (VRSQ) assessed subjective cybersickness levels. The results revealed that the SVR condition induced the highest VRSQ scores (M = 58.057), indicating the most severe cybersickness symptoms, while the DVR condition elicited significantly higher values in head movement variables, particularly in the coefficient of variation (CV) and integral values of head position along the vertical axis, and mean velocity (p < 0.05). These findings suggest that VR content characteristics directly influence users’ head movement patterns, closely related to cybersickness occurrence and severity. This study highlights the importance of analyzing head movement patterns in cybersickness research and provides insights for VR content design. Full article

Background: Several randomized controlled trials (RCTs) have shown conflicting results on cortisol levels following probiotic administration in healthy and diseased populations. Previous analyses were inconclusive due to limited studies, and evidence is lacking on how these effects vary by health status; region; therapy duration; medications, and use of single or multiple strains. Methods: In this systematic review and meta-analysis (PROSPERO [CRD42024538539]), we searched PubMed, Cochrane Library, Embase, Scopus, Web of Science, CINAHL, ProQuest, and Web of Science Preprints until 13 August 2024, for RCTs on probiotic administration, either alone or combined, across all age groups and without specific medical condition requirements. We applied random-effects meta-analysis, assessed bias using the Cochrane RoB 2 tool, and evaluated evidence certainty with GRADE. Findings: We screened 1739 records and retrieved 46 RCTs (3516 participants). Probiotics supplementation decreased cortisol levels compared to the control arm [46 RCTs; SMD: −0.45; 95% CI: −0.83; −0.07; I²: 92.5%, low certainty]. Among various subgroups; probiotics supplementation decreased the cortisol levels in the subgroups without concomitant medications [37 RCTs; SMD: −0.30; 95% CI [−0.58; −0.03], I²: 88.7%] with a single probiotic strain [30 RCTs; SMD: −0.33; 95% CI: −0.63; −0.028; I²: 88.8%], in a healthy population [35 RCTs; SMD:−0.3; 95% CI: −0.58; −0.03; I²: 88.7] and in the Asia region [21 RCTs; SMD: −0.83; 95% CI: −1.58; −0.07; I²: 95%]. Interpretation: A low level of evidence suggests probiotics might reduce cortisol levels, but more targeted studies are needed to identify variables affecting the response in specific subgroups. Full article

Formative assessment in K-12 education has been a notable teaching and learning focus area in schools over the last 20 years, as evidenced by numerous recent systematic reviews and meta-analyses investigating and summarizing the evidence for formative assessments’ effectiveness and sustainability. This umbrella review systematically reviews meta-analyses investigating the effects of formative assessment on learning, summarizes the current findings, and assesses the quality and risk of bias in the published meta-analyses. Meta-analyses were identified using systematic literature searches in the following databases: Scopus, ERIC, Academic Research Complete, ProQuest, APA PsycArticles, SPORTDiscus, Web of Science, and Humanities International Complete. Thirteen meta-analyses, each of which examined the effects of formative assessment on learning in K-12 students, were included in this umbrella review. The review considered evidence for the potential effectiveness of using formative assessment in class with primary and secondary school students. Formative assessment was found to produce trivial to large positive effects on student learning, with no negative effects identified. The magnitude of effects varied according to the type of formative assessment. The 13 included meta-analysis studies showed moderate (n = 10), high (n = 1), and low (n = 2) methodological quality (AMSTAR-2), although the robustness of the evidence (i.e., GRADE analysis) was very low (n = 9), low (n = 3), and moderate (n = 1). These findings offer valuable insights for designing and implementing different types of formative assessment aimed at optimizing student learning and ensuring the sustainability of assessment practices. However, the low-to-very-low certainty of the available evidence precludes robust recommendations regarding optimal formative assessment strategies for learning in K-12 students. Full article