Search Results (574)

Objective: Systemic lupus erythematosus (SLE) is a complex autoimmune disease, and its diagnosis can cause considerable anxiety and uncertainty for those affected. This study aimed to investigate the effect of a one-day educational seminar on disease-specific knowledge among patients with SLE. Additionally, the influence on subjective needs, the cognitive and emotional impact of the disease, and health-related lifestyle were examined. Methods: Patients were randomly assigned in a 1:1 ratio to an intervention group or a waiting list control group. Both groups attended the seminar. Disease-specific knowledge was measured using a multiple-choice questionnaire. The primary objective was the change in knowledge after the intervention. Results: Thirty-nine participants were included in the analysis. The mean score difference between the waiting list control group and the intervention group was 3.4 points out of a maximum of 20 (95% CI 1.8 to 5) immediately after the seminar and 1.6 (95% CI −0.6 to 3.5) three months later. Pooled data from both groups showed an increase in SLE-specific knowledge from 13.7 points to 17.3 points. Three months later, SLE-specific knowledge remained above the initial value at 15.4 points. However, no influence on lifestyle was observed. Conclusion: A one-day seminar can increase disease-specific knowledge and reduce unmet informational needs but does not lead to lifestyle modifications. Full article

Introduction: This study aimed to systematically assess the impact of hearing interventions on cognitive function in older adults with presbycusis. Methods: A comprehensive search was conducted across PubMed, EMBASE, and Web of Science databases from their inception to 22 June 2025 to identify eligible randomized clinical trials or cohort studies that used designated cognitive scales or cognitive test measures. Two separate meta-analyses were conducted: one using uncontrolled pre–post comparisons and another restricted to studies that included concurrent untreated control groups. Results: A total of 22 studies were identified, comprising 9 focused on hearing aid use and 13 on cochlear implantation. Ultimately, 19 studies were included in the quantitative analysis: 7 on hearing aid use and 12 on cochlear implantation. The pooled analysis of hearing intervention across 17 studies involving 1562 patients indicated a 4% improvement in cognitive test scores post-intervention compared with pre-intervention (ratio of means: 1.04; 95% CI: 1.03–1.05; p < 0.001). However, in the 4 controlled studies that included an untreated comparator group (815 intervention, 7450 control participants), hearing intervention did not confer a statistically significant cognitive benefit over no intervention (SMD = 0.03; 95% CI: −0.04 to 0.09; p = 0.369). Conclusions: Current controlled evidence does not support the claim that hearing interventions preserve or enhance cognitive function in older adults with presbycusis. Full article

Essential oil-based feed additives have been proposed as a practical strategy to mitigate enteric methane emissions in ruminants, but their effects are not always consistent. The objective of this study was to evaluate the effects of dietary supplementation with an essential oil blend on in vitro methane production, rumen fermentation, nutrient digestibility, growth performance, carcass traits, and meat quality in Lithuanian Blackface lambs. We hypothesized that supplementation would induce measurable changes in in vitro methane production and selected rumen fermentation variables, while growth performance and technological meat quality would remain comparable between treatments. Sixty Lithuanian Blackface lambs were allocated to control (C) and treatment (T) groups (30 lambs per group). The C group received a basal diet, and the T group received the same diet supplemented with an essential oil blend, Agolin Ruminant, at a dose rate of 0.1 g/animal/day, consisting of linalool, eugenol, geranyl acetate, and geraniol. An in vitro rumen fermentation assay was performed using rumen fluid pooled within both dietary groups from multiple lambs and incubated as a single batch with four replicate fermentation flasks per treatment (n = 4 fermenters per group) to quantify methane production and in vitro nutrient digestibility. In vivo apparent nutrient digestibility was evaluated in a dedicated sub-trial (n = 6 animals per group). Growth performance in the main trial was analyzed using the pen as the experimental unit (n = 3 pens per group), and slaughter-based measurements—including slaughter and carcass traits, rumen volatile fatty acids and protozoal counts, and Longissimus dorsi meat quality and intramuscular fatty acids—were determined in 10 lambs per treatment (n = 10 animals per group). In vitro methane production did not differ between groups (p = 0.366); in vitro crude fiber digestibility showed a tendency to increase with supplementation (p = 0.066). Fermentation end-products were largely unchanged, although propionate tended to be higher (p = 0.063), and the acetate:propionate ratio was lower (p = 0.043) in the supplemented group; protozoal counts were not different between groups. In vivo apparent nutrient digestibility was comparable between treatments. Growth performance was lower in the supplemented group, resulting in an overall mean ADG 19.0% lower. Slaughter and carcass traits were comparable between treatments. Meat proximate composition, cholesterol concentration, pH, color, water losses, and instrumental texture/shear parameters were not affected by supplementation. Intramuscular lauric (C12:0), myristic (C14:0), and pentadecanoic (C15:0) fatty acids were lower (p < 0.05), while C14:1 n-7 tended to decrease (p = 0.050); however, total saturated, monounsaturated, and polyunsaturated fatty acids and nutritional ratios were unchanged. Overall, under the study conditions and dose used, the essential oil blend did not significantly reduce in vitro methane production and elicited only limited rumen fermentation responses; ADG was 19.0% lower in the supplemented group, whereas carcass traits and technological meat quality were unaffected, and only specific intramuscular fatty acids were altered. Full article

Background/Objectives: Psychological barriers, particularly kinesiophobia and diminished psychological readiness, represent critical yet undertreated obstacles to a successful return to sport following anterior cruciate ligament reconstruction (ACLR). Scalable, preference-aligned educational interventions capable of addressing these barriers during early rehabilitation are lacking. We aimed to evaluate the effectiveness of structured educational content delivered via Snapchat, as an adjunct to standard ACLR rehabilitation, in reducing kinesiophobia (primary outcome) and improving psychological readiness and perceived knee function (secondary outcomes). Methods: A total of 120 adults with clinically elevated kinesiophobia (TSK-17 > 37) undergoing post-operative ACLR rehabilitation were enrolled in a quasi-experimental, two-arm study with non-randomized allocation at the clinic-branch level at two branches of the same sports rehabilitation clinic (Joint Clinics, Riyadh, Saudi Arabia). Branch allocation assigned 60 participants to each group (intervention and control). The intervention group received 12 weekly structured educational videos via Snapchat alongside standard rehabilitation; the control group received standard rehabilitation alongside general ACLR information videos via Snapchat. TSK-17, ACL-RSI, and IKDC were assessed at baseline and at 12 weeks. Primary analysis used ANCOVA covarying baseline scores, complemented by mixed repeated measures ANOVA and intent-to-treat analysis. Results: Both groups improved across all outcomes; the intervention group demonstrated significantly greater gains. ANCOVA revealed significant between-group differences favoring the intervention for TSK-17 (adjusted mean difference = −2.82; d = 0.54; p < 0.001; d represents Cohen’s d calculated from adjusted mean differences and pooled SD), ACL-RSI (+8.06; d = 0.77; p < 0.001), and IKDC (+8.90; d = 0.54; p = 0.002). Mean video completion was 82.8% among intervention participants. Intent-to-treat analyses using Multiple Imputation confirmed all findings. Conclusions: Snapchat-based structured education was associated with improvements in kinesiophobia, psychological readiness, and perceived knee function among the 102 analyzed participants (control n = 52; intervention n = 50) of the 120 enrolled. High engagement supports preference-based digital delivery as a scalable adjunct to standard rehabilitation. Full article

River corridor rehabilitation is increasingly expected to deliver coupled outcomes by combining ecological recovery with measurable improvements in human well-being. Cultural ecosystem services (CESs), the non-material benefits people derive from landscapes, are central to this objective but remain difficult to operationalize in securitized transboundary settings, where border governance, uneven mobility, and community histories shape access to rivers and the formation of cultural meanings. This study examines whether perceived conservation effectiveness is associated with higher CES value in the Lower Jordan River Basin (LJRB) and whether this association persists after accounting for the community-group structure. Using survey data from 445 respondents across seven community groups, the perceived CES valuation was assessed through a five-point Cultural Significance rating, analyzed alongside conservation-related and contextual variables. Conservation was measured through perceived conservation impact and self-reported conservation involvement (yes/no). A staged inference design combined group comparisons and multivariable regression with adjustments for the community-group structure and contextual controls. Conservation involvement was not associated with meaningful differences in Cultural Significance. The perceived conservation impact showed a positive association in pooled and simple models but lost independent significance after adjusting for community-group structure, which accounted for much of the explanatory power. These findings indicate that CES valuation in the LJRB is structured more by community-group differences and borderland conditions than by individual conservation participation, underscoring the importance of locally encounterable outcomes and group-tailored engagement strategies in transboundary river planning. Full article

The aim of this study was to understand the female swimmers’ annual performance progression and stability between 10 and 18 years across swimming distances and techniques. Data from female Portuguese Top-50 rankings in the short-course pool was extracted from an open access database (swimrankings.net). Performances were grouped by distances (50-, 100- and 200 m) and techniques (freestyle, backstroke, breaststroke and butterfly), totalizing 12 events as performance metrics. A total of 343 swimmers and 3087 performances distributed by nine consecutive competitive seasons were retrospectively assessed. The mean and normative stability were computed for tracking performance trends, while reporting the year-to-year percentage improvement. The differences across distances and techniques were tested with a linear mixed-effects model using intraclass correlation coefficient (ICC). The performance progression was characterized by marked improvements during the early ages (up to 13% yearly) and an emerging plateau around the 15–16 years. The stability patterns varied between events, with the backstroke technique (ICC = 0.13) demonstrating greater consistency of individual differences on developmental trajectories, whereas shorter races (i.e., 50 m; ICC = 0.15) tended to be more stable than 100 m or 200 m (ICC = 0.12). It can be concluded that female swimmers’ performance stabilizes at the 15–16 years of age. Despite reduced differences, the backstroke technique and short distances seem to show a slightly more stable trend in progressing from childhood to adulthood. Full article

Cymbidium eburneum Lindl. is a valuable ornamental orchid and breeding parent, but its genetic background remains unclear due to habitat destruction and germplasm mixing. This study developed specific SSR markers to evaluate the genetic diversity and structure of 96 C. eburneum Lindl. accessions from China and Vietnam. Transcriptome analysis identified 47,248 SSR loci. Sixteen polymorphic core primer pairs detected 150 alleles (mean Na = 9.375) with an average Polymorphism Information Content (PIC) of 0.444. Observed heterozygosity (Ho = 0.290) was noticeably lower than expected (He = 0.478), indicating heterozygote deficiency. UPGMA clustering identified eight groups strongly correlated with geography. Principal Coordinate Analysis (PCoA) revealed a clear geographical differentiation pattern, featuring the most genetically cohesive group from Guangxi and more differentiated geographically marginal populations from Hainan and Vietnam. STRUCTURE analysis (K = 2) indicated two main gene pools with signals of genetic admixture. Geographical isolation was suggested as a potential driver of genetic differentiation. The Guangxi population represents a genetically consistent major reservoir, while marginal populations harbor unique variations. These findings provide a scientific basis for germplasm identification, conservation, and parental selection in C. eburneum Lindl. breeding. Full article

Background: Effective and safe sedation is essential in pediatric dental practice to manage anxiety, pain, and cooperation during procedures. Objective: This exploratory systematic review and meta-analysis aimed to synthesize available RCT evidence comparing dexmedetomidine and ketamine across different sedation strategies (premedication and procedural sedation) in children undergoing dental procedures. Methods: This study was conducted and reported in accordance with the PRISMA 2020 statement. A comprehensive literature search was performed across PubMed, Web of Science, Scopus, and ScienceDirect for studies between 1990 and 2026. Randomized controlled trials (RCTs) were included. The primary outcomes assessed were intraoperative and postoperative analgesia, heart rate, systolic and diastolic blood pressure (SBP and DBP), oxygen saturation (SpO₂), and recovery time. A meta-analysis of the extracted data was performed, and the risk of bias was assessed using the Cochrane risk of bias tool 2. Results: The review included four RCTs involving 178 children, with a mean age of 6.5–9.1 years. Intraoperative and postoperative analgesia did not differ significantly between groups (p = 0.09 and p = 0.08, respectively). Pooled analysis showed numerically lower heart rates with dexmedetomidine compared to ketamine, but the difference was not statistically significant (MD = −11.70; 95% CI: −29.27 to 5.86; p = 0.07). Systolic blood pressure was significantly lower with dexmedetomidine (MD = −6.69; 95% CI: −6.91 to −6.47; p = 0.002). Oxygen saturation did not differ significantly between groups (p = 0.35). Two studies were rated as having a low risk of bias. The remaining two had some concerns, related to unverified blinding and lack of outcome pre-specification. Conclusions: Based on limited and clinically heterogeneous evidence, both dexmedetomidine and ketamine appear to be viable options for sedation in pediatric dental settings, though no firm superiority conclusion can be drawn. Further randomized controlled trials with larger sample sizes and standardized sedation protocols are recommended to strengthen these findings and inform practice guidelines. Full article

Background: The early diagnosis of pulmonary tuberculosis (PTB) remains a global challenge. While serum adenosine deaminase (ADA) has been associated with tuberculosis-related immune activation, its consistency across different regions and laboratory methods remains unclear. This study aims to evaluate group-level differences in serum ADA levels and identify factors influencing these variations. Methods: A systematic search was conducted across PubMed, Embase, and Scopus up to February 2026. A meta-analysis using a random-effects model was performed to calculate the pooled standardized mean difference (SMD), reflecting group-level differences in serum ADA levels between PTB patients and control groups. Results: Thirty-four studies were included. Serum ADA levels were significantly higher in PTB patients compared to healthy controls (SMD = 3.15, 95% CI: [2.51–3.79], p < 0.0001) and other respiratory diseases (SMD = 2.06, 95% CI: [1.38–2.74], p < 0.0001). Subgroup analyses revealed that geographical region and ADA measurement methods did not significantly account for the observed high heterogeneity (I² > 95%), indicating that ADA elevation was consistently observed across studies. Conclusions: Serum ADA levels were significantly elevated in patients with PTB, indicating a consistent biological association with disease status. However, given the high heterogeneity and the absence of diagnostic accuracy measures (e.g., sensitivity and specificity), these findings should not be interpreted as evidence of clinical diagnostic performance. Further diagnostic test accuracy studies are required to establish its clinical utility. Full article

Background: Depressive symptoms have been linked to systemic inflammation, yet estimates in population-representative data vary by symptom severity and analytic specifications. We quantified the association between depressive symptom severity and high-sensitivity C-reactive protein (hs-CRP) in U.S. adults using design-based inference. Methods: We analysed pooled NHANES 2015–2018 data for adults aged ≥ 20 years (unweighted n = 9164; complete-case adjusted models n = 8173). Depressive symptom severity was categorised using the Patient Health Questionnaire-9 (PHQ-9) with 0–4 as the reference group and a pre-specified primary contrast of 10–14 versus 0–4. Outcomes were (i) continuous hs-CRP modelled on the log scale, reported as geometric mean ratios (GMR), and (ii) elevated inflammation defined as hs-CRP > 3 mg/L, modelled using a log-link to obtain prevalence ratios (PR). Models incorporated NHANES complex sampling and adjusted for a pre-specified core covariate set (age, sex, race/ethnicity, education, poverty-income ratio, and smoking). Sensitivity analyses excluded hs-CRP > 10 mg/L and added BMI. Results: After adjustment, the geometric mean hs-CRP was 1.43 mg/L (95% CI 1.21–1.70) for PHQ-9 0–4 and 1.63 mg/L (95% CI 1.29–2.08) for PHQ-9 10–14. For the primary contrast (10–14 vs. 0–4), the adjusted GMR was 1.14 (0.96–1.35) and the PR was 1.15 (0.95–1.39). Using a clinically relevant dichotomy (PHQ-9 ≥ 10 vs. <10), depressive symptoms were associated with higher hs-CRP (GMR 1.24 (1.07–1.43)) and a higher prevalence of hs-CRP > 3 mg/L (PR 1.19 (1.01–1.39)). Associations were strongest for PHQ-9 15–19 (GMR 1.62 (1.20–2.19); PR 1.49 (1.15–1.92)). In sensitivity analyses for the primary contrast, GMR estimates ranged from 1.01 to 1.14 and PR estimates ranged from 1.05 to 1.15, with attenuation towards the null after excluding hs-CRP > 10 mg/L and after additional adjustment for BMI. Conclusions: Higher depressive symptom severity was associated with higher hs-CRP and a higher prevalence of low-grade systemic inflammation in U.S. adults, with the clearest elevations observed among those with moderately severe symptoms. For the pre-specified moderate-symptom contrast, point estimates were modest and sensitive to handling of high hs-CRP values and adiposity-related adjustment. Full article

Background/Objectives: Knee joint instability is frequently reported in individuals with knee osteoarthritis (OA) and may persist after total knee replacement (TKR), where it represents a leading cause of revision. However, neuromuscular factors associated with knee instability remain poorly understood. This systematic review and meta-analysis aimed to compare neuromuscular characteristics between individuals with stable and unstable knees in OA and TKR populations. Methods: PubMed, CENTRAL, Scopus, and EMBASE were searched from inception to 10 January 2025. Studies comparing neuromuscular outcomes between stable and unstable knees were included. Neuromuscular parameters included: muscle strength, muscle power, muscle activation pattern, and joint stiffness. Where appropriate, pooled standardized mean differences (SMD) were calculated using random-effects models. Certainty of evidence was evaluated using the GRADE approach. Results: Nineteen studies (16 OA, 3 TKR; n = 7369 participants) were included, with eleven studies eligible for meta-analysis. OA individuals with unstable knees demonstrated significantly lower limb muscle strength compared with stable counterparts (SMD = −0.49, 95% CI −0.81 to −0.16, p = 0.003). Muscle co-contraction did not differ significantly between groups (SMD = 0.12, 95% CI −0.70 to 0.94, p = 0.77). The overall certainty of evidence was rated as very low. Conclusions: Knee instability in OA populations is associated with reduced lower limb muscle strength, although evidence quality is limited and findings regarding neuromuscular control strategies remain inconclusive. Evidence in TKR populations is scarce. Future studies should investigate muscle activation patterns and dynamic joint stabilization during functional tasks to clarify the neuromuscular mechanisms underlying knee instability. Full article

This study aimed to estimate dietary exposure to aflatoxins (AFs) and characterize its associated risks through the consumption of dried fruits and chocolates among the adult population of Yerevan, the capital city of Armenia. Asflatoxin B1 (AFB1) and total AFs were determined using HPLC in 10 composite samples of widely consumed dried fruits and chocolates, prepared by pooling 100 individual sub-samples into 5 dried fruits and 5 chocolate composites. Individual consumption data were obtained via food frequency questionnaires and were stratified by consumer groups and percentiles. Exposure scenarios (lower-, middle-, upper-bound and detected mean) were applied, and risk was assessed using the margin of exposure (MOE) approach with a BMDL₁₀ of 0.4 μg/kg bw/day. The study findings revealed that dried fruits had higher contamination levels (detected mean content of 10 μg/kg AFB1, 15 μg/kg total AFs) compared to chocolates (detected mean content of 0.5 μg/kg AFB1, and 0.9 μg/kg total AFs), resulting in lower MOE values despite smaller consumption quantities. Detectable AFs in dried fruits from open (street) markets exceeded the EU maximum limits, while Armenia currently lacks national regulatory limits for these products. MOEs were below 10,000 for most consumption groups, indicating a potential public health concern. This research emphasizes the urgent need for continuous monitoring and the establishment of harmonized national regulatory limits for AFs in dried fruits. Full article

Acute coronary syndrome patients undergoing percutaneous coronary intervention remain at high risk for major adverse cardiovascular events (MACE: cardiovascular mortality, non-fatal myocardial infarction, and stroke). Inflammatory–oxidative stress biomarkers are potential prognostic tools; however, the influence of sampling timing—pre-procedural versus post-procedural—remains unclear. This meta-analysis evaluated six biomarkers: sST2, GDF-15, OPG, sLOX-1, H-FABP, and Galectin-3. Pooled Hazard Ratios (HRs) for time-to-event outcomes and Standardized Mean Differences (SMDs) between event and non-event groups were synthesized using random-effects models involving 40 studies (18,933 patients). Elevated pre-procedural levels of sST2 (HR = 3.32, p < 0.0001), GDF-15 (HR = 3.00, p < 0.0001), sLOX-1 (HR = 2.61, p = 0.0023), and OPG (HR = 1.79, p = 0.0206) significantly predicted MACE. Notably, pre-PCI sST2 strongly predicted heart failure hospitalization (HR = 6.30, p < 0.0001). Additionally, pre-PCI H-FABP demonstrated a moderate significant effect on adverse outcomes (SMD = 0.67, p < 0.0001). While pre-PCI Galectin-3 was not significant, its post-procedural levels showed a large significant effect (SMD = 1.15, p < 0.0001). In conclusion, inflammatory and oxidative stress biomarkers, particularly sST2 and GDF-15, demonstrate consistent associations with adverse outcomes in ACS patients undergoing PCI, offering more reliable baseline risk stratification than post-procedural measurements. Full article

This paper investigates the interaction between fiscal policy and non-performing loans (NPLs), a nexus often overlooked in banking stability literature. By proposing a generalized theoretical framework that augments the industrial organization (IO) theory of banking with liquidity preference theory, this study explains why a fiscal contraction (an improvement in the primary balance from deficit toward surplus) can decrease NPLs in a bank’s portfolio. Using bank-level quarterly data from Guyana (2009: Q4 to 2024: Q4) and a Panel Autoregressive Distributed Lag Pooled Mean Group (ARDL-PMG) model, we find that a fiscal contraction reduces NPLs in the long run. Specifically, a one-percentage-point improvement in the seasonally adjusted primary balance (as a % of GDP) is associated with a 0.473 percentage point decrease in NPLs in the long run. This finding contrasts with the existing literature, which often suggests that fiscal consolidations increase credit risk. In the short run, however, the results indicate a divergent effect where fiscal contractions lead to a temporary increase in NPLs, with a coefficient of 0.103, likely because of immediate pressure on borrower debt-service capacity. This study contributes to the literature by extending the IO theory of banking to the fiscal policy–NPL relationship in a developing, resource-rich economy. Notably, while higher oil prices and bank efficiency significantly lower NPLs, traditional macroeconomic drivers such as GDP growth, inflation, and the real effective exchange rate—as well as the COVID-19 pandemic—are found to be statistically insignificant in this framework. Full article

Background: The global burden of mental disorders continues to escalate, necessitating scalable, evidence-based interventions. Artificial intelligence (AI)-delivered health promotion programs represent a promising approach to addressing treatment gaps by targeting the neuropsychological mechanisms that underlie mental health outcomes. This meta-analysis synthesizes evidence on the effectiveness of AI-delivered interventions in improving executive function, emotion regulation, and clinical outcomes across diverse populations. Methods: A systematic search identified 186 studies (n = 22,755 participants) published between 2020 and 2025. Random-effects meta-analyses estimated pooled effect sizes (Hedges’ g, calculated as between-group standardized mean differences with small-sample correction [J = 1 − 3/(4df − 1)]) for primary outcomes. Between-study heterogeneity was quantified using I² and τ² statistics. To address dependency among effect sizes from studies reporting multiple outcomes, robust variance estimation (RVE) was employed. Subgroup analyses examined intervention modalities, delivery formats, and clinical populations. Moderator analyses explored sources of heterogeneity, including publication year, sample size, intervention duration, control condition type, risk-of-bias rating, geographic region, and AI sophistication tier, and mediational models tested putative therapeutic mechanisms. Results: AI-delivered interventions demonstrated a significant overall effect on health outcomes (g = 0.68, 95% CI [0.58, 0.78]; τ² = 0.12; I² = 73.4%). Executive function outcomes showed moderate effects (g = 0.61, τ² = 0.08), with working memory improvements being strongest (g = 0.72). Emotion regulation outcomes demonstrated moderate-to-large effects (g = 0.61, 95% CI [0.51, 0.70], τ² = 0.006); formal subgroup pooled estimates by emotion regulation strategy were not calculated due to insufficient studies per strategy (k < 3 per category); individual study effect sizes ranged from g = 0.27 to g = 1.11. Among 41 studies examining neuropsychological mechanisms, convergent patterns suggested involvement of prefrontal neural circuits (DLPFC), enhanced alpha-band activity, and improved heart rate variability; however, formal mediation was tested in only 18 studies (9.7%). Among clinical populations, interventions for cognitive impairment yielded the largest effects (g = 1.02; this finding should be interpreted cautiously given modest cumulative sample size [n = 482], potential small-study effects [Egger’s p = 0.08], and trim-and-fill adjusted estimate of g = 0.85), followed by mental health conditions (g = 0.72), while other clinical populations showed smaller but significant improvements (g = 0.19). Mobile applications (g = 0.78) and chatbot-based interventions (g = 0.74) demonstrated the strongest effects among delivery formats. Among studies testing formal mediation, analyses suggested mindfulness (β = 0.42), decentering (β = 0.38), and cognitive reappraisal (β = 0.45) as processes associated with therapeutic outcomes. Conclusions: AI-delivered health promotion programs demonstrate significant effectiveness across executive function, emotion regulation, and clinical outcomes, though substantial heterogeneity (I² = 45–82%) indicates meaningful variability warranting attention to subgroup-specific effects. Given the diversity of intervention types included (chatbots, mobile apps, VR systems, neuromodulation), pooled estimates should be interpreted as characterizing the average effect across this heterogeneous landscape; subgroup-specific estimates provide more precise guidance for clinical decision-making regarding specific modalities. Effects are associated with convergent patterns of neuropsychological mechanisms, though mechanistic conclusions remain preliminary given that only 22% of studies (41/186) examined neuropsychological mechanisms, and formal mediation analyses were conducted in only 18 studies (9.7%); most of the mechanistic evidence is correlational rather than causal. Future research should establish standardized AI taxonomies, optimize adaptive algorithms, conduct adequately powered replication studies in populations with cognitive impairment, prioritize experimental mediation designs to establish causal pathways, and evaluate long-term maintenance effects with a minimum of 6–12-month follow-up periods. Full article