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PubMed2026

A profile of firearm-related fatalities admitted to the Diepkloof Forensic Pathology Service Soweto medico-legal mortuary during the COVID-19 and post COVID-19 periods.

This retrospective descriptive study examined firearm-related fatalities during (April-December 2020; n = 241) and after (April-December 2023; n = 299) COVID-19 lockdowns using 540 cases from the Diepkloof Forensic Pathology Service, Soweto, South Africa. Data was obtained from autopsy reports, forensic records, police statements, and death scene documentation. Firearm violence affected young adult Black males (22-43 years), with only minor demographic shifts post-pandemic. The overall burden and core patterns of violence remained stable, with criminal activity - primarily robbery and interpersonal violence - persisting as the leading contexts, and homicide the dominant manner of death. Post-COVID-19 findings demonstrated contextual shifts, including increased incidents in public and social environments, reflecting greater mobility and resumption of social activity. A significant rise in mean blood alcohol concentration (0.09 g/100 mL vs 0.14 g/100 mL; p < 0.0001) suggests increased alcohol involvement following easing of restrictions. Unfortunately, persistent information gaps, noted particularly in circumstantial history, incident location, firearm type, highlighting the need for improved data provision and capture systems. While the epidemiology of firearm-related fatalities remained unchanged, the post-COVID-19 period was characterised by increased alcohol involvement, shifts toward public-space violence, and fewer gunshot wounds per victim, suggesting changes in situational and behavioural dynamics rather than underlying drivers of violence.

Humans↗

PubMed2025

Understanding Dynamics: A Systematic Review of the Attitudes, Knowledge, and Competencies of European Frontline Professionals Toward Domestic Abuse.

There remains a paucity of European research on attitudes and responses to domestic abuse from frontline workers and professionals who regularly encounter domestic abuse or engage with domestic abuse legislation. This systematic review synthesized qualitative, quantitative, and mixed-method peer-reviewed studies that explored professionals' knowledge, attitudes, and competencies related to domestic abuse. The professionals included medical staff (doctors, nurses, midwives), social care professionals, police officers, and criminal justice practitioners. The review was conducted on current European studies published between 2014 and 2025 and was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Databases consulted included APA PsycInfo, Scopus, Web of Science, PubMed, Sociological Abstracts, International Bibliography of the Social Sciences, Social Services Abstracts, and Google Scholar. Full-text review was performed on 273 articles, of which 36 were deemed appropriate for inclusion. The review included 8 multi-country studies spanning the United Kingdom (England, Scotland, and Wales), and 28 single-country studies conducted in England, Sweden, Turkey, Portugal, the Republic of Ireland, Wales, Bosnia, Spain, Italy, Slovenia, and Hungary. A narrative and thematic synthesis categorized professional attitudes toward domestic abuse into four emergent themes: attitudes toward engagement and responsibility, attitudes toward victims, knowledge and understanding of domestic abuse, and attitudes as predictors of professional practice. This review addresses a dearth of research and provides recommendations for promoting proactive practice among professionals most likely to receive disclosures of abuse.

Humans↗

PubMed2025

The Association Between Child Maltreatment and Quality of Life: A Systematic Review and Meta-Analysis.

The association between child maltreatment (CM) and quality of life (QoL) has been widely examined in the past decade. In this study, we estimated the association between CM and QoL using a systematic review and meta-analysis. Articles were searched up to May 15, 2024, in both English databases (Web of Science, EMBASE, CINAHL, PsycINFO & PsycArticles, MEDLINE, Cochrane Library, PubMed, and Scopus) and Chinese databases (CNKI, Weipu, and Wanfang). The meta-analysis was performed by a random-effects model, using 43 studies comprising 130,884 participants. This study demonstrated that general CM had an adverse impact on QoL and its sub-dimensions, including physical, mental, psychosocial, and environmental QoL. Further analysis showed that the subtypes of CM also had negative impacts on the dimensions of QoL, except for mental QoL. Emotional maltreatment had stronger negative associations with QoL than other subtypes of CM, while neglect received relatively less attention. In addition, the association between CM and QoL was moderated by region, gender ratio, and measurement methods. The findings of this study suggest that CM is negatively associated with QoL. Future studies need to investigate the impact of neglect on QoL and develop tailored programs to improve the QoL of people who have suffered from CM.

Humans↗

PubMed2026

Indigenous and local knowledge inclusion in forest fauna research: A systematic review in the tropics.

Indigenous and Local Knowledge (ILK) is an expression of biocultural diversity and is vital for inclusive and sustainable forest management and epistemic justice. We examine how researchers studying tropical forest fauna engage with ILK and the Indigenous Peoples and Local Communities (IPLC) who are holders of this knowledge. We conducted a systematic review of 62 articles that focus on tropical forest fauna and ILK. We used a category-based quantitative and qualitative content analysis on the types of forest fauna studied and how research engages with, defines and represents ILK. We also evaluated the varied forms of inclusion of IPLC in the research. We find that less than half of the reviewed studies (25) explicitly define ILK, and only four studies reported including IPLC in the decision-making processes. Our findings reveal that science has not fully acknowledged and understood the depth of ILK and we suggest ways to address this in future research.

Forests↗

PubMed2025

Mediators of the Association Between a Parent's Experience of Trauma and Their Children's Well-Being: A Systematic Review.

At present, our understanding of trauma's complexity is underdeveloped, particularly with regard to intergenerational effects. In this paper, we review peer-reviewed literature on parental trauma and child well-being, focusing on mediating factors. We conducted a global systematic review of longitudinal, observational studies assessing mediators between a parent's traumatic exposure and their children's well-being. The primary outcome of the review was quantitative measures of child well-being (physical and psycho-social) assessed when the child was 18 years or under. We considered the following experiences as trauma exposures: intimate partner violence, rape, sexual assault, victimization during violent crime, childhood abuse, and exposure to direct, immediate threats to personal survival during war, political unrest, natural disasters, and sudden, critical injury/illness. Thirty-two studies met our inclusion criteria. The two most common mediator categories were caregiver mental health (n = 13) and parenting behavior (n = 10). Other studies measured aspects of the parent-child relationship (n = 9), maternal stress factors (n = 5), parental physical health (n = 2), and child-level factors (n = 6) as mediators. Almost all included studies (n = 28) detected a mediation effect. The majority of studies (n = 21) cited robust theoretical frameworks to support their mediator and outcome choices. Studies varied in quality, but most used appropriate, formal mediation analyses. Several study designs could be enhanced by methods to improve precision and reduce bias. Currently, there is little consistency in how similar constructs are measured between mediation studies. We did not locate any studies in low-income countries, and few studies examined aspects of family dynamics, physical health, environmental characteristics, or paternal factors.

Humans↗

PubMed2025

Online Risk Behavior in Adolescents: A Systematic Review.

Identifying and categorizing online risk behaviors is crucial for assessing their impact on adolescents. Despite extensive research, previous studies have not provided a clear classification of these behaviors. This systematic review synthesizes the quantitative literature on adolescent online risk behaviors from the inception of research to September 2023, aiming to: (a) offer a comprehensive overview of the types of online risk behaviors and the specific actions encompassed within each category among adolescents; (b) summarize the adverse outcomes associated with these behaviors; and (c) discuss the implications and future research directions. Utilizing key terms, this study sourced studies from four electronic databases (Scopus, PubMed, Web of Science, and EMBASE), ultimately including 22 English-language quantitative studies. The review reveals that online risk behaviors are primarily categorized into content risk behaviors, contact risk behaviors, and conduct risk behaviors. Adolescents engaging in these behaviors are at an increased risk of experiencing physical health issues, mental health problems, externalizing behaviors, and even self-harm and suicidal thoughts or actions. Further research is needed to develop and validate an online risk behavior scale and conduct longitudinal and experimental studies to establish causal relationships and examine the long-term effects of these behaviors on adolescent well-being. The review concludes with implications for future research and potential prevention, intervention, and policy strategies to mitigate online risk behaviors in adolescents.

Humans↗

PubMed2026

The impact of alcohol sale restrictions on unnatural deaths during the COVID-19 pandemic in Johannesburg, South Africa.

The COVID-19-related restrictions on the sale of alcohol in South Africa presented a unique opportunity to examine the association between alcohol availability and the prevalence of unnatural deaths. The study sample included all unnatural deaths investigated by the Johannesburg Forensic Pathology Services Medico-Legal Laboratory during the four COVID-19 alcohol restriction periods compared to the same time periods in the previous year when there were no restrictions. When alcohol sales were initially prohibited, there was a 54.2% decrease in cases of unnatural deaths (p < 0.05), suggesting a link between alcohol use and the occurrence of such deaths. Over all four periods of alcohol sale bans, there was a total reduction of unnatural deaths by 26.4% with declining frequencies in all demographics. There were significant decreases (p < 0.05) in the frequency of deaths in males, Black and Coloured individuals, and the 21-40 years age group. Deaths whose circumstances were a result of motor vehicle accidents, pedestrian vehicle accidents, and firearm discharges decreased significantly (p < 0.05). The cause of death due to blunt forces trauma and gunshot wounds also significantly decreased (p < 0.05). This study highlights the significant impact alcohol consumption has on mortality in South Africa.

Humans↗

PubMed2026

Game-Based Intervention for Bullying: Assessing the Efficacy of the REThink Therapeutic Game in Primary School Children.

Children's mental health issues can have a lasting effect into adulthood, including enhanced risks for their social and emotional development, as well as their academic performance and overall behavior. Worldwide nearly 1 billion children are affected by the bullying phenomenon, with social, emotional, and economic consequences. In this vein, our study aimed to analyze the effect of the therapeutic game REThink on the improvement of emotion regulation abilities and the reduction of both bullying behavior and victimization in primary school children. Our sample consisted of 75 children who were voluntarily enrolled by their parents, and randomly assigned to the intervention group (n = 38) or to the control group (n = 37). They completed the baseline assessment consisting of emotion regulation, irrationality, bullying and victimization behavior measurements, then the children from the intervention group played the therapeutic game REThink. Four weeks later, after completing each level twice, every participant had completed the same questionnaires at the post-test assessment. The results indicated significant changes across victimization for children who were exposed to verbal, physical or social bullying, increased emotional control and lower levels of irrationality, low frustration tolerance to work and demandingness, with small to medium effect size improvements for the REThink game group compared to the control group. The REThink therapeutic game proved to be a promising intervention tool for reducing victimization effects and irrationality, and improving emotion regulation abilities in primary school children. Future research could improve on these results by addressing the timeline stability limit.

Humans↗

PubMed2025

Patient Ethnicity and Staff Use of Restraints and Restrictive Practice in Inpatient Psychiatric Services: A Systematic Review.

Restrictive practices such as restraints, seclusion, and forced medication are only intended to be used when the threat is at a level whereby an individual is likely to inflict harm on themselves or another individual. Demographic variations, including ethnicity, may be associated with the use of these practices. However, there is no systematic review on patient ethnicity specifically. The review therefore aimed to establish whether a patient's ethnic identity was associated with staff use of restrictive practices in inpatient psychiatric services. The systematic review followed the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Four databases were searched (PsycINFO, Medline, Embase, and CINAHL). Methodological quality was assessed using the Critical Appraisal Skills Program Checklists. Fifteen studies met the inclusion criteria. A variety of ethnicities were identified within the studies. These were driven by the location of the study. Seclusion (14 studies), forced medication (4), and physical restraint (4) were explored. There were mixed findings, with ethnicity shown to predict restrictive practices in studies having larger participant numbers, longer follow-up periods and less methodological bias. It remains unclear whether ethnicity is a genuinely independent predictor of restraint and coercive practices or interacts with other risk factors. Staff working in inpatient settings should be aware of how unconscious biases might affect clinical practice. Recruiting a diverse workforce from minority ethnic groups into inpatient psychiatric services would be a positive step. However, support for these staff members is important, and all staff should be equipped to respond to ethnic diversity. Future research should explore beyond patient-level factors.

Humans↗

PubMed2025

Parent-Child Communication after Parental Exposure to Potentially Traumatic Events: A Systematic Review.

Intergenerational traumatization poses a risk for the well-being of children whose parents have been exposed to potentially traumatic events (PTEs). Previous research has implied that parent-child communication may significantly contribute to the transmission of trauma across generations, but findings remain limited and inconclusive, particularly regarding the mechanisms and factors that could underlie this process. Therefore, the present paper performed a mixed methods systematic literature review to methodically map how PTE-exposed parents communicate with their children-both in general and about parental PTEs-and how such communication may contribute to trauma transmission. Five electronic databases were accessed to conduct keyword-led searches, yielding a final inclusion of 31 peer-reviewed, empirical studies that investigated parent-child communication among PTE-exposed parents and/or their nonexposed children. Parental PTE exposure was found to have a negative impact on general parent-child communication, often due to the presence of parental anger, irritability, and withdrawal. Conversations about parental PTEs showed substantial diversity in their frequency, content and style, with strategies of partial/modulated disclosure appearing most common. How parents approached PTE communication frequently stemmed from a desire to keep their children safe and unburdened by their previous experiences. Finally, both general communication and PTE communication were implied to contribute to trauma transmission, revealing a significant impact of parent-child communication on child functioning, identity, and well-being. Based on these key findings, the authors discuss meaningful implications for future research (i.e., prospective directions, addressing methodological concerns) and formulate suggestions for clinicians and policymakers surrounding the treatment of PTE-exposed parents and their offspring.

Humans↗

PubMed2026

A Critical Assessment of Evidence-Based Design's Knowledge Base and Inspiration: A Systematic Review.

PurposeThis study examines Evidence-Based Design (EBD) as an epistemological framework for guiding design research and practice, with a particular focus on its reliance on Evidence-Based Medicine (EBM) as a source of methodological inspiration.BackgroundOver the past two decades, EBD has been promoted as a way to strengthen design processes through the systematic use of scientific evidence. Its relationship to EBM, however, remains conceptually ambiguous: EBD draws legitimacy from EBM's hierarchical conception of "best evidence" while at the same time acknowledging the specificities of design practice, which do not easily fit such a model.MethodologyA systematic review was conducted on 31 publications in the design research literature that explicitly address the tension surrounding EBD's conception of "best evidence." The criticisms raised were coded and analyzed by main topics and subtopics.ResultsThe review highlights several reasons why EBM's hierarchical view of "best evidence" is an unsuitable epistemological foundation for EBD. It imposes scientifically inappropriate and practically ineffective methodological standards, devalues important sources of design knowledge, and fails to address central epistemic challenges intrinsic to design processes.ConclusionsBy bringing together critical yet fragmented insights from the literature, this study argues for the development of an updated epistemological framework for EBD. Constructing this framework will require sustained interdisciplinary dialogue between design research and philosophy of science.

Humans↗

PubMed2026

Interest holder-driven research priorities in sexual and reproductive health for migrant and refugee adolescents and young adults in Australia.

OBJECTIVE: To identify and prioritise sexual and reproductive health research priorities for migrant and refugee adolescents and young adults in Australia using a priority setting partnership approach. METHODS: A James Lind Alliance priority setting partnership was conducted with 92 interest holders: 31 youth from migrant and refugee backgrounds and 61 professionals (healthcare providers, researchers, policymakers and community leaders), recruited online and in-person. The priority setting partnership process included a rapid evidence scan, an online uncertainty survey, evidence verification, interim prioritisation and a final consensus workshop. RESULTS: Eighty-three research uncertainties yielded 11 final priorities across four sexual and reproductive health domains: sexual and reproductive health literacy, sexual violence prevention, accessible services and maternal health. A striking divergence emerged between youth and professional priorities only 3 achieved combined high-priority consensus. Youth prioritised a broader range of topics, including abortion access (rated high by youth but low by professionals), while professionals prioritised fewer areas. Two priorities achieved consensus: community-based maternal health support and barriers to reporting gender-based violence. CONCLUSION: This is the first priority setting partnership to identify sexual and reproductive health research priorities for migrant and refugee youth in Australia and to uniquely highlight substantial misalignment between youth and professional priorities. IMPLICATIONS FOR PUBLIC HEALTH: These identified priorities provide a foundation for targeted research, culturally responsive policy and more equitable sexual and reproductive health service provision for migrant and refugee adolescents and young adults.

Australia↗

PubMed2026

Contact tracing for hepatitis C: perspectives of people with experience of substance use and hepatitis C on intervention acceptability.

INTRODUCTION: Chronic hepatitis C (HCV) is a major cause of cirrhosis and hepatocellular carcinoma. In the UK, the principal risk factor for HCV is injecting drug use. The introduction of direct acting anti-virals (DAA's) have transformed HCV care, with cure rates of over 95%. However, HCV is often asymptomatic, and reinfection is a concern. Modelling and real-life studies demonstrate the potential effectiveness of a contact tracing approach for finding people who have acquired HCV through injecting drug use. However, it is not used routinely in the UK. This qualitative study was undertaken to assess the acceptability of a contact tracing approach to identify people who have injected drugs with an index patient recently diagnosed with HCV. METHODS: Twelve people with lived or living experience of injecting drug use and an HCV diagnosis were interviewed using semi-structured interview topic guides. Participants were purposefully selected according to the inclusion criteria and to ensure there was an even spread of male and female participants. Sekhon's Theoretical Framework of Acceptability, incorporating seven components (affective attitude, burden, ethicality, intervention coherence, opportunity cost, perceived effectiveness, and self-efficacy) was used to analyse data from interview transcripts. RESULTS: A sample of 12 people who inject drugs in the UK indicated that a contact tracing approach was acceptable across two components of Sekhon's acceptability framework: affective attitude and ethicality. Participants broadly found the idea of tracing people who may be at risk of contracting HCV acceptable, and the approach aligned with their value systems. A contact tracing approach would help alleviate concerns about putting other people's lives at risk through HCV transmission and was seen as a 'sensible' way of finding people at risk. However, there were caveats to this acceptability. Contact tracing approaches delivered by mainstream health, or governmental organisations increased burden, opportunity costs and perceived effectiveness of a contact tracing approach for HCV, particularly within contexts of exclusion and criminalisation of people who inject drugs. Burden and opportunity costs were also affected by individual experiences and risks of violence, sexual violence and abuse. There was a lack of knowledge of contact tracing approaches amongst respondents, leading to a lack of intervention coherence and misunderstandings of what contact tracing was and how it would work. Trusted relationships with NGOs and HCV specialist nurses reduced burden and increased confidence and ability (self-efficacy) to engage with a contact tracing approach. CONCLUSION: People who inject drugs broadly perceive contact tracing as an acceptable method of finding people who are at risk of HCV. However, this acceptability is based on specific modes of delivery through trusted organisations. Findings further highlight the importance of naming and describing contact tracing approaches appropriately, as well as assessing and mitigating against potential risk to index patients, to increase self-efficacy and capacity to engage. Considering these findings, the potential for expanding existing contact tracing approaches should be explored to ensure the UK reaches and maintains its elimination targets.

Humans↗

PubMed2026

A profile of suspected female homicide cases at the Johannesburg and Diepkloof Forensic Pathology Service Medico-legal Mortuaries for 2020-2022.

This study profiles suspected female homicide victims in Johannesburg, South Africa, during the COVID-19 period marked by socio-environmental changes from lockdown restrictions. Guided by the Socio-Ecological Model, a retrospective case series of 369 victims was reviewed using medico-legal mortuary records from Johannesburg and Diepkloof Forensic Pathology Service facilities. Descriptive analyses were conducted, supplemented by a chi-square test to assess whether distributions of causes of death among women differed between COVID-19 and non-COVID-19 periods. No statistically significant association was found, χ2 (6, N = 339) = 6.68, p = 0.35. Key findings highlight that Black, unemployed, unmarried women aged 21-40 were at greatest risk. Cause of death was established in 97.0% (358/369) of cases, with firearm injuries predominating (43.9%), followed by sharp‑force (24.5%) and blunt‑force trauma (13.1%). Approximately 90% of victims were suspected to have been killed by males, with half of deaths attributed to intimate partner violence. Homicide frequency decreased during strict lockdowns but rose as restrictions eased, suggesting that movement and alcohol controls may reduce risk. Despite temporary disturbance caused by COVID‑19 restrictions, the underlying risk profile of female homicide victims remained unchanged. These findings inform multi-level prevention and intervention strategies in South Africa.

Humans↗

PubMed2026

Sexual Abuse in Girls Aged ≤14: A Retrospective Observational Swiss Study.

INTRODUCTION: Child sexual abuse (CSA) is a critical public health concern with enduring physical and psychological consequences. OBJECTIVE: This study aimed to describe the sociodemographic profiles, contextual circumstances, and clinical findings of reported CSA cases involving girls aged ≤14, recorded between 2018 and 2021 at two university hospitals in Switzerland: Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois - CHUV) and Geneva University Hospitals (Hôpitaux Universitaires de Genève - HUG) to inform prevention and intervention strategies. METHODS: This retrospective observational study included 95 cases identified through forensic consultations at CHUV and HUG. All eligible cases recorded between 2018 and 2021 were analyzed. Collected data included sociodemographic characteristics, assault circumstances, perpetrator-victim relationship, and clinical findings. RESULTS: The median age of children exposed to sexual assault was 7 years (IQR 4-14). Intra-familial abuse predominated among premenarcheal girls (41.7%), while postmenarcheal girls were more frequently assaulted by non-familial perpetrators (76.2%) and experienced higher rates of physical violence (47.6%). Genital lesions were documented in 41% of cases, with a higher prevalence among younger patients, and were rarely specific to CSA. CONCLUSION: This study provides a detailed descriptive overview of CSA cases involving girls aged ≤14 in two Swiss cantons. It highlights age-related patterns in perpetrator profiles, assault characteristics, and clinical findings. Prevention strategies should be age-specific, addressing intra-familial risk in younger children and peer-related or situational vulnerabilities in adolescents. These findings support the implementation of standardized forensic practices, improved surveillance systems, and targeted prevention and care strategies.

Child sexual abuse Intra-familial abuse Pediatric ↗

PubMed2026

Experiences of stigma, bias, and communication challenges among pregnant healthcare workers: A systematic review of qualitative evidence.

BACKGROUND: Healthcare work environments are fraught with occupational hazards that can impact pregnant healthcare workers' health as well as patient care. Despite the feminization of healthcare globally, systematic discrimination against pregnant workers persists across diverse healthcare settings and cultural contexts. The intersection of stigma, bias, and communication challenges creates substantial barriers to career advancement and wellbeing. However, no systematic review has synthesized qualitative evidence on how these three constructs interact across healthcare professions and cultural contexts using an integrated theoretical framework. OBJECTIVE: To systematically review and synthesize qualitative evidence on experiences of stigma, bias, and communication challenges among pregnant healthcare workers across different healthcare settings and cultural contexts using an integrated theoretical framework. DESIGN: Systematic review of qualitative studies following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines with thematic synthesis. DATA SOURCES: Seven databases were searched from inception to January 2026. REVIEW METHODS: Included qualitative studies were appraised using the Critical Appraisal Skills Programme (CASP) checklist and synthesized through theory-guided thematic synthesis. Confidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) approach. RESULTS: Fourteen studies encompassing 1223 participants across 17 countries revealed four major themes: (1) professional identity stigma and workplace discrimination through systematic labeling and stereotyping; (2) gender-based institutional bias rooted in masculine organizational logic; (3) multilevel communication failures creating fear-based climates; and (4) individual and collective resistance strategies developed despite constraints. Occupational hazards specific to pregnancy included exposure to infectious diseases, imaging, physical tasks, cleaning products, patient violence, and medication administration. Support from coworkers and supervisors was identified as the most critical facilitator for avoiding hazards and making necessary modifications, while the desire to be 'supernurses' and fear of consequences emerged as significant barriers. These patterns were consistent across healthcare professions, settings, and cultural contexts, with specialty culture and healthcare system type moderating discrimination intensity. Confidence in core findings was rated high using GRADE-CERQual. CONCLUSIONS: Pregnant healthcare workers globally experience interconnected stigma, bias, and communication challenges that are systematically embedded within healthcare organizational structures. These challenges operate synergistically, requiring comprehensive multilevel interventions beyond policy compliance. Healthcare organizations must implement evidence-based strategies addressing stigma reduction, bias interruption, and communication transformation simultaneously to retain skilled workers and ensure quality patient care.

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