Anthony A. Laverty

Background: Patient portals are increasingly used to support self-management and facilitate care coordination in people with chronic diseases. Although some asthma quality-of-care gains and modest chronic obstructive pulmonary disease (COPD) improvements have been reported in wider digital health studies, a comprehensive review of patient portal-specific evidence is lacking. Objective: This study aimed to systematically synthesize evidence on the impacts of patient portals on adult asthma and COPD outcomes across 6 quality-of-care domains (effectiveness, patient-centeredness, equity, efficiency, safety, and timeliness). Methods: We searched 5 databases (MEDLINE/PubMed, Embase, PsycINFO, CINAHL, and Google Scholar) for quantitative evaluations published up to March 2026 (CRD42022316044). The Newcastle-Ottawa Scale and Cochrane Risk of Bias-2 tool were used for quality assessments, and certainty of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Findings were narratively synthesized using the SWiM (Synthesis Without Meta-analysis) framework. Results: We identified 4038 records, and 16 papers published between 2007 and 2024 met the inclusion criteria (asthma=13, COPD=2, both=1). Three were randomized controlled trials, all rated high risk of bias. Of the other studies, 5 had low risk, 6 had moderate risk, and 2 had high risk of bias. Effectiveness and patient-centeredness were most frequently reported, with 12 papers each. Eight papers were on equity, 5 each on efficiency and safety, and 4 on timeliness. In asthma, modest disease control improvements were reported in 27.8% (42/151) of participants using patient portals with home visit support versus portal use alone (35/150, 23.3%). In COPD, one large, interrupted time series study (N=909,724) reported post-implementation reductions in hospitalizations (slope change from 1.33 to −4.38 per 10,000 patients per month; P <.001) but no mortality benefits. Short-term improvements in asthma-related quality of life were observed among patient portal users (mean Mini Asthma Quality of Life Questionnaire score change of 0.67; 95% CI 0.36-0.98) but with no sustained effects. In terms of equity, several digital access barriers were noted. Assessments of efficiency outcomes were largely subjective, and safety events were weakly described. Across all outcome domains, GRADE assessment indicated low to very low evidence certainty. Conclusions: This review found low to very low certainty of evidence on the impacts of patient portals on quality of care for asthma and COPD. While modest disease control improvements and short-term quality-of-life gains were noted in asthma, and reduced hospitalizations in COPD were observed, the evidence base remains limited and methodologically weak. This review cautions against a reliance on patient portals for clinical management of asthma and COPD and highlights that more methodologically robust primary studies are needed to identify how portal functions may yield clinically meaningful benefits for patients with chronic respiratory disease.

This study examined whether broader environmental orientations are associated with current e-cigarette use and disposable e-cigarette use in the European Union (EU). We analysed data from Special Eurobarometer 99.3 (2023) across 27 EU Member States (n = 26,353), measuring environmental orientations via climate concern and pro-environmental behaviours. Climate concern was associated with lower likelihood of e-cigarette use (Prevalence Ratio = 0.84, 95% CI, 0.72–0.99); pro-environmental behaviour was associated with a lower likelihood of disposable e-cigarette use (0.72,0.53–0.99). Both estimates were attenuated in sensitivity analyses; the latter relied on a small subgroup. Findings should be considered exploratory. Further research using product-specific environmental measures is warranted.

Low Traffic Neighbourhoods (LTNs) restrict through-traffic in residential areas. One concern is that LTNs may displace motor traffic onto nearby boundary roads, increasing journey times and congestion.,We explored this using Google Directions API data to assess how five LTNs in London affected boundary road journey times and heavy congestion. We found that journey times increased in the first year on the boundary roads of all five LTNs, with an average relative increase of 8.6% (95%CI 2.6% to 15.0%). Heavy congestion showed a similar trend, although the pooled increase was not statistically significant. Both effects reduced substantially from year 2 onwards, with average journey times and congestion typically returning to pre-LTN levels. We conclude that LTNs do not cause persistent boundary-road delays on average, although short-term disruption is likely. Policymakers should monitor outcomes over extended periods and consider targeted mitigation measures on the minority of boundary roads where long-term effects persist.

Low Traffic Neighbourhoods (LTNs) restrict through-traffic in residential areas. One concern is that LTNs may displace motor traffic onto nearby boundary roads, increasing journey times and congestion.,We explored this using Google Directions API data to assess how five LTNs in London affected boundary road journey times and heavy congestion. We found that journey times increased in the first year on the boundary roads of all five LTNs, with an average relative increase of 8.6% (95%CI 2.6% to 15.0%). Heavy congestion showed a similar trend, although the pooled increase was not statistically significant. Both effects reduced substantially from year 2 onwards, with average journey times and congestion typically returning to pre-LTN levels. We conclude that LTNs do not cause persistent boundary-road delays on average, although short-term disruption is likely. Policymakers should monitor outcomes over extended periods and consider targeted mitigation measures on the minority of boundary roads where long-term effects persist.

Background: Estimates indicate that 45% of mortality among children under 5-year old is linked to nutrition. Increased food prices can reduce access to nutritious foods, increasing nutritional and health risks for children, particularly in low and middle-income countries (LMICs). We synthesised evidence on the relationship of rising food costs with nutritional outcomes and mortality in children in LMICs. Methods: EMBASE, MEDLINE, Global Health, EconLit, Web of Science and six grey literature sources were searched in September 2023. Searches included key phrases such as ‘food price shocks’ and ‘child malnutrition’. We included any longitudinal study design, with any measure of food price increase and any measure of child malnutrition or mortality as outcomes. Results were analysed narratively with risk of bias assessed using the Newcastle Ottawa Scale. Results: A total of 18 studies were included, covering 104 LMICs. There were 16 repeated cross-sectional or panel studies, one longitudinal cohort study and one quasi-experimental study. Five of these studies were multicountry. 16/18 studies reported a range of adverse nutritional outcomes associated with higher food costs, including mortality (five studies), stunting and low height for age (six studies), and wasting and low weight for height (five studies). Low birth weight, admissions to feeding centres, reduced consumption of rice, fruit, vegetables and animal protein, and reduced haemoglobin concentrations were also associated with higher food prices in one study each. Subgroup analyses were limited although two studies identified larger impacts on children in urban areas, and two studies identified larger impacts where children were exposed to higher food prices at younger ages. Discussion: Rising food prices present a risk to child health and nutrition in LMICs. Policies should prioritise increasing household income alongside structural reforms to mitigate the nutritional impacts of elevated food prices on young children and pregnant women. PROSPERO registration number: CRD42023469198.

Introduction: Secondhand smoke (SHS) constitutes a significant health risk for children. This study examined whether knowledge of SHS harms to children and concern about setting examples for children and are associated with intentions to quit among adults who smoke in Japan, a country where child health and parental role as models for their children are highly valued. Methods: Data came from respondents of the 2021 ITC Japan Wave 4 Survey who smoked cigarettes at least weekly (N = 2586). Weighted logistic regression analyzed whether respondents’ knowledge of SHS harms to children (Knowledge Index), concern that one’s smoking would influence children to smoke (Influence Index), and support for banning smoking in cars with children (Policy Index) were associated with intentions to quit. Results: 39.3% of respondents intended to quit smoking. 85.5% of all respondents supported a law to ban smoking in cars with children. The Influence Index was most strongly associated with quit intentions (OR = 2.21, 95% CI = 1.94, 2.53), and this association was stronger for respondents living with children at home than for respondents who did not (interaction p=.039). Greater knowledge of SHS harms (OR = 1.39, 1.27, 1.54) and support for banning smoking in cars with children (OR = 1.39, 1.27, 1.54) were also associated with quit intentions, but that association was no different among those who lived with children. Conclusions: Both knowledge about SHS health harms on children and concerns that one’s smoking would influence children to smoke were significantly related to quit intentions. This suggests that interventions to increase awareness among adults who smoke may reduce children’s exposure through increased quitting, especially among those with children. The very high support among those who smoke for a law to ban smoking in cars with children suggests that this is a feasible policy option in Japan. Implications: Public health campaigns and other interventions that raise awareness of the harms of tobacco smoke on children and emphasize the importance of serving as models for children may be particularly effective for motivating smoking cessation among adults who smoke in Japan and other countries.

We conducted a secondary analysis of Eurobarometer survey data from 27 European countries, collected in 2017 (n = 28 300) and 2023 (n = 26 358), to assess changes in public support for standardised tobacco packaging. In the pooled analysis, support remained unchanged in the 19 MS without relevant legislation (adjusted Prevalence Ratio [aPR]=0.94, 95% Confidence Interval: 0.86–1.03), whereas the 8 MS that had implemented the policy by 2023 were significantly more likely to experience an increase in support (interaction term: aPR = 1.28, 1.17–1.41). The increase in support offers reassurance to policymakers advocating for tobacco packaging regulations and encourages MS to consider the adoption of similar policies.