Articles

Background. Screen use begins early in infancy in many urban settings, but prospective evidence linking toddler screen time to language development in Southeast Asia is limited. Methods. We recruited 642 children at their 12-month well-child visit in six government health clinics in Kuala Lumpur and followed them to 24 months. Screen time was measured with 3-day caregiver time-use diaries at 12 and 18 months. Expressive vocabulary at 24 months was assessed with validated Malay, Mandarin and Tamil adaptations of the MacArthur–Bates Communicative Development Inventories, and late talking was defined as fewer than 50 words or no word combinations. Associations were estimated with modified Poisson and linear regression adjusted for child, family and home language factors. Results. A total of 568 children (88.5%) completed the 24-month assessment. Median screen time at 18 months was 1.6 hours per day (IQR 0.8–2.7), and 208 children (36.6%) used screens for 2 hours or more daily. Late talking occurred in 25.0% of children with 2 hours or more of daily screen time compared with 9.8% of those with less than 1 hour (adjusted risk ratio 2.18, 95% CI 1.29–3.67). Each additional hour per day was associated with a 17-word smaller vocabulary (95% CI 10–24). The association was weaker when caregivers usually co-viewed (p for interaction = 0.038). Conclusions. Higher screen time at 18 months was associated with poorer expressive language at 24 months. Anticipatory guidance during well-child visits should address both the amount of screen use and caregiver engagement during viewing.

Background. School closures and the shift to online learning during the COVID-19 pandemic increased screen time and reduced outdoor activity among children, raising concern about faster myopia onset. Population-based data on myopia among Indian schoolchildren after the pandemic are limited. Methods. A school-based cross-sectional survey was conducted between August and December 2025 in 30 government and private schools in urban Delhi selected by stratified cluster random sampling. Children aged 6–15 years underwent visual acuity testing and cycloplegic autorefraction, and parents completed a questionnaire on outdoor time, screen use, near work and parental myopia. Myopia was defined as a spherical equivalent of −0.50 D or less in either eye. Risk factors were examined using multivariable logistic regression accounting for clustering by school. Results. Of 5,400 eligible children, 4,862 (90.0%) completed the examination. The prevalence of myopia was 21.4% (95% CI 19.9–22.9), rising from 9.8% at 6–8 years to 32.2% at 12–15 years, and high myopia was found in 1.1%. Among myopic children, 61.2% were uncorrected or undercorrected. Myopia was independently associated with older age, female sex, private schooling, parental myopia (both parents: adjusted OR 3.12, 95% CI 2.41–4.04), spending less than 1 hour a day outdoors (adjusted OR 2.08, 95% CI 1.66–2.61) and recreational screen time above 3 hours a day (adjusted OR 1.92, 95% CI 1.53–2.41). Conclusions. About one in five schoolchildren in urban Delhi was myopic after the pandemic, a higher prevalence than reported in earlier surveys of the city. School-based programs that increase outdoor time, limit recreational screen use and provide spectacles are needed.

Background. Point-of-care (POC) HbA1c testing makes results available during the consultation and may support timely treatment decisions in type 2 diabetes, but its effect on glycemic control in primary care remains uncertain. Methods. We searched MEDLINE, Embase, CINAHL, the Cochrane Central Register of Controlled Trials, and Web of Science from inception to January 31, 2026, for randomized and nonrandomized controlled studies comparing POC with laboratory HbA1c testing in adults with type 2 diabetes managed in primary care. Two reviewers independently screened records, extracted data, and assessed risk of bias. Mean differences (MD) in HbA1c were pooled by random-effects meta-analysis, and certainty of evidence was rated with GRADE. Results. Fourteen studies (8 randomized trials and 6 nonrandomized studies; 5,872 participants) were included, and 12 (4,918 participants) contributed to the meta-analysis. POC testing was associated with a greater reduction in HbA1c (MD −0.26 percentage points, 95% CI −0.38 to −0.14; I² = 61%). The effect was smaller in randomized trials (MD −0.21, 95% CI −0.34 to −0.08) and larger when baseline HbA1c was 8.0% or higher (MD −0.41, 95% CI −0.60 to −0.22). POC testing increased the proportion of patients reaching an HbA1c below 7.0% (risk ratio 1.18, 95% CI 1.06–1.31) and treatment intensification at the index visit (risk ratio 1.34, 95% CI 1.12–1.60). Conclusions. Moderate-certainty evidence indicates that POC HbA1c testing in primary care produces a modest improvement in glycemic control, largely through more timely treatment intensification, with the greatest benefit in patients with poorly controlled diabetes.

Concern that social media harms adolescent mental health has shaped public debate and policy, from school phone bans to proposed age limits, yet the research evidence remains contested. Large cross-sectional studies typically find small negative associations between time spent on social media and well-being, while longitudinal and experimental studies yield smaller, inconsistent or null effects at the population level. This review argues that much of the apparent contradiction reflects three features of the literature rather than the simple presence or absence of harm. First, reliance on self-reported screen time, which correlates only moderately with logged use, obscures what adolescents actually do online. Second, average effects conceal substantial heterogeneity: a minority of adolescents, particularly those with existing vulnerabilities, appear to experience meaningful harm, while others benefit from social connection and identity exploration. Third, associations vary with developmental timing, with evidence of heightened sensitivity in early adolescence that differs by gender. We summarize evidence on specific mechanisms, including sleep displacement, cyberbullying, appearance-based social comparison and problematic use, and contrast them with documented benefits for social support. We conclude that research and policy should move beyond total screen time toward measures of content, context and individual susceptibility, and we outline priorities for study design, researcher access to platform data and the evaluation of regulatory interventions.

Background. Night-shift work reduces daytime sun exposure and may predispose healthcare workers to vitamin D deficiency, but comparative data from Turkish hospitals are limited. This study compared vitamin D status between night-shift and day-shift hospital staff. Methods. We conducted a cross-sectional study of 312 healthcare workers at a university hospital in Izmir between February and April 2025, comprising 156 workers with regular night shifts and 156 day-shift workers. Serum 25-hydroxyvitamin D (25(OH)D) was measured by chemiluminescent immunoassay, and deficiency was defined as a concentration below 20 ng/mL. Associated factors were examined with multivariable logistic regression. Results. The median 25(OH)D concentration was 15.8 ng/mL (interquartile range 11.2–21.4), and 216 participants (69.2%) were deficient. Deficiency was more common among night-shift than day-shift workers (79.5% vs 59.0%, p < 0.001), as was severe deficiency below 10 ng/mL (24.4% vs 10.9%, p = 0.002). Night-shift work remained independently associated with deficiency after adjustment for age, sex, body mass index, supplement use, and daily daylight exposure (adjusted odds ratio 2.61, 95% CI 1.49–4.57). Conclusions. Vitamin D deficiency was highly prevalent among hospital staff, particularly those working night shifts. Occupational health services should consider targeted screening or routine supplementation for night-shift workers.