BACKGROUND: Machine-learning algorithms and big data analytics, popularly known as 'artificial intelligence' (AI), are being developed and taken up globally. Patient and public involvement (PPI) in the transition to AI-assisted health care is essential for design justice based on diverse patient needs. OBJECTIVE: To inform the future development of PPI in AI-assisted health care by exploring public engagement in the conceptualization, design, development, testing, implementation, use and evaluation of AI technologies for mental health. METHODS: Systematic scoping review drawing on design justice principles, and (i) structured searches of Web of Science (all databases) and Ovid (MEDLINE, PsycINFO, Global Health and Embase); (ii) handsearching (reference and citation tracking); (iii) grey literature; and (iv) inductive thematic analysis, tested at a workshop with health researchers. RESULTS: The review identified 144 articles that met inclusion criteria. Three main themes reflect the challenges and opportunities associated with PPI in AI-assisted mental health care: (a) applications of AI technologies in mental health care; (b) ethics of public engagement in AI-assisted care; and (c) public engagement in the planning, development, implementation, evaluation and diffusion of AI technologies. CONCLUSION: The new data-rich health landscape creates multiple ethical issues and opportunities for the development of PPI in relation to AI technologies. Further research is needed to understand effective modes of public engagement in the context of AI technologies, to examine pressing ethical and safety issues and to develop new methods of PPI at every stage, from concept design to the final review of technology in practice. Principles of design justice can guide this agenda.

Background: Sexual and reproductive health (SRH) programmes and services aim to prevent complications of pregnancy and childbirth, unintended pregnancies, unsafe abortions, complications caused by sexually transmitted infections, including HIV, sexual violence and impacts from avoidable cancer. Objective: To systematically identify published economic evaluations of SRH programmes and services, assess the methods used and analyse how costs and outcomes are estimated in these studies. Settings: Low- and middle-income countries. Design: Systematic review and narrative synthesis. Methods: Eight databases were searched, including EMBASE, MEDLINE, Scopus, Health Technology Assessment, Web of Science, PsycINFO, National Health Service Economic Evaluation Database (NHS EED) and African Journals Online (AJOL) from 1998 to December 2023. The inclusion and exclusion criteria were developed using the Population, Intervention, Comparator, Outcome and Study Design framework. The review included economic evaluations alongside randomised trials and economic studies with modelling components. Study characteristics, methods and results of economic evaluations were extracted and tabulated. The quality of the studies was assessed using the Consensus Health Economic Criteria list and Philips checklists for trial-based and model-based studies, respectively. The review followed the reporting guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the results were synthesised narratively in line with Centre for Reviews and Dissemination guidance. Results: 7575 studies were screened and categorised. 20 studies were included in the review. The studies assessed the cost-effectiveness and costs of SRH programmes and services from an individual, healthcare or societal perspective. The main SRH programme considered was contraceptive services. The main outcome measures reported were disability-adjusted life years, quality-adjusted life years, couple years of protection and pregnancies averted. Most of the studies did not indicate the costing approach used, and many of the studies evaluated direct medical costs only. Most of the study designs were model-based with significant heterogeneity between the models. The review showed that many studies did not fulfil all of the requirements for a high-quality economic evaluation. 1 out of the 20 studies reviewed considered equity. Conclusions: The review revealed heterogeneity in approaches to evaluating the costs and outcomes of SRH programmes. These methodological limitations may have implications for their use by public health decision-makers to inform optimal decision-making. Prospero registration number: CRD42023435241.

Background: Population-wide newborn blood spot screening programmes are a successful public health intervention used to detect whether the baby is at risk of certain rare conditions, with the aim of earlier diagnosis and provision of optimal care and treatment. Evaluating candidate conditions to include in newborn blood spot and genetic sequencing raises questions regarding acceptability to parents/carers. Methods: In the context of the possible expansion of the newborn blood spot screening programme in the United Kingdom, this review aimed to systematically review research on the acceptability to parents of newborn blood spot screening and genetic sequencing. A protocol was developed prior to commencing the review and was registered on the PROSPERO database. A team of researchers carried out the review, with checking at all stages carried out by at least two individuals. We included research published after 2013 with participants who were pregnant or a recent parent of a newborn and were resident in a high-income country. We included quantitative and qualitative studies that investigated the acceptability to parents/carers of newborn blood spot screening or genetic sequencing. Quantitative studies were narratively synthesised, and theories/frameworks identified and evaluated. Qualitative studies were analysed for recurring themes, and a meta-synthesis was carried out to compare and contrast these two types of data. We quality appraised included articles using tools appropriate for their study design. Results: Searches were carried out in September to November 2023 and screening identified 25 relevant research articles. Just over half were from North America, with four existing reviews and nine qualitative studies. Domains of acceptability described in the literature were: support for screening; level of anxiety, information and knowledge; consent; views of the procedure; and support after screening. The research indicated consensus support for blood spot screening, and for expanding to some other conditions, although some parental anxiety was reported. Parents/carers mostly perceived that they had received sufficient information, but the timing of this could be improved. While parents indicated interest in genomic screening, studies highlighted the need for clearer consent procedures and greater support for parents following genomic screening than for blood spot screening. Only three included studies reported using any kind of theoretical framework. Discussion: Most parents/carers found newborn blood spot screening programmes to be acceptable and favoured their large-scale implementation. A minority of parents/carers expressed concerns regarding the acceptability of processes underpinning newborn blood spot screening, such as consent, the timing of receiving information and support available after testing. More research is needed regarding the acceptability of newborn genomic sequencing screening programmes, which are less established compared with newborn blood spot screening programmes. Limitations: The over-representation of studies conducted in the United States has implications for the applicability of findings to other countries where testing is not typically mandatory and health systems differ considerably. Most studies were of cross-sectional design and there was limited representation of people from lower incomes and non-white ethnicity. While the inclusion of studies only in populations of future or very recent parents provided coherence to the findings, unclear reporting of participants may have resulted in under- or overinclusion of some studies. Funding: This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number NIHR159927.

INTRODUCTION: The COVID-19 pandemic has instigated the development of telemedicine-mediated provision of medications for opioid use disorder such as buprenorphine and methadone, referred to as TMOUD in this study. As services start to return to pre-pandemic norms, there is a debate around the role of TMOUD as addition to or replacement of the conventional cascade of care for people with opioid use disorder (PWOUD). This scoping review is designed to characterize existing TMOUD services and provide insights to enable a more nuanced discussion on the role of telemedicine in the care of PWOUD. METHODS: The literature search was conducted in OVID Medline, CINAHL, and PsycINFO, from inception up to and including April 2023, using the Joanna Briggs Institute methodology for scoping reviews. The review considered any study design that detailed sufficient descriptive information on a given TMOUD service. A data extraction form was developed to collect and categorize a range of descriptive characteristics of each discrete TMOUD model identified from the obtained articles. RESULTS: A total of 45 articles met the inclusion criteria, and from this, 40 discrete TMOUD services were identified. In total, 33 services were US-based, three from Canada, and one each from India, Ireland, the UK, and Norway. Through a detailed analysis of TMOUD service characteristics, four models of care were identified. These were TMOUD to facilitate inclusion health, to facilitate transitions in care, to meet complex healthcare needs, and to maintain opioid use disorder (OUD) service resilience. CONCLUSIONS: Characterizing TMOUD according to its functional benefits to PWOUD and OUD services will help support evidence-based policy and practice. Additionally, particular attention is given to how digital exclusion of PWOUD can be mitigated against.

The sexual and reproductive health (SRH) needs of youths in sub-Saharan Africa are not being fully met, as evidenced by high rates of unintended pregnancies and sexually transmitted infections in this population. Understanding service needs and preferences of sub-Saharan African youths aged 10-24 years is critical for improving access and SRH outcomes and the focus of this systematic review of qualitative research. Four databases were searched with key words to identify relevant studies, supplemented by citation search, with an update in June 2023. The eligibility criteria were clear and developed a priori. Twenty included studies from seven countries underwent quality appraisal using the Critical Appraisal Skills Programme (CASP). A meta-ethnographic approach was used to synthesise concepts across studies by the researchers. Four key themes were generated: information needs; service needs; social needs; and delivery preferences. Information needs encompassed desires for age-appropriate education on contraception, safer sex, bodily changes, and healthy relationships to fill knowledge gaps. Social needs consisted of life skills training, vocational development, substance use rehabilitation, and support systems to foster healthy behaviours. Service needs included accessible youth-friendly sexual health services, preventative care, sexually transmitted Infections (STI) management, and contraception; and delivery preferences including competent providers who maintain privacy and confidentiality, convenient youth-oriented settings, free or low-cost provisions, and youth involvement in service design. In conclusion, the identified themes emphasise the diverse nature of SRH needs and preferences among sub-Saharan African youths. Insights from their unique priorities and unmet needs inform policy development and intervention strategies. Tailored awareness campaigns, youth-centred training for providers, youth-friendly and confidential SRH models, comprehensive education, and engaging youth in developing relevant solutions may improve acceptability, access, and health outcomes. These efforts could address barriers around stigma, costs, and lack of knowledge, contributing to enhanced SRH and wellbeing. Fulfilling youth SRH needs in sub-Saharan Africa requires commitment across sectors to evidence-based, youth-focused strategies placing their perspectives at the centre.

Increasing evidence suggests that urban health objectives are best achieved through a multisectoral approach. This approach requires multiple sectors to consider health and well-being as a central aspect of their policy development and implementation, recognising that numerous determinants of health lie outside (or beyond the confines of) the health sector. However, collaboration across sectors remains scarce and multisectoral interventions to support health are lacking in Africa. To address this gap in research, we conducted a mixed-method systematic review of multisectoral interventions aimed at enhancing health, with a particular focus on non-communicable diseases in urban African settings. Africa is the world's fastest urbanising region, making it a critical context in which to examine the impact of multisectoral approaches to improve health. This systematic review provides a valuable overview of current knowledge on multisectoral urban health interventions and enables the identification of existing knowledge gaps, and consequently, avenues for future research. We searched four academic databases (PubMed, Scopus, Web of Science, Global Health) for evidence dated 1989-2019 and identified grey literature from expert input. We identified 53 articles (17 quantitative, 20 qualitative, 12 mixed methods) involving collaborations across 22 sectors and 16 African countries. The principle guiding the majority of the multisectoral interventions was community health equity (39.6%), followed by healthy cities and healthy urban governance principles (32.1%). Targeted health outcomes were diverse, spanning behaviour, environmental and active participation from communities. With only 2% of all studies focusing on health equity as an outcome and with 47% of studies published by first authors located outside Africa, this review underlines the need for future research to prioritise equity both in terms of research outcomes and processes. A synthesised framework of seven interconnected components showcases an ecosystem on multisectoral interventions for urban health that can be examined in the future research in African urban settings that can benefit the health of people and the planet.Paper ContextMain findings: Multisectoral interventions were identified in 27.8% of African countries in the African Union, targeted at major cities with five sectors present at all intervention stages: academia or research, agriculture, government, health, and non-governmental.Added knowledge: We propose a synthesised framework showcasing an ecosystem on multisectoral interventions for urban health that can guide future research in African urban settings.Global health impact for policy and action: This study reveals a crucial gap in evidence on evaluating the long-term impact of multisectoral interventions and calls for partnerships involving various sectors and robust community engagement to effectively deliver and sustain health-promoting policies and actions.

Introduction Episodes of alienation and/or anomie in pharmacists have been reported in historical accounts since the 19th century. Alienation and anomie are distinct types of psychological or social ills where people are problematically separated from, or their skills and values are misaligned with, others and their environment. Alienation and/or anomie can be important precursors of many negative work experiences, including job dissatisfaction, burnout and/or intention to leave.Methods and analysis We aim to study alienation and/or anomie in pharmacists from across the globe, reviewing all types of methodological designs, published in peer-reviewed journals, including all primary qualitative, quantitative and/or mixed-method research studies. We will narratively describe any focuses, causes, associated factors and/or consequences of alienation and/or anomie. We will identify all published peer-reviewed research by searching seven electronic databases (MEDLINE, Embase, APA PsychINFO, CINAHL Plus, Cochrane Library, Web of Science Core Collection and Scopus) and Google Scholar in May 2024. Extensive hand and citation-searching will also take place. Two independent reviewers will identify eligible studies, conduct a critical appraisal of the study conduct, extract data and synthesise reported findings by narratively exploring relationships within and between studies. The synthesis will follow a hybrid thematic analysis. Initially, we will deductively structure the findings according to six themes from underpinning alienation and anomie theory: Care, Values, Meaning, Recognition, Autonomy and Shared Responsibility. This structure may thereafter be inductively adapted, by creating new additional themes, if required from the data. A GRADE Confidence in the Evidence from Reviews of the Qualitative research approach will be used to determine a confidence profile of each theme. A thematic map showing the links between themes will also be produced.Ethics and dissemination Ethical permission is not required, as this study uses data from published research. Dissemination will be through publication in peer-reviewed journals and conference presentations.PROSPERO registration number CRD42024536336.

Objectives HTA agencies vary significantly in their methodology, interpretation of clinical evidence and reporting of recommendations. This research builds on established frameworks for assessing HTA outcomes and proposes a novel approach towards characterising and comparing clinical issues raised by HTA agencies. Methods HTA data from Canada, England, Scotland, Sweden, Germany, and France were extracted from an internal HTA database (HTA-Hive), constructed using a validated and published framework for the assessment of HTA outcomes. Clinical issues are categorised into: magnitude of clinical benefit, long-term clinical evidence, study design, generalizability, potential adverse events, comparators, and indirect comparisons. A total of 786 HTA reports (spanning 2009-2024) were included in the study. A sentiment analysis model VADER using the nltk package in Python was applied to the uncertainties to assess sentiment severity across agencies. Results There were total of 3,272 clinical uncertainties in the sample. The most common clinical uncertainty raised related to magnitude of clinical benefit (22.6%), while issues relating to appropriateness of comparator were the least frequent (8.3%). TLV had the worst average sentiment (-0.024), it was significantly worse than HAS, INESSS, IQWiG and NICE (p<0.005). NICE had the most positive (0.20), significantly better than CADTH, HAS, SMC, and TLV. The average compound sentiment across all clinical uncertainties was 0.11. The category with the lowest average sentiment was adverse effects (-0.209) highest was clinical benefit (0.34). Sentiment scores were highly variable across manufacturers with more than 10 reports (0.015 – 0.205). Average sentiment was similar across orphan and non-orphan medicines (0.133 vs 0.107) and significantly higher for oncology drugs vs other drugs (0.185 vs 0.069). Conclusions Natural Language Processing (NLP) techniques can help shed light on the severity of clinical issues raised in the context of HTA, which tend to vary according to HTA agency, type of uncertainty, therapeutic area and disease area.

Problem and background: During the COVID-19 pandemic, there was substantial reconfiguration of maternity care services, affecting both users and healthcare providers (HCPs), in the United Kingdom (UK) and globally. Aim: To further our understanding of the impact of maternity service reconfigurations in the UK, from the perspective of maternity HCPs. Methods: Scopus, MEDLINE, EMBASE, CINAHL, PsycINFO and the Cochrane COVID Study Register were searched for relevant studies reporting qualitative data from the UK, published in English between 01 June 2021 and 30 September 2023. Qualitative data on HCPs' experiences of maternity care reconfiguration during the pandemic were extracted from 15 studies. Data were subjected to thematic synthesis according to key service reconfigurations. Results: Nine themes were identified: Care-seeking and Care Experience: Changes to existing care, Limitations placed on the partner, Mental health and lack of support networks, and Barriers to successful implementation of reconfiguration strategies; Virtual Care: Impact on quality of care, Increased convenience and flexibility, and Digital exclusion; and Ethical Future of Maternity Care Services: Optimising patient care, and Service users and staff as the driving force for change. No studies reported on the concepts of Self-monitoring or COVID-19 vaccination. Discussion and conclusion: The review findings highlight HCPs' views of the need for greater inclusion of partners, choice of virtual or in-person care for women and birthing people; and a need for co-designed services for future policy-making.

BackgroundMathematical models and advanced analytics play an important role in policy decision making and mobilizing action. The Imperial College Coronavirus Disease 2019 (COVID-19) Response Team (ICCRT) provided continuous, timely and robust epidemiological analyses to inform the policy responses of governments and public health agencies around the world. This study aims to quantify the policy impact of ICCRT outputs, and understand which evidence was considered policy-relevant during the COVID-19 pandemic.MethodsWe collated all outputs published by the ICCRT between 01-01-2020 and 24-02-2022 and conducted inductive thematic analysis. A systematic search of the Overton database identified policy document references, as an indicator of policy impact.ResultsWe identified 620 outputs including preprints (16%), reports (29%), journal articles (37%) and news items (18%). More than half (56%) of all reports and preprints were subsequently peer-reviewed and published as a journal article after 202 days on average. Reports and preprints were crucial during the COVID-19 pandemic to the timely distribution of important research findings. One-fifth of ICCRT outputs (21%) were available to or considered by United Kingdom government meetings. Policy documents from 41 countries in 26 different languages referenced 43% of ICCRT outputs, with a mean time between publication and reference in the policy document of 256 days. We analysed a total of 1746 policy document references. Two-thirds (61%) of journal articles, 39% of preprints, 31% of reports and 16% of news items were referenced in one or more policy documents (these 217 outputs had a mean of 8 policy document references per output). The most frequent themes of the evidence produced by the ICCRT reflected the evidence-need for policy decision making, and evolved accordingly from the pre-vaccination phase [severity, healthcare demand and capacity, and non-pharmaceutical interventions (NPIs)] to the vaccination phase of the epidemic (variants and genomics).ConclusionThe work produced by the ICCRT affected global and domestic policy during the COVID-19 pandemic. The focus of evidence produced by the ICCRT corresponded with changing policy needs over time. The policy impact from ICCRT news items highlights the effectiveness of this unique communication strategy in addition to traditional research outputs, ensuring research informs policy decisions more effectively.

Background: Childhood obesity is a significant public health crisis that is exposing children to associated morbidities and premature mortality. However, parents can positively influence physical activity trajectories and improve health outcomes by nurturing fundamental movement skills (FMS) in children. This is the first study to explore the determinants of family FMS practice via a systematic synthesis of qualitative evidence. Methods: Keyword searches were completed in SPORTDiscus, PubMed, Scopus, Web of Science, and Embase. Studies that offered perspectives relating to influences on the FMS of 2-6-year-old children in the family context via qualitative approaches, including visual methodologies that provided an important voice to children, were included. A thematic analysis was used to establish key themes. Results: The emergent themes included parent knowledge and beliefs, self-efficacy of parents to teach, and the home environment. Parents often undervalued FMS and lacked the self-efficacy to teach due to poor understanding, conflicting priorities, and multifaceted societal influences. Children preferred autonomous play and socialisation but were negatively influenced by technology and restrictive household rules. Conclusions: Greater knowledge exchange between stakeholders is necessary to empower parents and enhance FMS application at home. More community initiatives could facilitate greater access to outdoor spaces, facilities, and equipment, which may improve family engagement with FMS.

Background: Childhood malnutrition in all forms is a major public health issue worldwide. This review systematically examined the prevalence and determinants and identify the potential interventions and current gap in addressing malnutrition including undernutrition, overnutrition and micronutrient deficiencies (MNDs) in Vietnamese children aged 0-18 years old. Methods: Embase, Scopus, PubMed, and Web of Science were systematically searched through June 2022 to identify relevant articles published within the past 25 years. Study selection and data extraction were performed by one reviewer and checked for accuracy by the other two reviewers in accordance with PRISMA guideline. Risk of publication bias was assessed using American Dietetic Association Quality Criteria Checklist. Results: Seventy-two studies that met the inclusion criteria were included. Undernutrition has decreased over time but still 22.4%, 5.2% and 12.2% of children under 5 were stunted, wasted and underweight, respectively. Anaemia, iron, zinc, and vitamin D deficiencies were the more common forms of MNDs, the prevalence varied by age, region, and socioeconomic group. Population-based surveys reported that 11% and 48% of children aged 0-11 years old were iron and vitamin D deficient, respectively. Zinc deficiency affected almost one-quarter of the children and adolescents. Retinol deficiency was of less concern (< 20%). However, more evidence on MNDs prevalence is needed. Overweight and obesity is now on the rise, affecting one-third of school-aged children. The key determinants of undernutrition included living in rural areas, children with low birth weight, and poor socio-economic status, whereas living in urban and affluent areas, having an inactive lifestyle and being a boy were associated with increased risk of overweight and obesity. Nutrition specific intervention studies including supplementation and food fortification consistently showed improvements in anthropometric indices and micronutrient biomarkers. National nutrition-sensitive programmes also provided nutritional benefits for children's growth and eating behaviours, but there is a lack of data on childhood obesity. Conclusion: This finding highlights the need for effective double duty actions to simultaneously address different forms of childhood malnutrition in Vietnam. However, evidence on the potential intervention strategies, especially on MNDs and overnutrition are still limited to inform policy decision, thus future research is warranted.

Background: Evidence networks facilitate the exchange of information and foster international relationships among researchers and stakeholders. These networks are instrumental in enabling the integration of scientific evidence into decision-making processes. While there is a global emphasis on evidence-based decision-making at policy and organisational levels, there exists a significant gap in our understanding of the most effective activities to exchange scientific knowledge and use it in practice. The objective of this rapid review was to explore the strategies employed by evidence networks to facilitate the translation of evidence into decision-making processes. This review makes a contribution to global health policymaking by mapping the landscape of knowledge translation in this context and identifying the evidence translation activities that evidence networks have found effective. Methods: The review was guided by standardised techniques for conducting rapid evidence reviews. Document searching was based on a phased approach, commencing with a comprehensive initial search strategy and progressively refining it with each subsequent search iterations. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement was followed. Results: The review identified 143 articles, after screening 1135 articles. Out of these, 35 articles were included in the review. The studies encompassed a diverse range of countries, with the majority originating from the United States (n = 14), followed by Canada (n = 5), Sweden (n = 2), and various other single locations (n = 14). These studies presented a varied set of implementation strategies such as research-related activities, the creation of teams/task forces/partnerships, meetings/consultations, mobilising/working with communities, influencing policy, activity evaluation, training, trust-building, and regular meetings, as well as community-academic-policymaker engagement. Conclusions: Evidence networks play a crucial role in developing, sharing, and implementing high-quality research for policy. These networks face challenges like coordinating diverse stakeholders, international collaboration, language barriers, research consistency, knowledge dissemination, capacity building, evaluation, and funding. To enhance their impact, sharing network efforts with wider audiences, including local, national, and international agencies, is essential for evidence-based decision-making to shape evidence-informed policies and programmes effectively.

OBJECTIVES: Feedback frameworks/models focus on certain aspects of the feedback process, but a coherent and systematic model is lacking. A meta-ethnography was conducted to identify and synthesise guidance for optimising feedback interactions in undergraduate clinical communication simulations. METHODS: A systematic search of 4 electronic databases and grey literature was conducted. Following Noblit and Hare's seven phases for conducting meta-ethnography, key themes and concepts were synthesised to provide new interpretations of components in effective feedback interactions. RESULTS: 373 publications were identified and 14 included for the final synthesis, which informed the development of a new Feedback Kidney Model. The Model illustrates the interconnections of various components that allow for effective feedback interactions. The main processes include preparation, proactivity, analysis and feedback information, reception and response, and influencing factors. CONCLUSIONS: This meta-ethnography moves beyond providing an up-to-date synthesis of feedback guidance to proposing the brand-new Feedback Kidney Model, which can guide medical education and future research into how feedback is co-constructed and utilised to promote learning. PRACTICE IMPLICATIONS: Clinical communication should incorporate meta-cognitive training and using this Model will help students better utilise on-site face-to-face feedback to enhance their learning and improve future communication with patients.

Objectives: There is increasing recognition of the value and capabilities of design in healthcare. Beyond the development of medical devices, design is increasingly being applied to intangible, complex and systemic healthcare problems. However, there is limited evidence on the use of design specifically in the field of oral health. This systematic mapping study aims to collate and catalogue evidence of design in oral health. Methods: A systematic search of academic databases and grey literature was performed. Duplicate results were removed, and publications relating to the same project were grouped. Reviewers from design and oral health independently screened a sample of the dataset. Projects of both relevance to oral health, and with input from a designer or clear implementation of a design methodology or approach were included. Projects were coded and plotted on a novel interactive evidence map. Results: 119 design and oral health projects were included between 1973 and 2022. Interventional (n = 94, 79%), empirical (n = 46, 39%), methodological (n = 35, 29%) and theoretical (n = 7, 6%) design contributions were identified across the projects. The projects were categorized by four orders of design: first-graphics (n = 6, 5%), second-products (n = 41, 34%), third-interactions (n = 70, 59%), and fourth-systems (n = 2, 2%). Design was found in a diverse range of contexts in oral health; most commonly being relevant to general patients (n = 61, 51%), and for use in general dental practice (n = 56, 47%). Further design outcome categories (digital material; printed material; object; room or space; apparel; process; smart device; tangible interface; graphical interface; virtual reality; service; policy; system) and oral health themes (oral health literacy; oral care training; dental clinic design; dental instruments and equipment; personal oral care; dental appliance; clinician health and productivity; clinical information systems; informed consent; oral health promotion and prevention; oral care training; patient interactions and experience) were identified. Conclusions: The novel interactive evidence map of design in oral health created enables ongoing and open-ended multivariant documentation and analysis of the evidence, as well as identification of strategic opportunities. Future research and policy implications include; recognition and engagement with the full capabilities of design; integration of design experts; fostering inclusive engagement and collaboration; disentangling patient and public involvement; advancing human-centred systems approaches; adopting design-led approaches for policy-making.

Background: Improving the adoption and implementation of policies to curb non-communicable diseases (NCDs) is a major challenge for better global health. The adoption and implementation of such policies remain deficient in various contexts, with limited insights into the facilitating and inhibiting factors. These policies have traditionally been treated as technical solutions, neglecting the critical influence of political economy dynamics. Moreover, the complex nature of these interventions is often not adequately incorporated into evidence for policy-makers. This study aims to systematically review and evaluate the factors affecting NCD policy adoption and implementation. Methods: We conducted a complex systematic review of articles discussing the adoption and implementation of World Health Organization's (WHO's) "best buys" NCD policies. We identified political economy factors and constructed a causal loop diagram (CLD) program theory to elucidate the interplay between factors influencing NCD policy adoption and implementation. A total of 157 papers met the inclusion criteria. Results: Our CLD highlights a central feedback loop encompassing three vital variables: (1) the ability to define, (re)shape, and pass appropriate policy into law; (2) the ability to implement the policy (linked to the enforceability of the policy and to addressing NCD local burden); and (3) ability to monitor progress, evaluate and correct the course. Insufficient context-specific data impedes the formulation and enactment of suitable policies, particularly in areas facing multiple disease burdens. Multisectoral collaboration plays a pivotal role in both policy adoption and implementation. Effective monitoring and accountability systems significantly impact policy implementation. The commercial determinants of health (CDoH) serve as a major barrier to defining, adopting, and implementing tobacco, alcohol, and diet-related policies. Conclusion: To advance global efforts, we recommend focusing on the development of robust accountability, monitoring, and evaluation systems, ensuring transparency in private sector engagement, supporting context-specific data collection, and effectively managing the CDoH. A system thinking approach can enhance the implementation of complex public health interventions.

Background: In South Asia, 89 million children under 5 are at risk of not reaching their developmental potential. Household socioeconomic position (SEP) is a determinant of early child development (ECD). However, synthesised evidence for the association between ECD and SEP in young children in South Asia is not available. Therefore, this review synthesises evidence on the relationship of household SEP with ECD in children under 36 months of age in South Asia. Method: PubMed, Cochrane Library, MEDLINE and Scopus were systematically searched to identify studies from South Asian countries that reported evidence on the association between SEP and ECD. Search terms included items related to motor, cognitive, language and socioemotional development. Study quality was assessed using the QualSyst tool, with three quality levels (high/medium/low), and a narrative review for each ECD outcome was constructed (PROSPERO registration: CRD42019131533). Results: Twelve of the 950 publications screened met the inclusion criteria (nine from India, two Nepal and one Bangladesh). The majority (n = 10, 83%) reported language development on its own or alongside another ECD outcome. Fewer articles assessed cognitive (n = 6, 50%), motor (n = 7, 58%) or socioemotional development (n = 3, 25%). Higher SEP was associated with better ECD for one third of the associations reported. One ECD outcome (socioemotional development) was negatively associated (with socioeconomic status) based on low quality evidence. Mother's education and family income were the major SEP constructs associated with ECD. One, four and seven studies were rated as having a low, medium and high risk of bias, respectively. Conclusion: This review reveals the scarcity of evidence exploring associations between household SEP and ECD in children under 36 months in South Asia, especially outside of India. Enhancing evidence for associations between ECD and SEP is needed for evidence-based policy making to reduce developmental delays associated with a disadvantaged SEP in the South Asian region.

Background: Mental disorders remain the most significant contributor to years lived with disability in South Asia, yet governmental health expenditure on mental health in South Asia remains very low with limited strategic policy development. To strengthen the case for action it is important to better understand the profound economic costs associated with poor mental health. Methods: We conducted a systematic review on the costs of all mental disorders, as well as intentional self-harm and suicide, in the World Bank South Asia Region. Ten global and South Asian databases as well as grey literature sources were searched. Results: 72 studies were identified, including 38 meeting high quality criteria for good reporting of costs. Of these, 27 covered India, five Pakistan, four Nepal and three Bangladesh and Sri Lanka. Most studies focused on depressive disorders (15), psychoses (14) and harmful alcohol use (7); knowledge of economic impacts for other conditions was limited. Profound economic impacts within and beyond health care systems were found. In 15 of 18 studies which included productivity losses to individuals and/or carers, these costs more than outweighed costs of health care. Conclusion: Mental disorders represent a considerable economic burden, but existing estimates are conservative as they do not consider long-term impacts or the full range of conditions. Modelling studies could be employed covering longer time periods and more conditions. Clear distinctions should be reported between out-of-pocket and health system costs, as well as between mental health service-specific and physical health-related costs.

Objectives: Randomized controlled trials evaluate diverse interventions. This can include medical interventions such as drugs or surgical procedures, or behavior change interventions (BCIs) that aim to change a habit, belief, or attitude to improve health, for example, healthy eating, psychological wellbeing. Harms are often recorded poorly or inconsistently within randomized controlled trials of BCIs. This scoping review aimed to collate and describe literature on categories, definitions, and mechanisms of harms from BCIs; methods of identifying plausible harms; and recommendations for recording harms. Study design and setting: A scoping review was conducted. Three databases (MEDLINE, PsycINFO, and CINAHL) were searched. Reference list checking and citation searching were performed. Articles were included if they discussed (1) interventions that aimed to modify behavior, (2) categories or mechanisms of harms, and (3) methods or recommendations for recording harms. All research designs were included. One reviewer reviewed titles, abstracts, and full texts; queries were checked with another reviewer. Data were extracted and synthesized descriptively by one reviewer and checked by another reviewer. A thematic map was constructed to summarize the review findings. Harms described from specific BCIs were identified, and examples were selected and summarized. Results: The review included 37 articles. Nineteen of 37 articles contributed to a thematic review. Three articles described categories of harms; categories of harm included physical, psychological, group and social interactions, cultural, equity, opportunity cost, environmental, and economic. Seven articles included mechanisms or underlying factors for harms including feelings of failure leading to shame or stigma, and group interventions enabling knowledge exchange on unhealthy behaviors. Twelve articles provided recommendations for recording harms, including taking a proportionate approach by focusing on the most plausible and important harms, collecting different perspectives on whether harms had occurred (eg, caregivers and family members), and using qualitative research methods to identify harms. One article described a three-step method to identify plausible harms from an intervention, and six articles supported aspects of the method. Eighteen of 37 articles contributed to a review which collated harms arising from specific interventions, for example, a peer support intervention in inflammatory bowel disease caused distressing conversations which might lead to anxiety and confrontation with a possible negative future. Conclusion: BCIs can cause harm. This review identified categories and proposed mechanisms of harms, as well as methods and recommendations for identifying and recording harms in BCIs for inclusion in forthcoming recommendations.

Objectives: The aim was to synthesize evidence on the use of person-centered outcome measures to facilitate integrated palliative care for older people and build a logic model depicting the mechanisms through which person-centered outcome measures support integrated care. Design: Mixed methods systematic review using a data-based convergent synthesis design. Setting and participants: Older people aged ≥60 years who are approaching the end of their lives in multiple settings. Methods: The study was underpinned by a conceptual framework of integrated palliative care, which informed the search strategy, data extraction, analysis, and synthesis. A hybrid search strategy was implemented, with database searches (PsycINFO, MEDLINE, CINAHL, and ASSIA) complemented by snowball searches. Qualitative and quantitative data were analyzed by narrative synthesis to summarize and explain the findings. The findings informed a logic model depicting the mechanisms of using person-centered outcome measures to support integrated palliative care. Results: Twenty-six studies were included. Three mixed methods studies, 2 qualitative studies, and 21 quantitative studies were included. There was evidence that person-centered outcome measures could support integrated palliative care through informing palliative care policy development (n = 4), facilitating joint working across settings (n = 5), enabling close collaboration of multidisciplinary teams (n = 14), promoting joint education (n = 1), facilitating timing and specialist referral (n = 6), and enhancing patient-centered care (n = 3). Conclusions and implications: This review makes an important, novel, and theoretically informed contribution to the delivery of scalable and sustainable integrated palliative care into the care of older people using person-centered outcome measures. The constructed logic model provides a conceptual framework and practical approach to how person-centered outcome measures support multilevel integration. A future area of research is the development of person-centered outcome measure interventions informed by the logic model to meet clinical needs.