Aims: The World Health Organization (WHO) Health Emergency Programme funded three systematic reviews to inform development of guidance for emergency preparedness in health emergencies. The current review investigated the type of learning interventions that have been developed and used during health emergencies, and how they were developed. Methods: We searched PubMed, CINAHL, Communication and Mass Media Complete (EBSCO), and Web of Science. Study quality was appraised by WHO-recommended method-specific checklists. Findings were extracted using a narrative summary approach. Results: 187 studies were included. Studies were split between online, in-person, and hybrid modalities, conducted mostly by hospitals and universities, and most frequently training nurses and doctors. Studies emphasized experiential learning to develop and reinforce skills; online learning for knowledge dissemination; multi-sectoral partnerships, institutional support and carefully constructed planning task forces, rapid training development and dissemination, and use of training models. Conclusion: It Most studies evaluated only knowledge or self-confidence of trainees. Relatively few assessed skills; evaluations of long-term outcomes were rare. Little evidence is available about comparative effectiveness of different approaches, or optimum frequency and length of training programming. Based on principles induced, six recommendations for future JIT training are presented.

Background and aims: Current and future healthcare professionals, such as medical students, are at risk of contracting Hepatitis B virus infection. Vaccination against Hepatitis B is an effective means of prevention. However, studies have reported variable vaccination rates among medical students from different regions of South Asia. Understanding vaccination rates and barriers can guide effective interventions to protect future doctors. Therefore, we aimed to find out the vaccination rate among medical students in South Asia. Methods: A comprehensive literature search was conducted across multiple databases (PubMed, PubMed Central, Scopus, Embase, CINAHL, Google Scholar, MEDLINE, and other sources) beginning from inception to July 15, 2024. Observational studies reporting vaccination rates among Bachelor of Medicine and Bachelor of Surgery (M.B.B.S.) students in South Asia were included. Two reviewers independently screened and performed the quality assessment. Pooled vaccination rates were calculated and visualized using a random-effects model in R Studio (Version 2023.12.0). Subgroup analysis was performed based on country and year of publication of the studies. Results: Fifty studies from the South Asian region, including 12,231 participants, were included in the quantitative analysis. The overall pooled Hepatitis B vaccination rate using the random-effects model was 56% (CI: 49-63%), with significant heterogeneity among the included studies (I2 = 98%; P = 0). Subgroup analysis based on country revealed a significant regional variation in vaccination rate (59% in Pakistan, 57% in India, 55% in Nepal, and 41% in Bangladesh; P < 0.01). Lack of awareness, perceived low risk or necessity, concerns about side effects, logistical challenges, and lack of motivation have been reported as barriers to vaccination. Conclusion: The overall vaccination rate was relatively low in South Asia, with significant regional variation. Based on the reported barriers, we recommend that relevant authorities focus on vaccination awareness, motivation, cost-effectiveness, logistics management, policy formulation, and monitoring.

Introduction: There is no recent consensus on the effectiveness of teledentistry versus in-person examination in the diagnosis of dental caries, especially after the COVID-19 pandemic. Objective: To assess the diagnostic accuracy of teledentistry versus in-person examination for dental caries diagnosis (PROSPERO #CRD42023410962). Methods: This systematic review and meta-analysis compared the effectiveness of teledentistry versus in-person examination for dental caries diagnosis. The eligibility criteria were peer-reviewed studies published in English between January 2013 and December 2021 that reported diagnostic parameters (specificity and sensitivity) for caries detection in primary and permanent dentition. Articles were extracted using search strategies from PubMed and CINAHL databases and screened using PRISMA-DTA guidelines, following a review for quality assessment and risk of bias using the QUADAS-2 and JBI Critical Appraisal Checklists. Meta-analysis was conducted in R using the MADA package. A descriptive analysis of the sensitivity, specificity, diagnostic odds ratio, and confidence intervals was performed with respective forest plots. Heterogeneity was assessed using Cochrane and Higgins's 2 tests. Univariate measures of diagnostic accuracy were performed based on the DerSimonian-Laird random effect and reported summary diagnostic odds ratios. Results: Twelve studies met the inclusion criteria and were reviewed and included in the meta-analysis. The diagnostic parameters ranged from 45.6% to 88.3% for sensitivity, 55.2% to 98.3% for specificity, 79% to 92% for positive predictive value, 48% to 97% for negative predictive value, and 70% to 96% for accuracy. The κ scores ranged from 0.46 to 0.89 for teledentistry modalities. Tests for equality of sensitivities and specificities were significant ( < 0.001). The studies were not heterogeneous with Cochran's : 14.502 ( = 0.206) and Higgins's 2 of 24%. The multivariable analysis showed a diagnostic odds ratio based on the DerSimonian-Laird random effect of 35.14, which indicates that the odds of caries detection via teledentistry is 35 times more true positive (i.e., correctly identifying a positive condition) than false positive. Conclusions: Diagnosis of caries via teledentistry is effective and comparable to in-person diagnosis. Remote assessments are consistent in diagnostic accuracy for caries.Knowledge Transfer Statement:This systematic review and meta-analysis added to the evidence about using teledentistry assessment as a diagnostically accurate tool to detect dental caries. Using teledentistry dental practices could promote greater access to dental and oral health care in the absence of in-person assessment.

Purpose: To perform a scoping review of the literature investigating the use of telemedicine in retinoblastoma (RB) care, as well as its integration into broader health-care systems worldwide. Methods: A comprehensive search of academic databases, Medline and Embase, as well as public, web-based sources, was performed. Article references were also screened for inclusion within the review. Only English-language sources that presented evidence of dedicated frameworks incorporating telemedicine-based RB care were included. Results: The review identified 57 peer-reviewed studies, of which 19 were found potentially eligible for inclusion. Following exclusion criteria and a web-based search, 11 sources referencing 10 telemedicine frameworks, comprising four peer-reviewed articles, and seven publicly available initiatives, were included. Major themes leveraging telemedicine in RB care included knowledge exchange and capacity building, the establishment of direct partnerships incorporating teleconsultation, and the development of care coordination networks. Many telehealth platforms were effectively integrated into health-care systems; however, challenges included the absence of RB specific initiatives, the need for publicly available, measurable peer-reviewed outcomes and the complexities of multidimensional RB care. Conclusion: Tele-efforts have the potential to enhance delivery of RB care to remote, resource-limited communities. Future research should explore improved integration of policy-driven telemedicine within health-care systems, assess the economic feasibility of providing such care, and facilitate empirical evaluations, ultimately leading to increased sustainability, funding and investment of these models.

Objectives: This systematic review (SR) highlights principles for nutrient clinical trials and explore the diverse physiological functions of vitamin D beyond its traditional role in the musculoskeletal system related to clinical study designs. Background: Thousands of published research articles have investigated the benefits of vitamin D (a nutrient example taken in this SR) beyond the musculoskeletal system, including the immune, pulmonary, and cardiovascular systems; pregnancy; autoimmune disorders; and cancer. They illustrated vitamin D's molecular mechanisms, interactions, and genomic and nongenomic actions. Methods: This SR was designed to identify shortcomings in clinical study designs, statistical methods, and data interpretation that led to inconsistent findings in vitamin D-related publications. SR also highlights examples and insights into avoiding study design errors in future clinical studies, including randomized controlled clinical trials (RCTs). The SR adheres to the latest PRISMA statement, guidelines, and the PICOS process. Results: Inappropriate or flawed study designs were frequent in clinical trials. Major failures discussed here include too short clinical study duration, inadequate or infrequent doses, insufficient statistical power, failure to measure baseline and achieved levels, and recruiting vitamin D-sufficient participants. These design errors have led to misleading interpretations. Thus, conclusions from such studies should not be generalized or used in guidelines, recommendations, or policymaking. Conclusion: Adequately powered epidemiological studies and RCTs with sufficient vitamin D and duration in individuals with vitamin D deficiency reported favorable clinical outcomes, enriching the literature, enabling to understand its physiology and mechanisms. Proper study designs with rigorous methodologies and cautious interpretation of outcomes are crucial in advancing the nutrient field. The principles discussed apply not only to vitamin D, but also other micro-nutrients and nutraceutical research. Adhering to them enhances the credibility and reliability of clinical trials, SRs, and meta-analysis outcomes. The study emphasizes the importance of focused, hypothesis-driven, well-designed, statistically powered RCTs to explore the diverse benefits of nutrients, conducted in index nutrient deficient participants, and avoidance of study design errors. Findings from such studies should be incorporated into clinical practice, policymaking, and public health guidelines, improving the health of the nation and reducing healthcare costs.

Objective: This scoping review aimed to map the volume (number of studies) and nature (topics and designs) of chiropractic education research and scholarly publications on chiropractic learners and programs worldwide. Introduction: Despite the expansion of the chiropractic profession and its recognition by entities such as the World Health Organization, a gap exists in comprehending the international landscape of chiropractic education. No prior studies have systematically mapped the volume and nature of chiropractic education research and scholarly publications. A scoping review of chiropractic education research and scholarly publications is needed to guide future policy development, research agendas, and educational initiatives within the chiropractic profession. Inclusion criteria: Publications in the indexed literature on chiropractic students, graduates, academics, and programs in any chiropractic education setting were included. Studies focused on chiropractic programs and education for chiropractic students or chiropractors worldwide. All research designs, literature reviews, descriptive studies, and commentaries were included. Methods: This scoping review was conducted according to JBI methodology for scoping reviews and was reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). The databases PubMed (NLM), Scopus, CINAHL via EBSCOhost, Index to Chiropractic Literature, Biblioteca Virtual em Saúde, and Educational Resources Information Center were searched from their inception to November 5 and 6, 2023, with no language limits. Data were extracted for primary topics, study designs, and regions of the included documents and entered in Covidence by paired independent reviewers. The findings were organized into figures and tables with a narrative description. Results: The search identified 7494 documents. After deduplication, 5041 were screened for relevance, of which 667 were selected for full-text review. From these, 598 were selected for data extraction. The chiropractic education topics included values/ethical competence (n=3), personal/behavioral competence (n=34), knowledge and cognitive competence (n=49), functional and clinical competence (n=93), and program-relevant research (n=419). Most designs were quantitative (n=391), followed by descriptive reports (n=91), qualitative (n=43), mixed methods (n=40), commentaries (n=22), and literature reviews (n=11). Chiropractic education was most studied in the United States (n=359), Australia (n=116), and Canada (n=106). Conclusions: This scoping review reports the volume and nature of indexed publications relating to chiropractic learners and programs worldwide. This body of literature contains learner competencies in knowledge, skills, and attitudes, as well as studies about chiropractic programs. The increasing number of publications and proportion of study designs over time show that chiropractic scholars and programs are engaged in collecting, analyzing, and distributing data relevant to education and training. The map of professional competencies in the chiropractic education literature shows that the profession possesses the fundamental traits needed to contribute to the global health care workforce. Review registration: Open Science Frameworkhttps://osf.io/9b3ap.

Background: The economic and public health benefits of adult pneumococcal vaccines vary across countries due to different epidemiology and costs. We systematically reviewed and summarized findings and assumptions of cost-effectiveness analyses (CEA) of the recently introduced 15- and 20-valent pneumococcal conjugate vaccines (PCV15 and PCV20) in adults. Methods: We performed a systematic search for CEA studies of PCV15 and/or PCV20 versus existing strategies via PubMed, EMBASE, CEA Registry, EconLit, HTA Database, and NITAG resource center through April 23, 2024. Study characteristics, methods, assumptions, and findings were extracted independently by two reviewers; quality was assessed using ECOBIAS. Results were synthesized qualitatively to summarize key attributes and conclusions. Results: Of 137 identified records, 26 studies were included; the majority (24/26) concerned high-income countries. All employed static Markov-type models comparing higher-valent PCVs used alone or in combination with 23-valent pneumococcal polysaccharide vaccine (PPSV23) to current recommendations (PPSV23 alone, PCV13 alone, PCV13 + PPSV23, no vaccination). Most studies (22/26) concluded PCV20 used alone was cost-saving (dominant) or cost-effective compared to other adult pneumococcal strategies (PPSV23 alone, PCV13 ± PPSV23, PCV15 ± PPSV23, or no vaccination). PCVs were generally assumed to have serotype-specific effectiveness equal to PCV13 efficacy in the pivotal trial, though four studies used estimates from a Delphi panel; protection was assumed to last between 10 and 20 years. PPSV23 was assumed to have lower effectiveness against non-bacteremic pneumonia and shorter duration of protection. Herd effects from higher-valent PCVs in childhood (12/26), serotype replacement (2/26), or both (1/26) were included in half (13/26) of studies, which attenuated adult vaccine impact. Most studies were assessed as low risk of bias; five abstracts did not provide sufficient information for assessment. Conclusion: Current evidence indicates that 20-valent PCV used alone is likely to be cost-effective or dominate other adult pneumococcal strategies. Future research is needed to address remaining uncertainties in assumptions and to support evidence-based policymaking.

Vaccine hesitancy is a significant global issue and is recognized by the World Health Organization (WHO) as one of the most pressing threats to public health. Defined as the delay in acceptance or refusal of vaccines despite their availability, vaccine hesitancy undermines decades of progress in preventing vaccine-preventable diseases. The issue is complex, influenced by misinformation, distrust in healthcare systems, cultural beliefs, and access barriers. These challenges require innovative and empathetic solutions to increase vaccine acceptance. Addressing this growing epidemic requires a multifaceted approach, which involves broader strategies and policymaking and in addition, effective communication tools for clinicians. Motivational Interviewing (MI), a patient-centered communication technique, offers an effective strategy to address pediatric vaccine hesitancy by fostering trust, understanding, and informed decision-making. This review aims to explore the problem of pediatric vaccine hesitancy in the United States, examine its underlying factors, and highlight evidence-based strategies, including Motivational Interviewing, to address this growing concern in clinical and public health settings. It offers practical guidance for healthcare providers and pediatricians to tackle this growing problem effectively and emphasizes the need for a combined effort of communication, community outreach, education, and systemic policy to overcome vaccine hesitancy.

Overview Equitable access to learning opportunities is one of UNICEF strategic priorities, described in the organization’s SPs and Education Strategy. Since 2010, UNICEF has been supporting out-of-school children and adolescents through its participation in the Global Initiative for Out-of-School Children (OoSCI). The school closures and the mobility restrictions experienced during the COVID-19 pandemic increased the number of children and adolescents at risk of not returning to school, particularly affecting the most marginalized and vulnerable. The evaluation aims at generating evidence to assess the work done by UNICEF in this area for accountability and learning purposes. 22. More recently, to expand access to learning and skill development opportunities for children and adolescents, the organization is rolling out the Multiple and Flexible Pathways Initiative. This initiative focuses on supporting the most marginalized and vulnerable, including efforts to guide policy reforms and to improve public budgeting and financing strategies to expand access to MFPs to learning and skills development. This initiative is being guided by the 2020 Secondary Education Guidance: Multiple and Flexible Pathway and the 2015 and 2023 OosCI operational manuals. The evaluation will assess prior and ongoing work in this area with a learning and forward-looking purpose. The overall objective of this evaluation is to assess UNICEF work in support of addressing the issues as they relate to ISCA at risk of dropping out of school and out-of-school children and adolescents (OoSCA). The evaluation aims to evaluate the extent to which UNICEF efforts have made a difference in supporting the school retention and the transition into higher formal education levels of ISCA at risk of dropping out; facilitating the return to formal education of OoSCA; and increasing the access to MFPs to learning and skills development. Report Details Year Published 2025 Type Project/Programme Joint No Partner/s N/A Consultant name Tami Aritomi Agency Focal Point Wycliffe Otieno Focal Point Email wotieno@unicef.org Managed by Independent Evaluation Office No Geographic Scope Country Country/ies United States

Rationale: Despite growing emphasis among healthcare decision-makers on patient perspectives and real-world outcomes to inform care and access decisions, understanding of patient journey experiences in rare diseases remains limited due to data collection and evaluation challenges. Aims and objectives: This systematic literature review (SLR) assessed study designs, methodologies, and outcomes reported in real-world investigations of rare disease patient journeys. Methods: Searches in PubMed and Google Scholar targeted English-language publications and congress proceedings from 1 January 2014, to 30 April 2024, including rare disease patients, caregivers, or healthcare providers. Keywords included 'Journey', 'Path', or 'Odyssey'. Two reviewers independently assessed eligibility and abstracted data. Descriptive analyses and quality assessments were conducted. Results: Thirty-one studies met inclusion criteria, with 296,548 participants spanning over 600 rare diseases. Most studies used prospective observational (61%) and cross-sectional (26%) designs and were conducted in Europe (45%). Interviews (39%) and surveys (29%) were common methodologies. Patients (87%) were the primary research focus, compared to caregivers (32%) or providers (10%). The most studied journey stages were 'Pre-diagnosis/Screening' (97%) and 'Diagnosis' (84%), while 'Disease Awareness' (16%) and 'Treatment Adherence' (6%) were less common. Across 164 outcomes reported, frequent outcomes included 'Healthcare Resource Utilization' (94%), 'Symptoms' (74%), and 'Time-to-Diagnosis' (71%). Fewer studies reported 'Costs' (19%), 'Caregiver/Family Burden' (16%), and 'Productivity' (13%). Time-to-diagnosis averaged 11.8 years and a median of 6.1 years. All but one study (97%) was rated low or very low quality due to observational designs. Conclusion: Most rare disease patient journey evidence focuses on 'Pre-diagnosis/Screening' and 'Diagnosis' stages using qualitative methods and surveys. While symptoms, time-to-diagnosis, and resource utilization were commonly reported, evidence gaps included treatment adherence, caregiver burden and productivity. Longitudinal assessments to collect real-world care and treatment burden outcomes, including caregiver perspectives, can enhance both clinician and policy decision-making for individuals living with rare diseases.

Objectives: This study aims to summarize the existing research literature examining Medicare-skilled home health (HH) utilization and clinical outcomes for persons with dementia (PwD). We sought to answer the following questions: (1) How is dementia defined and classified in the HH literature? (2) What associations have been observed between dementia status and patterns of HH utilization? (3) What associations have been observed between dementia status and HH outcomes? Methods: Using Arksey and O'Malley's framework for scoping reviews, we searched PubMed, Google Scholar, and select relevant journals for quantitative studies conducted in the United States between 2000 and 2023 examining Medicare HH use and outcomes for PwD. We describe and compare approaches to classify dementia, identify findings related to HH utilization and outcomes supported by the preponderance of evidence, and comment on existing gaps and areas of ambiguity in the literature. Results: Thirty-two articles met the inclusion criteria. Most used claims-based data to classify dementia, leveraged national data, and were limited to traditional Medicare beneficiaries. Studies found meaningful differences in HH utilization by dementia status; most notably, PwD were more likely to access HH without a preceding hospitalization, had longer lengths of stay, and incurred higher HH costs. Literature relating to clinical outcomes was more difficult to interpret, due to significant variation in study objectives, samples, and outcome measures which prompted more nuanced and even contradictory conclusions. There is a dearth of research identifying how specific HH care pathways (e.g., service types, visit frequency) impact outcomes for this patient population. Conclusions: This review supports the understanding that PwD are a unique subpopulation of HH patients who require special attention in policy development and evaluation. Critical research is needed to examine clinical outcomes in PwD further to inform practice and improve care quality.

Background: Expanding chronic hepatitis B (CHB) testing through effective implementation strategies in primary- and community-care setting is crucial for elimination. Our study aimed to determine the effectiveness of all available strategies in the literature and evaluate their specifications and implementation outcomes, thereby informing future programming and policymaking. Methods: We conducted a systematic review and meta-analysis (PROSPERO CRD42023455781), searching Scopus, Embase, PubMed, and CINAHL databases up to June 05, 2024, for randomized controlled trials investigating primary- and community-care-based implementation strategies to promote CHB testing. Studies were screened against a priori eligibility criteria, and their data were extracted using a standardized protocol if included. ROB-2 was used to assess the risk of bias. Implementation strategies' components were characterized using the Behavior Change Wheel (BCW) framework. Random-effect models were applied to pool the effectiveness estimate by strategy. Mixed-effect meta-regression was employed to investigate if effectiveness varied by the number of strategy's BCW components. Findings: 7146 unique records were identified. 25 studies were eligible for the review, contributing 130,598 participants. 19 studies were included in the meta-analysis. No studies were conducted in low-and-middle-income countries. Implementation outcomes were reported in only ten studies (40%). Community-based strategies included lay health workers-led education (Pooled Risk Difference = 27.9% [95% Confidence Interval = 3.4-52.4], I2 = 99.3%) or crowdsourced education on social media (3.1% [-2.2 to 8.4], 0.0%). Primary care-based strategies consisted of electronic alert system (8.4% [3.7-13.1], 95.0%) and healthcare providers-led education (HCPs, 62.5% [53.1-71.9], 27.5%). The number of BCW-framework-driven strategy components showed a significant dose-response relationship with effectiveness. Interpretation: HCPs-led education stands out, and more enriched multicomponent strategies had better effectiveness. Future implementation strategies should consider critical contextual factors and policies to achieve a sustainable impact towards hepatitis B elimination targets. Funding: Tran Dolch Post-Doctoral Fellowship in Hepatology, Johns Hopkins University School of Medicine, Baltimore MD, USA.

The number of health care educational institutions/organizations adopting implicit bias training is growing. Our systematic review of 77 studies (published 1 January 2003 through 21 September 2022) investigated how implicit bias training in health care is designed/delivered and whether gaps in knowledge translation compromised the reliability and validity of the training. The primary training target was race/ethnicity (49.3%); trainings commonly lack specificity on addressing implicit prejudice or stereotyping (67.5%). They involved a combination of hands-on and didactic approaches, lasting an average of 343.15 min, often delivered in a single day (53.2%). Trainings also exhibit translational gaps, diverging from current literature (10 to 67.5%), and lack internal (99.9%), face (93.5%), and external (100%) validity. Implicit bias trainings in health care are characterized by bias in methodological quality and translational gaps, potentially compromising their impacts.

The number of health care educational institutions/organizations adopting implicit bias training is growing. Our systematic review of 77 studies (published 1 January 2003 through 21 September 2022) investigated how implicit bias training in health care is designed/delivered and whether gaps in knowledge translation compromised the reliability and validity of the training. The primary training target was race/ethnicity (49.3%); trainings commonly lack specificity on addressing implicit prejudice or stereotyping (67.5%). They involved a combination of hands-on and didactic approaches, lasting an average of 343.15 min, often delivered in a single day (53.2%). Trainings also exhibit translational gaps, diverging from current literature (10 to 67.5%), and lack internal (99.9%), face (93.5%), and external (100%) validity. Implicit bias trainings in health care are characterized by bias in methodological quality and translational gaps, potentially compromising their impacts.

Importance: Falls are the most common cause of injury-related morbidity and mortality in older adults. Objective: To systematically review evidence on the effectiveness and harms of fall prevention interventions in community-dwelling older adults. Data sources: MEDLINE, Cumulative Index for Nursing and Allied Health Literature, and Cochrane Central Register of Controlled Clinical Trials for relevant English-language literature published between January 1, 2016, and May 8, 2023, with ongoing surveillance through March 22, 2024. Study selection: Randomized clinical trials of interventions to prevent falls in community-dwelling adults 65 years or older. Data extraction and synthesis: Critical appraisal and data abstraction by 2 independent reviewers. Random-effects meta-analyses with Knapp-Hartung adjustment. Main outcomes and measures: Falls, injurious falls, fall-related fractures, hospitalizations or emergency department visits, people with 1 or more falls, people with injurious falls, people with fall-related fractures, and harms. Results: Eighty-three fair- to good-quality randomized clinical trials (n = 48 839) examined the effectiveness of 6 fall prevention interventions in older adults. This article focuses on the 2 most studied intervention types: multifactorial (28 studies; n = 27 784) and exercise (37 studies; n = 16 117) interventions. Multifactorial interventions were associated with a statistically significant reduction in falls (incidence rate ratio [IRR], 0.84 [95% CI, 0.74-0.95]) but not a statistically significant reduction in individual risk of 1 or more falls (relative risk [RR], 0.96 [95% CI, 0.91-1.02]), injurious falls (IRR, 0.92 [95% CI, 0.84-1.01]), fall-related fractures (IRR, 1.01 [95% CI, 0.81-1.26]), individual risk of injurious falls (RR, 0.92 [95% CI, 0.83-1.02]), or individual risk of fall-related fractures (RR, 0.86 [95% CI, 0.60-1.24]). Exercise interventions were associated with statistically significant reductions in falls (IRR, 0.85 [95% CI, 0.75-0.96]), individual risk of 1 or more falls (RR, 0.92 [95% CI, 0.87-0.98]), and injurious falls (IRR, 0.84 [95% CI, 0.74-0.95]) but not individual risk of injurious falls (RR, 0.90 [95% CI, 0.79-1.02]). Harms associated with multifactorial and exercise interventions were not well reported and were generally rare, minor musculoskeletal symptoms associated with exercise. Conclusions and relevance: Multifactorial and exercise interventions were associated with reduced falls in multiple good-quality trials. Exercise demonstrated the most consistent statistically significant benefit across multiple fall-related outcomes.

Importance: The overdose epidemic continues in the US, with 107 941 overdose deaths in 2022 and countless lives affected by the addiction crisis. Although widespread efforts to train and support physicians to implement medications and other evidence-based substance use disorder interventions have been ongoing, adoption of these evidence-based practices (EBPs) by physicians remains low. Objective: To describe physician-reported reasons for reluctance to address substance use and addiction in their clinical practices using screening, treatment, harm reduction, or recovery support interventions. Data sources: A literature search of PubMed, Embase, Scopus, medRxiv, and SSRN Medical Research Network was conducted and returned articles published from January 1, 1960, through October 5, 2021. Study selection: Publications that included physicians, discussed substance use interventions, and presented data on reasons for reluctance to intervene in addiction were included. Data extraction and synthesis: Two reviewers (L.N., M.C., L.F., J.P., C.S., and S.W.) independently reviewed each publication; a third reviewer resolved discordant votes (M.C. and W.C.). This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and the theoretical domains framework was used to systematically extract reluctance reasons. Main outcomes and measures: The primary outcome was reasons for physician reluctance to address substance use disorder. The association of reasons for reluctance with practice setting and drug type was also measured. Reasons and other variables were determined according to predefined criteria. Results: A total of 183 of 9308 returned studies reporting data collected from 66 732 physicians were included. Most studies reported survey data. Alcohol, nicotine, and opioids were the most often studied substances; screening and treatment were the most often studied interventions. The most common reluctance reasons were lack of institutional support (173 of 213 articles [81.2%]), knowledge (174 of 242 articles [71.9%]), skill (170 of 230 articles [73.9%]), and cognitive capacity (136 of 185 articles [73.5%]). Reimbursement concerns were also noted. Bivariate analysis revealed associations between these reasons and physician specialty, intervention type, and drug. Conclusions and relevance: In this systematic review of reasons for physician reluctance to intervene in addiction, the most common reasons were lack of institutional support, knowledge, skill, and cognitive capacity. Targeting these reasons with education and training, policy development, and program implementation may improve adoption by physicians of EBPs for substance use and addiction care. Future studies of physician-reported reasons for reluctance to adopt EBPs may be improved through use of a theoretical framework and improved adherence to and reporting of survey development best practices; development of a validated survey instrument may further improve study results.

Advance care planning (ACP) supports individuals in aligning their medical care with personal values and preferences in the face of serious illness. The variety of ACP tools available reflects diverse strategies intended to facilitate these critical conversations, yet evaluations of their effectiveness often show mixed results. Following the Arskey and O'Malley framework, this scoping review aims to synthesize the range of ACP tools targeted at patients and families, highlighting their characteristics and delivery methods to better understand their impact and development over time. Studies included focused on patient-facing ACP tools across all settings and mediums. Exclusions were applied to studies solely targeting healthcare providers or those only aiming at completion of advance directives without broader ACP discussions. Searches were conducted across PubMed, Embase, CINAHL, The Cochrane Library, and Web of Science. Data were extracted using a predesigned spreadsheet, capturing study population, setting, intervention modality, and intervention theme. Tools were categorized by delivery method and further analyzed through a year-wise distribution to track trends and developments. We identified 99 unique patient-facing tools, with those focusing on counseling (31) and video technologies (21) being the most prevalent while others incorporated online platforms, print materials, games, or some combination of different delivery methods. Over half the tools were designed for specific patient groups, especially for various diseases and racial or ethnic communities. Recent years showed a surge in tool variety and innovation, including integrated patient portals and psychological techniques. The review demonstrates a broad array of innovative ACP tools that facilitate personalized and effective ACP. Our findings contribute to an enhanced understanding of their utilization and potential impacts, offering valuable insights for future tool development and policy making in ACP.

Overview Overweight and obesity in children and adolescents are emerging as major development concerns globally, impacting countries across various economic strata. Factors contributing to this trend include poor feeding practices in early childhood, increased consumption of ultra-processed foods, expensive nutritious and diverse food options, limited physical activity spaces, and social and gender norms. In 2019, UNICEF expanded its nutrition programming to prevent overweight and obesity in children and adolescents, thus addressing the triple burden of malnutrition in children: undernutrition (stunting and wasting), micronutrient deficiencies, and overweight and obesity. This programmatic shift to include the prevention of overweight and obesity in children and adolescents is reflected by the inclusion of specific targets and monitoring indicators in the UNICEF Strategic Plan 2022-2025 and the development of comprehensive programming guidance. The UNICEF Evaluation Office commissioned the Economic Policy Research Institute (EPRI) to conduct an evaluation of UNICEF’s work on preventing overweight and obesity among children and adolescents. The evaluation was organized around six key criteria: relevance, coherence, effectiveness, efficiency, sustainability, and UNICEF’s positioning and leadership in preventing overweight and obesity among children and adolescents. This global synthesis report is the final one developed as part of the evaluation, complementing the four individual case study reports. Report Details Year Published 2024 Type Project/Programme Joint No Partner/s N/A Agency Focal Point Beth Ann Plowman Focal Point Email baplowman@unicef.org Managed by Independent Evaluation Office No Geographic Scope Country Country/ies United States

Overview The evaluation is about assessing UNICEF's work on child poverty reduction. It aims to evaluate UNICEF's child poverty work in influencing national processes and interventions to bring about an impact in the lives of children living in poverty. The evaluation will focus on both summative and formative components, documenting the results achieved through UNICEF's actions and strategies to reduce child poverty, as well as providing forward-looking lessons and practical solutions to strengthen UNICEF's work in this area. The evaluation will cover the period from 2018 to the present and will encompass all three of UNICEF's organizational levels—HQ, RO, and CO. It will also explore the relevance of UNICEF's strategic work on child poverty in humanitarian and fragile settings. The evaluation will assess UNICEF's capacities to achieve child poverty objectives, identify lessons learned and good practices, and gauge the role, prioritization, and relevance of UNICEF's child poverty reduction work among all UNICEF levels and external stakeholders. The evaluation will also assess the achievement of results in child poverty reduction under Goal Area 5 and its linkages to social protection, as well as the status of UNICEF's resources to deliver on its child poverty agenda. The evaluation will provide insights to UNICEF divisions and offices, as well as other development partners associated with the Global Coalition to End Child Poverty. Report Details Year Published 2024 Type Project/Programme Joint No Partner/s N/A Agency Focal Point Adrian Shikwe Focal Point Email ashikwe@unicef.org Managed by Independent Evaluation Office No Geographic Scope Country Country/ies United States

Overview This Inter-Agency Humanitarian Evaluation (IAHE) is an independent assessment of the collective humanitarian response to the crisis in the three northern regions of Ethiopia, Afar, Amhara and Tigray, from November 2020 until 1 April 2023. The Principals of the Inter-Agency Standing Committee (IASC) activated the IASC System-Wide Scale-Up Protocols for Northern Ethiopia on 28 April 2021 in response to the outbreak of the armed conflict in Tigray in early November 2020. This Scale-Up activation, which sought to mobilize system-wide capacities and resources beyond standard levels, triggered this IAHE. Report Details Year Published 2024 Type Project/Programme Joint Yes Partner/s N/A Consultant name Ed Schenkenberg et al Agency Focal Point Carlotta Tincati Focal Point Email ctincati@unicef.org Managed by Independent Evaluation Office No Geographic Scope Country Country/ies United StatesEthiopia