The global rise in pharmaceutical production and consumption has led to an increase in pharmaceutical waste, posing significant risks to both public health and the environment. Improper disposal methods contribute to environmental degradation, including disruptions to aquatic ecosystems and the spread of antimicrobial resistance. Despite these growing concerns, a comprehensive review of pharmaceutical waste management and disposal practices is still lacking. To address this gap, a scoping review was conducted, analyzing 4269 records from three databases (Medline OVID, Web of Science, and Embase) and grey literature, with 67 studies ultimately included. The initial records were identified through a comprehensive search across the aforementioned databases using a structured strategy based on three core concepts: medication waste, disposal methods, and environmental or human health impacts. This was followed by a two-stage screening process guided by the PCC framework and predefined inclusion criteria. The review aims to assess disposal practices and their impacts, identify research gaps, and guide future research toward effective strategies for managing pharmaceutical waste while protecting ecological balance and public health. The publications timeline shows increasing interest in the topic, particularly with a surge in studies during 2022 and 2023. The findings reveal a significant regulatory gap, especially in the Global South, where limited infrastructure and public awareness lead to reliance on household waste disposal. In contrast, medication take-back programs are more common in the Global North. This disparity underscores the urgent need for policy development. Addressing pharmaceutical waste effectively requires coordinated efforts from the pharmaceutical industry, healthcare providers, regulatory bodies, and local communities. Key strategies should include regulatory action, public education, technological innovation, and addressing issues like drug misuse and overconsumption, particularly of antibiotics, which contribute to antimicrobial resistance. A holistic approach is essential to mitigate both environmental and public health risks.

Background: Health Impact Assessment (HIA) procedures can include the assessment of inequalities and inequities associated with the distribution of environmental health risks and benefits, aimed at attenuating the exacerbation of environmental health disparities. This systematic review, conducted as part of the Joint Action Prevent Non-Communicable Diseases initiative, explores methods for assessing health inequalities and equity within HIA frameworks, particularly in local projects affecting the distribution of environmental risks and benefits. Methods: Adhering to the PRISMA guidelines, a systematic review of the scientific literature was conducted using the MEDLINE/PubMed, Scopus, and Embase databases, searching until March 8, 2024. Furthermore, a grey literature analysis encompassed the Institutional Repository for Information Sharing (IRIS) of the World Health Organization, to identify guidelines and recommendations addressing equity considerations in HIAs. Studies were included based on predefined eligibility criteria if they explored issues related to inequalities, inequities, and vulnerabilities within the context of HIAs. Data extraction focused on methodologies that incorporated equity considerations within the HIA framework, particularly concerning local urban planning initiatives, transport infrastructure, and industrial settings. Results: A total of 33 studies met the inclusion criteria. Among these, eight documents from the grey literature, identified as guidelines and guidance, underscored the importance of prioritizing equity to ensure that health impacts are addressed fairly across diverse population groups. The remaining 25 peer-reviewed studies employed a combination of quantitative and qualitative methodologies. Quantitative approaches, including exposure-response modeling and Geographic Information System (GIS) mapping, were utilized to evaluate spatial and demographic health disparities. Qualitative methods, such as focus groups, interviews, and participatory tools, provided insights into the lived experiences of vulnerable populations affected by local interventions. Studies addressing urban and transportation planning predominantly emphasized socioeconomic stratification, whereas those focused on industrial settings highlighted occupational hazards and community vulnerabilities. Conclusion: This review highlights the diverse and fragmented approaches used to address health inequalities and equity in HIA. It underscores the need for interdisciplinary and systematic methodologies that integrate quantitative and qualitative perspectives, ensuring equity remains a central consideration in policymaking and project implementation. Finally, it proposes a practical framework for integrating equity into HIA.

Authors' objectives: The chimeric antigen receptor (CAR) T-cell therapies tisagenlecleucel (tisa-cel) and axicabtagene ciloleucel (axi-cel) are provisionally listed in Appendix 1 of the Health Insurance Benefits Ordinance in Switzerland until 31 December 2024 for the third-line treatment of B-cell acute lymphoblastic leukaemia (B-ALL), diffuse large B-cell lymphoma (DLBCL) and primary mediastinal B-cell lymphoma (PMBCL). This health technology assessment (HTA) evaluates the available evidence regarding the efficacy, effectiveness, safety, costs, cost-effectiveness and budget impact of tisa-cel and axi-cel compared to standard care in these populations. Ethical, legal, social and organisational issues associated with these therapies are also explored.

BackgroundActive workstations have been proposed as a feasible approach for reducing occupational sedentary time. This study used a network meta-analysis (NMA) to assess and compare the overall efficacy of active workstation interventions according to type and concomitant strategy for reducing work-specific sitting time in office workers.MethodsPubMed, Web of Science, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched from database inception until May 2022 to obtain randomized controlled trials (RCTs) assessing the efficacy of active workstations with or without concomitant strategies for reducing occupational sedentary time in office workers. The risk of bias of the RCTs included in this study was assessed according to the Cochrane Handbook. An NMA with STATA 15.1 was used to construct a network diagram, league figures, and the final surface under the cumulative ranking curve (SUCRA) values. The certainty of evidence was assessed using the grading of recommendations, assessment, development, and evaluation (GRADE) approach.ResultsA total of 23 eligible studies including eight different types of interventions with 1428 office workers were included. NMA results showed that compared to a typical desk, multicomponent intervention (standardized mean difference (SMD) = - 1.50; 95% confidence interval (CI) - 2.17, - 0.82; SUCRA = 72.4%), sit-stand workstation + promotion (Reminders of rest breaks, posture variation, or incidental office activity) (SMD = - 1.49; 95%CI - 2.42, - 0.55; SUCRA = 71.0%), treadmill workstation + promotion (SMD = - 1.29; 95%CI - 2.51, - 0.07; SUCRA = 61.6%), and sit-stand workstation (SMD = - 1.10, 95%CI - 1.64, - 0.56; SUCRA = 50.2%) were effective in reducing occupational sedentary time for office workers.ConclusionsMulticomponent intervention, sit-stand workstation + promotion, treadmill workstation + promotion, and sit-stand workstation appear to be effective in reducing work-specific sedentary time for office workers. Furthermore, multicomponent interventions and active workstations + promotion better reduced work-specific sedentary time than active workstation alone. However, the overall certainty of the evidence was low.

The global rise in deaths caused by pulmonary tuberculosis (TB) has placed increased pressure on overburdened healthcare systems to provide TB diagnostic services. Artificial intelligence-based computer-aided diagnosis (AI-based CAD) promises to be a powerful tool in responding to this health challenge by providing actionable outputs which support the diagnostic accuracy and efficiency of clinicians. However, these technologies must first be extensively evaluated to understand their impact and risks before pursuing wide-scale deployment. Yet, health technology assessments for them in real world settings have been limited. Comprehensive evaluation demands consideration of technical safety, human factors, and health impacts to generate robust evidence and understand what is needed for long-term sustainable benefit realisation. This work-in progress study presents a three-stage methodological approach that will be used to guide the data collection and analysis process for evaluating the impact of implementing a commercial AI-based CAD system for TB diagnosis in a real-world radiological setting.

Mental health is largely shaped by the daily environments in which people live their lives, with positive components of mental health emphasising the importance of feeling good and functioning effectively. Promoting mental health relies on broad-based actions over multiple sectors, which can be difficult to measure. Different types of Impact Assessment (IA) frameworks allow for a structured approach to evaluating policy actions on different levels. A systematic review was performed exploring existing IA frameworks relating to mental health and mental wellbeing and how they have been used. A total of 145 records were identified from the databases, from which 9 articles were included in the review, with a further 6 studies included via reference list and citation chaining. Five different mental-health-related IA frameworks were found to be implemented in a variety of settings, mostly in relation to evaluating community actions. A Narrative Synthesis summarised key themes from the 15 included articles. Findings highlight the need for participatory approaches in IA, which have the dual purpose of informing the IA evaluation and advocating for the need to include mental health in policy development. However, it is important to ensure that IA frameworks are user-friendly, designed to be used by laypeople in a variety of sectors and that IA frameworks are operational in terms of time and monetary resources.

Background: We were engaged by policy stakeholders to undertake a scoping review of cannabis measurement instruments to inform the evaluation of cannabis legalization impacts. We identified instruments employed in population-based or clinical research to screen and assess cannabis use, including measurement properties. We also identified the content domains included in each instrument and gaps in the measurement of key priority areas as established by policy stakeholders. Methods: We followed PRISMA and conducted searches on MEDLINE, PsycINFO, Web of Science, EMBASE, HAPI, Scopus and grey literature. We included publications from the past 15 years that reported the use of an instrument to measure cannabis use. Six study team members calibrated screening and data abstraction, independently identified records and abstracted data. Results: Across 915 included publications, we identified 187 unique instruments covering seven content domains and 35 subdomains. The most identified instruments were the Composite International Diagnostic Interview, the Timeline Follow-Back and the National Epidemiologic Survey on Alcohol and Related Conditions (109/915; 91/915; 64/915). The Canadian Cannabis Survey addressed the most subdomains (22/35). Frequency of use, prevalence of use, and mental health impacts were the most addressed subdomains (110/187; 94/187; 67/187) and storage, growing cannabis, and second-hand exposure were the least addressed (1/187; 4/187; 6/187). Conclusion: This research identified instruments and domains critical to the assessment of public health impacts of cannabis legalization, which can facilitate the harmonization of measures to inform policy development. Future research should develop new instruments for less commonly-addressed constructs and thoroughly explore psychometric properties of existing instruments.

Authors' objectives: This health technology assessment evaluates the effectiveness and safety of transcatheter valve-in-valve implantation for adults with degenerated mitral or tricuspid bioprosthetic valves. It also evaluates the budget impact of publicly funding transcatheter valve-in-valve implantation and the experiences, preferences, and values of people with degenerated mitral or tricuspid bioprosthetic valves.

Authors' objectives: Background: In Switzerland, relatively low biosimilar prescription rates have prompted the interest of the authorities. A health technology assessment (HTA) was requested to compare the available evidence of the infliximab reference product and its biosimilar for treating rheumatoid arthritis (RA). Objective: This HTA examines the efficacy, effectiveness and safety of the infliximab biosimilar compared to its reference product in RA and presents the health economic impact of a potentially increased biosimilar utilization in Switzerland. Furthermore, ethical, legal, social and organisational aspects of treatment initiation with biosimilars or switching to biosimilars are analysed. Research questions: Is it safe, efficacious and effective 1) to initiate treatment with infliximab biosimilar instead of the infliximab reference product, 2) to switch treatment from the infliximab reference product to infliximab biosimilar and 3) to switch treatment from infliximab biosimilar to the infliximab reference product in patients with RA?

The COVID-19 pandemic affects people's psychological well-being as well as their risk of physical complications. Under the circumstance, it is essential to synthesize the existing evidence on psychological consequences with a view to fostering policymaking. Thus, a systematic attempt was compiled to review the Bangladeshi literature related to common mental health problems (i.e. depression, anxiety, and stress) during the COVID-19 pandemic. Adhering to the PRISMA guidelines, a systematic literature search was performed using Medline or PubMed, Scopus, PsycINFO, Web of Science, CINAHL, Google Scholar, PsyArxiv, MedRxiv, and ResearchGate, between 20 December 2020 and 5 March 2021, followed by predetermined eligibility criteria. The inclusion criteria for this review were observational studies involving at least one mental health problem (i.e. stress, depression, and anxiety) published in peer-reviewed journals or preprint servers in the English language after the inception of the pandemic in Bangladesh. The pooled prevalence of depression, anxiety, and stress was 47% (95% CI 39-55%, I 2 = 99.14%), 47% (95% CI 39-54%, I 2 = 99.78%), and 44% (95% CI 30-58%, I 2 = 99.36%), respectively. Subgroup analysis revealed that students were experiencing a higher rate of depression, anxiety, and stress than general people and healthcare professionals. The associated risk factors of mental health problems were gender, age, residence area, family size, monthly family income, educational status, marital status, physical exercise, smoking, alcohol use, fear of COVID-19, presence of chronic illness, unemployment status, and exposure to COVID-19-related news and social media. This systematic review provides baseline data on the symptoms of depression, anxiety, and stress across various Bangladeshi cohorts, which are anticipated to be helpful to the respective authorities for implementing cohort-specific mental health strategies.

Background This systematic map principally sought to understand the different forms of effectiveness that existing studies evaluate in relation to Natural Flood Management (NFM) in the UK with a supplementary question of whether studies engaged with climate change and future flood risk. NFM measures seek to protect, enhance, emulate, or restore the natural function of rivers as part of approaches to flood risk management (FRM). While there is agreement in both academic and practice/policy literature that NFM should be part of a holistic FRM strategy to address current and future flood risk, the specifics of how to expand the application of and consistently implement NFM successfully in practice are less well known. A core focus of this study is on how the effectiveness of NFM measures is evaluated in different studies based on approaches drawn from the Environmental Impact Assessment (EIA) literature: procedural, substantive, transactive and normative. The systematic map also examines how studies account for climate change, which is a crucial issue given the connections between NFM and climate change adaptation and resilience. Methods We searched 13 bibliographic databases, Google scholar as a web-based search engine, and 21 organisational sites. Articles were screened by title, abstract, and full text based on defined eligibility criteria. Checks were performed for consistency amongst reviewers. Forms of effectiveness were coded on the basis of the included studies in the systematic map. The quantity and characteristics of the available evidence are summarised with the frequencies of effectiveness forms for each NFM measure are presented in heat maps. Review findings A total of 216 articles reported eligible studies that were coded as part of the systematic map. Overall, the systematic map shows that the majority of studies considered at least one approach to effectiveness; however, very few studies considered multiple forms of effectiveness. The systematic map also demonstrates that climate change is considered systematically by around one-quarter of studies although many studies make claims about NFM’s effectiveness in the face of future climatic change. Conclusions NFM can be effective in several different ways owing to their multiple benefits; however, there are evidence gaps around understanding these different forms of effectiveness. This is particularly marked for studies considering transactive and normative effectiveness. Interdisciplinary studies are more likely to consider multiple forms of effectiveness. This systematic map also found that whilst 75% of studies mention future climate change in their studies, only 24.1% contain a systematic consideration of the issue through, for example, using climate change projections. NFM is also at risk of climate change (e.g. through drought) and therefore it is imperative that study designs seek to incorporate consideration of effectiveness under future climate change. Policymakers should be made aware of the lack of understanding of how NFM measures perform under future climate change. Keywords Flooding, Flood risk management, Environmental Impact Assessment, Climate change adaptation, River catchments, Nature-based solutions, Natural Flood Management Background Natural flood management (NFM) measures seek to protect, enhance, emulate, or restore the natural function of rivers as part of approaches to flood risk management (FRM). While there is agreement in both academic and practice/policy literature that NFM, in a general sense, should be part of a holistic FRM strategy to address current and future flood risk, the specifics of how to consistently implement NFM successfully in practice are less well known. This is particularly acute for practitioners in the UK given the nature of the UK’s biophysical and socio-political context. There is a recognition that existing reviews of NFM effectiveness in the UK tend to focus on the natural science basis and it is unclear how studies account for climate change. Further, reviews tend to focus only on UK studies. This systematic map aims to highlight the way in which existing NFM studies, from different disciplinary backgrounds and across Europe, evaluate effectiveness, and the extent to which they account for climate change. This knowledge can help to make recommendations for future areas of research where the multiple issues around understanding effectiveness can be synthesised, and where climate change is systematically taken into account. Methods This systematic map protocol addresses the following question: what approaches exist to evaluate the effectiveness of UK-relevant natural flood management measures? The protocol details the methodology that will be used to conduct a systematic map of the range of peer-reviewed journal papers, policy documents, guidance, and other forms of grey literature which currently exist on NFM to give an overview on the way in which the effectiveness of NFM is conceived. The methods detail the search strategy employed for gathering items across the peer-reviewed academic literature and grey literature. Additionally, the methods outline how the reviewers will approach article screening, and the eligibility criteria to include/exclude articles. The methods also details the steps taken to ensure consistency across all reviewers, the data coding strategy, and methods for presenting the final systematic map. Together, the methods employed will help to identify current knowledge gaps, and will enable recommendations to be made for future research.

Background: In order to understand and measure the policy impact of research we need a definition of research impact that is suited to the task. This article systematically reviewed both peer-reviewed and grey literature for definitions of research impact to develop a definition of research impact that can be used to investigate how public health research influences policy. Method: Keyword searches of the electronic databases Web of Science, ProQuest, PubMed, EMBASE, CINAHL, Informit, PsycINFO, The Cochrane Database of Systematic Reviews and Google Scholar were conducted between August 2015 and April 2016. Keywords included 'definition' and 'policy' and 'research impact' or 'research evidence'. The search terms 'health', public health' or 'mental health' and 'knowledge transfer' or 'research translation' were used to focus the search on relevant health discipline approaches. Studies included in the review described processes, theories or frameworks associated with public health, health services or mental health policy. Results: We identified 108 definitions in 83 publications. The key findings were that literature on research impact is growing, but only 23% of peer-reviewed publications on the topic explicitly defined the term and that the majority (76%) of definitions were derived from research organisations and funding institutions. We identified four main types of definition, namely (1) definitions that conceptualise research impacts in terms of positive changes or effects that evidence can bring about when transferred into policies (example Research Excellence Framework definition), (2) definitions that interpret research impacts as measurable outcomes (Research Councils UK), and (3) bibliometric and (4) use-based definitions. We identified four constructs underpinning these definitions that related to concepts of contribution, change, avenues and levels of impact. Conclusion: The dominance of bureaucratic definitions, the tendency to discuss but not define the concept of research impact, and the heterogeneity of definitions confirm the need for conceptual clarity in this area. We propose a working definition of research impact that can be used in a range of health policy contexts.

Cost-of-illness studies, the systematic quantification of the economic burden of diseases on the individual and on society, help illustrate direct budgetary consequences of diseases in the health system and indirect costs associated with patient or carer productivity losses. In the context of the BURQOL-RD project (“Social Economic Burden and Health-Related Quality of Life in patients with Rare Diseases in Europe”) we studied the evidence on direct and indirect costs for 10 rare diseases (Cystic Fibrosis [CF], Duchenne Muscular Dystrophy [DMD], Fragile X Syndrome [FXS], Haemophilia, Juvenile Idiopathic Arthritis [JIA], Mucopolysaccharidosis [MPS], Scleroderma [SCL], Prader-Willi Syndrome [PWS], Histiocytosis [HIS] and Epidermolysis Bullosa [EB]). A systematic literature review of cost of illness studies was conducted using a keyword strategy in combination with the names of the 10 selected rare diseases. Available disease prevalence in Europe was found to range between 1 and 2 per 100,000 population (PWS, a sub-type of Histiocytosis, and EB) up to 42 per 100,000 population (Scleroderma). Overall, cost evidence on rare diseases appears to be very scarce (a total of 77 studies were identified across all diseases), with CF (n=29) and Haemophilia (n=22) being relatively well studied, compared to the other conditions, where very limited cost of illness information was available. In terms of data availability, total lifetime cost figures were found only across four diseases, and total annual costs (including indirect costs) across five diseases. Overall, data availability was found to correlate with the existence of a pharmaceutical treatment and indirect costs tended to account for a significant proportion of total costs. Although methodological variations prevent any detailed comparison between conditions and based on the evidence available, most of the rare diseases examined are associated with significant economic burden, both direct and indirect.

BACKGROUND: Public involvement in health-care policy has been advocated as a means to enhance health system responsiveness, yet evidence for its impact has been difficult to ascertain. OBJECTIVES: To review the peer-reviewed empirical evidence on outcomes of public involvement in health-care policy. METHODS: We systematically searched PsychINFO and PubMed from November 2000 to April 2010 for empirical studies that reported on original research only; studies in languages other than English, German or French were excluded. Data were extracted using a standardized evidence table with a priori determined headings. MAIN RESULTS: Nineteen studies were identified as eligible for inclusion in our review. We found that sound empirical evidence of the outcomes of public involvement activities in health care remains underdeveloped. The concept and the indicators used to examine and determine outcomes remain poorly specified and inconsistent, as does the reporting of the evidence. There was some evidence for the developmental role of public involvement, such as enhancing awareness, understanding and competencies among lay participants. Evidence for instrumental benefits of public involvement initiatives was less well documented. CONCLUSIONS: Despite the growing body of work on public involvement in health-care policy, evidence of its impact remains scarce; thus, firm conclusions about involvement activities that are appropriate and effective for policy development are difficult to draw. However, focus on outcomes risks missing the normative argument that involving the public in the health-care policy process may be seen to be of intrinsic value.

The purpose of this guidance note is to describe and define impact evaluation for member organizations of UNEG; and to articulate some of the main theoretical and practical considerations when carrying out impact evaluations.