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Objective: To review the evidence on using family resilience as a concept in interventions by public health nurses/health visitors with families with children and young people as part of an evaluation of the evidence base for the Family Resilience Assessment Instrument and Tool (FRAIT). FRAIT was developed by University faculty with Health Visitors and a Community of Practice in Wales, and is used by Health Visitors in Wales with families with children under 5 years to assess family resilience. Method: A standard Cochrane Systematic Review methodology was used to review published literature. A protocol (crd.york.ac.uk/PROSPERO/display_record.php?RecordID = 230845) was submitted to Prospero in September 2021, and reviewing began in January 2022. Title and abstract searching were undertaken 12 databases and results were captured using PRISMA and Excel spreadsheet. Second reviewers reviewed title and abstract screening, and full‐text extraction. Results: Initial title screening brought back 1350 papers across 12 databases. Titles and abstract screening reduced these to 106, 44 papers were considered for full‐text extraction, with 25 papers included for review. Discussion: Results demonstrated a focus on specific demographics, and use of family resilience with families living with specific health problems. Existing family resilience scales showed improved results in selected specific demographic groups, albeit in a reactive way. FRAIT has originality within the literature as it is used in a universal, preventative way with all families regardless of demographic or health issues. There is evidence to show that using a family resilience program in this way has originality and implications for the physical and mental health of children and young people. No patient or public contribution: This was a systematic review of existing literature so public or patient contribution would not have been appropriate. [ABSTRACT FROM AUTHOR]

Aim: This review investigated the outcomes and methodological quality of infant sleep intervention studies utilizing actigraphy. Background: Parents need appropriate support for infant sleep from nurses. There are few methodological reports of actigraphy in infant sleep intervention studies that objectively measure infant sleep in a natural setting. Design: This was a systematic review study. Data Sources Ovid MEDLINE, Embase, Cochrane, CINAHL and PsycINFO were searched from database establishment to 30 December 2021. Review Methods: This systematic review utilized the Cochrane Collaboration review guidelines. Results: Eleven sleep intervention studies were reviewed. Three used extinction‐based behavioural interventions, and eight included parental education programs. The infant sleep interventions positively affected the sleep outcomes of both infants and parents. Fairly consistent effects were found on infants' number of awakenings and sleep onset latency. However, parental psychosocial outcomes were inconsistent. All studies reported device placement, the algorithm for analysis, the use of a sleep diary and number of days/nights, but external movements affecting infants' sleep records were insufficiently reported. Only two studies had a low risk of bias. Conclusions: The infant sleep interventions had positive effects on both infants and their parents. Comprehensive methodological considerations are required for more standardized assessments using actigraphy for infant sleep evaluation. Summary statement: What is already known about this topic? Strong evidence exists that behavioural interventions improve infant sleep.Infant sleep interventions using actigraphy have gradually increased in paediatric sleep research. What this paper adds: Behavioural interventions were found to be fairly effective for infants' sleep onset latency and night‐wakings.Parental education programs were inconsistent in their effectiveness on infant sleep outcomes, compared to extinction‐based behavioural interventions. Infant behavioural sleep interventions also did not show consistent positive effects on parental variables.The use of actigraphy with infants is challenging in terms of comparability across studies due to the lack of standardized criteria for defining and scoring daytime and nighttime sleep data, and unexpected external movement detection due to variability of infants' sleep conditions. The implications of this paper: This study contributes to nursing knowledge and practice by increasing the feasibility of implementing infant behavioural sleep interventions using actigraphy and considering family contexts.Meta‐analysis is needed to clarify the effectiveness of infant sleep interventions, and further studies should investigate the long‐term effects of infant sleep interventions.In infant sleep intervention studies using actigraphy, it is necessary to use subjective and objective measures as complementary modalities. Follow‐up studies are needed to establish standards in actigraphic measurement and reporting methodology. [ABSTRACT FROM AUTHOR]

Aim: Nursing interventions include the preventive care that can support and guide the nurse's effort to provide asthma interventions for children. Hence, this review was done to assess the effectiveness of nursing interventions for management of childhood asthma. Methods: We conducted a search in Medline, the Cochrane library, EMBASE, ScienceDirect and Google Scholar from 1964 until April 2022. Meta‐analysis was done using a random‐effects model and pooled weighted mean difference (WMD) or standardized mean difference (SMD) and/or risk ratio (RR) with 95% confidence intervals (CIs). Results: Fourteen studies were analysed. The pooled RR was 0.49 for emergency visits (95% CI: 0.32 to 0.77) and 0.46 for hospitalizations (95% CI: 0.27 to 0.79). The pooled WMD was −1.20 for number of days with symptoms (95% CI: −3.50 to 1.11), −0.98 for number of nights with symptoms (95% CI: −2.94 to 0.98) and −0.69 for frequency of asthma attacks (95% CI: −1.19 to −0.20). The pooled SMD was 0.39 for quality of life (95% CI: 0.11 to 0.66) and 0.58 for asthma control (95% CI: −0.29 to 1.46). Conclusion: Nursing interventions were relatively effective in improving the quality of life and reducing asthma related emergencies, acute attacks and hospitalization amongst childhood asthma patients. Summary statement: What is already known about this topic? There have been limited reviews on effectiveness of nursing intervention for the management of asthma amongst children including only the randomized controlled trials. What this paper adds? This is the first review that assessed the impact of nursing intervention for childhood asthma including only RCT.Nursing interventions showed significant impact on ED visits and hospital admissions.There was also an impact on reducing the frequency of asthma attacks and improving QoL. The implications of this paper: It is necessary to implement any form of nursing intervention either in hospital setting, school and community or in virtual mode to assist with managing childhood asthma patients. [ABSTRACT FROM AUTHOR]

The aim of this systematic review is to verify the development of the International Classification of Functioning, Disability and Health for Child and Youth (ICF-CY), investigating methodology and how many core sets have been created. Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were used to carry out the systematic review. Six bibliographic databases were searched: MEDLINE, SCOPUS, Web of Sciences, CINHAL, PEDro, and OT Seeker. Papers included in the study have the following characteristics: (a) pediatric population with different health conditions, (b) assessment of ICF domains, (c) development of ICF-CY core set in different health conditions, and (d) recommendation for clinical uses. Search strategies allowed to identify 270 research papers. After the elimination of duplicates, 154 articles were analyzed. Finally, 28 records were included for qualitative synthesis. Twelve different ICF-CY Core Sets were identified. Autism spectrum disorder, attention-deficit/hyperactivity disorder, and cerebral palsy were the main health conditions studied at international level. Most of the studies involved international experts using Cieza' methodology to inform ICF-CY Core Set. After 15 years since the adoption of ICF-CY, it still finds some barriers to use. Concrete actions should be taken to develop further core sets following a rigorous methodology and to contribute implementing the ICF framework. In 15 years since the implementation of International Classification of Functioning, Disability and Health for Child and Youth (ICF-CY), only 12 core sets have been developed. To develop ICF-CY Core Set, health professionals should follow methodology described by Cieza et al. Strong collaboration between low- and middle-income countries and high-income countries are recommended. [ABSTRACT FROM AUTHOR]

The rapid growth in digital technology usage among children and adolescents has highlighted the need for novel approaches to promote their physical and mental health. This paper investigates the viability of gamification—the application of game mechanics to non-gaming contexts—as a potent instrument for health promotion and mental health support. This conceptual systematic review seeks to examine the various published articles promoting children and adolescents' physical and mental health through gamified techniques. These interventions can provide an interactive and engaging platform for encouraging physical activity, promoting healthy nutrition, enhancing emotional regulation, and promoting mental health. The significance of this topic stems from the pervasive use of electronic games, beginning at a young age, which makes them popular educational tools. For the review to be systematic and reproducible, the PsycINFO, Scopus, PubMed, and Elsevier databases were searched and the PRISMA method was utilized for the analysis. After analyzing the research data, empirical studies assessing the use of gamification in promoting adolescents' physical and mental health are discussed. In conclusion, gamification has demonstrated promise for promoting children's and adolescents' physical and mental health. It improves motivation, commitment, and adherence to healthy behaviors. However, additional research is required to evaluate gamification interventions' long-term effectiveness and sustainability in promoting health behaviors among this population. [ABSTRACT FROM AUTHOR]

Background and Aims: Unmet supportive care needs (SCN) refer to perceived gaps in the support parents want to manage caregiving activities for children with chronic health conditions (CHC) and the support received. This review aims to systematically identify the unmet SCN of families with children living with five common paediatric CHC and characterise the assessment tools used to measure SCN. Design: Systematic review methodology with narrative synthesis of data. Reporting followed the PRISMA statement guidelines. Method: Literature searches were conducted in electronic databases Medline complete, PsycINFO, CINHAL and EMBASE to retrieve relevant articles published between 1990 and July 2022. Eligible studies involved (i) children aged 0–18 years diagnosed with either of cancer, congenital heart disease (CHD), diabetes, asthma, renal disease and (ii) assessment of unmet SCN. Studies involving children with genetic or developmental conditions were excluded. The methodological quality of studies was assessed using JBI assessment tool. Results: Of 6223 articles screened, 34 papers were included (25 quantitative, 5 qualitative and 4 mixed design). Most papers explored unmet needs of families with cancer (n = 26). The remaining articles concerned CHD (n = 5), asthma (n = 2) and mixed CHC (n = 1, renal failure, and diabetes). Information (e.g. treatment, lifestyle, etc.) and health care (e.g. emotional support, practical services, etc.) were the most common unmet need domains across health conditions. A variety of methods and need assessments hampered comparisons between studies both across and within CHC. Conclusion: Irrespective of illness, addressing unmet informational or health care needs may help to optimise outcomes and care for children and families living with common CHC. There was considerable variation in reporting styles, study design and need assessments both within and across conditions. Relevance to Clinical Practice: Health care professionals must routinely evaluate the type, quality and quantity of psychoeducation and support that families of children with CHC want and receive. Providing nurses with more effective strategies to assess child and family needs across a broad range of domains may help to increase understanding of where further support for families is required. Patient or Public Contribution: There was no patient or public contribution to this study as it involved a systematic review of existing literature. [ABSTRACT FROM AUTHOR]

Children who experience the traumatic (i.e., violent and/or unexpected) death of a loved one are at risk for a range of adverse developmental and mental health problems, including pathological processes of grief. Over the last decades, conceptualizations of maladaptive grief have varied, resulting in a range of assessment tools and no "gold standard" measure to assess symptoms of prolonged grief in children. The current paper is a systematic review of studies that measured grief in children who experienced traumatic loss in order to determine the measures currently used in the literature with children who experience traumatic loss. Searches were conducted according to the preferred reporting items for systematic reviews and meta-analyses in PUBMED, PsycINFO, and OVID and through hand searches of relevant reference lists. Two authors reviewed each study yielded by searches and conducted data extraction on included studies. Studies were included if they were peer-reviewed, included a measure of grief, and consisted of samples of children (age 18 and younger) whereby at least a portion experienced traumatic loss. Thirty-nine studies met inclusion criteria, from which 17 measures were identified. The most commonly used measure was the Inventory of Complicated Grief (n = 10 studies) followed by the Extended Grief Inventory (n = 6). Most studies used different measures and variations of the same measures to assess similar constructs. All but one measure relied on child self-report. More standardization of measurement across studies is needed, along with parent and/or teacher reported measures. [ABSTRACT FROM AUTHOR]

Background: This paper aimed to examine the effects of probiotics on eight factors in overweight or obese children by meta-analysis, namely, body mass index (BMI), total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), adiponectin, leptin and tumor necrosis factor-α (TNF-α) and summarize the mechanisms of action of probiotics based on the existing researches. Methods: Six databases (PubMed, Web of Science, Embase, Cochrane Library, SinoMed and CNKI) were searched until March 2023. Review Manager 5.4 was used for meta-analysis. The data were analysed using weighted mean differences (WMDs) or standardized mean differences (SMDs) under a fixed effect model or random effect model to observe the effects of probiotic administration on the included indicators. Results: Four publications with a total of 206 overweight or obesity children were included. According to the meta-analysis, probiotics were able to significantly decrease the levels of HDL-C (MD, 0.06; 95% CI 0.03, 0.09; P = 0.0001), LDL-C (MD, − 0.06; 95% CI − 0.12, − 0.00; P = 0.04), adiponectin (MD, 1.39; 95% CI 1.19, 1.59; P < 0.00001), leptin (MD, − 2.72; 95% CI − 2.9, − 2.54; P < 0.00001) and TNF-α (MD, − 4.91; 95% CI − 7.15, − 2.67; P < 0.0001) compared to those in the placebo group. Still, for BMI, the palcebo group seemed to be better than the probiotic group (MD, 0.85; 95% CI 0.04, 1.66; P = 0.04). TC (MD, − 0.05; 95% CI − 0.12, 0.02; P = 0.14) and TG (MD, − 0.16; 95% CI − 0.36, 0.05; P = 0.14) were not different between two groups. Conclusions: This review drew that probiotics might act as a role in regulating HDL-C, LDL-C, adiponectin, leptin and TNF-α in overweight or obesity children. Additionally, our systematic review yielded that probiotics might regulate lipid metabolism and improve obese associated symptoms by some paths. This meta-analysis has been registered at PROSPERO with ID: CRD42023408359. [ABSTRACT FROM AUTHOR]

Various studies have shown the effectiveness of motor interventions for children with neurodevelopmental disorders (NDDs). Web-based interventions may provide an opportunity for remote access to effective interventions with less burden on therapists. This systematic review aimed to examine the effects of web-based exercise interventions for children with NDDs. We searched PubMed for relevant articles published in English since 1994 and included intervention studies focusing on NDDs in children aged ≤18 years, who received web-based exercise interventions. We categorized the extracted information by outcome measure and intervention type and assessed the risk of bias of the included studies. We selected five articles whose subjects had autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), and developmental coordination disorder (DCD). The exercise interventions used active video games, a Zoom-based intervention, and a WhatsApp-based intervention. Three papers showed improvements in physical activity, motor function, and executive function, whereas two papers on DCD showed no improvements in motor coordination or physical activity. Web-based exercise intervention for children with ASD and ADHD may improve their motor function, executive function, and physical activity rather than for children with NDDs. An intervention may be more effective when the content of the intervention is based on objectives and symptoms, when guidance is provided by specialists, or when sufficient explanation and support are provided to parents. However, more research is needed to statistically evaluate the effectiveness of web-based exercise interventions for children with NDDs. [ABSTRACT FROM AUTHOR]

Little is known about the current state of research on the involvement of young people in hate speech. Thus, this systematic review presents findings on a) the prevalence of hate speech among children and adolescents and on hate speech definitions that guide prevalence assessments for this population; and b) the theoretical and empirical overlap of hate speech with related concepts. This review was guided by the Cochrane approach. To be included, publications were required to deal with real-life experiences of hate speech, to provide empirical data on prevalence for samples aged 5 to 21 years and they had to be published in academic formats. Included publications were full-text coded using two raters (κ =.80) and their quality was assessed. The string-guided electronic search (ERIC, SocInfo, Psycinfo, Psyndex) yielded 1,850 publications. Eighteen publications based on 10 studies met the inclusion criteria and their findings were systematized. Twelve publications were of medium quality due to minor deficiencies in their theoretical or methodological foundations. All studies used samples of adolescents and none of younger children. Nine out of 10 studies applied quantitative methodologies. Eighteen publications based on 10 studies were included. Results showed that frequencies for hate speech exposure were higher than those related to victimization and perpetration. Definitions of hate speech and assessment instruments were heterogeneous. Empirical evidence for an often theorized overlap between hate speech and bullying was found. The paper concludes by presenting a definition of hate speech, including implications for practice, policy, and research. [ABSTRACT FROM AUTHOR]

Our systematic qualitative analysis advances the field of human development with an integrative review of sensory research in children's reading of books and e-books. Based on a systematic literature review of 35 papers, we qualitatively synthesise multidisciplinary literature concerned with children's sensory development and the activity of reading. We map the studies' characteristics, including their methodological designs and primary theoretical concepts (embodiment and materiality). We highlight empirical research gaps and lack of literature attention particularly for critical engagement with sensorial research. We find notable terminological discrepancies across qualitative and quantitative studies and insufficient emphasis on the developmental aspects of children's sensory reading and its dynamic interaction with books' affordances. Our theoretical contribution lies in identifying the emerging area of multisensory m(ai)cro research as a future agenda for studies of children's reading, which we support with a terminological guide and a conceptual framework. [ABSTRACT FROM AUTHOR]

Background and purpose: Vocal nodules are the main cause of voice disorders in children, which can be caused by several behaviors such as excessive speaking and yelling, and can significantly impact their overall communication development. Different nonmedical treatments exist for vocal nodules, but there is no consensus on the most effective methods. The aim of the present systematic review was to study the nonmedical interventions for vocal nodules in children. Materials and methods: The systematic search was performed in electronic databases, including PubMed, Scopus, Science Direct, ISI (Web of Science), Cochrane Database of Systematic Reviews, and Google Scholar. The search involved articles published between 2000 and 2022. The following terms were used as keywords: vocal nodule, vocal fold nodules, therapy, treatment, intervention, voice disorder, pediatric, and telepractice. Studies were selected if they 1) had examined 0-18-year-old subjects with vocal fold nodules; 2) had obviously stated the kind, process, and evaluation tools and also 3) the kind and the process of the interventions and the intervention groups; 4) had provided nonmedical interventions; 5) had been published in English and after 2000; and 6) presented the outcome data. The methodological quality of the papers was evaluated using the Physiotherapy Evidence Database scale. Results: We identified 729 articles, of which 11 met the inclusion criteria. These studies were different in the study design, participant characteristics, types of assessments, types of interventions, and follow-up periods. According to findings, nonmedical treatments of vocal nodules were successful in elimination of/decreasing the vocal nodules sizes (four studies), improving the quality of life (two studies), and improving acoustic parameters of voice (nine studies). Conclusion: The present systematic review showed the effectiveness of nonmedical treatment of vocal nodules in children, despite being challenging. Further researches are required to have higher levels of evidence, more accurate methodological quality, and long-term follow-up evaluations to draw more accurate conclusions. [ABSTRACT FROM AUTHOR]

Background: Inborn errors of immunity (IEIs) are considered significant challenges for children with IEIs, their families, and their medical providers. Infections are the most common complication of IEIs and children can acquire coronavirus disease 2019 (COVID-19) even when protective measures are taken. Objectives: To estimate the incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children with IEIs and analyse the demographic parameters, clinical characteristics and treatment outcomes in children with IEIs with COVID-19 illness. Methods: For this systematic review, we searched ProQuest, Medline, Embase, PubMed, CINAHL, Wiley online library, Scopus and Nature through the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guideline for studies on the development of COVID-19 in children with IEIs, published from December 1, 2019 to February 28, 2023, with English language restriction. Results: Of the 1095 papers that were identified, 116 articles were included in the systematic review (73 case report, 38 cohort 4 case-series and 1 case–control studies). Studies involving 710 children with IEIs with confirmed COVID-19 were analyzed. Among all 710 IEIs pediatric cases who acquired SARS-CoV-2, some children were documented to be admitted to the intensive care unit (ICU) (n = 119, 16.8%), intubated and placed on mechanical ventilation (n = 87, 12.2%), suffered acute respiratory distress syndrome (n = 98, 13.8%) or died (n = 60, 8.4%). Overall, COVID-19 in children with different IEIs patents resulted in no or low severity of disease in more than 76% of all included cases (COVID-19 severity: asymptomatic = 105, mild = 351, or moderate = 88). The majority of children with IEIs received treatment for COVID-19 (n = 579, 81.5%). Multisystem inflammatory syndrome in children (MIS-C) due to COVID-19 in children with IEIs occurred in 103 (14.5%). Fatality in children with IEIs with COVID-19 was reported in any of the included IEIs categories for cellular and humoral immunodeficiencies (n = 19, 18.6%), immune dysregulatory diseases (n = 17, 17.9%), innate immunodeficiencies (n = 5, 10%), bone marrow failure (n = 1, 14.3%), complement deficiencies (n = 1, 9.1%), combined immunodeficiencies with associated or syndromic features (n = 7, 5.5%), phagocytic diseases (n = 3, 5.5%), autoinflammatory diseases (n = 2, 3%) and predominantly antibody deficiencies (n = 5, 2.5%). Mortality was COVID-19-related in a considerable number of children with IEIs (29/60, 48.3%). The highest ICU admission and fatality rates were observed in cases belonging to cellular and humoral immunodeficiencies (26.5% and 18.6%) and immune dysregulatory diseases (35.8% and 17.9%) groups, especially in children infected with SARS-CoV-2 who suffered severe combined immunodeficiency (28.6% and 23.8%), combined immunodeficiency (25% and 15%), familial hemophagocytic lymphohistiocytosis (40% and 20%), X-linked lymphoproliferative diseases-1 (75% and 75%) and X-linked lymphoproliferative diseases-2 (50% and 50%) compared to the other IEIs cases. Conclusion: Children with IEIs infected with SARS-CoV-2 may experience higher rates of ICU admission and mortality in comparison with the immunocompetent pediatric populations. Underlying immune defects does seem to be independent risk factors for severe SARS-CoV-2 infection in children with IEIs, a number of children with SCID and CID were reported to have prolonged infections–though the number of patients is small–but especially immune dysregulation diseases (XLP1 and XLP2) and innate immunodeficiencies impairing type I interferon signalling (IFNAR1, IFNAR2 and TBK1). [ABSTRACT FROM AUTHOR]

Background: This paper aimed to examine the effects of probiotics on eight factors in overweight or obese children by meta-analysis, namely, body mass index (BMI), total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), adiponectin, leptin and tumor necrosis factor-α (TNF-α) and summarize the mechanisms of action of probiotics based on the existing researches. Methods: Six databases (PubMed, Web of Science, Embase, Cochrane Library, SinoMed and CNKI) were searched until March 2023. Review Manager 5.4 was used for meta-analysis. The data were analysed using weighted mean differences (WMDs) or standardized mean differences (SMDs) under a fixed effect model or random effect model to observe the effects of probiotic administration on the included indicators. Results: Four publications with a total of 206 overweight or obesity children were included. According to the meta-analysis, probiotics were able to significantly decrease the levels of HDL-C (MD, 0.06; 95% CI 0.03, 0.09; P = 0.0001), LDL-C (MD, − 0.06; 95% CI − 0.12, − 0.00; P = 0.04), adiponectin (MD, 1.39; 95% CI 1.19, 1.59; P < 0.00001), leptin (MD, − 2.72; 95% CI − 2.9, − 2.54; P < 0.00001) and TNF-α (MD, − 4.91; 95% CI − 7.15, − 2.67; P < 0.0001) compared to those in the placebo group. Still, for BMI, the palcebo group seemed to be better than the probiotic group (MD, 0.85; 95% CI 0.04, 1.66; P = 0.04). TC (MD, − 0.05; 95% CI − 0.12, 0.02; P = 0.14) and TG (MD, − 0.16; 95% CI − 0.36, 0.05; P = 0.14) were not different between two groups. Conclusions: This review drew that probiotics might act as a role in regulating HDL-C, LDL-C, adiponectin, leptin and TNF-α in overweight or obesity children. Additionally, our systematic review yielded that probiotics might regulate lipid metabolism and improve obese associated symptoms by some paths. This meta-analysis has been registered at PROSPERO with ID: CRD42023408359. [ABSTRACT FROM AUTHOR]

Background: The aim of this paper is the systematic review of psychological/psychosocial interventions for gender diverse youth under 18 years of age and their families, based on the published protocol: PROSPERO 2020 CRD42020163995. Methods: A search strategy was developed using key terms. An electronic literature search was completed using the following data bases (OVID MEDLINE; EBSCO CINAHL; ProQuest MEDLINE; OVID PsycINFO). Only studies published in English between 2001–2021 were included. This review is based on PRISMA guidance. Studies meeting inclusion criteria were quality appraised using the Mixed Methods Assessment Tool (MMAT). Results: 8405 studies were independently screened. Four studies met the inclusion criteria for the study. Parents of transgender youth attended between one and 11 psychological/psychosocial group interventions. Parents reported reduced isolation and increased knowledge, which enabled them to advocate for their young person's needs. Psychological/psychosocial group interventions were creating challenges in terms of group processes, with some parents dominating interactions. Psychological/psychosocial group interventions were positive for parents, but no outcomes were collected for transgender young people. Conclusion: More research is required to understand the role of group facilitators, the optimal group size and the number of psychological/psychosocial intervention sessions required. [ABSTRACT FROM AUTHOR]

Background: Automated Writing Evaluation (AWE) systems to aid writing learning and instruction in primary and secondary education are growing increasingly popular. However, their effectiveness is hardly known. We conducted a systematic review focusing on the effects of these systems providing writing feedback to students in school settings. Objectives: Our goal was to identify and characterize AWE systems tested in the last 20 years for Grades 1–12 and examine their impact on text quality and other writing‐related outcomes. Methods: The review followed PRISMA guidelines. We identified eight studies reporting the effects on writing of six AWE systems on 1659 students 11–17 years of age. Results and conclusions: Our review supported the usefulness of AWE systems for writing learning and instruction. Except for one, all studies showed a positive effect of automated feedback in at least one writing‐related measure. The integration of AWE systems into more extensive instructional programs, the amount of writing practice provided to students, the type of the control groups, and the role of teachers are factors influencing their impact on students' writing outcomes. Relevance: Our review generally supported the value of AWE systems in the teaching/learning process of writing. A closer look into the conditions in which AWE systems are put to practice suggested that they are particularly effective when embedded into comprehensive instructional programs providing ample writing opportunities. Findings from this review expand knowledge on AWE systems as valuable tools to enhance writing in school settings. Lay Description: What is already known about this topic: The use of automated writing evaluation (AWE) systems is increasingly popular in education.Little is known about their effectiveness in school settings. What this paper adds: This paper reviews studies reporting the effectiveness of AWE systems to enhance 11‐ to 17‐year‐old students' writing.The main characteristics of the AWE systems tested in the last 20 years for school settings, and their impact on writing, are identified and discussed. Implications for practice and/or policy: Embedding AWE systems into more extensive instructional programs benefits students' writing more than using the systems in isolation.Providing students with ample opportunity to practice writing seems related to better text quality.The combination of teacher and system feedback seems to positively impact students' writing outcomes.Teachers' and students' perceived impact of use may be a critical factor. [ABSTRACT FROM AUTHOR]

Background: The Lidcombe Program is a stuttering treatment approach for children between the ages of 3 and 6 years. Most papers about the Lidcombe Program, however, are based on studies conducted in native English-speaking countries. The aim of this paper is to systematically review the delivery and implementation of the Lidcombe Program in non-native English-speaking countries. Summary: A resource search was conducted between October and November 2019. Scopus, PubMed, ASHA, Cochrane Library, ERIC, Google Scholar, and SpeechBITE databases and reference lists of relevant papers were searched for the identification process. Joanna Briggs Institute tools were used for the appraisal of the studies. The search yielded 8 studies conducted in non-native English-speaking countries. The Lidcombe Program is efficacious in non-native English-speaking countries when delivered to both preschool and young school age children who stutter. It is reported to be delivered with minor changes and challenges. The number of weekly clinic visits and the total time needed to reach zero or near-zero stuttering levels with the Lidcombe Program can be up to 3 times greater in non-native English-speaking countries than in native English-speaking countries, mostly due to the increased time needed to introduce the parental verbal contingencies. Key Messages: Speech and language therapists practicing in non-native English-speaking countries are encouraged to use the Lidcombe Program for both preschool and young school age children who stutter, although this can take more time than that reported in native English-speaking countries. Further investigation to explore the therapy process with children and parents in non-native English-speaking countries is needed. [ABSTRACT FROM AUTHOR]

To identify and appraise the existing clinical practice guidelines, consensus statements and Cochrane systematic reviews for the management of adult and paediatric focal spasticity to generate a single synthesized guideline. Systematic review of 12 electronic databases. Clinical practice guidelines, consensus statements and Cochrane systematic reviews for focal spasticity in adults and children. Included studies were appraised according to the AGREE II criteria. A total of 25 papers were included in this review, comprising 12 clinical practice guidelines, nine consensus statements and four Cochrane systematic reviews. The areas most strongly endorsed were: (1) management to be provided by a multi-disciplinary team, (2) therapy should be goal-directed, (3) goals to be developed in conjunction with the patient and family, and (4) importance of follow-up evaluations. There was a greater focus on activity outcomes and classification in the paediatric papers. The guidelines varied considerably in their quality, with AGREE II scores ranging from 52.8 to 97.1%. This systematic review has synthesized the key elements regarding principles of focal spasticity management, outcome measures, physical interventions and educational recommendations into a single, readily applied guideline available for clinical use. Despite considerable variability in the quality of the guidelines, several strong themes emerged. Focal spasticity management should be multi-disciplinary, patient-centred and goal-directed. Routine measurement of impairment and activity are strongly endorsed. Botulinum toxin A injection should only be provided as part of an integrated approach to focal spasticity management. [ABSTRACT FROM AUTHOR]

Introduction: Headache is the most prevalent neurological manifestation in adults and one of the leading causes of disability worldwide. In children and adolescents, headaches are arguably responsible for a remarkable impact on physical and psychological issues, yet high-quality evidence is scarce. Material and methods: We searched cross-sectional and cohort studies in Embase, Medline, Web of Science, and Cochrane databases from January 1988 to June 2022 to identify the prevalence of headaches in 8–18 years old individuals. The risk of bias was examined with the Joanna Briggs Institute (JBI) scale. A random-effects model was used to estimate the pooled prevalence of pediatric headache. Subgroup analyses based on headache subtypes were also conducted. Results: Out of 5,486 papers retrieved electronically, we identified 48 studies that fulfilled our inclusion criteria. The pooled prevalence of primary headaches was 11% for migraine overall [95%CI: 9–14%], 8% for migraine without aura (MwoA) [95%CI: 5–12%], 3% for migraine with aura (MwA) [95%CI:2–4%] and 17% for tension-type headache (TTH) [95% CI: 12–23%]. The pooled prevalence of overall primary headache in children and adolescents was 62% [95% CI: 53–70%], with prevalence in females and males of 38% [95% CI: 16–66%] and 27% [95% CI: 11–53%] respectively. After the removal of studies ranked as low-quality according to the JBI scale, prevalence rates were not substantially different. Epidemiological data on less common primary headaches, such as trigeminal autonomic cephalalgias, were lacking. Conclusion: We found an overall remarkably high prevalence of primary headaches in children and adolescents, even if flawed by a high degree of heterogeneity. Further up-to-date studies are warranted to complete the picture of pediatric headache-related burden to enhance specific public interventions. [ABSTRACT FROM AUTHOR]

Introduction: Tenofovir alafenamide (TAF) is approved for paediatric use in fixed‐dose combination tablets, but efficacy and safety data in children are limited. We conducted a systematic review on the efficacy/effectiveness and safety of TAF in infants, children and adolescents living with HIV. Methods: We searched MEDLINE, Embase, the Cochrane Library, clinical trial registries, reference lists and relevant conferences to identify literature published January 2009–March 2021. We included clinical trials and observational studies assessing the efficacy/effectiveness or safety of TAF through ≥6 months of treatment in participants aged 0–19 years. Results and discussion: Overall 3626 abstracts and 371 full papers were screened. Four single‐arm, innovator‐funded trials (341 participants) and a pooled analysis of those trials were identified. All four trials included treatment‐experienced and virally suppressed children or adolescents. One trial also included treatment‐naïve adolescents with baseline viral load >1000 copies/ml. The risk of bias was rated as low in one study and unclear in the other three owing to missing data on study design (all conference presentations). At 48 weeks, 92% (46/50) of treatment‐naïve participants were virally suppressed (one trial). Among treatment‐experienced participants with viral load at 48 weeks, 214 of 224 participants were virally suppressed. Across the studies, one grade 3/4 adverse event was considered drug‐related (intermediate uveitis). There were three discontinuations for adverse events (grade 2 anxiety and insomnia, grade 1 iridocyclitis [drug‐related] and grade 1 pulmonary tuberculosis [unrelated to treatment]). One accidental death occurred across the four studies. In the pooled analysis of 223 participants, the median change in bone mineral density z‐score (height‐ and age‐adjusted) from baseline to 48 weeks was −0.12 (interquartile range [IQR] −0.46, 0.17) to 0.05 (IQR not reported) for spine, and −0.09 (IQR −0.33, 0.07) to 0.09 (IQR not reported) for total body less head. Weight‐for‐age z‐scores increased by 0.25 from baseline to 48 weeks. Conclusions: Four single‐arm trials were identified in this systematic review, with initial evidence suggesting good viral suppression and no obvious safety concerns in children and adolescents on TAF‐containing regimens over 24–48 weeks. However, further comparative and longer‐term safety data are needed in children and adolescents, including on weight and metabolic changes. [ABSTRACT FROM AUTHOR]

The discourse of quality has permeated everyday discussions about education, yet the concept as such remains complex. Moreover, during the constant struggle to improve educational quality, governments have increasingly devoted attention to the results of international large-scale assessments. As those results are used to inform policy decisions to improve countries' educational quality, it is important to understand how this concept of quality is appropriated. As a synthesis of how quality is conceptualised and operationalised in this body of research is lacking, the current paper seeks to fill that gap by presenting a systematic review. Our analysis identified definitional patterns and explored the corresponding methods for measuring quality. Based on this analysis of the reviewed studies, a framework of four approaches towards quality emerged to render the concept more accessible. In light of these results, benefits and limitations of the concept's complexity are discussed, and implications for research are forwarded. [ABSTRACT FROM AUTHOR]

Objectives: To systematically evaluate the association of individual and contextual social capital with oral health outcomes in children and adolescents. Methods: Electronic searches were performed in PubMed/Medline, Embase, Web of Science and Scopus databases for articles published from 1966 up to June 2021. Two calibrated reviewers screened and critically appraised the identified papers. Observational studies that evaluated the relationship of individual or/and contextual social capital or their proxies with oral health outcomes in children and adolescents using validated methods were included. Quality assessment was conducted using the Newcastle‐Ottawa Scale. Data were extracted for narrative synthesis and meta‐analysis followed by a meta‐regression model. Meta‐analysis using random effects method was used to estimate pooled prevalence ratio (PR) and 95% confidence intervals (CI). Results: Of the 3060 studies initially retrieved, 31 were included in the systematic review and 21 in the meta‐analysis, totalling 81 241 individuals. The clinical outcomes included dental caries and gingival bleeding and subjective outcomes were oral health‐related quality of life (OHRQoL) and self‐rated oral health (SROH). Individuals with lower levels of individual social capital had a higher prevalence of poor clinical (PR 1.11; 95%CI 1.02–1.22) and subjective (PR 1.25; 95%CI 1.09–1.45) oral health conditions. The prevalence of worse clinical (PR 1.34; 95%CI 1.11–1.61) and subjective (PR 1.56; 95%CI 1.13–2.16) oral health outcomes were also associated with lower levels of contextual social capital. In general, the contextual level of social capital exerted more impact, and the subjective oral health outcomes were the more affected. Conclusions: Contextual and individual social capital were positively related to oral health outcomes, such as dental caries, gingival bleeding, SROH and OHRQoL in children and adolescents. [ABSTRACT FROM AUTHOR]

Vaccination is an effective way to prevent infectious diseases. However, parental resistance to childhood immunizations has recently been a growing trend due to various factors. This systematic review and meta-analysis study focused on randomized controlled trials to investigate interventions for preventing parental vaccine refusal/hesitancy. This study was conducted according to the preferred reporting items for systematic review and Meta-analysis Protocols. PubMed, Science Direct, Web of Science, MEDLINE, Cochrane Library, Ovid, CINAHL, and ProQuest databases were screened with no year restriction. Two researchers each used the Cochrane risk-of-bias tool to determine the quality of the trials. Data were synthesized using a meta-analysis package. The study population consisted of 3,302 articles. The sample consisted of 22 randomized controlled trials, which implemented the interventions of text message reminders, digital training in vaccination, training in physician communication, training in parental decision- making, web-based activities, perinatal training in vaccination, immunization reminder and follow-up bracelets, and mother-daughter training. The results showed that slightly more parents agreed to get their children vaccinated after the interventions. The trials were moderately heterogeneous due to differences in sample size, country, and year. This paper investigated the effect of interventions on parental vaccine refusal/hesitancy and provided level-A evidence to suggest such interventions can be used to change parents' vaccination comprehension and decisions. [ABSTRACT FROM AUTHOR]

Minimal but increasing number of assessment instruments for Executive functions (EFs) and adaptive functioning (AF) have either been developed for or adapted and validated for use among children in low and middle income countries (LAMICs). However, the suitability of these tools for this context is unclear. A systematic review of such instruments was thus undertaken. The Systematic review was conducted following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) checklist (Liberati et al., in BMJ (Clinical Research Ed.), 339, 2009). A search was made for primary research papers reporting psychometric properties for development or adaptation of either EF or AF tools among children in LAMICs, with no date or language restrictions. 14 bibliographic databases were searched, including grey literature. Risk of bias assessment was done following the COSMIN (COnsensus-based Standards for the selection of health status Measurement INstruments) guidelines (Mokkink et al., in Quality of Life Research,63, 32, 2014). For EF, the Behaviour Rating Inventory of Executive Functioning (BRIEF- multiple versions), Wisconsin Card Sorting Test (WCST), Go/No-go and the Rey-Osterrieth complex figure (ROCF) were the most rigorously validated. For AFs, the Vineland Adaptive Behaviour Scales (VABS- multiple versions) and the Child Function Impairment Rating Scale (CFIRS- first edition) were most validated. Most of these tools showed adequate internal consistency and structural validity. However, none of these tools showed acceptable quality of evidence for sufficient psychometric properties across all the measured domains, particularly so for content validity and cross-cultural validity in LAMICs. There is a great need for adequate adaptation of the most popular EF and AF instruments, or alternatively the development of purpose-made instruments for assessing children in LAMICs. Systematic Review Registration numbers: CRD42020202190 (EF tools systematic review) and CRD42020203968 (AF tools systematic review) registered on PROSPERO website (https://www.crd.york.ac.uk/prospero/). [ABSTRACT FROM AUTHOR]

To determine the efficacy of interventions with active parent implementation for young children with cerebral palsy (CP) to improve child and parent outcomes in low-middle income countries (LMICs). Five databases were systematically searched. Randomised or comparison studies evaluating interventions with the training of the parent and/or home practice components to implement with their child with CP (<60 months of age) were included. The modified Downs and Black scale assessed methodological quality. Data were pooled to calculate mean differences and 95% confidence intervals (95% CI). Searches yielded 189 unique articles. 11 studies from ten papers of moderate to high quality were included. Parent-implemented general developmental interventions had a small negative effect on gross motor function compared to interventionist-implemented therapy. Parent-implemented upper limb training compared to interventionist-implemented neurodevelopmental therapy had a small positive effect on bimanual hand function. Parent-implemented functional feeding training had a large significant effect on chewing function compared to parent-implemented oral motor exercises. Parent-implemented interventions targeting general child development and feeding had mixed effects on parent stress outcomes. Parent-implemented interventions in LMICs are promising to improve child bimanual hand and chewing function. Further research evaluating the efficacy of parent-implemented interventions to improve parent mental health is needed. Intensive motor training-based interventions with active parent implementation were effective to improve child gross motor, bimanual hand, and chewing function in young children with CP compared to passive, generic interventionist-implemented or health education interventions. Interventions with active parent implementation had mixed results to improve parent mental health, however, this was frequently not assessed. A consistent level of support and training provided to parents may be required to have a positive effect on parent stress. To further understand the feasibility of early interventions with active parent implementation in LMICs, data on adherence to home practice dose and session attendance and a qualitative understanding of contextual and child factors influencing parent implementation is needed. [ABSTRACT FROM AUTHOR]

Introduction: Globally about 1.7 million children were living with HIV in 2020. Two integrase strand transfer inhibitors, dolutegravir and raltegravir, are increasingly used in children. We conducted a systematic review to assess the effectiveness and safety of dolutegravir and raltegravir in children and adolescents living with HIV, aged 0–19 years. Methods: Sources included MEDLINE, Embase, the Cochrane Library, clinical trial registries, abstracts from key conferences and reference list searching. Observational studies and clinical trials published January 2009–March 2021 were eligible. Outcomes included efficacy/effectiveness (CD4 counts and viral load) and/or safety outcomes (mortality, grade 3/4 adverse events and treatment discontinuation) through 6 months or more post‐treatment initiation. Risk of bias was assessed using previously published tools appropriate for the study design. Narrative syntheses were conducted. Results and discussion: In total, 3626 abstracts and 371 papers were screened. Eleven studies, including 2330 children/adolescents, reported data on dolutegravir: one randomized controlled trial (RCT; low risk of bias), one single‐arm trial (unclear risk of bias) and nine cohort studies (three low risk of bias, two unclear risk and four high risk). Ten studies, including 649 children/adolescents receiving raltegravir, were identified: one RCT (low risk of bias), one single‐arm trial (low risk of bias) and eight cohort studies (four low risk of bias, three unclear risk and one high risk). Viral suppression levels in children/adolescents at 12 months were high (>70%) in most studies assessing dolutegravir (mostly second‐ or subsequent‐line, or mixed treatment lines), and varied from 42% (5/12) to 83% (44/53) at 12 months in studies assessing raltegravir (mostly second‐ or subsequent‐line). Across all studies assessing dolutegravir or raltegravir, grade 3/4 adverse events (clinical and/or laboratory) were reported in 0–50% of subjects, few resulted in discontinuation, few were drug related and no deaths were attributed to either drug. Conclusions: These reassuring findings suggest that dolutegravir and raltegravir are effective and safe as preferred regimens in children and adolescents living with HIV. With the rollout of dolutegravir in paediatric populations already underway, it is critical that data are collected on safety and effectiveness in infants, children and adolescents, including on longer‐term outcomes, such as weight and metabolic changes. [ABSTRACT FROM AUTHOR]

Systematically review the current literature for evidence on the "real-life" benefits of hearing preservation cochlear implantation (HPCI) for children and adults. Systematic search of Pubmed, MEDLINE, EMBASE, CINHAL and Cochrane Library for MesH terms hearing¸ preservation and cochlear implantation. Inclusion criteria were the "real-life" benefit of HPCI i.e. other than pre- and post-operative pure tone thresholds. Exclusion criteria were non-English language, conference abstracts, reviews and animal and cadaveric studies. Risk of bias was assessed using the Evidence Project Tool. 37 studies that matched criteria for review with 8/37 including children and 29/37 including adults. HPCI was associated with better speech perception in noise in 18/26 papers and better music perception in 4/5 papers. There was no significant benefit reported in speech perception in quiet (14/20 papers) or binaural cues (3/4 papers), nor was there convincing evidence of HPCI outperforming bimodal users (5/7 papers). QoL scores were high amongst HPCI patients (2/2 papers). Interpretation of findings was hindered by small study groups and significant heterogeneity in various parameters. Current literature on the "real-life" benefit of HPCI, although limited, supports the existence of meaningful benefit, especially in speech perception in noise and music perception. [ABSTRACT FROM AUTHOR]

Background: Childhood overweight and obesity is a global public health issue. Although there is evidence of a reduced prevalence in some countries, there is still much controversy about the efficacy of health interventions that aim to prevent and treat obesity in this specific population. The objective of the present study is to develop an overview of systematic reviews (OSRs) that assesses the effects of school-based, family, and multi-component health interventions for the prevention and treatment of obesity, change in physical activity, dietary, and/or hydration behaviors, and change in metabolic risk factors in school-aged children. Methods: This protocol was developed using the methodology proposed by Cochrane. It outlines a comprehensive search in 12 electronic databases to identify systematic reviews of health interventions, including studies that evaluate and how to prevent and/or treat overweight and/or obesity in children aged 6 to 12 years. The risk of bias of the included Systematic Reviews will be assessed with the ROBIS tool. Discussion: Since the OSRs methodology's purpose is only to harmonize evidence from open access publications, ethical consent is not necessary for the present protocol. In terms of diffusion, a paper will be submitted for publication in a scientific journal to describe the main results obtained through the OSRs. Trial registration: The present overview of the systematic review protocol has been registered in PROSPERO (ID number 218296). [ABSTRACT FROM AUTHOR]

There is a growing body of modelling evidence that demonstrates the potential for immediate and substantial benefits to adult health from greenhouse gas mitigation actions, but the effects on the health of younger age groups is largely unknown. We conducted a systematic review to identify the available published evidence of the modelled effects on child and adolescent health (≤18 years of age) of greenhouse gas mitigation. We searched six databases of peer-reviewed studies published between January 1, 1990 and July 27, 2022, screened 27,282 original papers and included 23 eligible papers. All included studies were set in high- and middle-income countries; and all studies modelled the effects of interventions that could mitigate greenhouse gas emissions and improve air quality. Most of the available evidence suggests positive benefits for child and adolescent respiratory health from greenhouse gas mitigation actions that simultaneously reduce air pollution (specifically PM2.5 and nitrogen dioxide). We found scant evidence on child and adolescent health from regions more vulnerable to climate change, or on mitigation interventions that could affect exposures other than air pollution. [ABSTRACT FROM AUTHOR]

Background: The last 20 years have seen a marked increase in the use of cluster randomised trials (CRTs) in schools to evaluate interventions for improving pupil health outcomes. Schools have limited resources and participating in full-scale trials can be challenging and costly, given their main purpose is education. Feasibility studies can be used to identify challenges with implementing interventions and delivering trials. This systematic review summarises methodological characteristics and objectives of school-based cluster randomised feasibility studies in the United Kingdom (UK). Methods: We systematically searched MEDLINE from inception to 31 December 2020. Eligible papers were school-based feasibility CRTs that included health outcomes measured on pupils. Results: Of 3285 articles identified, 24 were included. School-based feasibility CRTs have been increasingly used in the UK since the first publication in 2008. Five (21%) studies provided justification for the use of the CRT design. Three (13%) studies provided details of a formal sample size calculation, with only one of these allowing for clustering. The median (IQR; range) recruited sample size was 7.5 (4.5 to 9; 2 to 37) schools and 274 (179 to 557; 29 to 1567) pupils. The most common feasibility objectives were to estimate the potential effectiveness of the intervention (n = 17; 71%), assess acceptability of the intervention (n = 16; 67%), and estimate the recruitment/retention rates (n = 15; 63%). Only one study was used to assess whether cluster randomisation was appropriate, and none of the studies that randomised clusters before recruiting pupils assessed the possibility of recruitment bias. Besides potential effectiveness, cost-effectiveness, and the intra-cluster correlation coefficient, no studies quantified the precision of the feasibility parameter estimates. Conclusions: Feasibility CRTs are increasingly used in schools prior to definitive trials of interventions for improving health in pupils. The average sample size of studies included in this review would be large enough to estimate pupil-level feasibility parameters (e.g., percentage followed up) with reasonable precision. The review highlights the need for clearer sample size justification and better reporting of the precision with which feasibility parameters are estimated. Better use could be made of feasibility CRTs to assess challenges that are specific to the cluster design. Trial registration: PROSPERO: CRD42020218993. [ABSTRACT FROM AUTHOR]

The baseline risk for multiple febrile seizures within the same febrile illness is largely unknown. Estimates range from 5 to 30%. Imprecise estimates can lead to incorrectly powering studies investigating the management of febrile seizures. To estimate the risk of multiple febrile seizures in the same febrile illness, we systematically reviewed and conducted a meta-analysis of studies from January 2000 to December 2021 that contained data for the number of children for both simple and complex febrile seizures in the same febrile illness. We searched MEDLINE, EMBASE, and Web of Science for randomized, quasi-randomized, prospective, and retrospective trials that involved children with febrile seizures. A total of 23,131 febrile illnesses with febrile seizures met the inclusion criteria. The estimated baseline risk of multiple febrile seizures in the same febrile illness was 17% (95% CI, 16–19%). However, the 30 cohorts that included both admitted and non-admitted patients had a lower percentage of multiple FSs within the same illness (14%; 95% CI, 12–15%) than the 30 cohorts that enrolled only admitted patients (20%; 95% CI, 16–25%). Conclusion: Researchers can use estimates in this paper to design future studies. Taking into the account the substantial heterogeneity between countries and studies, clinicians could cautiously use our estimates in their clinical assessment and be better able to set parental expectations about a child's chances of having another febrile seizure during the current illness. Trial registration: PROSPERO CRD42020191784. Registered July 18, 2020. What is Known: • There is renewed interest in the diagnostic workup and prophylactic treatment of febrile seizures to prevent repeat seizures in the same febrile illness. • There is a lack of accurate estimates of the baseline risk for multiple febrile seizures in the same illness to properly design studies investigating management. What is New: • This study provides the most robust estimates for the baseline risk for multiple febrile seizures in the same illness. [ABSTRACT FROM AUTHOR]

Background and Objectives: Exposure to lead and its effects on children's health is one of the most important and widespread concerns of human societies today. Therefore, the purpose of this systematic study was to evaluate blood lead levels in Iranian children. Materials and Methods: In this systematic review, PubMed, Scopus, Science Direct, Scientific Information Database (SID), and Iran Medex databases were comprehensively searched for papers published from 2005 to the end of October 2021. Studies that reported blood lead levels in Iranian children were collected. Then the articles were evaluated according to a pre-prepared checklist. Results: Of a total of 143 articles found in the initial search, 13 studies were included in our systematic review. The lowest and highest mean blood lead levels were 0.65 micrograms per deciliter in Abadan and 57.1 micrograms per deciliter in Mashhad, respectively. In three studies conducted in Mashhad and Isfahan, blood lead levels were reported to be higher than 5 Micrograms per deciliter in all children studied. The level of education of the father, the use of canned food, the habit of eating soil by the child, damage to the paint of the house, and the reduction of blood iron levels were the effective factors in increasing the blood lead levels in Iranian children. Conclusion: Due to the high prevalence of blood lead samples above 5 micrograms per deciliter in some studies, reducing the exposure to lead should be seriously pursued by health policy makers and health systems. [ABSTRACT FROM AUTHOR]

Background: Unaccompanied refugee minors (URM) are at significantly higher risk of trauma exposure and mental illness. Research examining the most effective treatments for this population is limited. Aims: To study the available research evidence on outcomes from various group interventions in this population. The objective is to investigate if these can be used clinically in future interventions. Methods: Systematic review was carried out for patient outcomes where group therapy was used as treatment in URM. Studies with ARM (Accompanied refugee minors) were included because of similarities between these groups and because many studies were mixed population. Results: Seventeen papers met eligibility criteria with a total of N = 1,119 participants. About 80% studies with a quantitative component reported improvements, and 69% of the studies that carried out statistical analyses reported statistically significant improvements in mental health symptoms. Every qualitative measure reported positive outcome for the participants. Studies with URM tended to show improved outcomes more often than studies exclusively with ARM. Conclusions: The evidence demonstrates the efficacy of group therapy in improving mental health outcomes, although the number of studies with robust methodology is small. Group intervention has potential to improve engagement and outcomes of URM with mental illness. Future direction for research is discussed. [ABSTRACT FROM AUTHOR]

Purpose: This systematic review aimed to examine the evidence on adventure therapy (AT) intervention for child, adolescent, and young adult (AYA) cancer patients in order to inform the design of future research and clinical practice. Methods: This review included studies that tested the AT intervention among child and AYA cancer patients. Nine electronic databases (CINAHL, Cochrane Central Register of Controlled Trials, EMBase, Medline via EbscoHost, OpenGrey, PsycInfo, Web of Science, Scopus, and PubMed) were searched for English-language published studies using a quasi-experimental design, one-group pre-test–post-test experimental study design, or randomized controlled trial (RCT) from 1981 to May 2020. The methodological quality of the included studies was evaluated using JBI Critical Appraisal Checklists for RCTs and for Quasi-Experimental Studies by two researchers independently. A narrative synthesis of intervention characteristics and related health-related outcomes was performed. Results: Eight papers from seven studies were included in the review, namely four RCTs, two quasi-experimental study papers, and two one-group pre-test–post-test experimental study papers. Studies varied in the components and duration of AT. Medium to high methodological quality of included studies was noted in all study designs. Results showed the positive effects of AT on the physical activity, fatigue, psychological distress, and quality of life of child and AYA cancer patients. Conclusion: AT is a promising intervention that may improve a number of health-related outcomes in child and AYA cancer patients. Evidence-based AT interventions should be developed and incorporated as part of supportive care for the target population. [ABSTRACT FROM AUTHOR]

Whole-body magnetic resonance imaging (MRI) is increasingly being used for a number of indications. Our aim was to review and describe indications and scan protocols for diagnostic value of whole-body MRI for multifocal disease in children and adolescents, we conducted a systematic search in Medline, Embase and Cochrane for all published papers until November 2018. Relevant subject headings and free text words were used for the following concepts: 1) whole-body, 2) magnetic resonance imaging and 3) child and/or adolescent. Included were papers in English with a relevant study design that reported on the use and/or findings from whole-body MRI examinations in children and adolescents. This review includes 54 of 1,609 papers identified from literature searches. Chronic nonbacterial osteomyelitis, lymphoma and metastasis were the most frequent indications for performing a whole-body MRI. The typical protocol included a coronal STIR (short tau inversion recovery) sequence with or without a coronal T1-weighted sequence. Numerous studies lacked sufficient data for calculating images resolution and only a few studies reported the acquired voxel volume, making it impossible for others to reproduce the protocol/images. Only a minority of the included papers assessed reliability tests and none of the studies documented whether the use of whole-body MRI affected mortality and/or morbidity. Our systematic review confirms significant variability of technique and the lack of proven validity of MRI findings. The information could potentially be used to boost attempts towards standardization of technique, reporting and guidelines development. [ABSTRACT FROM AUTHOR]

Background: Various parent training interventions have been shown to have some effect on the symptoms of children with autism. We carried out a systematic review and meta-analyses to assess effectiveness of parental training for children with autism on their symptoms and parental stress. Methods: Four electronic databases, CINAHL, EMBASE, MEDLINE and PsycINFO were searched until March 2020 for relevant literature. Two reviewers independently screened bibliographies using an eligibility checklist and extracted data using a structured proforma. We have also carried out meta-analyses when data were available for pooling. Results: Seventeen papers from 15 studies were included for data analysis. Fifteen papers showed a positive treatment effect when compared with the control group, although not always significant. Meta-analysis based on pooled data from only two studies in each respective intervention, showed small to moderate treatment effects for three interventions, DIR/Floortime, Pivotal Response and Parent focused training respectively. Conclusions: As in previous systematic reviews there was a mild to moderate treatment effects of three specific types of interventions respectively. However, it was difficult to draw any definitive conclusion about the effectiveness and generalisability of any intervention because of the wide variation in the interventions, control groups, outcome measures, small sample size, small number of studies in meta-analysis, overlap between the intervention and control procedures used in the included studies. There is an urgent need for experts in various international centres to jointly standardise a parent training intervention for children with autism and carry out a large scale RCT to assess its clinical and economic effectiveness. Research Registry Unique Identifying Number: reviewregistry915. [ABSTRACT FROM AUTHOR]

Background: Despite considerable public health efforts over the past 20 years, childhood stunting (physical and/or cognitive) levels globally remain unacceptably high—at 22% amongst children under 5 years old in 2020. The aetiology of stunting is complex and still largely unknown. Helminths can cause significant mortality and morbidity and have often been cited as major causative agents for stunting, although their actual role in childhood stunting remains unclear. Our aim was to systematically review the current evidence to help support or refute the hypothesis that helminths cause physical stunting in children. Methods: Inclusion criteria were as follows: infected with (and/or exposed to) helminths (soil-transmitted helminths, schistosomes or food-borne trematodes), children, pregnant or breastfeeding women as study participants (children included infants 0–1 year old, preschool-age children 1–5 years and school-age children > 5 years old), anthelmintic treatment intervention, stunting-related variables reported (e.g. height, height-for-age z-score, birth weight), helminth infection reported in relation to stunting, any geographic location, any date, peer-reviewed literature only. Exclusion criteria were: non-primary research, study protocols, studies with no new data, non-English language papers and animal (non-human) helminth studies. Seven databases were searched on 28 May 2021. Risk of bias was assessed for included studies and GRADE was used for studies included in RCT subgroup meta-analyses (in preschool-age children and pregnant women). This systematic review was registered with PROSPERO (CRD42021256201). Results: Eighty studies were included in the analyses. No significant overall evidence was found in support of the hypothesis that helminths cause physical stunting in children, although there was some association with wasting. Conclusions: Whilst analyses of the available literature to date failed to support a direct association between helminth infection and childhood stunting, there was significant heterogeneity between studies, and many had follow-up periods which may have been too short to detect impacts on growth. Most apparent was a lack of available data from key demographic groups wherein one may predict the greatest association of helminth infection with stunting—notably that of infants, preschool-age children, and pregnant or nursing women. Thus this review highlights the urgent need for further targeted empirical research amongst these potentially most vulnerable demographic groups. [ABSTRACT FROM AUTHOR]

Background: Despite considerable public health efforts over the past 20 years, childhood stunting (physical and/or cognitive) levels globally remain unacceptably high—at 22% amongst children under 5 years old in 2020. The aetiology of stunting is complex and still largely unknown. Helminths can cause significant mortality and morbidity and have often been cited as major causative agents for stunting, although their actual role in childhood stunting remains unclear. Our aim was to systematically review the current evidence to help support or refute the hypothesis that helminths cause physical stunting in children. Methods: Inclusion criteria were as follows: infected with (and/or exposed to) helminths (soil-transmitted helminths, schistosomes or food-borne trematodes), children, pregnant or breastfeeding women as study participants (children included infants 0–1 year old, preschool-age children 1–5 years and school-age children > 5 years old), anthelmintic treatment intervention, stunting-related variables reported (e.g. height, height-for-age z-score, birth weight), helminth infection reported in relation to stunting, any geographic location, any date, peer-reviewed literature only. Exclusion criteria were: non-primary research, study protocols, studies with no new data, non-English language papers and animal (non-human) helminth studies. Seven databases were searched on 28 May 2021. Risk of bias was assessed for included studies and GRADE was used for studies included in RCT subgroup meta-analyses (in preschool-age children and pregnant women). This systematic review was registered with PROSPERO (CRD42021256201). Results: Eighty studies were included in the analyses. No significant overall evidence was found in support of the hypothesis that helminths cause physical stunting in children, although there was some association with wasting. Conclusions: Whilst analyses of the available literature to date failed to support a direct association between helminth infection and childhood stunting, there was significant heterogeneity between studies, and many had follow-up periods which may have been too short to detect impacts on growth. Most apparent was a lack of available data from key demographic groups wherein one may predict the greatest association of helminth infection with stunting—notably that of infants, preschool-age children, and pregnant or nursing women. Thus this review highlights the urgent need for further targeted empirical research amongst these potentially most vulnerable demographic groups. [ABSTRACT FROM AUTHOR]

Background: Sleep‐disordered breathing (SDB) has negative influence on children's development and well‐being. Malocclusion due to some craniofacial anatomical characteristics may be associated with SDB. Objectives: The aim of this paper is to ascertain whether SDB is associated with malocclusion in children/adolescents, aged 6–15 years compared to healthy controls. Methods: Prospero ID: CRD42021232103. A systematic electronic literature search following PRISMA was performed in PubMed, Embase and Cochrane Library. Inclusion criteria were as follows: Healthy children/adolescents aged 6–15 years with malocclusion undergoing polysomnography (PSG) or polygraphy (PG) and/or sleep questionnaire and orthodontic screening; compared to a healthy age‐matched control group with neutral or minor deviation in the occlusion without requirement for orthodontic treatment; publications in English, Danish, Norwegian or Swedish published until 23 March 2021. JBI Critical Appraisal Tools and GRADE were used to evaluate the risk of bias and level of evidence. Results: The search resulted in 1996 records, 610 duplicates were removed, 1386 records were screened, and 1322 records were excluded. Sixty‐four studies were selected for full‐text reading, and four publications fulfilled the inclusion criteria. The included studies had moderate risk of bias, and the quality of evidence was low. Conclusion: No firm conclusion can be drawn regarding an association between specific malocclusion traits and SDB. Thus, the studies found no association between molar relationship and crowding and SDB symptoms in children. It may be recommended that future studies include objective PSG or PG in diagnosis of SDB and compare groups of children with skeletal malocclusion and controls with neutral malocclusion. [ABSTRACT FROM AUTHOR]

Migration is a key social determinant of health affecting children's life chances and health outcomes. Yet, relatively little is known about young migrants' own health experiences. This paper reports findings from a systematic review examining the health experiences of children who migrated in the Western Pacific region. A systematic search of the peer-reviewed literature from 2007–17 was conducted using MEDLINE, EMBASE, PsycINFO, CINAHL, Cochrane Database of Systematic Reviews, Web of Science, ASSIA and IBSS. Included articles reported data generated with children up to 18 years and who had migrated across international borders to the Western Pacific region (predominantly Australasia). The Mixed Methods Appraisal Tool was used to assess study quality. Eleven of 499 articles identified were included in the review and focused on three areas: diet and body size; mental health; and social integration. The review exposes the paucity of research on the health experiences of child migrants in the Western Pacific region. More child-centred research that examines the health-related impacts of migration on young people, and from their own perspectives, is urgently needed. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to examine the evidence for an association between the dietary protein intake in children and the growth and risk of overweight or obesity up to 18 years of age in settings relevant for the Nordic countries. Methods: We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Scopus up to February 26, 2021 for randomized controlled trials (RCTs) or prospective cohort studies assessing for protein intake from foods (total and from different sources) in children. The outcomes include weight, height/length, adiposity indices, and/or risk of overweight and/or obesity. The risk of bias was evaluated with instruments for each respective design (Cochrane's Risk of Bias 2.0 and RoB-NObS). A meta-analysis of five cohort studies was performed. The evidence was classified according to the criteria of the World Cancer Research Fund. Results: The literature search resulted in 9,132 abstracts, of which 55 papers were identified as potentially relevant. In total, 21 studies from 27 publications were included, of which five were RCTs and 16 were cohort studies. The RCTs found generally null effects of high-protein intake in infants on weight gain, nor that lower protein diets negatively affected growth. All included RCTs had some concern regarding the risk of bias and were limited by small sample sizes. Total protein intake and BMI were assessed in 12 cohorts, of which 11 found positive associations. The meta-analysis revealed a pooled effect estimate of 0.06 (95% CI 0.03, 0.1) kg/m² BMI per one E% increment in total protein (I² = 15.5). Therefore, the evidence for a positive relationship between total protein intake and BMI was considered probable. Furthermore, there was probable evidence for an association between higher intake of animal protein and increased BMI. There was limited, suggestive evidence for an effect of total protein intake and higher risk of overweight and/or obesity, while no conclusions could be made on the associations between animal vs. plant protein intake and risk of overweight and/or obesity. Discussion: In healthy, well-nourished children of Western populations, there is probably a causal relationship between a high-protein intake in early childhood (≤ 18 months) -- particularly protein of animal origin -- and higher BMI later in childhood, with consistent findings across cohort studies. A lack of RCTs precluded a stronger grading of the evidence. [ABSTRACT FROM AUTHOR]

This scoping review aimed to systematically map studies/tests for assessing the tactical domain of young soccer players. The study followed the PRISMA-ScR and Joanna Briggs Institute guidelines. The databases searched were Scopus, SPORTDiscus, SciELO, LILACS, and BDTD. The eligibility criteria were defined based on the elements of population, context, and concept, without restrictions on the period, language, and type of publication. Twenty-four papers were included, from 1997 to 2020, totalling 29 tests/instruments for the assessment of the tactical domain, with the majority of studies having an European sample. Twelve terms were used to nominate the tactical component, regardless of the assessment method and approach. Six tests met eight or nine criteria in the critical appraisal: TCTOF, TACSIS Spanish version, Semi-Structured Interview, TCTP-OE, GPET, and FUTSAT. Thus, it is concluded that studies and tests for the assessment of the tactical domain of young soccer players are recent and mainly European; there is no consensus about the adopted terminology; and few tests met the majority of the quality criteria. Therefore, we suggest: a) the construction/adaptation of tests with samples from other continents; b) the use of the proposed criteria; and c) that the terms tactical knowledge and tactical performance are adopted. [ABSTRACT FROM AUTHOR]

Early intervention is critical for addressing the challenge of childhood obesity. Yet many preventive interventions do not target infants most at risk of future overweight or obesity. This systematic review examines interventions delivered before 2 years that aim to ameliorate excess weight gain among infants at high risk of overweight or obesity, due to sociodemographic characteristics, parental weight or health status, infant feeding or health behaviours. We searched six databases for interventions: (a) delivered before age two, (b) specifically aimed at infants at high risk of childhood obesity and (c) that reported outcomes by weight status beyond 28 days. The search identified over 27,000 titles, and 49 papers from 38 studies met inclusion criteria: 10 antenatal interventions, 16 postnatal and 12 conducted both before and after birth. Nearly all targeted infant and/or maternal nutrition. Studies varied widely in design, obesity risk factors, outcomes and quality. Overall, nine interventions of varying quality reported some evidence of significantly improved child weight trajectory, although effects tended to diminish over time. Interventions that improved weight outcomes tended to engage parents for a longer period, and most offered health professional input and support. Two studies of limited quality reported significantly worse weight outcomes in the intervention group. [ABSTRACT FROM AUTHOR]

Background: Many studies have evaluated the effects that a lack of resources has in children's physical and cognitive development. Although there are reviews that have focused on applied interventions from different perspectives, there is still a need for a comprehensive review of what has been attempted with these children from the cognitive intervention field. The aim of this paper is to present a protocol for a systematic review collecting randomized controlled trials (RCTs) studies whose purpose was to enhance cognitive development through the implementation of cognitive interventions in children and adolescents (< 18 years old) from low socioeconomic Status (SES) settings. Methods: The following databases will be searched: Web of Science (WoS core collection), PsycINFO, Cochrane Central Register of Controlled Trial, ERIC, PubMed, ICTRP and Opengrey Register (System for Information of Grey Literature in Europe). Searches will be adapted for each database. Additionally, the reference list of articles included in the review will also be searched. As part of this process, two reviewers will determine, independently, the suitability of each article taking into account predefined inclusion/exclusion criteria. Pertinent data will then be extracted, including sample characteristics, specifics of the intervention, and outcomes, as well as follow-up measures. Internal validity will be assessed using the Cochrane Risk of Bias Tool. A quantitative synthesis of results will be conducted using a meta-analysis. However, if a meta-analysis is difficult to implement due to the diversity of the studies (for example, in terms of measures used to estimate the effect size, intervention types, outcomes, etc.), the technique synthesis without meta-analysis (SWiM) will be used. A description of outcome measures will be provided, as measured by validated neuropsychological instruments of any cognitive function. Discussion: The systematic review will offer a framework based on evidence to organisations, institutions, and experts who want to implement or promote interventions aimed at enhancing cognitive domains in children and adolescents who live in disadvantaged contexts. Systematic review registration: This protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 16 March 2020 (registration number: CDR42020150238). [ABSTRACT FROM AUTHOR]

Visual cues such as plate size, amount of food served and packaging are known to influence the effects of portion size on food intake. Unit bias is a well characterised heuristic and helps to determine consumption norms. In an obesogenic environment where large portions are common place, the unit or segmentation bias may be overridden promoting overconsumption of both amorphous or unit foods. The aim of this review was to investigate the impact of offering unit or amorphous food on the portion size effect (PSE) in children aged 2-12 years. A systematic search for literature was conducted in Medline, PsycInfo and Web of Science in February 2018. A total of 1197 papers were retrieved following the searches. Twenty-one papers were included in the systematic review, of which 15 provided requisite statistical information for inclusion in a random effects meta-analysis. Increasing children's food portion size by 51-100% led to a significant increase in intake (SMD = 0.47, 95% CI: 0.39-0.55). There was no evidence to suggest that increases in consumption were related to food type (p = 0.33), child age (p = 0.47) or initial portion size served (p=0.14). Residual heterogeneity was not significant (p=0.24). The PSE was demonstrated in children aged 2-12 years when offered both unit and amorphous food items. The effect was not restricted by food type, child age or influenced by initial portion size served. Of the studies included in the meta-analysis between study heterogeneity was low suggesting minimal variation in treatment effects between studies, however, more research is required to understand the mechanisms of the PSE in preschool children. Future research should determine feasible methods to downsize portion sizes served to children. [ABSTRACT FROM AUTHOR]

Ten years after publication of two reviews of the evidence on phonics, a number of British policy initiatives have firmly embedded phonics in the curriculum for early reading development. However, uncertainty about the most effective approaches to teaching reading remains. A definitive trial comparing different approaches was recommended in 2006, but never undertaken. However, since then, a number of systematic reviews of the international evidence have been undertaken, but to date they have not been systematically located, synthesised and quality appraised. This paper seeks to redress that gap in the literature. It outlines in detail the reading policy development, mainly in England, but with reference to international developments, in the last 10 years. It then reports the design and results of a systematic 'tertiary' review of all the relevant systematic reviews and meta-analyses in order to provide the most up-to-date overview of the results and quality of the research on phonics. [ABSTRACT FROM AUTHOR]

Abstract Aims External beam radiotherapy is widely used in various ways in the management of neuroblastoma. Despite extensive clinical experience, the precise role of radiotherapy in neuroblastoma remains unclear. The purpose of this systematic review was to survey the published literature to identify, without bias, the evidence for the clinical effectiveness of external beam radiotherapy as part of the initial multimodality treatment of high-risk neuroblastoma. We considered four areas: treatment of the tumour bed and residual primary tumour, identification of any dose–response relationship, treatment of metastatic sites, identification of any technical advances that may be beneficial. We also aimed to define uncertainties, which may be clarified in future clinical trials. Materials and methods Bibliographic databases were searched for neuroblastoma and radiotherapy. Reviewers assessed 1283 papers for inclusion by title and abstract, with consensus achieved through discussion. Data extraction on 57 included papers was carried out by one reviewer and checked by another. Studies were assessed for their level of evidence and risk of bias, and a descriptive analysis of data was carried out. Results Fifteen papers provided some evidence that radiotherapy to the tumour bed and residual tumour may possibly be of value. However, there is a significant risk of bias and no evidence that all subgroups will benefit. There is some suggestion from six papers that dose may be important, but no hard evidence. It remains unclear whether irradiation of metastatic sites is helpful. Technical advances may be of value in radiotherapy of high-risk neuroblastoma. Conclusions There are data that show that radiotherapy is of some efficacy in the management of high-risk neuroblastoma, but there is no level one evidence that shows that it is being used in the best possible way. Prospective randomised trials are necessary to provide more evidence to guide development of optimal radiotherapy treatment schedules. Highlights • A systematic review of radiotherapy for high-risk neuroblastoma. • Explored the need for radiotherapy, the dose and metastatic site irradiation. • All evidence identified was low quality, with a significant risk of bias. • Radiotherapy may be of value, but the evidence is unclear and conflicting. • Prospective randomised trials are essential to strengthen the evidence base. [ABSTRACT FROM AUTHOR]

This paper presents findings from a systematic literature review that explored the delivery arrangements of school‐based reading interventions for struggling readers aged 5–8 years. Databases were searched for published and unpublished studies from 1970 to 2017, which employed a randomised controlled trial or quasi‐experimental design. Sixty‐four texts that met the inclusion criteria were categorised according to targeted tier based on the response‐to‐intervention model. Findings showed that tier 2/3 interventions targeting pupils who did not respond to whole class teaching (tier 1) were almost exclusively delivered in pull‐out sessions by people other than the classroom teacher. At present, certain delivery arrangements appear to be used more than others in reading interventions conducted with young pupils in schools. This could to some extent reflect practices already used in primary schools and suggests that pupils who are identified for tier 2/3 support might have less access to their teacher's time and expertise. Highlights: What is already known about this topicIntervention delivery is becoming increasingly important in light of the attention that the response‐to‐intervention model has been receiving.Intervention delivery is relevant to whether schools continue using successful interventions after the end of a study.Few papers have explored the way reading interventions have been delivered. What this paper addsCertain delivery arrangements appear to be used more than others in primary school‐based reading intervention trials, for example, classroom teachers delivering tier 1 sessions and other individuals delivering tier 2/3 sessions.This could to some extent reflect practices used in primary schools.This suggests that pupils who are identified for tier 2/3 support might have less access to their teacher's time and expertise. Implications for theory, policy or practiceQuestions are raised about how tier 1 is designed in terms of quality and relevance of provision for the diversity of pupil needs.And how tiers 2 and 3 are then defined and designed in relation to tier 1 both with regard to their goals, methods, location of delivery and who delivers the tier 2/3 programmes.The aforementioned data reflect broader issues about the relationship between general and additional programming and teaching, which bear on the future of inclusive teaching [ABSTRACT FROM AUTHOR]

Aims: There has been a surge in child mental health literacy training programmes for non‐mental health professionals. No previous review has examined the effectiveness of child mental literacy training on all professionals in contact with children. Methods: Studies were identified through a systematic literature search of the Cochrane, EMBASE, Medline, and PsycINFO databases in February 2019. The review included studies that delivered training to professionals who have regular contact with young people aged 0 to 19 in the context of their role and at least one component of mental health literacy; (a) knowledge, (b) attitudes, (c) confidence in helping, (d) intention to help and (e) actual helping behaviour. The quality of papers was reviewed using the Cochrane revised Risk of Bias Tool for randomized controlled trials (RCTs) and the Integrated Quality Criteria for the Review of Multiple Study Designs for non RCTs. Results: Twenty‐one studies met eligibility criteria (n = 3243). There was some evidence that global and specific child mental health literacy training improved professionals' knowledge and stigma‐related attitudes towards mental health. Few studies investigated the impact of training on actual helping behaviour. Conclusion: There may be value in providing child mental health literacy training to professionals in contact with children, however there is a need for studies to evaluate the long‐term impact of such training, particularly on subsequent access to appropriate support. Findings raise concerns about the quality of the studies reported in the systematic review and recommendations are made for future studies. [ABSTRACT FROM AUTHOR]

• Care-experienced young people experience high levels of mental health problems. • System resources, cultures and stakeholder values, impact interventions. • Care-experienced young people valued meaningful relationships in interventions. • Carers felt interventions often overlooked their expertise and experiences. • Future interventions should support carers' time and emotional commitment. The mental health and well-being of care-experienced children and young people remains a concern. Despite a range of interventions, the existing evidence base is limited in scope, with a reliance on standalone outcome evaluations which limits understanding of how contextual factors influence implementation and acceptability. The Care-experienced cHildren and young people's Interventions to improve Mental health and wEll-being outcomes Systematic review (CHIMES) aimed to synthesise evidence of intervention theory, outcome, process and economic effectiveness. This paper reports the process evaluation synthesis, exploring how system factors facilitate and inhibit implementation and acceptability of mental health and wellbeing interventions for care-experienced children and young people. Sixteen databases and 22 websites were searched between 2020 and 2022 for studies published from 1990 and May 2022. This was supplemented with contacting experts in the field, citation tracking, screening of relevant systematic reviews and stakeholder consultations. We drew on framework synthesis of qualitative data and incorporated a systems lens, taking account of contextual influences across socio-ecological domains. Quality appraisal assessed reliability and usefulness. Confidence in synthesised findings was assessed with the GRADE-CERQual tool. We report the review in accordance with relevant elements of both the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), and the Enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) checklist. Searches retrieved 15,068 unique study reports, and 23 of these were eligible for process evaluation synthesis, reporting on sixteen interventions. Studies were published between 2003 and 2021. Nine interventions were from the UK and Ireland, six interventions were from the USA, and one was from Australia. They were largely classified as interpersonal, where the aim was to modify carer-child relationships. Five key context factors were identified that supported and prohibited intervention delivery: (1) lack of system resources; (2) intervention burden, which encompasses the time, cognitive, and emotional burden associated with implementation and participation; (3) interprofessional relationships between health and social care professionals; (4) care-experienced young people's identity; and (5) carer identity. We identified several supportive and restrictive factors across social and health care systems that may impact intervention implementation and acceptability. Key implications include: the importance of involving diverse stakeholders in intervention development and delivery; the need to better resource and support those involved in interventions, particularly training and support for carers; and ensuring future evaluations integrate process evaluations in order to optimise interventions. [ABSTRACT FROM AUTHOR]