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Background: Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder, for which there are effective pharmacological treatments that improve symptoms and reduce complications. Guidelines published by the National Institute for Health and Care Excellence recommend that primary care practitioners prescribe medication for adult ADHD under shared-care agreements with Adult Mental Health Services (AMHS). However, provision remains uneven, with some practitioners reporting a lack of support. Aim: This study aimed to describe elements of support, and their availability/use, in primary care prescribing for adult ADHD medication in England to improve access for this underserved population and inform service improvement. Design and setting: Cross-sectional surveys were used to elicit data from commissioners, health professionals (HPs), and people with lived experience of ADHD (LE) across England about elements supporting pharmacological treatment of ADHD in primary care. Method: Three interlinked cross-sectional surveys were used to ask every integrated care board in England (commissioners), along with convenience samples of HPs and LEs, about prescribing rates, AMHS availability, wait times, and shared-care agreement protocols/policies for the pharmacological treatment of ADHD in primary care. Descriptive analyses, percentages, and confidence intervals were used to summarise responses by stakeholder group. Variations in reported provision and practice were explored and displayed visually using mapping software. Results: Data from 782 responders (42 commissioners, 331 HPs, 409 LEs) revealed differences in reported provision by stakeholder group, including for prescribing (95% of HPs versus 64% of LEs). In all, >40% of responders reported extended AMHS wait times of ≥2 years. There was some variability by NHS region – for example, London had the lowest reported extended wait time (25%), while East of England had the highest (55%). Conclusion: Elements supporting appropriate shared-care prescribing of ADHD medication via primary care are not universally available in England. Coordinated approaches are needed to address these gaps. [ABSTRACT FROM AUTHOR]

Background: Schools have a duty of care to prevent violence between students but a significant amount of dating and relationship violence and gender-based violence occurs in schools. These are important public health issues with important longitudinal consequences for young people. Objectives: To understand functioning and effectiveness of school-based interventions for the prevention of dating and relationship violence and gender-based violence. Review methods: We undertook a mixed-methods systematic review to synthesise different types of evidence relating to school-based interventions for the prevention of dating and relationship violence and gender-based violence to understand if, how and in what ways these interventions are effective. We searched 21 databases and 2 trial registers and undertook forwards and backwards citation chasing, author contact and other supplementary search methods. Searches identified all literature published to June 2021. All screening was undertaken in duplicate and independently, and we quality appraised all included studies. Results: We included 247 reports (68 outcome evaluations, 137 process evaluations). Synthesis of intervention components produced an intervention typology: single-component, curricular, multicomponent, and multilevel programmes. Synthesis of intervention theories suggested that interventions aiming to increase students' sense of school belonging and sense of safety in the school building could encourage increased learning of prosocial skills and increased prosocial peer norms, and so potentially reducing dating and relationship violence and gender-based violence. Synthesis of factors affecting delivery highlighted school organisation and leaders who believed in the importance of addressing dating and relationship violence/gender-based violence, along with time and resources to deliver the interventions. The ease with which the intervention could be delivered and modified was also important. Meta-analysis found stronger evidence for intervention effectiveness in reducing dating and relationship violence than for gender-based violence, with significant long-term impacts on dating and relationship violence victimisation and perpetration, and some evidence that interventions in high-income countries could be effective for reducing victimisation and perpetration of gender-based violence in the long-term. Impacts on knowledge and attitudes were primarily short-term. Network meta-analysis did not suggest superiority of any intervention type. Moderation evidence suggested interventions reduced dating and relationship violence perpetration in boys more than girls, but reduced gender-based violence perpetration more in girls. Metaregression by intervention component did not explain heterogeneity in effectiveness, but qualitative comparative analysis suggested that reducing perpetration was important to reducing victimisation, and that perpetration could be reduced via focus on interpersonal skills, guided practice and (for gender-based violence) implementation of social structural components. Limitations: Despite an exhaustive search, trials may have been missed and risk of publication bias was high for several analyses. Conclusions: This is the most comprehensive systematic review of school-based interventions for dating and relationship violence and gender-based violence to date. It is clear that the prevention of dating and relationship violence and gender-based violence in schools will require longer-term investment to show benefit. Future work: Future research is needed to understand why intervention effectiveness appears stronger for dating and relationship violence than gender-based violence. Study registration: The study is registered as PROSPERO CRD42020190463. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: NIHR130144) and is published in full in Public Health Research; Vol. 12, No. 3. See the NIHR Funding and Awards website for further award information. Plain language summary: Schools are places where dating and relationship violence and gender-based violence occur. Therefore, interventions conducted within schools are ideally placed to prevent and reduce dating and relationship violence and gender-based violence. We reviewed existing research on these interventions, exploring how they were expected to work, what factors affected their implementation in practice, how they had an impact on dating and relationship violence and gender-based violence, and what specific parts of the interventions were most effective and in what contexts. We defined what sort of evidence to include in the review, carried out a comprehensive search and found 247 reports on school-based interventions to prevent dating and relationship violence or gender-based violence, most of which were conducted in North America. Most interventions aimed to provide students with the knowledge, attitudes and skills needed to prevent perpetration and victimisation. They varied in complexity; some had one activity, others had multiple activities, some were integrated into the existing school curricula and others were complex in that they sought to change how schools as a whole respond to dating and relationship violence or gender-based violence. We theorised that complex interventions would bring about greater and more sustainable change, but this was not supported by our findings. The implementation of interventions was affected by factors such as school organisation and leaders who believed in the importance of addressing dating and relationship violence/gender-based violence, along with time and resources to deliver the interventions. The ease with which the intervention could be delivered and modified was also important. There was stronger evidence for intervention effectiveness in reducing dating and relationship violence than for gender-based violence, with significant long-term impacts on dating and relationship violence victimisation and perpetration. There was some evidence that interventions in high-income countries could be effective for reducing victimisation and perpetration of gender-based violence in the long-term. More complicated interventions were not more effective, and interventions tended to reduce dating and relationship violence perpetration in boys more than in girls. We have also been able to identify where there are gaps in available evidence, which may provide avenues for future research. Scientific summary: Background and rationale: This systematic review focused on dating and relationship violence (DRV) and gender-based violence (GBV). The long-term impacts of both for young people are numerous and, consequently, addressing them is a public health priority. Adolescence is a crucial stage for focusing on the prevention of DRV and GBV and schools are an ideal location for this, as this is where young people are socialised into gender norms and where significant amounts of DRV and GBV occurs. Schools also offer an opportunity to reach many young people who may not otherwise be accessible for intervention. Previous reviews have evaluated the effectiveness of interventions for DRV or GBV for adolescents but do not specifically focus on interventions in schools or analyse outcomes jointly. Aim and review questions: We systematically searched for and synthesised the evidence for the following research questions (RQs): What are the theories of change and components of evaluated interventions? What factors affect the implementation of evaluated interventions? Are interventions effective and cost-effective in preventing DRV and GBV and reducing social inequalities in these outcomes? Based on the findings of RQs 1–3, what factors are important for joint effectiveness on DRV and GBV outcomes? What is the comparative effectiveness of different approaches to DRV and GBV prevention? What do the different sources of evidence suggest about intervention mechanisms and how these are contingent on context? Methods: Inclusion criteria: We included randomised controlled trials and process evaluations of school-based interventions for DRV and/or GBV for children between 5 and 18 years. DRV was defined as physical, sexual and emotional violence (including coercive control) in relationships between young people. GBV was defined as violence rooted in gender equality and sexuality such as harassment or bullying on the basis of gender or sexuality, sexual violence, coercion and assault including rape, within or outside dating relationships. Searching information sources: The search strategy included both free-text terms and subject headings (e.g. MeSH in MEDLINE) for the school setting and DRV/ GBV outcomes. In order to identify outcome, process and economic evaluations, we did not apply publication type or study design limitations. In July 2020, we searched 21 bibliographic databases from inception and without limitation on date or language: MEDLINE, EMBASE, PsycINFO, Social Policy and Practice (Ovid); Cumulative Index to Nursing and Allied Health Literature, Education Resources Information Center, British Education Index, Education Research Complete, EconLit, Criminal Justice Abstracts (EBSCOhost); Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials; NHS Economic Evaluation Database (via the Centre for Reviews and Dissemination); Social Science Citation Index and Conference Proceedings Citation Index (Web of Science, Clarivate Analytics); Australian Education Index, ProQuest Dissertations and Theses Global, Sociological Abstracts including Social Services Abstracts, Applied Social Sciences Index and Abstracts (ProQuest); Trials Register of Promoting Health Interventions and Bibliomap [Evidence for Policy and Practice Information (EPPI)-Centre]; Campbell Systematic Reviews (Campbell Collaboration). The bibliographic database searches were updated in June 2021 with a revised strategy developed to improve precision, and added further search terms for named interventions. We completed forwards and backwards citation chasing on included studies in Scopus (Elsevier), Web of Science (Clarivate Analytics) and Google Scholar, and reviewed the reference lists of relevant systematic reviews and reports. To identify linked studies and further grey literature, we conducted targeted searches in Web of Science and Scopus and searched Google Scholar for specific intervention names. We also searched publication lists on key websites. Information management and study selection: Studies were screened by the title and abstract by six reviewers. The reviewers screened a random sample of 100 records and then discussed disagreements before proceeding to screening by title and abstract, and then full-text, independently and in duplicate. Data extraction and assessments of quality: Data were extracted into a data extraction tool that was developed and piloted a priori. Data extracted included details about the study design, study sample, intervention characteristics, analysis methods and outcome data. Studies were appraised using the Cochrane risk of bias tool or the EPPI-Centre tool. Synthesis of theories and components: We synthesised theories of change for the interventions via a staged approach: (1) using line-by-line coding and developing a coding template; (2) synthesising programme theories of change for the interventions and (3) using a meta-ethnographic approach to develop a line-of-argument for an overarching theory of change. We undertook an intervention components analysis to analyse intervention descriptions. We used an inductive approach (open coding initially and then axial coding) to comprehensively describe and categorise intervention components. Synthesis of process data: Process evaluations reported qualitative data and were synthesised qualitatively using thematic synthesis methods. Synthesis of effectiveness: Pairwise meta-analysis tested effectiveness on victimisation and perpetration outcomes, knowledge and attitudes, using robust variance estimation meta-analyses with random effects. Synthesis of mediation and moderator data: We used harvest plots to examine how interventions impact health inequalities, focusing on ethnicity, socioeconomic position, gender, sexuality and age. We narratively synthesised findings relating to mediation. Effectiveness of different approaches to dating and relationship violence and gender-based violence prevention: We used metaregression to test if components explained heterogeneity, and qualitative comparative analysis (QCA) to consider pathways to effectiveness in victimisation and perpetration. We used network meta-analysis to understand the comparative effectiveness of intervention types on DRV and GBV victimisation and perpetration. Synthesis of evidence on intervention mechanisms contingent on context: To understand the links between contexts and mechanisms in generating outcomes, we followed a realist synthesis approach and used findings from the syntheses of the theories of change and process evaluations as a framework to infer and induce mechanisms from studies. This allowed previously 'untheorised' findings to emerge as relevant from our synthesis. Results: Included studies: Searches identified 40,160 records after deduplication, of which 793 were screened in full text. Of these, 247 reports were identified as eligible for inclusion, and these were coded into 68 outcome evaluations and 137 process evaluations. No economic evaluations were identified, but we examined seven cost and resource use studies. What are the theories of change and components of evaluated interventions?: Most interventions focused on preventing victimisation and perpetration in DRV or GBV and fewer addressed bystander-intervention skills. Interventions had student components (e.g. group discussions, individual reflection), staff components (e.g. training, lesson plans), parent/family components (e.g. involvement in intervention) and school structures or physical environment (e.g. changes to school policies). Interventions were categorised as single-component interventions (usually short and focused on a novel technology or activity) and generally focused on a single change mechanism; curricular programmes integrated into the wider school curriculum, which generally focused on one or more change mechanisms at the student level; multicomponent programmes involving multiple modes of intervention and focusing on multiple change mechanisms operating at the student or staff level; and multilevel programmes, which were complex interventions involving multiple modes focused on change mechanisms within schools at multiple levels including the individual, classroom and school structural/environment context. The interventions were theorised as aiming to trigger a complex set of mechanisms to promote students' school belonging, engagement with pro-social behaviours and avoidance of DRV/ GBV behaviours. This was theorised to occur through interventions that 'weakened classification' and 'reframing'. 'Weakened classification' involved strengthening relationships between and among staff and students, between the classroom and the wider school, and between schools and their communities. 'Reframing' aimed to increase student involvement in decisions at the level of the classroom and the school. Both 'weakening classification' and 'reframing' were then theorised as increasing student belonging and a sense of safety in the school building which could encourage increased learning of prosocial skills and interactions. Not all interventions addressed all of these mechanisms; some multilevel interventions could trigger mechanisms at multiple levels of the school system; classroom-level interventions could trigger mechanisms at the level of staff–student relationships or could focus on mechanisms that sought, for example, to promote specific skills for preventing or reducing DRV/ GBV. It was theorised that multilevel interventions triggering a complex set of mechanisms across multiple levels would achieve larger effects (e.g. at the school level) and be more sustainable than mechanisms at the individual and group level. What factors affect the implementation of evaluated interventions?: Key factors influencing the implementation of interventions were school resources and infrastructure, space and supplies, school organisation and leadership, perceived importance of addressing DRV/ GBV , intervention interactivity and development of positive relations among students, facilitator content knowledge and availability of external support, ease of delivery and modification of interventions to suit the particularities of settings. Significant barriers to implementation included time constraints and competing priorities. However, strong staff commitment to prevention of DRV/ GBV could offset time and resource limitations. Interventions may be best delivered when they align with school organisational readiness which includes a receptive school climate, staff buy-in and/or strong school leadership. Are interventions effective in preventing dating and relationship violence and gender-based violence and reducing social inequalities in these outcomes?: Significant long-term, but not short-term, impacts on DRV victimisation [odds ratio (OR) = 0.82, 95% confidence interval (CI) (0.68 to 0.99)] and DRV perpetration [OR = 0.78, 95% CI (0.64 to 0.94)] were found. Although there was no overall effect for GBV victimisation [long-term OR = 0.93, 95% CI (0.80 to 1.08)] or perpetration [long-term OR = 0.90, 95% CI (0.73 to 1.12)], there was some evidence that interventions in high-income countries could be effective for reducing victimisation and perpetration of GBV in the long-term, and that the proportion of girls in the trial sample moderated the effect of the interventions for DRV and GBV victimisation, but not DRV or GBV perpetration. This may be where a critical mass of female students might have encouraged greater overall student engagement with the intervention. There was evidence for gender moderating programme effects on DRV perpetration with greater benefits for boys, particularly for emotional and physical DRV perpetration. Interventions improved DRV violence acceptance, knowledge and attitudes to personal help-seeking in the short term only. Interventions improved GBV violence acceptance, knowledge and individual self-efficacy in the short term, and violence acceptance in the long-term. What factors are important for joint effectiveness on dating and relationship violence and gender-based violence outcomes?: Metaregression of intervention components did not explain heterogeneity in intervention effectiveness. We were able to estimate QCA models for short-term and long-term DRV victimisation, long-term DRV perpetration and short-term GBV victimisation and perpetration. A key finding from the QCA models for victimisation is that a central causal condition for reduction of victimisation is reduction of perpetration. There were a number of other pathways to the reduction of victimisation, namely the inclusion of single-gender components or a critical mass of girls. A critical mass of girls was especially important where interventions went beyond single components. There was also some evidence that components that were absent, for example, the absence of parental involvement was central to achieving effectiveness for long-term DRV victimisation. Perhaps the absence of such a component reduces opportunities to minimise GBV and DRV , or to receive conflicting messages about their importance. For long-term DRV perpetration and short-term GBV perpetration, interventions that were most effective incorporated a range of opportunities for guided practice of skills and attitudes, and interpersonal components focusing on student relationships. The implementation of social structural components was central to effectiveness for short-term GBV perpetration, but not for DRV perpetration. What is the comparative effectiveness of different approaches to dating and relationship violence and gender-based violence prevention?: Network meta-analysis was consistent for DRV but not for GBV outcomes. No one intervention type was clearly more effective than any other, but single-component interventions may have been useful for reducing short-term and long-term DRV victimisation and perpetration, and short-term GBV victimisation. Multilevel interventions showed some effectiveness for DRV outcomes compared to other intervention formulations. For GBV outcomes, there was strong evidence for the role of curriculum interventions which were more successful than any other types at short-term follow-up victimisation outcomes, and short-term and long-term perpetration. What do the different sources of evidence suggest about intervention mechanisms and how these are contingent on context?: There is evidence that the interventions in this review worked not by complex mechanisms (e.g. increasing school commitment), as initially hypothesised, but by the 'basic safety' mechanism which aimed to disrupt violent behaviours by communicating to students the unacceptability of violence. This simpler mechanism may have involved reductions in DRV perpetration among males. That simpler interventions if delivered well may be effective in reducing DRV would be a significant finding, especially for resource-poor settings. We argue that destabilising harmful practices is foundational whereas establishing prosocial behaviours will take more time and investment, so schools may focus on foundational mechanisms initially. Simpler interventions were easier to implement and receive so it may be more important to deliver simpler programmes achieving basic levels of school safety with fidelity than attempt more complex, multicomponent or multilevel programmes. It may be particularly important to prioritise such programmes in resource-poor settings. We also theorise that the individual-level basic safety mechanisms are more likely to effect change in DRV than in GBV perpetration because of the more dyadic, private nature of DRV. The more public nature of GBV means that it might be influenced by social norms that programmes do not seem to successfully address. We found that programmes could be effective in preventing GBV but that this was only likely in high-income settings. It may be that the transformation of school organisation and culture required to reduce GBV is beyond the reach of many schools in low- and middle-income settings because of low school organisational capacity and higher levels of inequality and GBV. Conclusions: The evidence suggests that a well-delivered single-component intervention may be as effective as a complex, multicomponent or multilevel intervention. Such an intervention may be more acceptable within the school environment and receive greater staff buy-in. Preventing GBV may require normative and social structural change which may not be sufficiently triggered by current interventions. Overall, the evidence is more conclusive for DRV than GBV. It is possible that differential mechanisms will need to be activated for DRV than for GBV and that existing theories of change do not adequately account for differences between DRV and GBV in terms of intervention functioning. Study registration: This study is registered as PROSPERO CRD42020190463. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: NIHR130144) and is published in full in Public Health Research; Vol. 12, No. 3. See the NIHR Funding and Awards website for further award information. [ABSTRACT FROM AUTHOR]

Background: Whole-school interventions modify the school environment to promote health. A subset of these interventions promotes student commitment to school to prevent substance (tobacco, alcohol, other drugs) use and/or violence. A previous review identified the theory of human functioning and school organisation as a comprehensive theory of such interventions, and found evidence that these interventions reduce substance use and/or violence. Objectives: The objectives were to search for, appraise and synthesise evidence to address the following questions: (1) What whole-school interventions promoting student commitment to school to prevent substance use and/or violence have been evaluated, what intervention subtypes are apparent and how closely do these align with the theory of human functioning and school organisation? (2) What factors relating to setting, population and intervention affect implementation? (3) What are the effects on student substance use, violence and educational attainment? (4) What is the cost-effectiveness of such interventions? (5) Are intervention effects mediated by student commitment to school or moderated by setting or population? Data sources: A total of 56 information sources were searched (in January 2020), then an updated search of 48 of these was carried out (in May 2021). Reference lists were also searched and experts were contacted. Review methods: Eligible studies were process/outcome evaluations of whole-school interventions to reduce student violence or substance use among students aged 5–18 years attending schools, via actions aligning with the theory of human functioning and school organisation: modifying teaching to increase engagement, enhancing student–staff relationships, revising school policies, encouraging volunteering or increasing parental involvement. Data extraction and quality assessments used existing tools. Theory and process reports were synthesised qualitatively. Outcome and economic data were synthesised narratively; outcome data were meta-analysed. Results: Searches retrieved 63 eligible reports on 27 studies of 22 interventions. We identified four intervention subtypes focused on student participation in school-wide decisions, improving staff–student relationships, increasing engagement in learning and involving parents. The theories of change of most intervention subtypes aligned closely with the theory of human functioning and school organisation, and informed refinement of an intervention theory of change. Theories of change for interventions increasing learning engagement did not align with this theory, aiming instead to increase school commitment primarily via social skills curricula. Factors influencing the implementation included whether or not interventions were tailorable, workable and well explained. Interventions with action groups comprising staff/students, etc. and providing local data were well implemented. Implementation was also affected by whether or not schools accepted the need for change and staff had the resources for delivery. Meta-analyses suggest small, but significant, intervention effects in preventing violence victimisation and perpetration, and substance use. There was sparse and inconsistent evidence of moderation and some evidence of mediation by student commitment to school. Two economic evaluations suggested that there is the potential for the interventions to be cost-effective. Limitations: The quality of the studies was variable and the economic synthesis was limited to two studies. Conclusions: Whole-school interventions aiming to promote student commitment to school share similar theories of change and factors affecting implementation. They have the potential to contribute to preventing violence and substance use among young people. Future trials should aim to optimise intervention effectiveness by better theorisation, and assess implementation and effect moderators and mediators. Study registration: This study is registered as PROSPERO CRD42019154334. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: 17/151/05) and is published in full in Public Health Research; Vol. 12, No. 2. See the NIHR Funding and Awards website for further award information. Plain language summary: Whole-school health interventions aim to modify how schools are run, to promote students' health. Some aim to promote student commitment to school to prevent the important interlinked outcomes of substance (tobacco, alcohol, other drugs) use and violence. We searched for all evaluations of such interventions. We summarised what this research said about the sorts of interventions used, how they are meant to work, what factors affect delivery, whether or not they reduce violence and substance use and whether or not they are worth the money. We found 63 reports on 27 studies of 22 interventions. We identified four subtypes of interventions. These aimed to involve students in school decisions, improve staff–student relationships, increase engagement in learning or involve parents. Most of these interventions were intended to work by making sure schools focused on student needs, or by improving relationships between staff and students, between different areas of learning or between schools and communities. This aimed to make students feel committed to school and therefore avoid violence or substance use. A few aimed to work mostly by teaching students how to avoid violence and substance use. We found that interventions were well implemented if they were tailored for each school and had good materials and support. Interventions were well delivered if they were led by action groups (comprising staff, students, etc.) or provided schools with information on students' needs. Implementation was affected by whether or not schools accepted the need for change and whether or not staff had the necessary time and money to do the work. These interventions appear to have small, but significant, intervention impacts in preventing violence and substance use among young people. There was not consistent evidence of different effects for different students. A small number of studies suggest that such interventions might show economic benefit, but this would need further research. Future research should focus on interventions that are refined to make sure that they can be well delivered. Scientific summary: Background and rationale: Substance use and violence are important interconnected outcomes often associated with disengagement from school. Whole-school interventions aiming to modify the school environment to promote student commitment to school might be an effective way to prevent these outcomes. This review synthesised evidence on such interventions. According to a previous review, the theory of human functioning and school organisation provides the most comprehensive theory of how schools can influence student commitment to school and health behaviours. This proposes that promoting student commitment to school can decrease involvement in risk behaviours by promoting student practical reasoning and positive peer affiliations. Schools can promote commitment by reframing provision on student needs and eroding boundaries between staff and students, between different areas of learning and between schools and local communities. We used this theory to define our initial theory of change and inclusion criteria, and as a starting point for categorising interventions and synthesising theories of change. Aim and review questions: The aim was to search systematically for, appraise and synthesise evidence to address the following questions: What whole-school interventions promoting student commitment to school to prevent student substance use and/or violence have been evaluated, what subtypes are apparent and how closely do these align with the theory of human functioning and school organisation? What factors influence implementation of such interventions? Overall and by intervention subtype, what are the effects of such interventions on student substance use, violence and educational attainment? What is the cost-effectiveness of such interventions? Are the effects of such interventions on student substance use and/or violence mediated by student commitment to school, or moderated by setting or population? Methods: Inclusion criteria: Eligible studies were process or experimental/quasi-experimental outcome evaluations of whole-school interventions aiming to reduce violence or substance (tobacco, alcohol, other drug) use among students aged 5–18 years in schools, by modifying teaching to increase engagement in learning, enhancing student–staff relationships, revising school policies, encouraging student volunteering or involving parents in school. Searching information sources: The search strategy included terms covering population, intervention and evaluation design. We initially searched 21 databases, 3 trial registries and 32 websites (16–27 January 2020), and updated the search across 14 databases, 2 trial registries and 32 websites (11–25 May 2021). We searched reference lists and contacted subject experts. Information management and study selection: Citations identified by our searches were de-duplicated before being uploaded to EPPI-Reviewer 4.0 software (Evidence for Policy and Practice Information and Co-ordinating Centre, University of London, London, UK). Two reviewers double-screened batches of 50 references. Disagreements were resolved by discussion. After reaching an agreement rate of ≥ 90% on these batches, each subsequent reference was single-screened on title/abstract. If references were considered likely to be eligible based on the title/abstract, the full report was reviewed using a similar process. Data extraction: Two reviewers independently extracted data using existing tools. Disagreements were resolved by discussion. For intervention descriptions, date were extracted on domains included in a standard framework. For theory reports, we extracted data on constructs, mechanisms and contextual contingencies affecting these. For empirical studies, we extracted data on basic study details, methods, interventions and findings. Assessments of quality and risk of bias: The quality of each report was assessed independently by two reviewers using existing tools. The reviewers met to compare assessments and resolve any differences through discussion. Theory reports were assessed on the basis of whether or not this described the path from intervention to outcomes, clarity of constructs, clarity of inter-relationships between constructs, whether or not the underlying mechanisms were explained, and whether or not the theory considered how mechanisms and outcomes might vary by context. Process evaluations were assessed on the basis of rigour of sampling, data collection and data analysis; the extent to which findings were grounded in data; whether or not the study privileged the perspectives of students; and breadth/depth of findings. Outcome studies were assessed for risk of bias on the basis of sequence generation, allocation concealment, blinding of participants or personnel, blinding of outcome assessors, incomplete outcome data, selective outcome reporting and other sources of bias. Economic evaluations were assessed using an adapted version of an existing tool. Data analysis: To create a categorisation of intervention subtypes, we drew on descriptions of interventions and theories of change, using these to refine an initial categorisation informed by the theory of human functioning and school organisation. Reviewers grouped interventions into discrete categories and subcategories. To synthesise theories of change, we used best-fit framework synthesis. We defined a priori themes based on the theory of human functioning and school organisation and then coded data from included studies against these. When concepts from the included studies could not be coded with these, we coded inductively. This coding was then used to refine the existing theory of change by intervention subtype. We synthesised qualitative and quantitative elements of process evaluation reports using thematic synthesis methods. We conducted a narrative synthesis of outcome evaluations ordered by outcome then, within this, by intervention subtype, follow-up time and study design. Outcomes were categorised into violence, use of tobacco, alcohol and other drugs, and academic attainment. We produced forest plots for different outcomes and follow-up times. Plots included point estimates and standard errors for each study, expressed as standardised mean differences (Cohen's d) to ensure comparability across reports. When data allowed, we calculated pooled effect sizes within each pairwise comparison, accounting for the extent of heterogeneity among the studies, estimating separate models for each outcome. We regarded follow-up times of up to 1 year and > 1 year post baseline as different outcomes, pooling first by follow-up times and, when appropriate, overall across follow-up times. We used the Grading of Recommendations Assessment, Development and Evaluation to present the quality of evidence. For synthesising economic evaluations, measures of costs, indirect resource use and cost-effectiveness were summarised in a table and adjusted for currency and inflation to the then-current UK context. These data were used to inform a narrative synthesis of economic evidence. Stakeholder consultation: We consulted policy and practice stakeholders once during the review. In October 2021, stakeholders reviewed slides summarising the main findings. We asked stakeholders to advise on interpretation, implications and knowledge exchange. Ethics approval: The research involved no human participants and drew solely on evidence in the public realm, so ethics approval was not required. Results: Included studies: The original searches retrieved 62,742 unique references and 56 eligible reports. The updated search retrieved 9709 unique references and 9 eligible reports. In total, 63 reports on 27 studies of 22 interventions were included: 63 on theories of change, 16 on process evaluations, 48 on outcome evaluations and 3 on economic evaluations. Of the included interventions, 10 addressed violence (with 2 of these also addressing educational attainment), 3 addressed substance use (with 1 of these also addressing educational attainment) and 9 addressed violence and substance use (with 1 of these also addressing educational attainment). What interventions have been evaluated and what intervention subtypes are apparent?: We identified four intervention subtypes, focused on the following: developing student participation in school-wide decisions, improving staff–student relationships, increasing student engagement in learning and increasing parental involvement in school. How closely do intervention theories of change align with the theory of human functioning and school organisation?: We synthesised interventions developing student participation, enhancing staff–student relationships and involving parents together because of commonalities in theories of change. Despite only one intervention being explicitly informed by the theory of human functioning and school organisation, theories of change aligned closely with this theory, with recurrent themes that reciprocally translated with this theory and each other. Inductive coding suggested a number of refinements to the starting theory, for example relating to how school organisation, learning, discipline and school–community links were reframed. Interventions aimed not only to reduce risk behaviours but to promote positive overall development via increasing commitment to school. The theories of change for interventions developing student engagement in learning aligned much less with the theory of human functioning and school organisation. These interventions were theorised to increase students' school engagement primarily through social skills curricula, with whole-school elements secondary. What factors relating to setting, population and intervention influence the implementation of these interventions?: Evaluations suggested that school staff were more likely to understand what was required to implement an intervention when provided with good materials and support. Whether or not staff would commit to delivery was influenced by whether interventions could be integrated with existing practices, locally tailored or built on existing work. Interventions providing local data helped build buy-in. Staff were more likely to commit when external providers were credible and experienced. Students were more likely to commit if an intervention offered opportunities for active roles or expressing their views. School leaders were more likely to commit to an intervention that addressed an issue they were already interested in tackling and when there was already a recognition of the need for change. To ensure those in schools worked together to deliver interventions, interventions needed to be locally workable, fitting with timetables and providing clear guidance. Interventions that included 'action groups' (consisting of staff, students, etc.) helped build collective action. Interventions with synergistic components were implemented more successfully. Whether or not staff could come together to deliver interventions also depended on having the time, budgets, authority and connections to support this. Action groups enabled members to reflexively monitor implementation and assess what else was needed. This could give participants the permission and resources to try different things, persisting with what worked. What are the effects on student substance use, violence and educational attainment of whole-school interventions aiming to promote student commitment?: Overall, meta-analyses suggested that interventions led to a small, but statistically significant, reduction in violence perpetration at up to 1 year post baseline [odds ratio (OR) 0.85, 95% confidence interval (CI) 0.76 to 0.96] and > 1 year post baseline (OR 0.79, 95% CI 0.65 to 0.98). Considering intervention subtypes, meta-analyses suggested possible, but inconsistent, impacts on violence perpetration of interventions promoting student participation in school policy decisions and student relationships with teachers at up to 1 year post baseline and at > 1 year post baseline. Meta-analyses suggested that interventions promoting student engagement in learning and parental involvement were unlikely to affect violence perpetration up to 1 year post baseline and at > 1 year post baseline. Overall, meta-analyses suggested that interventions led to small, but statistically significant, reductions in violence victimisation at up to 1 year post baseline (OR 0.84, 95% CI 0.72 to 0.98) and > 1 year post baseline (OR 0.85, 95% CI 0.73 to 0.99). Considering subtypes, evidence suggested possible but inconsistent impacts of interventions promoting student participation in decisions and student relationships with teachers on violence victimisation at up to 1 year post baseline and > 1 year post baseline. Studies suggested that interventions promoting parental involvement were unlikely to affect violence victimisation up to 1 year post baseline and > 1 year post baseline. Studies of intervention effects on observed violence were not meta-analysed owing to heterogeneity of study designs, but evidence suggested that interventions promoting student participation in decisions significantly reduced observed violence at > 1 year post baseline. Interventions promoting parental involvement significantly reduced observed violence at up to 1 year post baseline and at > 1 year post baseline. Overall, meta-analyses suggested that interventions led to small, but statistically significant, reductions in substance use at up to 1 year post baseline (OR 0.83, 95% CI 0.70 to 0.97) and at > 1 year post baseline (OR 0.79, 95% CI 0.62 to 0.998). Meta-analyses of such interventions suggested small and statistically non-significant reductions in measures of specific outcomes (alcohol, smoking, illicit drugs, general substance use) at up to 1 year post baseline and at > 1 year post baseline. Considering subtypes, the evidence suggested possible, but inconsistent, impacts of interventions promoting student participation in decisions in reducing substance use at up to 1 year post baseline and at > 1 year post baseline, with similar findings for alcohol outcomes and illicit drug use outcomes separately. There was less evidence of impact on tobacco outcomes. An analysis of omnibus substance use outcomes suggested a larger, but still substantially heterogeneous and non-significant, effect. One trial reported on the effects of an intervention promoting student–teacher relationships: up to 1 year post baseline, there were no significant effects on alcohol or cannabis outcomes, and no significant effects on any reported lifetime smoking, but there was a significant effect on regular smoking; at > 1 year post baseline, there were no significant effects on alcohol use, tobacco smoking or cannabis use outcomes. Findings from two randomised trials suggested possible, but inconsistent, impacts of interventions promoting student engagement in learning in reducing substance use, but a non-significant impact on reducing alcohol use at up to 1 year post baseline. Evidence suggested possible, but inconsistent, impacts of interventions promoting student engagement in learning in reducing substance use at > 1 year post baseline, and a non-significant impact of such interventions on reducing alcohol use at > 1 year post baseline. Our syntheses of effects on academic attainment are exploratory. All such studies were of interventions promoting student participation in decisions and reporting attainment at > 1 year post baseline. Findings did not suggest clear evidence of impact on academic attainment. Are the effects of whole-school interventions on student substance use and violence mediated by student commitment to school, or moderated by setting or population?: Evidence was sparse and inconsistent across trials for moderation of effects on all outcomes by population and school characteristics. Three studies examined mediation of intervention effects by student commitment to school. All focused on interventions promoting student participation in decisions. There was some evidence that student commitment to school mediated intervention effects on violence and substance use outcomes. What is the cost-effectiveness of such interventions, overall and by intervention subtype?: Economic evidence was sparse but suggested that two interventions aiming to involve students in decision-making were cost-effective. Conclusions: Whole-school interventions aiming to promote student commitment to school to prevent violence and substance use can be categorised into those promoting (1) student participation in decision-making, (2) staff–student relationships, (3) engagement in learning and (4) parental involvement in school. Despite not generally being explicitly informed by the theory of human functioning and school organisation, most interventions are underpinned by theories of change closely aligning with this. Factors influencing implementation include whether or not interventions were tailorable, workable, well explained and had synergistic components. Implementation was also affected by whether or not schools accepted the need for school transformation and whether or not staff had the necessary time, budgets, authority and connections for delivery. Interventions were effective in preventing violence victimisation and perpetration and substance use, although effects are small. Such interventions may contribute to broader efforts to reduce violence and substance use among young people but are unlikely to achieve large population impacts alone. Future trials should aim to optimise intervention effectiveness by better theorisation, and assess implementation and effect moderators and mediators. Study registration: This study is registered as PROSPERO CRD42019154334. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: 17/151/05) and is published in full in Public Health Research; Vol. 12, No. 2. See the NIHR Funding and Awards website for further award information. [ABSTRACT FROM AUTHOR]

Background: Attention deficit hyperactivity disorder (ADHD) is a highly prevalent neurodevelopmental disorder. UK guidance states that primary care has a vital role in effective ADHD management, including referral, medication prescribing and monitoring, and providing broader mental health and wellbeing support. However, many GPs feel unsupported to provide health care for young people with ADHD. Inadequate health care is associated with rising costs for patients and society. Aim: To investigate the experiences of young people with ADHD accessing primary care in England, from the perspectives of people with lived experience of ADHD and healthcare professionals (HCPs). Design and setting: A qualitative study. Interviews were conducted with HCPs (GPs, practice managers, and a wellbeing worker) and people with lived experience of ADHD (young people aged 16–25 years and their supporters) located in integrated care systems across England. Method: Semi-structured interviews were conducted with participants at five purposively selected general practices (varying by deprivation, ethnicity, and setting). Questions focused on experiences of accessing/providing health care for ADHD. Reflexive thematic analysis was undertaken within a critical realist framework to understand how provision works in practice and to explore potential improvements. Results: In total, 20 interviews were completed with 11 HCPs and nine people with lived experience. Three themes were generated: a system under stress, incompatibility between ADHD and the healthcare system, and strategies for change in ADHD primary care provision. Conclusion: Standardisation of ADHD management in primary care, providing better information and support for HCPs, and advising on reasonable adjustments for people with lived experience could help improve access to effective treatments for young people living with ADHD. [ABSTRACT FROM AUTHOR]

Objective: To analyse the components used in exercise interventions for people with symptoms of neurogenic claudication due to lumbar spinal stenosis and identify components associated with successful interventions. Data sources: Eligible papers published up to April 2023 from MEDLINE, EMBASE, CINAHL, PEDro, CENTRAL, Web of Science, and trial registry websites. Review methods: Literature searches were performed by an Information Specialist. We searched for randomised trials evaluating exercise interventions for people with neurogenic claudication symptoms (the primary symptom of lumbar spinal stenosis). Two authors independently performed study selection, data extraction, and quality assessments using the Cochrane Risk of Bias tool Version 2 and the TIDieR checklist for intervention reporting. Details of intervention components were extracted, tabulated, and synthesised using an intervention component analysis approach. Results: We found thirteen trials reporting 23 exercise interventions delivered to 1440 participants. These featured 60 different components. Most exercise interventions included supervision and flexion-based exercises. Balance exercises were rarely included. Exercise components featured more frequently in successful interventions included stretches, strength or trunk muscle exercises, fitness exercises, especially cycling, and psychologically informed approaches. Interpretation is limited by low study numbers and heterogeneity. No conclusions could be drawn about exercise supervision or dose. Discussion: Exercise interventions for people with neurogenic claudication typically feature multiple components. Common features such as supervision, lumbar flexion, and aerobic fitness exercises and also less common features such as stretches, strengthening exercises, and psychologically informed approaches warrant consideration for inclusion when designing and optimising exercise interventions for people with lumbar spinal stenosis. [ABSTRACT FROM AUTHOR]

: Introduction: Adolescents and young people comprise a growing proportion of new HIV infections globally, yet current approaches do not effectively engage this group, and adolescent HIV‐related outcomes are the poorest among all age groups. Providing psychosocial interventions incorporating psychological, social, and/or behavioural approaches offer a potential pathway to improve engagement in care and health and behavioural outcomes among adolescents and young people living with HIV (AYPLHIV). Methods: A systematic search of all peer‐reviewed papers published between January 2000 and July 2020 was conducted through four electronic databases (Cochrane Library, PsycINFO, PubMed and Scopus). We included randomized controlled trials evaluating psychosocial interventions aimed at improving engagement in care and health and behavioural outcomes of AYPLHIV aged 10 to 24 years. Results and discussion: Thirty relevant studies were identified. Studies took place in the United States (n = 18, 60%), sub‐Saharan Africa (Nigeria, South Africa, Uganda, Zambia, Zimbabwe) and Southeast Asia (Thailand). Outcomes of interest included adherence to antiretroviral therapy (ART), ART knowledge, viral load data, sexual risk behaviours, sexual risk knowledge, retention in care and linkage to care. Overall, psychosocial interventions for AYPLHIV showed important, small‐to‐moderate effects on adherence to ART (SMD = 0.3907, 95% CI: 0.1059 to 0.6754, 21 studies, n = 2647) and viral load (SMD = −0.2607, 95% CI −04518 to −0.0696, 12 studies, n = 1566). The psychosocial interventions reviewed did not demonstrate significant impacts on retention in care (n = 8), sexual risk behaviours and knowledge (n = 13), viral suppression (n = 4), undetectable viral load (n = 5) or linkage to care (n = 1) among AYPLHIV. No studies measured transition to adult services. Effective interventions employed various approaches, including digital and lay health worker delivery, which hold promise for scaling interventions in the context of COVID‐19. Conclusions: This review highlights the potential of psychosocial interventions in improving health outcomes in AYPLHIV. However, more research needs to be conducted on interventions that can effectively reduce sexual risk behaviours of AYPLHIV, as well as those that can strengthen engagement in care. Further investment is needed to ensure that these interventions are cost‐effective, sustainable and resilient in the face of resource constraints and global challenges such as the COVID‐19 pandemic., INTRODUCTION Adolescents living with HIV are unlikely to meet the necessary milestones to end the AIDS epidemic by 2030. In 2019, an estimated 1.7 million (1.1 to 2.4 million) adolescents [...]

Maternal mortality is disproportionately higher in low- and middle-income countries compared to other parts of the world. International research efforts are reflective of the urgency to improve global maternal outcomes. The existing literature of maternal health interventions in low- and middle-income countries targets a variety of populations and intervention types. However, there is a notable lack of systemic reviews that examine the wider contextual and mechanistic factors that have contributed to the outcomes produced by interventions. This article aims to use realist synthesis design to identify and examine the relationships between the contexts, mechanisms and outcomes of maternal health interventions conducted in low- and middle-income countries. This will inform evidence-based practice for future maternal health interventions. In May 2022, we searched four electronic databases for systematic reviews of maternal health interventions in low- and middle-income countries published in the last 5 years. We used open and axial coding of contexts, mechanisms and outcomes to develop an explanatory framework for intervention effectiveness. After eligibility screening and full-text analysis, 44 papers were included. The majority of effective interventions reported good healthcare system contexts, especially the importance of infrastructural capacity to implement and sustain the intervention. Most intervention designs used increasing knowledge and awareness at an individual and healthcare-provider level to produce intended outcomes. The majority of outcomes reported related to uptake of healthcare services by women. All mechanism themes had a relationship with this outcome. Health system infrastructure must be considered in interventions to ensure effective implementation and sustainability. Healthcare-seeking behaviours are embedded within social and cultural norms, environmental conditions, family influences and provider attitudes. Therefore, effective engagement with communities and families is important to create new norms surrounding pregnancy and delivery. Future research should explore community mobilization and involvement to enable tailored interventions with optimal contextual fit. [ABSTRACT FROM AUTHOR]

Objectives: We set out to map the quantitative and qualitative systematic review evidence available to inform the optimal prescribing of drugs that can cause dependency (benzodiazepines, opioids, non-benzodiazepine hypnotics, gabapentinoids and antidepressants). We also consider how this evidence can be used to inform decision-making in the patient care pathway for each type of medication. Methods: Eight bibliographic databases were searched for the period 2010 to 2020. All included reviews were initially appraised using four items from the Collaboration for Environmental Evidence Synthesis Assessment Tool, with reviews that scored well on all items proceeding to full quality appraisal. Key characteristics of the reviews were tabulated, and each review was incorporated into an evidence and gap map based on a patient care pathway. The care pathway was based upon an amalgamation of existing NICE guidelines and feedback from clinical and patient stakeholders. Results: We identified 80 relevant reviews and displayed them in an evidence and gap map. The evidence included in these reviews was predominantly of low overall quality. Areas where systematic reviews have been conducted include barriers and facilitators to the deprescribing of drugs that may cause dependency, although we identified little evidence exploring the experiences or evaluations of specific interventions to promote deprescribing. All medications of interest, apart from gabapentinoids, were included in at least one review. Conclusions: The evidence and gap map provides an interactive resource to support (i) policy developers and service commissioners to use evidence in the development and delivery of services for people receiving a prescription of drugs that may cause dependency, where withdrawal of medication may be appropriate, (ii) the clinical decision-making of prescribers and (iii) the commissioning of further research. The map can also be used to inform the commissioning of further systematic reviews. To address the concerns regarding the quality of the existing evidence based raised in this report, future reviews should be conducted according to best-practice guidelines. Systematic reviews focusing on evaluating interventions to promote deprescribing would be particularly beneficial, as would reviews focusing on addressing the paucity of evidence regarding the deprescription of gabapentinoids. [ABSTRACT FROM AUTHOR]

Objectives: Whole-school interventions and programmes aim to change school environments to promote health. Previous reviews suggest these are often inappropriately informed by individualistic psychological theories. We undertook a systematic review of whole-school interventions to prevent substance use and violence. This paper reports on a synthesis of theories of change, assessing whether these aligned with, and suggested refinements to, the theory of human functioning and school organisation, a more encompassing, sociological theory. This theory proposes that schools improve health by promoting student commitment, achieved by eroding various 'boundaries' (e.g. between staff and students) and reframing provision based on student needs so that students commit more fully to school 'instructional' (learning) and 'regulatory' (behaviour) orders. Setting: International. Design: Systematic review. Methods: The study involved systematic searches, data extraction and quality assessment. Theories of change were synthesised using a best-fit framework. Results: Despite only one intervention being explicitly informed by the theory of human functioning and school organisation, the theories of change of most interventions aligned (at least in part) with aspects of this theory. Synthesis suggested various refinements to the theory. First, it suggested specific activities that can modify boundaries and reframing to increase student commitment. Second, it refined the concept of reframing to include building learning on existing student knowledge using a 'constructivist' approach. Third, it suggested future intervention might usefully seek to erode boundaries between the 'instructional' and 'regulatory' orders of the school to create a single 'developmental' order. Finally, it recognised that whole-school interventions might prevent violence and substance use among students in ways other than by building student commitment. Conclusion: Our refined theory of change provides a firmer basis for interventions. Future work is needed to examine empirical support for the refined theory. [ABSTRACT FROM AUTHOR]

We reflect on how qualitative research can be used to develop or refine theories about how the mechanisms triggered by intervention enactment might generate outcomes, referring to examples from a 'realist trial' of a whole-school health intervention. Qualitative research can explore mechanisms directly, by asking participants how they think interventions work, or indirectly, by exploring participant experiences of intervention-related actions to understand the conditions and consequences of these actions. Both of these approaches can inform theorisation of how mechanisms are triggered and generate outcomes, and how this is contingent on context. We discuss methods for sampling, data collection and data analysis, and recommend dimensional analysis as a means to analyse qualitative data on mechanisms. We then consider how to draw on qualitative research to inform hypotheses to be tested statistically. [ABSTRACT FROM AUTHOR]

Aim: This systematic review identifies, appraises and synthesizes the evidence on the provision of fundamental nursing care to hospitalized patients with a highly infectious virus and the effectiveness of adaptations to overcome barriers to care. Design: Systematic review. Data Sources: In July 2020, we searched Medline, PsycINFO (OvidSP), CINAHL (EBSCOhost), BNI (ProQuest), WHO COVID‐19 Database (https://search.bvsalud.org/) MedRxiv (https://www.medrxiv.org/), bioRxiv (https://www.biorxiv.org/) and also Google Scholar, TRIP database and NICE Evidence, forwards citation searching and reference checking of included papers, from 2016 onwards. Review Methods: We included quantitative and qualitative research reporting (i) the views, perceptions and experiences of patients who have received fundamental nursing care whilst in hospital with COVID‐19, MERS, SARS, H1N1 or EVD or (ii) the views, perceptions and experiences of professional nurses and non‐professionally registered care workers who have provided that care. We included review articles, commentaries, protocols and guidance documents. One reviewer performed data extraction and quality appraisal and was checked by another person. Results: Of 3086 references, we included 64 articles; 19 empirical research and 45 review articles, commentaries, protocols and guidance documents spanning five pandemics. Four main themes (and 11 sub‐themes) were identified. Barriers to delivering fundamental care were wearing personal protective equipment, adequate staffing, infection control procedures and emotional challenges of care. These barriers were addressed by multiple adaptations to communication, organization of care, staff support and leadership. Conclusion: To prepare for continuation of the COVID‐19 pandemic and future pandemics, evaluative studies of adaptations to fundamental healthcare delivery must be prioritized to enable evidence‐based care to be provided in future. Impact: Our review identifies the barriers nurses experience in providing fundamental care during a pandemic, highlights potential adaptations that address barriers and ensure positive healthcare experiences and draws attention to the need for evaluative research on fundamental care practices during pandemics. [ABSTRACT FROM AUTHOR]

Adolescent dating and relationship violence is associated with health harms and is an important topic for sex education. School-based interventions addressing this have been effective in the USA, but schools in England confront pressures that might hinder implementation. We assessed the feasibility of, and contextual enablers/barriers to implementing Project Respect, a whole-school intervention. We conducted a pilot trial with process evaluation in six English secondary schools. Intervention comprised: training; policy-review; mapping and patrolling 'hotspots'; parent information; help-seeking app; and a curriculum (including student-led campaigns) targeting dating violence. Process evaluation included assessments of fidelity and interviews with the trainer and school staff. Schools delivered training and lessons partially or completely and made parent and app information available. Two schools conducted policy reviews; none patrolled hotspots or implemented campaigns. Implementation was strengthened where staff saw dating violence as a priority. Delivery was undermined where staff were insufficiently involved, lacked time for planning or struggled to timetable lessons, and where new school challenges undermined engagement. School-based health interventions must work to build staff buy-in and ensure they do not overburden schools. Dating and relationship violence might best be addressed in this context as a broader aspect of sex education. [ABSTRACT FROM AUTHOR]

Men who have sex with men (MSM) experience disproportionately high rates of HIV and substance use. Though interventions based on cognitive behavioural therapy (CBT) are effective for many psychiatric disorders, systematic reviews of CBT for substance use present mixed results and CBT has not been systematically reviewed for HIV risk reduction in MSM. Randomised controlled trials (RCTs) of non-pharmacological CBT for substance-using MSM were systematically reviewed to assess the evidence for these interventions’ impact on unprotected anal intercourse (UAI). We searched 20 databases on 22 September 2012. Of the 2801 records identified, both authors separately assessed 70 full-text articles for inclusion. In three included RCTs, one RCT compared CBT against non-treatment control and two RCTs compared CBT against CBT variants. Across studies, CBT led to UAI reductions, though at one-year follow-up, these reductions were generally not greater than in other trial arms. This evidence of moderate quality indicates that while CBT may reduce UAI in substance-using MSM, it is unclear if CBT is more effective than mere assessment. All RCTs tested intensive, clinic-based interventions requiring sustained participant commitment, indicating a need for research into briefer interventions, with particular focus on episodic substance use and effectiveness trials. [ABSTRACT FROM PUBLISHER]

Mental health conditions constitute a major burden of disease for adolescents globally and can lead to significant adverse consequences. This systematic review aimed to identify if psychosocial interventions are effective in preventing mental health conditions in adolescents already experiencing emotional problems. We searched for randomized controlled trials comparing psychosocial interventions for preventing mental health conditions with care as usual in adolescents aged 10-19 who are experiencing symptoms of emotional problems. We searched PubMed/Medline, PsycINFO, ERIC, EMBASE, and ASSIA databases to identify studies. We found 82 eligible studies (n = 13,562 participants). Findings show that interventions can reduce mental health conditions and increase positive mental health. Across all reported time points, psychosocial interventions showed significant, small-to moderate-sized beneficial effects on preventing mental health conditions (SMD: -0.26, 95% CI [-0.42, -0.19] and small positive effects on positive mental health (SMD: 0.17, 95% CI [0.097, 0.29]. There were no statistically significant pooled findings suggesting that psychosocial interventions had either a positive or negative effect on self-harm or suicide; aggressive, disruptive and oppositional behavior; substance use; or school attendance. Despite the positive findings, a critical gap exists in the design of effective psychosocial interventions to reduce self-harm and suicide, and other risk behaviors in adolescents with symptoms of emotional problems., (Copyright © 2024 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Parenting programs aim to motivate change in parents' behaviors, perceptions, and knowledge to promote desirable changes in children's adjustment and behavior. Parenting programs are typically delivered in a group-based or individual format, and it is unknown which format most effectively supports parents. On the one hand, group-based programs may be more effective since they provide access to peer-based support. On the other hand, individual programs may be more successful since they offer a tailored approach. Therefore, this meta-analysis investigated which delivery format is most effective in optimizing child behavior management (i.e., positive reinforcement and nonviolent discipline), parenting stress, and parental depressive symptoms. Studies were selected from the systematic review by Backhaus et al. (2023). Our sample included evaluations of 121 group-based and 41 individual programs based on social learning theory principles. Robust variance estimation indicated that parents' child behavior management and parenting stress improved in both delivery formats. In contrast, parental depressive symptoms improved only in group-based programs. Our findings suggest that whether parents benefit more from a group-based or individual program in part depends on the outcome examined. Therefore, it is important for clinicians to understand parents' goals to effectively guide them toward the most appropriate parenting program delivery format. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Online parenting programs to support parents of children with behavioral problems and emotional problems have become widely available in recent years. Research has consistently shown their positive effects on child development, parents' adaptive parenting practices, and parents' mental health. However, knowledge is lacking on which type of content is more suitable to be delivered online. Our work addresses this knowledge gap by conducting traditional and network meta-analyses to improve our understanding of (1) how effective online parenting programs are to improve children's behavior and emotional problems, and (2) what clusters of components are most likely to yield the strongest effects. Following the PROSPERO preregistration, we systematically searched PsycINFO, MEDLINE, Web of Science, and Cochrane. Of the 8292 records retrieved, 28 records on 27 randomized controlled trials (N = 5,312) met the inclusion criteria. Results show moderate effect sizes of online parenting programs on reduced child behavioral and emotional problems, parents' ineffective parenting practices, and parents' mental health problems. Online programs adopting a learning theory perspective, either with or without additional parental self-care and parents as therapist approaches, are most likely to yield the strongest effects on child behavioral problems. Online programs adopting a learning theory perspective, parental self-care and parents as therapist approaches, with or without additional relationship perspectives, are most likely to yield the strongest effects on child emotional problems. Online parenting programs seem promising tools for improving child behavioral and emotional problems. Future research should identify the circumstances that allow parents and children to benefit more from specific components in these programs., (© 2024. The Author(s).)

Objective: Although parenting programs are the most widely used approach to reduce disruptive behavior in children, there is a notable lack of understanding of the exact changes in parenting that underlie their effects. Challenges include the frequent use of composite measures of parenting behavior and insufficient power to detect mediation effects and individual differences in these in individual trials., Method: Individual participant data from 14 European randomized controlled trials of social learning-based parenting programs were pooled to examine which specific parenting behaviors best explain program effects. Participants included 3,252 families with children ages 1 to 13 years. Parental use of praise, tangible rewards, physical discipline, harsh verbal discipline, and not following through on discipline were included as putative mediators. Additionally, the study explored whether subgroups of families showing different mediational pathways exist., Results: Changes in parenting partially mediated program effects, with all included parenting behaviors except parental use of praise serving as unique mediators. Less harsh verbal discipline and increased following through on discipline were the strongest mediators. The study identified 3 subgroups with distinct responses to parenting programs. Most families benefited, partly through increased following through on discipline; families with the least or most difficulties were more likely to benefit less or not at all., Conclusion: These findings offer insight into the specific parenting behavior changes key to reducing disruptive child behavior, while highlighting the need for innovative research methodologies to gain a deeper understanding of individual differences in parenting program benefits and mechanisms., Study Preregistration Information: Study Preregistration: Individual Participant Data Meta-analysis: Individual Differences in Mediators of Parenting Program Effects on Disruptive Behavior; https://doi.org/10.1016/j.jaac.2023.11.005., (Copyright © 2024 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.)

Objectives: This study examines the impact of slippage in hazard ratios (tending toward the null over subsequent datacuts) for overall survival for combination treatment with a PD-(L)-1 inhibitor and a tyrosine kinase inhibitor in advanced renal cell carcinoma., Methods: Four trials' Kaplan-Meier curves were digitized over several datacuts and fitted with standard parametric curves. Accuracy and consistency of early data projections were calculated versus observed restricted mean survival time and fitted lifetime survival from the longest follow-up datacut. The change in economically justifiable price (eJP) was calculated fitting the same curve to both arms, using an assumed average utility of 0.7 and willingness-to-pay threshold of £30 000 per quality-adjusted life-year. The eJP represents the lifetime justifiable price increment for the new treatment, including differences in drug-, administration-, and disease-related costs., Results: Slippage in hazard ratios was observed in trials with longer follow-up, potentially influenced by subsequent PD-(L)-1 use after tyrosine kinase inhibitor monotherapy, early stoppage of PD-(L)-1, and development of resistance. Lognormal and log-logistic curves were more likely to overpredict the observed result; Gompertz and gamma underpredicted. Statistical measures of goodness of fit did not select the curves that resulted in the RMST closest to what was observed in the final data cut. Large differences in incremental mean life-years were observed between even the penultimate and final datacuts for most of the fitted curves, meaningfully affecting the eJP., Conclusions: This work demonstrates the challenge in predicting treatment benefits with novel therapies using immature data. Incorporating information on the impact of subsequent treatment is likely to play a key role in improving predictions., Competing Interests: Author Disclosures Author disclosure forms can be accessed below in the Supplemental Material section., (Copyright © 2024. Published by Elsevier Inc.)

The mental health and wellbeing of children and young people who have been in care, primarily foster care, kinship care or residential care, remains a public health priority. The Care-experienced cHildren and young people's Interventions to improve Mental health and wEll-being outcomes Systematic review (CHIMES) synthesized evidence for the effectiveness of interventions targeting: subjective wellbeing; mental, behavioral and neurodevelopmental disorders; and suicide-related outcomes. Searches were conducted in 16 bibliographic databases and 22 websites between 1990 and 2022. This was supplemented by citation tracking, screening of relevant systematic reviews, and expert recommendation. We identified 35 interventions, with 44 evaluations via randomized controlled trials. Through meta-analyses, we found that interventions have a small beneficial impact on a variety of mental health outcomes in the short term (0-6 months). Interventions improved total social, emotional, and behavioral problems ( d  = -0.15, 95% CI [-0.28, -0.02]), social-emotional functioning difficulties ( d  = -0.18, 95% CI [-0.31, -0.05]), externalizing problem behaviors ( d  = -0.30, 95% CI [-0.53, -0.08]), internalizing problem behaviors ( d  = -0.35, 95% CI [-0.61, -0.08]); and depression and anxiety ( d  = -0.26, 95% CI [-0.40, -0.13]). Interventions did not demonstrate any effectiveness for outcomes assessed in the longer term (>6 months). Certainty of effectiveness was limited by risk of bias and imprecision. There was limited available evidence for interventions targeting subjective wellbeing and suicide-related outcomes. Future intervention design and delivery must ensure that programs are sufficient to activate causal mechanisms and facilitate change. Evaluation research should use a robust methodology.PROSPERO Registration: CRD42020177478., Competing Interests: Data availabilityExtracted data, analysis and syntheses are available from the corresponding author on reasonable request. Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: We tested if baseline disruptive child behavior problem severity predicts parental attendance at sessions of a parenting group program., Method: We used a database of randomized trials of the Incredible Years parenting program in Europe and restricted the sample to participants randomized to the intervention arm. Using baseline Eyberg Child Behavior Inventory scores, we distinguished between trial-level problem severity and child-level problem severity, compared linear and quadratic functional forms at both levels, and considered cross-level interactions, all in a multilevel Poisson regression framework., Results: Drawing on 918 participants in 12 trials, we found that within trials, parents of children with the least and most severe problems attended fewer sessions. Between trials, each additional 10-point increase in the Eyberg Child Behavior Inventory trial mean predicted an 11% increase in attendance. Models including child sex, age, or family low-income did not change coefficients or their interpretation., Conclusions: Our findings suggest that although generally attendance is higher in parents of children with more challenging behavior, it seems difficult for group programs to keep families with the least or most severe problems engaged. Our findings call for the need to better understand the conditions under which lower attendance translates into equivalent or lesser program benefits. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

This preliminary interrupted time series analysis evaluated different interventions to improve identification of victim-survivors of domestic abuse in one U.K. National Health Service trust, focusing on emergency department, sexual health services and HIV care, and obstetrics and gynecology. This analysis demonstrated that while system-level interventions can improve identification of domestic abuse in clinical contexts, the exact nature of interventions most likely to be effective may vary in different clinical contexts. For example, none of the modeled interventions generated significant impacts in emergency department contexts, and estimates were close to the null in all cases, but routine inquiry demonstrated effectiveness in sexual health services, while implementation generated improved effectiveness in the obstetrics and gynecology setting., (© 2024 Springer Publishing Company.)

Homicide is considered a crime against the state rather than the covictims, which impacts on criminal justice system (CJS) processes and can lead to secondary victimization. This review explores the experience of co-victims (i.e., family members) engaging with the CJS. Thirty studies met the inclusion criteria and were identified through searching six bibliographic databases (MEDLINE, HMIC, CINAHL, ASSIA, IBSS, and SSCI) and supplementary searches. Two reviewers conducted screening, data extraction, and quality appraisal. Thematic synthesis resulted in three themes: (a) information and meaningful inclusion, (b) who is the justice system for?, and (c) relating to victims as people. These themes highlight concerns regarding the marginalization of co-victims within the CJS and suggest ways to enhance processes to avoid further marginalizing and traumatizing co-victims., (© 2024 Springer Publishing Company.)

Background: Parental domestic violence and abuse (DVA), mental ill-health (MH), and substance misuse (SU) can have a negative impact on both parents and children. However, it remains unclear if and how parental DVA, MH, and SU cluster and the impacts this clustering might have. We examined how parental DVA, MH, and SU cluster during early childhood, the demographic/contextual profiles of these clusters, and how these clusters relate to child MH trajectories., Methods: We examined data from 15,377 families in the UK Millennium Cohort Study. We used: (1) latent class analysis to create groups differentially exposed to parental DVA, MH, and SU at age three; (2) latent growth curve modelling to create latent trajectories of child MH from ages 3-17; and (3) a case-weight approach to relate latent classes to child MH trajectories., Results: We identified three latent classes: high-frequency alcohol use (11.9%), elevated adversity (3.5%), and low-level adversity (84.6%). Children in the elevated adversity class had higher probabilities of being from low-socioeconomic backgrounds and having White, younger parents. Children exposed to elevated adversity displayed worse MH at age three (intercept = 2.274; p < 0.001) compared the low-level adversity (intercept = 2.228; p < 0.001) and high-frequency alcohol use class (intercept = 2.068; p < 0.001). However, latent growth factors (linear and quadratic terms) of child MH did not differ by latent class., Conclusions: Parental DVA, MH, and SU cluster during early childhood and this has a negative impact on children's MH at age three, leading to similar levels of poor MH across time. Intervening early to prevent the initial deterioration, using a syndemic-approach is essential., (© 2024. The Author(s).)

Background: The costs associated with healthcare are of critical importance to both decision-makers and users, given the limited resources allocated to the health sector. However, the available scientific evidence on healthcare costs in low- and middle-income countries, such as Peru, is scarce. In the Peruvian context, the health system is fragmented, and the private health insurance and its financing models have received less research attention. We aimed to analyse user cost-sharing and associated factors within the private healthcare system., Methods: Our study was cross-sectional, using open data from the Electronic Transaction Model of Standardized Billing Data-TEDEF-SUSALUD, between 2021-2022. Our unit of analysis is the user's medical bills. We considered the total amount of cost-sharing, proportion of total payments as cost-sharing, and cost-sharing as a proportion of minimum salaries. We use a multiple regression model to perform the analyses., Results: Our study included 5,286,556 health services provided to users of the private health insurance in Peru. We found a significant difference was observed in the cost-sharing for hospitalization-related services, with an average of 419.64 soles per day (95% CI: 413.44 to 425.85). Also, we identified that for hospitalization-related services per day is, on average, 0.41 (95% CI: 0.41 to 0.41) minimum salaries more expensive than outpatient care, although cost-sharing per day of hospitalization represent on average only 14% of the total amount submitted., Conclusions: Our study provides a detailed overview of cost-sharing in the private healthcare system in Peru and the factors associated with them. Policymakers can use the study's finding that higher cost-sharing for inpatient hospitalization compared to outpatient care in private insurance can create inequities in access to healthcare to design policies aimed at reducing these costs and promoting a more equitable and accessible healthcare system in Peru., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Bellido-Boza et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objectives: This study aims to review the National Institute of Health and Care Excellence (NICE) technology assessments to gain insights into the implementation of treatment effect (TE) waning, whereby the hazard or survival in an assessed technology converges to that of the comparator. This analysis aims to contribute to inform future guidance in this area., Methods: Technology appraisals published October 20, 2021 to September 20, 2023 were reviewed and data extracted on TE waning circumstances, methods, and rationale to compile a database based on 3 research questions: When are TE waning assumptions used? What methods are used? Why have the company/Evidence Assessment Group/committee preferred these methods?, Results: Both the evidence assessment group/company and the committee included TE waning assumptions in 28 appraisals. There was no pattern of waning assumptions between shorter (<20 years) and longer (>20 years) time horizons. The most prominent time point for applying waning assumptions was at 5 years, with 30 out of 59 (50.8%) of the methods applied used 5 years. Stopping rules were used in 21 out of 30 (70.1%) of the appraisals for which the committee included waning, and waning assumptions were used more in oncology. The most common reason given for including TE waning assumptions was precedent from prior appraisals., Conclusions: Considerable heterogeneity existed in both the methods used and justifications given for TE waning assumptions. This variability poses a risk of inconsistent decision making. Reliance on past appraisals emphasizes the necessity to advocate for evidence-driven approaches and underscores the demand for guidance on suitable methods for incorporating assumptions., Competing Interests: Author Disclosures Author disclosure forms can be accessed below in the Supplemental Material section. For the purpose of open access, the author has applied a Creative Commons Attribution (CC BY) license to any Author Accepted Manuscript version arising from this submission., (Copyright © 2024. Published by Elsevier Inc.)

Health Pathfinder is a multilevel system change intervention initiated to transform the health response to domestic violence and abuse in eight sites in England. The current study drew upon interviews with health professionals ( n  = 27) and victim-survivors ( n  = 20) to provide a realist account of how this intervention achieved its goals. Findings show that five change mechanisms explain why Health Pathfinder was effective as an ecological intervention: awareness, expertise, relationships, empowerment, and evidence. Positive progress in respect of each mechanism had meaningful impacts on victim-survivor experiences of enquiry, disclosure, and uptake of services and had the potential to meaningfully impact health inequities., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: In 2021, more than two-thirds of the world's children lived in a conflict-affected country. In 2022, 13 million Ukrainians were forced to flee their homes after Russia's full-scale invasion. Hope Groups are a 12-session psychosocial, mental health, and parenting support intervention designed to strengthen parents, caregivers, and children affected by war and crisis. The primary objective of this study is to evaluate the effectiveness of Hope Groups among Ukrainians affected by war, compared to a wait-list control group. This protocol describes a promising decentralized intervention delivery model and an innovative research design, which estimates the causal effect of Hope Groups while prioritizing prompt delivery of beneficial services to war-affected participants., Methods: This protocol describes a pragmatic cluster randomized controlled trial (RCT) among Ukrainians externally displaced, internally displaced within Ukraine, and living at home in war-affected areas. This study consists of 90 clusters with 4-7 participants per cluster, totaling approximately n = 450 participants. Intervention clusters will receive 12-session Hope Groups led by peer facilitators, and control clusters will be wait-listed to receive the intervention after the RCT concludes. Clusters will be matched on the facilitator performing recruitment and intervention delivery. Primary outcomes are caregiver mental health, violence against children, and positive parenting practices. Secondary outcomes include prevention of violence against women and caregiver and child well-being. Outcomes will be based on caregiver report and collected at baseline and endline (1-week post-intervention). Follow-up data will be collected among the intervention group at 6-8 weeks post-intervention, with aims for quasi-experimental follow-ups after 6 and 12 months, pending war circumstances and funding. Analyses will utilize matching techniques, Bayesian interim analyses, and multi-level modeling to estimate the causal effect of Hope Groups in comparison to wait-list controls., Discussion: This study is the first known randomized trial of a psychosocial, mental health, and parenting intervention among Ukrainians affected by war. If results demonstrate effectiveness, Hope Groups hold the potential to be adapted and scaled to other populations affected by war and crisis worldwide. Additionally, methodologies described in this protocol could be utilized in crisis-setting research to simultaneously prioritize the estimation of causal effects and prompt delivery of beneficial interventions to crisis-affected populations., Trial Registration: This trial was registered on Open Science Framework on November 9, 2023., Registration: OSF.IO/UVJ67 ., (© 2024. The Author(s).)