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Abstract Background Employment provides economic security, a social network, and is important for self-identity. A review published by van der Noordt and colleagues in 2014 showed that employment was beneficial for depression and general mental health. However, an updated synthesis including research published in the last decade is lacking. In the planned review, we aim to update, critically assess, and synthesise the current evidence of the association between paid employment (excluding precarious employment) and common mental health outcomes (depression, anxiety, and psychological distress) among the working age population in the labour force. Methods We will follow recommended guidelines for conducting and reporting systematic reviews. Four electronic databases (MEDLINE, Embase, APA PsycINFO, and Web of Science) will be searched from 2012, using appropriate MeSH terms and text words related to our inclusion criteria. We will screen the records against predefined eligibility criteria, first by title and abstract using the priority screening function in EPPI-Reviewer, before proceeding to full-text screening. Only studies investigating the longitudinal relationship between employment and common mental health outcomes will be included. We will search for grey literature in OpenAlex and conduct backward and forward citation searches of included studies. The methodological quality of the included studies will be assessed using the Cochrane risk-of-bias tool (RoB 2), Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I), or the Newcastle–Ottawa scale (NOS). We will conduct a narrative review and, if possible following pre-set criteria, conduct random-effects meta-analyses to estimate the pooled effect of employment on depression, anxiety, and psychological distress, across the included studies. Discussion An updated review of the association between non-precarious employment and mental health outcomes is needed. In the planned review, we will assess the quality of the included studies and synthesise the results across studies to make them easily accessible to policy makers and researchers. The results from the review can be used to aid in policy decisions and guide future research priorities. Systematic review registration PROSPERO CRD42023405919.

Highlights Machine learning (ML) tools for evidence synthesis now exist, but little is known about whether they lead to decreased resource use and time-to-completion of reviews. We propose a protocol to systematically measure any resource savings of using machine learning to produce evidence syntheses. Co-primary analyses will compare “recommended” ML use (in which ML replaces some human activities) and no ML use. We will additionally explore the differences between “recommended” ML use and “non-recommended” ML use (in which ML is over-used or under-used).

Abstract Background Although the life expectancy of people living with HIV has increased, they are still often disconnected from society through stigma and discrimination. Peer support has been found to increase social support. Given the limited research on peer support from the providers’ perspective, this study explored how peer supporters experience their roles and contributions in outpatient clinics (OPCs). Additionally, healthcare professionals’ perceptions of working with peer supporters in OPCs were examined. Methods This qualitative study included purposively selected peer supporters (n = 10) and healthcare professionals (n = 5) from five OPCs in Norway in 2020. In-depth interviews and focus group discussions were conducted in Norwegian or English, using interview guides. Interview transcripts were analysed in NVivo 12 using reflexive and collaborative thematic analysis. Results The results show that peer supporters experience mutual support through emotional and honest interactions. Further, the peer supporters found it essential to negotiate with the service users about their preconception of HIV, confront their views through dialogue, and replicate positive experiences by being credible role models. The participants expressed that integrating peer support in the OPCs’ usual care processes increased the prospect of equitable services. Quality of peer support and role clarity were identified as critical components. The results demonstrate that emotional and honest conversations promote support between peers and that peer supporters identify a need for a reframed understanding of HIV by modelling plausible alternative interpretations and coping experiences. Conclusions This study contributes to knowledge on how peer support can meet the needs of people living with HIV. Incorporating people living with HIV in the co-production and distribution of healthcare services may improve the knowledge and perspectives in healthcare services. However, the skill standards of peer supporters should be addressed when implementing peer support in usual care.

Abstract Background Long-term sick leave is a serious concern in developed countries and the cost of sickness absence and disability benefits cause major challenges for both the individual and society as a whole. Despite an increasing body of research reported by existing systematic reviews, there is uncertainty regarding the effect on return to work of workrelated interventions for workers with different diagnoses. The objective of this systematic review was to assess and summarize available research about the effects of work-related interventions for people on long-term sick leave and those at risk of long-term sick leave. Methods We conducted a systematic review in accordance with international guidelines. Campbell Collaboration (Area: Social Welfare), Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Embase, Epistemonikos, MEDLINE, PsycINFO, Scopus, and Sociological Abstracts were systematically searched in March 2021. Two authors independently screened the studies. We conducted risk of bias assessments and meta-analyses of the available evidence in randomized controlled trials (RCTs). The remaining comparisons were synthesized narratively. The certainty of evidence for each outcome was assessed. Results We included 20 RCTs comprising 5753 participants at baseline from 4 different countries. The studies had generally low risk of bias. Our certainty in the effect estimates ranged from very low to moderate. Eight different interventions were identified. Meta-analysis revealed no statistically significant difference between multidisciplinary rehabilitation (MR) and usual care (US) (Risk Ratio [RR] 1.01; Confidence Interval [CI] 95% 0.70-1.48 at 12 months follow-up) and between MR and other active intervention (Risk Ratio [RR] 1.04; Confidence Interval [CI] 95% 0.86-1.25 at 12 months follow-up). Remaining intervention groups revealed marginal, or no effect compared to the control group. The results for the secondary outcomes (self-efficacy, symptom reduction, function, cost-effectiveness) showed varied and small effects in the intervention groups. Conclusion Overall, the present data showed no conclusive evidence of which work-related intervention is most effective for return to work. However, a handful of potential interventions exist, that may contribute to a foundation for future research. Our findings support the need for adequately powered and methodologically strong studies.

Abstract Purpose To identify instruments used to measure parents’ Quality of Life (QoL) during pregnancy and the postpartum period, and to describe their characteristics and psychometric properties. Methods For this scoping review we conducted systematic literature searches in MEDLINE, EMBASE, PsychINFO, CINAHL and HaPI in mid-December 2020, to identify studies evaluating psychometric properties. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) were used to define and categorize psychometric properties. Two reviewers screened the studies independently, and customized screening questions were used to assess eligibility against inclusion criteria. Data were systematically extracted into a predesigned data charting matrix, and descriptively analyzed. Results The searches identified 5671 studies, of which 53 studies met the inclusion criteria. In total, there were 19 QoL instruments: 12 generic and seven period specific. The most reported instruments were SF-36, SF-12 and WHOQOL-BREF, and the most evaluated instruments were SF-12, WHOQOL-BREF, QOL-GRAV, and PQOL. We found that none of the identified instruments had been evaluated for all nine psychometric properties recommended by the COSMIN. The most reported psychometric properties were internal consistency and structural validity. The instruments were primarily assessed in parents residing in Asia (50%), and 83% of the studies were conducted from 2010 to 2020. Only three studies included psychometric measures assessed on fathers. Conclusion Our review shows there is extensive evidence on the internal consistency and structural validity of QoL instruments used on parents during pregnancy and the postpartum period, but that the evidence on other psychometric properties is sparse. Validation studies and primary studies are needed to provide evidence on the reliability, validity, responsiveness, and interpretability of QoL instruments for this target group, in particular for fathers and partners.

Abstract Background Although human immunodeficiency virus (HIV) has become a manageable condition with increasing life expectancy, people living with HIV (PLHIV) are still often isolated from society due to stigma and discrimination. Peer support provides one avenue for increased social support. Given the limited research on peer support from the perspective of PLHIV, this study explored their experiences of peer support organised by healthcare professionals in an outpatient clinical setting. Methods The study used a qualitative, descriptive research design for an in-depth understanding of peer support provided to PLHIV in the context of outpatient clinics. Healthcare professionals contributed to the recruitment of 16 participants. We conducted in-depth interviews about participants’ experiences of peer support, and performed a directed content analysis of the data. Further, we sorted the data into pre-determined categories. Results The pre-determined categories constituted attachment, social integration, an opportunity for nurturance, reassurance of worth, reliable alliance, and guidance. The identified themes were: gained emotional support, disclosure behaviour allowed garnering of emotional support, non-disclosure promoted the need to meet a peer, experienced a sense of belonging, activated an opportunity for mutual support, means to re-establish belief in one’s own worth, perceived a positive affirmation of disease management, facilitated dialogue about disease management, the outpatient clinic as a safe place, and a setting for flexible, individualised support. Conclusions This study highlights the peer support experiences of PLHIV in the context of outpatient clinics. The participants’ experiences align with previous findings, showing that peer support contributes to mutual emotional support between peers. This is particularly important in cultures of non-disclosure where PLHIV experience intersectional stigma. Additionally, our results show outpatient clinics to be supportive surroundings for facilitating peer support, ensuring confidentiality in peer support outreach. Therefore, peer support contributes positively to individualising outpatient clinic services to meet the changing needs of PLHIV.

Abstract Background Little research exists on the effectiveness of motivational interviewing (MI) on return to work (RTW) in workers on long term sick leave. The objectives of this study protocol is to describe a randomized controlled trial (RCT) with the objectives to compare the effectiveness and cost-effectiveness of usual case management alone with usual case management plus MI or usual case management plus stratified vocational advice intervention (SVAI), on RTW among people on sick leave due to musculoskeletal (MSK) disorders. Methods A multi-arm RCT with economic evaluation will be conducted in Norway with recruitment of 450 participants aged 18–67 years on 50–100% sick leave for > 7 weeks due to MSK disorders. Participants will be randomized to either usual case management by the Norwegian Labour and Welfare Administration (NAV) alone, usual case management by NAV plus MI, or usual case management by NAV plus SVAI. Trained caseworkers in NAV will give two MI sessions, and physiotherapists will give 1–4 SVAI sessions depending upon risk of long-term sick leave. The primary outcome is the number of sick leave days from randomization to 6 months follow-up. Secondary outcomes are number of sick leave days at 12 months follow-up, time until sustainable RTW (≥4 weeks of at least 50% of their usual working hours) at 12 months, proportions of participants receiving sick leave benefits during 12 months of follow-up, and MSK symptoms influencing health at 12 months. Cost-utility evaluated by the EuroQoL 5D-5L and cost-benefit analyses will be performed. Fidelity of the interventions will be assessed through audio-recordings of approximately 10% of the intervention sessions. Discussion The results from this RCT will inform stakeholders involved in supporting RTW due to MSK disorders such as staff within NAV and primary health care. Trial registration ClinicalTrials.gov ID: NCT03871712 registered March 12th 2020.

Abstract Background In Europe, the highest proportion of HIV diagnoses are in gay men and other men who have sex with men (MSM). Globally, HIV prevalence is particularly high among males who report selling sex, but rates among men who buy sex from other men are less clear. This study analyzed the association of transactional sex (TS) and HIV diagnosis, sexually transmitted infection (STI) diagnoses, and various drug use; and examined the variations in TS by payment direction. Methods We conducted a cross-sectional, non-randomized, observational study. This European MSM Internet Survey recruited MSM from 38 European countries. For descriptive purposes we stratified according to TS behavior (frequently selling sex, frequently buying sex, neither frequently selling nor buying sex in the previous 12 months), and we constructed separate multivariable logistic regression models to investigate whether engaging in TS accounted for some of the HIV- and STI diagnoses and drug use in this population. Results Of almost 161,000 sexually active MSM, 12.2% engaged in TS. The multivariable logistic regression results showed that relative to not frequently engaging in TS, frequently selling sex was independently associated with a higher odds of reporting diagnosed HIV (ever, adjusted odds ratio [aOR] 1.60, confidence interval [CI] 95% 1.39 to 1.85), bacterial STIs (past 12 months, aOR 1.75 CI 95% 1.54 to 2.00), using heroin or crack cocaine or injecting drugs (aOR 3.17, CI 95% 2.70 to 3.73), and using benzodiazepines (aOR 2.13, CI 95% 1.88 to 2.41). Compared to men not engaging in frequent TS, frequently buying sex was associated with a higher odds of using benzodiazepines (aOR 2.13, CI 95% 1.88 to 2.41). Conclusions MSM who frequently sell sex suffer greater sexual- and substance use risks than other MSM, but both men who frequently sell and those who buy sex are more likely to use benzodiazepines. MSM who sell sex to other men constitute an important at-risk population who must be offered targeted health services.

Abstract Background Pubic hair grooming, including the complete removal of pubic hair, has become an increasingly common practice, particularly among young women. Although widespread, there is limited data regarding the methods, products, reasons, and complications of pubic hair removal, particularly among Saudi women. The objective was to examine pubic hair removal practices and the prevalence of its complications among Saudi women living in Jeddah, Saudi Arabia. Methods In this cross-sectional study conducted at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, Saudi women between 16 and 60 years of age who had the ability to read and speak Arabic, were eligible to complete an anonymous and self-administered survey on pubic hair removal practices and its complications. Results Between December 2015 and September 2016, 400 Saudi women completed the survey. The age was 26.3 ± 6.9, 16–58 (mean ± SD, range) years. About three quarters (77.0%) self-removed their pubic hair, while the remainder made use of professional personnel in medical clinics (15.5%), beauty salons (5.3%), and professional services at home (2.2%). Many women (41.8%) used a combination of hair removal methods, with non-electric razor as the most common single method used (33.5%), followed by laser (8.7%), sugaring (6.0%), waxing (4.5%), trimming (2.0%), electric razor (2.0%), and cream (1.5%). Three-quarters of women (75.5%) reported complications, and although they were mostly minor injuries, treatment had to be sought for 17.9% of complications. Multivariable analyses showed that no variables remained correlated with the occurrence of complications (age of starting hair removal, income, BMI, level of education, mode of removal, advice on removal). Conclusions Saudi women initiate pubic hair removal in early adolescence. While most complications are minor, close to one in five women experience complications.

Abstract Background The GRADE-CERQual (Confidence in Evidence from Reviews of Qualitative research) approach has been developed by the GRADE (Grading of Recommendations Assessment, Development and Evaluation) Working Group. The approach has been developed to support the use of findings from qualitative evidence syntheses in decision-making, including guideline development and policy formulation. CERQual includes four components for assessing how much confidence to place in findings from reviews of qualitative research (also referred to as qualitative evidence syntheses): (1) methodological limitations, (2) coherence, (3) adequacy of data and (4) relevance. This paper is part of a series providing guidance on how to apply CERQual and focuses on a probable fifth component, dissemination bias. Given its exploratory nature, we are not yet able to provide guidance on applying this potential component of the CERQual approach. Instead, we focus on how dissemination bias might be conceptualised in the context of qualitative research and the potential impact dissemination bias might have on an overall assessment of confidence in a review finding. We also set out a proposed research agenda in this area. Methods We developed this paper by gathering feedback from relevant research communities, searching MEDLINE and Web of Science to identify and characterise the existing literature discussing or assessing dissemination bias in qualitative research and its wider implications, developing consensus through project group meetings, and conducting an online survey of the extent, awareness and perceptions of dissemination bias in qualitative research. Results We have defined dissemination bias in qualitative research as a systematic distortion of the phenomenon of interest due to selective dissemination of studies or individual study findings. Dissemination bias is important for qualitative evidence syntheses as the selective dissemination of qualitative studies and/or study findings may distort our understanding of the phenomena that these syntheses aim to explore and thereby undermine our confidence in these findings. Dissemination bias has been extensively examined in the context of randomised controlled trials and systematic reviews of such studies. The effects of potential dissemination bias are formally considered, as publication bias, within the GRADE approach. However, the issue has received almost no attention in the context of qualitative research. Because of very limited understanding of dissemination bias and its potential impact on review findings in the context of qualitative evidence syntheses, this component is currently not included in the GRADE-CERQual approach. Conclusions Further research is needed to establish the extent and impacts of dissemination bias in qualitative research and the extent to which dissemination bias needs to be taken into account when we assess how much confidence we have in findings from qualitative evidence syntheses.