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Objective: To systematically review research analyzing the effectiveness of decision aids for end-of-life care, including how researchers specifically measure decision aid success. Methods: We conducted a systematic review synthesizing quantitative, qualitative, and mixed-methods study results using Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Four databases were searched through February 18, 2023. Inclusion criteria required articles to evaluate end-of-life care decision aids. The review is registered under PROSPERO (#CRD42023408449). Results: A total of 715 articles were initially identified, with 43 meeting the inclusion criteria. Outcome measures identified included decisional conflict, less aggressive care desired, knowledge improvements, communication improvements, tool satisfaction, patient anxiety and well-being, and less aggressive care action completed. The majority of studies reported positive outcomes especially when the decision aid development included International Patient Decision Aid Standards. Conclusion: Research examining end of life care decision aid use consistently reports positive outcomes. Innovation: This review presents data that can guide the next generation of decision aids for end-of-life care, namely using the International Patient Decision Aid Standards in developing tools and showing which tools are effective for helping to prevent the unnecessary suffering that can result when patients' dying preferences are unknown.

Background There is limited evidence on how to engage health workers as advocates in preventing female genital mutilation (FGM). This study assesses the feasibility, acceptability, appropriateness and impact of a person-centered communication (PCC) approach for FGM prevention among antenatal care (ANC) providers in Guinea, Kenya and Somalia.Methods Between August 2020 and September 2021, a cluster randomised trial was conducted in 180 ANC clinics in three countries testing an intervention on PCC for FGM prevention. A process evaluation was embedded, comprising in-depth interviews (IDIs) with 18 ANC providers and 18 ANC clients. A qualitative thematic analysis was conducted, guided by themes identified a priori and/or that emerged from the data.Results ANC providers and clients agreed that the ANC context was a feasible, acceptable and appropriate entry point for FGM prevention counselling. ANC clients were satisfied with how FGM-related information was communicated by providers and viewed them as trusted and effective communicators. Respondents suggested training reinforcement, targeting other cadres of health workers and applying this approach at different service delivery points in health facilities and in the community to increase sustainability and impact.Conclusion These findings can inform the scale up this FGM prevention approach in high prevalence countries.

The Home Office Windrush Scandal of 2018 has had major implications for the wellbeing of survivors and is thought to have affected more than 15,000 individuals. The Government led compensation scheme to provide retribution to those impacted has been consistently argued as insufficient, in part linked to under appreciation of mental health consequences of the scandal. However, there is limited evidence which documents the nature of mental health issues that survivors and families have faced. This need for further evidence intersects with the need to protect a highly vulnerable community from further traumatisation. Our study contributes to this gap through a content analysis of survivor testimonies (n = 96) published in publicly available media sources between 2017 and 2023. Analysis explored social pathways to the development of mental distress and experiences of potential mental health consequences. Our analysis was informed by a complex trauma and complex racial trauma framework. Findings demonstrate that the scandal disrupted numerous social domains linked to livelihoods and positive wellbeing, driving survivors into homelessness, and experiences of dehumanization within state systems. This shaped survivors’ experiences of emotional distress, resulting in symptoms linked to depression, chronic stress, and anxiety disorders. Our work illuminates new details about the nature of trauma faced by survivors. Findings suggest the need for systems that provide targeted mental health supports that also address social disruption, to fully respond to the harms created by the scandal.

Much SDT research in the language learning domain focuses on the learning of English as a second or foreign language, in many cases by undergraduate students. By contrast, our work focuses on adolescent learners (aged between 11 and 16) of what are termed Modern Foreign Languages--languages other than English--in schools in England. In this context, school-level policy means that language learning is often optional for students beyond the age of 14, and this optionality makes motivation critical. In this article, we suggest that Self-Determination Theory provides a suitable framework for measuring the motivation of such students and compare it with the well-known Second Language Motivation SelfSystem (L2MSS) developed by Dörnyei. We draw on data from two large-scale studies of school students in England (N[subscript 1] = 666; N[subscript 2] = 1797), the first to use the Self-Regulation Questionnaire (Academic) in this context, and a smaller pilot study (N = 338), similarly the first to use the L2MSS in this context, and argue that SDT provides a more useful lens for studying motivation in English schools. As the L2MSS relies heavily on the learner's Ideal Self, a version of themselves who can communicate competently in the target language, we argue that it is not suitable for use with learners in this context, although there is scope to incorporate some elements of it. SDT's lack of focus on the target language community, which is not always within reach for students, allows it to better access students' motivation for study. We consider the implications for future studies of student motivation in an English context, as well as other Anglophone settings.

ObjectivesTo examine how sales of sexual and reproductive health (SRH) products varied among pharmacies in Kenya using administrative data, leveraging natural variation in the COVID-19 pandemic and accompanying policy restrictions between 2019 and 2021.Design and settingEcological study of pharmacies in Kenya.Participants761 pharmacies using the Maisha Meds product inventory management system (capturing 572 916 products sold).OutcomesSales quantity, price and revenue of SRH products sold per pharmacy per week.ResultsCOVID-19 deaths were associated with a -2.97% (95% CI -3.82%, -2.11%) decrease in sales quantity, a 1.09% (95% CI 0.44%, 1.72%) increase in sales price and a -1.89% (-1.00%, -2.79%) decrease in revenues per pharmacy per week. Results were similar when considering new COVID-19 cases (per 1000) and the Average Policy Stringency Index. Results differed substantially between individual SRH products-a large decrease in sales quantity in pregnancy tests, injectables and emergency contraception, a modest decrease in condoms and no change in oral contraception. Sales price increases were similarly varied; four of the five most sold products were revenue neutral.ConclusionsWe found a robust negative association between SRH sales at pharmacies in Kenya and COVID-19 reported cases, deaths and policy restriction. Although our data cannot definitively point to reduced access, existing evidence from Kenya regarding unchanged fertility intentions, increases in unintended pregnancies and reported reasons for non-use of contraceptives during COVID-19 suggests a prominent role of reduced access. While policymakers may have a role in sustaining access, their role may be limited by broader macroeconomic problems, such as global supply chain disruptions and inflation, during supply shocks.

The aim of this study is to profile academic institutions (n = 127) based on publications, citations in the top 10% of journals, patent citations in Food and Drug Administration (FDA) approvals, clinical trials with uploaded results, contributions to clinical practice guidelines, awarded patents, start-ups, and licenses generating income in response to the Association of University Technology Managers (AUTM) Licensing Activity Survey: Fiscal Years 2011-2015. Latent variable modeling (LVM) was conducted in Mplus v.8.1, specifically latent profile analysis (LPA) was utilized to predict institutional profiles of research, which were compared with the 2015 Carnegie Classification System ranks. Multivariate regression of profile assignment on research expenditure and income generated by licensure was used to show concurrent validity. The LPA resulted in three profiles as the most parsimonious model. Mantel-Haenszel test of trend to the Carnegie Classification found a positive and significant association among institution rankings (r = 0.492, X[superscript 2](1) = 26.69, p < 0.001). Profile assignment significantly predicted differences in research expenditure and income generated by licensure. By classifying academic institutions into improving, mobilizing and thriving translational research profiles allows for a universal metric of translation of science from basic or bench to practice or policy.

Background: The worldwide COVID-19 government restrictions imposed on young people to limit virus spread have precipitated a growing and long-term educational and health crisis. Contributions to the Theory: This novel study used Sen's Capabilities Approach as a theoretical framework to examine the current health and educational impacts of COVID-19 on youth, referencing emerging literature. The objective was to inform the design of an internationally relevant framework for school health promotion to support young people through and after the COVID-19 pandemic. Mapping of existing health resources, internal/external conversion factors and capabilities were used to identify classroom, school and system level strategies that will enable young people to flourish. Four central enablers were identified and used in the design of the International Framework for School Health Promotion (IFSHP). Implications for School Health Policy, Practice, and Equity: The IFSHP can be used by educational institutions, school leaders and teachers to innovate existing health promotion programs, policies and practices to support young people through and after the COVID-19 pandemic. Conclusions: School systems, schools and teachers are encouraged to utilize the IFSHP to review and innovate existing school health programs to ensure they meet the increased physical and mental health needs of young people.