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Data availability: No data was used for the research described in the article. Short Communication Copyright © 2023 The Authors. Flame retardants are chemical substances that are intended to mitigate fire safety risks posed by a range of goods including furniture, electronics, and building insulation. There are growing concerns about their effectiveness in ensuring fire safety and the potential harms they pose to human health and the environment. In response to these concerns, on 13 June 2022, a roundtable of experts was convened by the UKRI Six Clean Air Strategic Priorities Fund programme 7. The meeting produced a Consensus Statement that summarises the issues around the use of flame retardants, laying out a series of policy recommendations that should lead to more effective fire safety measures and reduce the human and environmental health risks posed by these potentially toxic chemicals.

The Cochrane Qualitative and Implementation Methods Group develops and publishes guidance on the synthesis of qualitative and mixed-method evidence from process evaluations. Despite a proliferation of methods for the synthesis of qualitative research, less attention has focused on how to integrate these syntheses within intervention effectiveness reviews. In this article, we report updated guidance from the group on approaches, methods, and tools, which can be used to integrate the findings from quantitative studies evaluating intervention effectiveness with those from qualitative studies and process evaluations. We draw on conceptual analyses of mixed methods systematic review designs and the range of methods and tools that have been used in published reviews that have successfully integrated different types of evidence. We outline five key methods and tools as devices for integration which vary in terms of the levels at which integration takes place; the specialist skills and expertise required within the review team; and their appropriateness in the context of limited evidence. In situations where the requirement is the integration of qualitative and process evidence within intervention effectiveness reviews, we recommend the use of a sequential approach. Here, evidence from each tradition is synthesized separately using methods consistent with each tradition before integration takes place using a common framework. Reviews which integrate qualitative and process evaluation evidence alongside quantitative evidence on intervention effectiveness in a systematic way are rare. This guidance aims to support review teams to achieve integration and we encourage further development through reflection and formal testing. Refereed/Peer-reviewed

Background Conservation activities and natural resource management interventions have often aimed to tackle the dual challenge of improving nature conservation and human well-being. However, there is concern over the extent to which this dual goal has been achieved, and an increasing recognition of trade-offs and synergies within and between aspects of each of the goals. The amount and scope of the available evidence on the success of conservation and management interventions in both arenas has lacked documentation, for a number of reasons, including limited resources for monitoring and evaluation and the difficulty in bringing together a disparate evidence base. This systematic map focuses on the interaction between marine conservation management and the health and well-being of coastal communities in South East Asia. Method We searched bibliographic databases to find published literature, and identified grey literature through institutional and organisational website searches and key stakeholders. Eligibility criteria were applied in two stages, title and abstract and full text, with consistency checks. We extracted meta-data on the design and characteristics of each study, from which we produced an interactive database and map, and a narrative summary. Results We assessed 42,894 records at title and abstract from the main searches. 1,331 articles were assessed at full text (30 articles were not retrievable). 287 articles (281 studies) were included in the systematic map. Most studies were peer-reviewed publications (90%), and from the Philippines and Indonesia (72%). 31% of studies were solely qualitative, 45% were solely quantitative and 24% included both qualitative and quantitative research. Only 24% (31/127) of quantitative studies included a comparator. We identified knowledge clusters where studies investigated the links between the marine conservation interventions: Site Protection, Economic or Livelihood Incentives or Alternatives, or Habitat Management, and the human health and well-being outcomes: Economic Living Standards, Governance and Empowerment, or Social Relations. In addition, qualitative research clusters were identified exploring the links between the intervention Habitat Management, and the outcome Governance and Empowerment, and between the intervention Economic or Livelihood Incentives or Alternatives, and the outcomes of Governance and Empowerment, and Social Relations. We identified major knowledge gaps in evidence for the effect of marine conservation interventions on the outcomes Freedom of Choice and Action, Security and Safety, Subjective Well-being, Health, and Culture and Spirituality. There was a lack of studies involving Education, Awareness and Activism interventions that reported any human health and well-being outcomes. Conclusion We present the first updatable, interrogable and comprehensive evidence map on this topic for South East Asia. Our work supports further, detailed investigation of knowledge clusters using systematic review and also serves to identify understudied topic areas. The lack of comparative, quantitative studies suggests that future research should include counterfactuals to strengthen the robustness of evidence base. Users of this systematic map should recognise that much evidence may be national or locally specific, and that we did not undertake an assessment of study quality. Thus, when considering implications for policy and decision-making, users should carefully consider the heterogeneity of available evidence and refer to original research articles to gain a full depth of understanding and context.

Objective To examine the impact of gardens and outdoor spaces on the mental and physical well-being of people with dementia who are resident in care homes and understand the views of people with dementia, their carers, and care home staff on the value of gardens and outdoor spaces. Design Systematic review. Methods Fourteen databases were searched from inception to February 2013. Forward and backward citation chasing of included articles was conducted; 38 relevant organizations were contacted to identify unpublished reports. Titles, abstracts, and full texts were screened independently by 2 reviewers in a 2-stage process and were discussed with a third reviewer where necessary. Results were synthesized narratively. Results Seventeen studies were included: 9 quantitative, 7 qualitative, and 1 mixed methods. The quantitative studies were of poor quality but suggested decreased levels of agitation were associated with garden use. The views and experiences of the garden are discussed in relation to themes of how the garden was used, nature of interactions, impact/effect of the gardens, mechanisms/how the garden was thought to have an effect, and negatives (such as perception of the garden as a hazard and the limited staff time). Conclusion There are promising impacts on levels of agitation in care home residents with dementia who spend time in a garden. Future research would benefit from a focus on key outcomes measured in comparable ways with a separate focus on what lies behind limited accessibility to gardens within the residential care setting.

Objective To assess the cost-effectiveness of surveillance of Barrett's oesophagus. Design Cost-utility model. Setting UK NHS. Patients One thousand 55-year-old men with Barrett's oesophagus. Intervention Surveillance programme : endoscopy and biopsy at 3 yearly intervals for non-dysplastic Barrett's oesophagus; low-grade dysplasia yearly; high grade-dysplasia 3 monthly. Outcome measures Incremental cost-effectiveness ratio, expected value of perfect information. Results Non-surveillance dominated surveillance (i.e. cost less and conferred more benefit), but there was substantial uncertainty around many of the model inputs. Probabilistic analyses showed that non-surveillance cost less and conferred more benefit in 75% of model runs. Surveillance was cost-effective at usual levels of willingness to pay in 11% of runs. For people with Barrett's oesophagus in England and Wales, a value of £6.5 million is placed on acquiring perfect information about surveillance of Barrett's oesophagus. Conclusions The PenTAG cost-utility model suggests that surveillance programmes do more harm than good.

Background In social prescribing, people are referred by primary-care professionals to non-medical, community-based activities. The transfer between primary care and the community-based provider can be difficult, with low uptake and poor engagement with and adherence to interventions. There is an ambition to increase the use of social prescribing in the UK health service; however, to achieve this ambition the process of referral and retention needs improving. This study aimed to increase our understanding of what works and why in the social prescribing process and to apply this knowledge in primary-care settings where the use of the approach is being developed. Methods In a realist review of literature considering the process of social prescribing, bibliographic and grey literature searches were used to locate evidence. The relevance of the evidence was assessed and then used to develop theory. Findings were contextualised through focus groups in the partner primary-care setting. Findings Bibliographic and grey literature searches identified a total of 253 primary sources, and data were fully extracted from the most conceptually rich (n=109). Overarching programme theory integrating 40 active elements of the social prescribing process was developed through synthesis of the primary literature. This list was then refined through expert prioritisation leading to targeted searches conducted on key elements of the process relating to enrolment in, engagement with, and adherence to social prescribing. Key contexts and mechanisms contributing to successful uptake and enrolment included patient beliefs about suitable treatment options, presentation of the intervention and social prescribing process, accessibility of social prescribing (physically and psychologically), and supported uptake (eg, a link worker). Skilful and flexible intervention leadership and a change in the patient's condition were key contexts or mechanisms in maintaining adherence. Interpretation Use of a realist approach, with findings iteratively refined and applied in a primary-care setting, has facilitated a better understanding of what works in the social prescribing process. However, despite increasing interest in the approach, there is a paucity of information in the current evidence base about how social prescribing interventions are developed, offered, and delivered. Therefore, future social prescribing interventions should integrate process evaluations. Funding Part funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula at the Royal Devon and Exeter NHS Foundation Trust.

Background Actions taken to enhance and conserve the outdoor environment offer opportunities to improve the health and wellbeing of people taking part in those activities and of those who are exposed to the improved environments. Both health and environmental organisations have used conservation activities as health promotion interventions; however evidence of effect is disparate, dispersed, and limited and therefore requires novel approaches to evidence synthesis. Our aim was to systematically review the evidence and then build on the results to consider if, how, for whom, and in what contexts environmental conservation activities are beneficial to those taking part. Methods After a theory-driven, mixed-method systematic review, a conceptual model was derived from the results of the primary synthesis to illustrate mechanisms of change and the role of mediators, moderators, and feedback loops that might have led to or influenced health gain. Because of the nature of the primary evidence the plausibility of key pathways was then assessed through the identification and application of further high level evidence. Since the evidence was highly dispersed, a multistage extended search strategy of academic and grey literature was used. 27 databases spanning health, social, and geographical sciences were searched for studies published in English between Jan 1, 1990, and Oct 1, 2012. 13 quantitative and 13 qualitative studies were identified. Findings Although the results were largely inconclusive there was some evidence of positive effects in six of the quantitative studies to physiological, mental, and emotional health outcomes. The qualitative evidence suggested that positive experiences contribute to quality of life, particularly for marginalised groups. The benefits of these complex interventions operate through complex pathways and might differ between individual participants. The potential mechanisms, through which positive health and wellbeing benefits can occur, such as reducing social isolation and increasing levels of physical activity, are well supported by existing high level research. Interpretation Conservation activities can offer a win-win situation, with potential to improve both the environment and health and wellbeing through one delivery mechanism. Although the extended review process maximised the available evidence, further robust research is needed. Funding This research and the original systematic review were funded by the National Institute for Health Research School for Public Health Research (NIHR SPHR). The European Centre for Environment and Human Health (part of the University of Exeter Medical School) is part financed by the European Regional Development Fund Programme 2007 to 2013 and European Social Fund Convergence Programme for Cornwall and the Isles of Scilly.