Search

Introduction: The aim of this project was to systematically review UK evidence on the effectiveness of long‐term (≥12 months) weight management services (WMSs) for weight loss and weight maintenance for adults (≥16 years) with severe obesity (body mass index ≥35 kg m−2), who would generally be eligible for Tier 3 services. Methods: Four data sources were searched from 1999 to October 2018. Results: Our searches identified 20 studies, mostly noncomparative studies: 10 primary care interventions, nine in secondary care specialist weight management clinics and one commercial setting intervention. A programme including a phase of low energy formula diet (810–833 kcal day−1) showed the largest mean (SD) weight change at 12 months of –12.4 (11.4) kg for complete cases, with 25.3% dropout. Limitations or differences in evaluation and reporting (particularly for denominators), unclear dropout rates, and differences between participant groups in terms of comorbidities and psychological characteristics, made comparisons between WMSs and inferences challenging. Conclusions: There is a persistent and clear need for guidance on long‐term weight data collection and reporting methods to allow comparisons across studies and services for participants with severe obesity. Data could also include quality of life, clinical outcomes, adverse events, costs and economic outcomes. A randomised trial comparison of National Health Service Tier 3 services with commercial WMSs would be of value. [ABSTRACT FROM AUTHOR]

We systematically assessed evidence of overweight and obesity prevalence, and possible determinants, in people who experience incarceration globally. We searched Embase, Medline, and Cochrane databases. Overweight and obesity proportions were pooled into a meta-analysis and compared with national prevalences. Seventy-one studies met the inclusion criteria; 38 were included in the meta-analysis. Studies in high-income countries reported higher proportions of overweight and obesity (73.3%, 95% CI 73.1, 73.5) than upper-middle-income countries (66.1%, 95% CI 64.1, 67.7) and lower-middle-income countries (52.8%, 95% CI 47.1, 58.1). The prevalence of overweight and obesity in female incarcerated individuals was higher than that in the general population (RD 11.7%, 95% CI 9.1, 14.3), especially in low and middle-income countries (RD 35.1%, 95% CI 29.4, 40.7). The prevalence of overweight and obesity in male incarcerated individuals was lower than that in the general population in all income categories (RD -10.8%, 95% CI -13.2, -8.4). Incarcerated individuals in low and lower-middle-income countries were less likely to achieve sufficient energy intake, fruit/vegetable intake, and sufficient physical activity, compared with high- and upper-middle-income countries. The prevalence of overweight and obesity in incarcerated populations differed between developed and developing countries. Future research should focus on female incarcerated individuals, especially in lower-middle-income countries., (© 2025 The Author(s). Obesity Reviews published by John Wiley & Sons Ltd on behalf of World Obesity Federation.)

Seafood can contribute towards healthy and sustainable food systems by improving public health and helping achieve net zero carbon emissions. Here, we provide a high-resolution perspective on UK seafood supplies and nutrient flows at the species level. We mapped seafood production (capture and aquaculture), trade (imports and exports), purchases (within and out of home) and seafood consumption between 2009 and 2020. UK dietary recommendations for finfish consumption were not achieved by domestic production nor national supplies. Mapping dietary nutrient flows revealed that the UK undergoes substantial losses of omega-3 fatty acids, vitamin B 12 and vitamin D, which could contribute 73%, 46% and 7% towards UK-recommended nutrient intakes, respectively, through exports of oily fish such as salmon, herring and mackerel. Policies should consider promoting greater consumption of locally produced oily fish species to improve public health and seafood system resilience., Competing Interests: Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Systematic Review (SR) are foundational to influencing policies and decision-making in healthcare and beyond. SRs thoroughly synthesise primary research on a specific topic while maintaining reproducibility and transparency. However, the rigorous nature of SRs introduces two main challenges: significant time involved and the continuously growing literature, resulting in potential data omission, making most SRs become outmoded even before they are published. As a solution, AI techniques have been leveraged to simplify the SR process, especially the abstract screening phase. Active learning (AL) has emerged as a preferred method among these AI techniques, allowing interactive learning through human input. Several AL software have been proposed for abstract screening. Despite its prowess, how the various parameters involved in AL influence the software's efficacy is still unclear. This research seeks to demystify this by exploring how different AL strategies, such as initial training set, query strategies etc. impact SR automation. Experimental evaluations were conducted on five complex medical SR datasets, and the GLM model was used to interpret the findings statistically. Some AL variables, such as the feature extractor, initial training size, and classifiers, showed notable observations and practical conclusions were drawn within the context of SR and beyond where AL is deployed., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background/objectives: Metrics drive diagnosis, and metrics will also drive our response to the challenge of climate change. Recognising how current scientific research defines and uses metrics of the environmental impact of human diets is essential to understand which foods, food groups, or dietary patterns are associated with a higher environmental impact., Methods: This research, aided by artificial intelligence (AI), aimed to search, map, and synthesise current evidence on the commonly used definitions and metrics of the environmental impacts of human diets., Results: We identified 466 studies measuring the environmental impact of diets. Most studies were from North American or European countries (67%), with data mainly from high-income countries (81%). Most studies did not include methods to recall the provenance of the foods consumed. Most (53%) of the studies only used one metric to estimate the environmental impact of human diets, with 82% of the studies using GHGE., Conclusions: Agreement on how the environmental impact of diets is measured and more comprehensive and accurate data on the environmental impact of single foods is essential to better understand what changes in food systems are needed, at a consumer and policy level, to make a well-meaning change towards a more sustainable diet.

Background: Low levels of testosterone cause male hypogonadism, which is associated with sexual dysfunction, tiredness and reduced muscle strength and quality of life. Testosterone replacement therapy is commonly used for ameliorating symptoms of male hypogonadism, but there is uncertainty about the magnitude of its effects and its cardiovascular and cerebrovascular safety., Aims of the Research: The primary aim was to evaluate the safety of testosterone replacement therapy. We also assessed the clinical and cost-effectiveness of testosterone replacement therapy for men with male hypogonadism, and the existing qualitative evidence on men's experience and acceptability of testosterone replacement therapy., Design: Evidence synthesis and individual participant data meta-analysis of effectiveness and safety, qualitative evidence synthesis and model-based cost-utility analysis., Data Sources: Major electronic databases were searched from 1992 to February 2021 and were restricted to English-language publications., Methods: We conducted a systematic review with meta-analysis of individual participant data according to current methodological standards. Evidence was considered from placebo-controlled randomised controlled trials assessing the effects of any formulation of testosterone replacement therapy in men with male hypogonadism. Primary outcomes were mortality and cardiovascular and cerebrovascular events. Data were extracted by one reviewer and cross-checked by a second reviewer. The risk of bias was assessed using the Cochrane Risk of Bias tool. We performed one-stage meta-analyses using the acquired individual participant data and two-stage meta-analyses to integrate the individual participant data with data extracted from eligible studies that did not provide individual participant data. A decision-analytic Markov model was developed to evaluate the cost per quality-adjusted life-years of the use of testosterone replacement therapy in cohorts of patients of different starting ages., Results: We identified 35 trials (5601 randomised participants). Of these, 17 trials (3431 participants) provided individual participant data. There were too few deaths to assess mortality. There was no difference between the testosterone replacement therapy group (120/1601, 7.5%) and placebo group (110/1519, 7.2%) in the incidence of cardiovascular and/or cerebrovascular events (13 studies, odds ratio 1.07, 95% confidence interval 0.81 to 1.42; p  = 0.62). Testosterone replacement therapy improved quality of life and sexual function in almost all patient subgroups. In the testosterone replacement therapy group, serum testosterone was higher while serum cholesterol, triglycerides, haemoglobin and haematocrit were all lower. We identified several themes from five qualitative studies showing how symptoms of low testosterone affect men's lives and their experience of treatment. The cost-effectiveness of testosterone replacement therapy was dependent on whether uncertain effects on all-cause mortality were included in the model, and on the approach used to estimate the health state utility increment associated with testosterone replacement therapy, which might have been driven by improvements in symptoms such as sexual dysfunction and low mood., Limitations: A meaningful evaluation of mortality was hampered by the limited number of defined events. Definition and reporting of cardiovascular and cerebrovascular events and methods for testosterone measurement varied across trials., Conclusions: Our findings do not support a relationship between testosterone replacement therapy and cardiovascular/cerebrovascular events in the short-to-medium term. Testosterone replacement therapy improves sexual function and quality of life without adverse effects on blood pressure, serum lipids or glycaemic markers., Future Work: Rigorous long-term evidence assessing the safety of testosterone replacement therapy and subgroups most benefiting from treatment is needed., Study Registration: The study is registered as PROSPERO CRD42018111005., Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 17/68/01) and is published in full in Health Technology Assessment ; Vol. 28, No. 43. See the NIHR Funding and Awards website for further award information.

Objective: To establish a baseline understanding of whether consuming food with the highest nutritional quality, lowest greenhouse gas emissions (GHGE) and cost differs between different UK demographic and socio-economic population groups., Design: Multiple linear regression models were fitted to evaluate the relationship between predictor socio-demographic variables in this study (i.e. sex, ethnic group, age, BMI and level of deprivation) and the response variables (i.e. consumption of items considered most nutritious, with a low GHGE and price, as a proportion of total items consumed)., Setting: The UK., Participants: 1374 adult (18-65 years) participants from the National Diet and Nutrition Survey latest waves 9-11 (2016-2017 and 2018-2019)., Results: Based on the total energy consumption in a day, the average diet-based GHGE was significantly higher for participants with a higher BMI. Non-white and most deprived participants spent significantly ( P < 0·001) less money per total energy consumption. Participants with a BMI between 18·6 and 39·9 kg/m 2 and those living in the least deprived areas consumed a significantly ( P < 0·001) higher amount of those items considered the most nutritious, with the lowest GHGE and cost per 100 kcal., Conclusions: Consumption of food with the highest nutritional quality, lowest GHGE and cost in the UK varies among those with different socio-demographic characteristics, especially the deprivation level of participants. Our analysis endorses the consideration of environmental sustainability and affordability, in addition to the consideration of nutritional quality from a health perspective, to make current dietary guidelines more encompassing and equitable.

Background: Testosterone replacement therapy is known to improve sexual function in men younger than 40 years with pathological hypogonadism. However, the extent to which testosterone alleviates sexual dysfunction in older men and men with obesity is unclear, despite the fact that testosterone is being increasingly prescribed to these patient populations. We aimed to evaluate whether subgroups of men with low testosterone derive any symptomatic benefit from testosterone treatment., Methods: We did a systematic review and meta-analysis to evaluate characteristics associated with symptomatic benefit of testosterone treatment versus placebo in men aged 18 years and older with a baseline serum total testosterone concentration of less than 12 nmol/L. We searched major electronic databases (MEDLINE, Embase, Science Citation Index, and the Cochrane Central Register of Controlled Trials) and clinical trial registries for reports published in English between Jan 1, 1992, and Aug 27, 2018. Anonymised individual participant data were requested from the investigators of all identified trials. Primary (cardiovascular) outcomes from this analysis have been published previously. In this report, we present the secondary outcomes of sexual function, quality of life, and psychological outcomes at 12 months. We did a one-stage individual participant data meta-analysis with a random-effects linear regression model, and a two-stage meta-analysis integrating individual participant data with aggregated data from studies that did not provide individual participant data. This study is registered with PROSPERO, CRD42018111005., Findings: 9871 citations were identified through database searches. After exclusion of duplicates and publications not meeting inclusion criteria, 225 full texts were assessed for inclusion, of which 109 publications reporting 35 primary studies (with a total 5601 participants) were included. Of these, 17 trials provided individual participant data (3431 participants; median age 67 years [IQR 60-72]; 3281 [97%] of 3380 aged ≥40 years) Compared with placebo, testosterone treatment increased 15-item International Index of Erectile Function (IIEF-15) total score (mean difference 5·52 [95% CI 3·95-7·10]; τ 2 =1·17; n=1412) and IIEF-15 erectile function subscore (2·14 [1·40-2·89]; τ 2 =0·64; n=1436), reaching the minimal clinically important difference for mild erectile dysfunction. These effects were not found to be dependent on participant age, obesity, presence of diabetes, or baseline serum total testosterone. However, absolute IIEF-15 scores reached during testosterone treatment were subject to thresholds in patient age and baseline serum total testosterone. Testosterone significantly improved Aging Males' Symptoms score, and some 12-item or 36-item Short Form Survey quality of life subscores compared with placebo, but it did not significantly improve psychological symptoms (measured by Beck Depression Inventory)., Interpretation: In men aged 40 years or older with baseline serum testosterone of less than 12 nmol/L, short-to-medium-term testosterone treatment could provide clinically meaningful treatment for mild erectile dysfunction, irrespective of patient age, obesity, or degree of low testosterone. However, due to more severe baseline symptoms, the absolute level of sexual function reached during testosterone treatment might be lower in older men and men with obesity., Funding: National Institute for Health and Care Research Health Technology Assessment Programme., Competing Interests: Declaration of interests CNJ reports a research grant from Logixx Pharma. ShB reports research grants from AbbVie and the US NIH; participation on the OKPO Health data safety monitoring board; consulting fees from Aditum, a leadership or fiduciary role from the Endocrine Society; and a patent relating to the diagnosis and treatment of androgen disorders (US patent number 10386375). SSE reports a research grant from AbbVie. MG reports research grants from Otsuka, Bayer, Lilly, Weight Watchers, Novartis, National Health and Medical Research Council (Australia); speaker honoraria from Besins Healthcare, Bayer, and Otsuka; consulting fees from Bayer; and royalties from Walter and Eliza Hall Institute Melbourne Australia. KLH is supported by the National Institute on Aging K23 Career Development Award; reports an unpaid role in the Executive Committee, Kavod Senior Life Board of Directors; and stock or stock options from Medaware Systems. NO reports research grants from Dexcom, Roche Diabetes, Medtronic Diabetes; speaker honoraria from Roche Diabetes; consulting fees from Roche Diabetes and Medtronic Diabetes; payment for expert testimony (Bird and Bird); and a patent issued for an automatic closed loop glucose control system with an adaptive meal bolus calculator. SR reports a research grant from North Staffordshire Medical Institute; and support for meetings or travel from Besins Healthcare. PJS reports a research grant from AbbVie; and payment for expert testimony from Teva. RQ reports speaker honoraria and support for attending meetings or travel from Bayer. SiB reports speaker honoraria from the Obstetrical & Gynaecological Society of Singapore and pharmaceutical companies (Merck and Ferring); a financial role as a non-executive member of NHS Grampian Health Board; and royalties from Cambridge University Press. GBB reports speaker honoraria and consulting fees from Acerus Pharmaceutical. HMT reports speaker honoraria from Besin Healthcare. EmJG reports provision of study materials from Bayer. All other authors declare no competing interests., (Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Context: Obesity and mental health issues increasingly affect children and adolescents, but whether obesity is a risk factor for mental health issues is unclear., Objective: To systematically review the association between obesity and mental health issues (ie, anxiety and/or depression) among Mexican children and adolescents., Data Sourcing, Extraction, and Synthesis: A literature search of 13 databases and 1 search engine was conducted. Population, exposure, comparison, outcomes, and study design data were extracted, analyzed, and narratively synthesized. The JBI critical appraisal tool was used to evaluate evidence quality., Results: A total of 16 studies with 12 103 participants between 8 and 18 years old were included. Four studies focused on anxiety outcomes, 10 on depression, and 2 on both (ie, anxiety and depression). Evidence is unclear about the association of obesity with anxiety. However, most evidence shows that Mexican children and adolescents with overweight or obesity are more likely to have depression or report a higher number of depressive symptoms than normal-weight participants. Such likelihood is greater for females., Conclusion: Health promotion interventions to treat or prevent obesity could also consider mental health outcomes., Systematic Review Registration: PROSPERO registration no. CRD42019154132., (© The Author(s) 2022. Published by Oxford University Press on behalf of the International Life Sciences Institute.)

Objective: To examine whether ready meals and equivalent home-cooked meals differ in nutritional quality indicators, greenhouse gas emissions (GHGE) and cost., Design: We performed a cross-sectional analysis of meal data from the National Diet and Nutrition Survey (NDNS) nutrient databank (2018/19). Additional data on nutrient composition, cost and cooking-related GHGE were calculated and compared between fifty-four ready meals and equivalent home-cooked meals., Setting: The UK., Participants: Not applicable., Results: Ready meals, overall and those that were animal-based, had significantly higher levels of free sugar compared with equivalent home-cooked meals ( P < 0·0001 and P < 0·0004, respectively). Animal-based ready meals had significantly higher levels of GHGE ( P < 0·001), whereas the cost of ready meals, overall, was significantly higher ( P < 0·001), compared with equivalent home-cooked meals. Animal-based meals, whether ready meals or equivalent homemade meals, had significantly higher levels of protein ( P < 0·0001), contained significantly more kilocalories ( P = 0·001), had significantly higher levels of GHGE ( P < 0·0001) and were significantly more expensive ( P < 0·0001), compared with plant-based meals. Overall, plant-based meals home-cooked on the gas or electric stove had the lowest GHGE and cost, whereas animal-based oven-cooked ready meals had the highest levels of GHGE and were most expensive., Conclusions: Ready meals have lower nutritional quality and higher GHGE and are more expensive than equivalent home-cooked meals, especially those meals that are animal-based and prepared in an oven.

Background: Encouraging adolescents to adopt healthy lifestyles can be challenging. The aim of the " Som la Pera " study was to engage adolescents by applying new strategies to increase both their fruit and vegetable consumption and their physical activity (PA), while reducing their sedentary behavior (screen time per day). Methods: In disadvantaged neighborhoods of Reus (Spain), two high schools were randomly assigned to the intervention ( n  = 169 adolescents, 13- to 16-year old) and two were assigned to the control group ( n  = 223 adolescents, 13- to 16-year old). The intervention, which lasted 12 months and spanned two academic years (2013-2015), used social marketing (SM) to improve healthy choices. The peer-led strategy involved 5 adolescents, who designed and implemented 10 activities as challenges for their 169 school-aged peers. The control group received no intervention. To assess self-reported lifestyles in both groups, the Health Behavior in School-aged Children survey was used at baseline and end of study. Results: After 12 months, the weekly PA improved in the intervention group vs. the control one ( p  = 0.047). When male and female groups were examined separately, the improvement in PA remained with a borderline significance only in the male group ( p  = 0.050). Conclusions: A school-based, peer-led SM intervention designed and implemented by adolescents attending high schools in low-income neighborhoods promoted an increase in PA, particularly in male adolescents 13 to 16 years of age. No effect on fruit or vegetable consumption or screen time was observed. Clinical Trial Registration number: NCT02157402.

Culture and culturally specific beliefs or practices may influence perceptions and decisions, potentially contributing to childhood obesity. The objective of this study is to identify the cultural factors (expressed through decisions, behaviors, individual experiences, perceptions, attitudes, or views) related to childhood and adolescent obesity in Mexico. Ten databases and one search engine were searched from 1995 onwards for qualitative studies. The Sunrise Enabler Model, described within the Cultural Care Theory, guided this review. Sample, the phenomenon of interest, study design, and evaluation data were extracted, and the Critical Appraisals Skills Programme tool was used to assess the quality of the included studies. Twenty-four studies were included. Of these, 12 studies included children or adolescents, 12 included parents, eight included schoolteachers, four included school staff (other than teachers), four included food vendors, and one included policymakers. Cultural values, beliefs, lifeways (especially food and food costumes), kinship, and social factors (particularly immediate and extended family) strongly influenced childhood and adolescent obesity-related lifestyles in Mexico. Most cultural factors related to childhood obesity in Mexico identified in this review may be modifiable and amenable to practical interventions., (© 2022 The Authors. Obesity Reviews published by John Wiley & Sons Ltd on behalf of World Obesity Federation.)

Background: Testosterone is the standard treatment for male hypogonadism, but there is uncertainty about its cardiovascular safety due to inconsistent findings. We aimed to provide the most extensive individual participant dataset (IPD) of testosterone trials available, to analyse subtypes of all cardiovascular events observed during treatment, and to investigate the effect of incorporating data from trials that did not provide IPD., Methods: We did a systematic review and meta-analysis of randomised controlled trials including IPD. We searched MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, MEDLINE Epub Ahead of Print, Embase, Science Citation Index, the Cochrane Controlled Trials Register, Cochrane Database of Systematic Reviews, and Database of Abstracts of Review of Effects for literature from 1992 onwards (date of search, Aug 27, 2018). The following inclusion criteria were applied: (1) men aged 18 years and older with a screening testosterone concentration of 12 nmol/L (350 ng/dL) or less; (2) the intervention of interest was treatment with any testosterone formulation, dose frequency, and route of administration, for a minimum duration of 3 months; (3) a comparator of placebo treatment; and (4) studies assessing the pre-specified primary or secondary outcomes of interest. Details of study design, interventions, participants, and outcome measures were extracted from published articles and anonymised IPD was requested from investigators of all identified trials. Primary outcomes were mortality, cardiovascular, and cerebrovascular events at any time during follow-up. The risk of bias was assessed using the Cochrane Risk of Bias tool. We did a one-stage meta-analysis using IPD, and a two-stage meta-analysis integrating IPD with data from studies not providing IPD. The study is registered with PROSPERO, CRD42018111005., Findings: 9871 citations were identified through database searches and after exclusion of duplicates and of irrelevant citations, 225 study reports were retrieved for full-text screening. 116 studies were subsequently excluded for not meeting the inclusion criteria in terms of study design and characteristics of intervention, and 35 primary studies (5601 participants, mean age 65 years, [SD 11]) reported in 109 peer-reviewed publications were deemed suitable for inclusion. Of these, 17 studies (49%) provided IPD (3431 participants, mean duration 9·5 months) from nine different countries while 18 did not provide IPD data. Risk of bias was judged to be low in most IPD studies (71%). Fewer deaths occurred with testosterone treatment (six [0·4%] of 1621) than placebo (12 [0·8%] of 1537) without significant differences between groups (odds ratio [OR] 0·46 [95% CI 0·17-1·24]; p=0·13). Cardiovascular risk was similar during testosterone treatment (120 [7·5%] of 1601 events) and placebo treatment (110 [7·2%] of 1519 events; OR 1·07 [95% CI 0·81-1·42]; p=0·62). Frequently occurring cardiovascular events included arrhythmia (52 of 166 vs 47 of 176), coronary heart disease (33 of 166 vs 33 of 176), heart failure (22 of 166 vs 28 of 176), and myocardial infarction (10 of 166 vs 16 of 176). Overall, patient age (interaction 0·97 [99% CI 0·92-1·03]; p=0·17), baseline testosterone (interaction 0·97 [0·82-1·15]; p=0·69), smoking status (interaction 1·68 [0·41-6·88]; p=0.35), or diabetes status (interaction 2·08 [0·89-4·82; p=0·025) were not associated with cardiovascular risk., Interpretation: We found no evidence that testosterone increased short-term to medium-term cardiovascular risks in men with hypogonadism, but there is a paucity of data evaluating its long-term safety. Long-term data are needed to fully evaluate the safety of testosterone., Funding: National Institute for Health Research Health Technology Assessment Programme., Competing Interests: CNJ reports research grants from Logixx Pharma. SBhas reports research grants from AbbVie and National Institutes of Health; consulting fees from Aditum; participation on the Data Safety Monitoring board of OKPO; a leadership or fiduciary role in the Endocrine Society; and a patent (free T calculator based on the ensemble allosteric model, reference 20200174026). SSE reports research grants from AbbVie. MG reports research grants from Otsuka, Bayer, Lilly, Weight Watchers, Novartis, National Health and the Medical Research Council Australia; speaker honoraria from Besins Healthcare, Bayer, and Otsuka; consulting fees from Bayer; and Royalties from Walter and Eliza Hall Institute Melbourne Australia. KLH reports research grants from NIA K23 Career Development Award; a leadership or fiduciary role from Kavod Senior Life Board of Directors, Executive Committee; and stock or stock options from Medaware Systems. NO reports research grants from Dexcom, Roche Diabetes, and Medtronic Diabetes; speaker honoraria from Roche Diabetes; consulting fees from Roche Diabetes and Medtronic Diabetes; payment for expert testimony from London law firm Wilmer Hale; and an issued patent for automatic closed loop glucose control with an adaptive meal bolus calculator. SR reports research grants from North Staffordshire Medical Institute and support for attending meetings or travel from Besins Healthcare. PJS reports research grants from Abbvie and payment for expert testimony from Teva. RQ reports speaker honoraria and support for attending meetings or travel from Bayer. SBhat reports speaker honoraria from Obstetrical & Gynaecological Society of Singapore, Merck SMART Masterclass, and Merck FERRING Forum; leadership or fiduciary role at National Health Service Grampian; editorial role (Editor in Chief of Human Reproduction Open, Special Senior Editor of Cochrane Gynaecology and Fertility); membership of NHS Grampian Board; other financial or non-financial interests from Oxford University Press; and Royalties from Cambridge University Press (Royalties for book Reproductive Medicine for the MRCOG, Cambridge University Press). GBB reports speaker honoraria and consulting fees from Acerus Pharmaceutical. HMT reports consulting fees from Besin Healthcare. EJGil reports provision of study materials from Bayer. All other authors declare no competing interests., (© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license.)

Objective: Our objective was to determine the extent to which current evidence from long-term randomised controlled trials (RCTs) of weight management is generalisable and applicable to underserved adult groups with obesity (body mass index (BMI) ≥35 kg/m 2 )., Methods: Descriptive analysis of 131 RCTs, published after 1990-May 2017 with ≥1 year of follow-up, included in a systematic review of long-term weight management interventions for adults with BMI ≥35 kg/m 2 (the REBALANCE Project). Studies were identified from MEDLINE, EMBASE, PsychINFO, SCI, CENTRAL and from hand searching. Reporting of trial inclusion and exclusion criteria, trial recruitment strategies, baseline characteristics and outcomes were analysed using a predefined list of characteristics informed by the PROGRESS (Place of residence, Race/ethnicity/culture/language, Occupation, Gender/sex, Religion, Education, Socioeconomic status, Social capital)-Plus framework and the UK Equality Act 2010., Results: Few (6.1%) trials reported adapting recruitment to appeal to underserved groups. 10.0% reported culturally adapting their trial materials. Only 6.1% of trials gave any justification for their exclusion criteria, yet over half excluded participation for age or mental health reasons. Just over half (58%) of the trials reported participants' race or ethnicity, and one-fifth reported socioeconomic status. Where outcomes were reported for underserved groups, the most common analysis was by sex (47.3%), followed by race or ethnicity (16.8%). 3.1% of trials reported outcomes according to socioeconomic status., Discussion: Although we were limited by poor trial reporting, our results indicate inadequate representation of people most at risk of obesity. Guidance for considering underserved groups may improve the appropriateness of research and inform greater engagement with health and social care services., Funding: National Institute for Health Research Health Technology Assessment Programme (project number: 15/09/04)., Prospero Registration Number: CRD42016040190., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.)

Context: A relationship between obesity and poor oral health has been reported., Objective: To investigate the association between overweight/obesity and oral health in Mexican children and adolescents., Data Sources: A literature search was conducted of 13 databases and 1 search engine for articles published from 1995 onward., Data Analysis: A total of 18 publications were included. Evidence was inconclusive and varied according to sociodemographic factors or outcome measuring tools. The Decayed, Missing, and Filled Teeth and Filled Teeth Surfaces indices and the decayed extracted filled teeth index outcomes were included in a random effects model meta-analysis. Pooled estimates showed no statistically significant oral health differences (measured via the decayed extracted filled teeth or the Decayed, Missing, and Filled Teeth Surfaces indexes) among body mass index (BMI) categories. However, pooled estimates of 6 studies showed that children with higher BMI had worse oral health in permanent teeth (measured via the Decayed Missing Filled Teeth Index) than children with lower BMI (overall mean difference, -0.42; 95%CI, -0.74, -0.11)., Conclusion: Whether there is an association between poor oral health and high BMI is inconclusive; however, both co-exist among Mexican children. Therefore, health promotion and prevention efforts should address common risk factors and broader risk social determinants shared between noncommunicable diseases., (© The Author(s) 2021. Published by Oxford University Press on behalf of the International Life Sciences Institute.)

The exponential increase in published articles makes a thorough and expedient review of literature increasingly challenging. This review delineated automated tools and platforms that employ artificial intelligence (AI) approaches and evaluated the reported benefits and challenges in using such methods. A search was conducted in 4 databases (Medline, Embase, CDSR, and Epistemonikos) up to April 2021 for systematic reviews and other related reviews implementing AI methods. To be included, the review must use any form of AI method, including machine learning, deep learning, neural network, or any other applications used to enable the full or semi-autonomous performance of one or more stages in the development of evidence synthesis. Twelve reviews were included, using nine different tools to implement 15 different AI methods. Eleven methods were used in the screening stages of the review (73%). The rest were divided: two in data extraction (13%) and two in risk of bias assessment (13%). The ambiguous benefits of the data extractions, combined with the reported advantages from 10 reviews, indicating that AI platforms have taken hold with varying success in evidence synthesis. However, the results are qualified by the reliance on the self-reporting of the review authors. Extensive human validation still appears required at this stage in implementing AI methods, though further evaluation is required to define the overall contribution of such platforms in enhancing efficiency and quality in evidence synthesis., (© 2022 John Wiley & Sons Ltd.)

The prevalence of overweight and obesity has been rising among Mexican children and adolescents in the last decades. To systematically review obesity prevention interventions delivered to Mexican children and adolescents. Thirteen databases and one search engine were searched for evidence from 1995 to 2021. Searches were done in English and Spanish to capture relevant information. Studies with experimental designs, delivered in any setting (e.g., schools or clinics) or digital domains (e.g., social media campaigns) targeting Mexican children or adolescents (≤ 18 years) and reporting weight outcomes, were included in this review. In addition, the risk of bias was appraised with the Effective Public Health Practice Project Quality Assessment Tool. Twenty-nine studies with 19,136 participants (3-17 years old) were included. The prevalence of overweight and obesity at baseline ranged from 21 to 69%. Most of the studies (89.6%) were delivered in school settings. The duration ranged from 2 days to 3 school years, and the number of sessions also varied from 2 to 200 sessions at different intensities. Overall, anthropometric changes varied across studies. Thus, the efficacy of the included studies is heterogeneous and inconclusive among studies. Current evidence is heterogeneous and inconclusive about the efficacy of interventions to prevent obesity in Mexican children and adolescents. Interventions should not be limited to educational activities and should include different components, such as multi-settings delivery, family inclusion, and longer-term implementations. Mixed-method evaluations (including robust quantitative and qualitative approaches) could provide a deeper understanding of the effectiveness and best practices., (© 2021. The Author(s).)

Objective: Men with male hypogonadism (MH) experience sexual dysfunction, which improves with testosterone replacement therapy (TRT). However, randomised controlled trials provide little consensus on functional and behavioural symptoms in hypogonadal men; these are often better captured by qualitative information from individual patient experience., Methods: We systematically searched major electronic databases to identify qualitative data from men with hypogonadism, with or without TRT. Two independent authors performed the selection, extraction, and thematic analysis of data. Quality of eligible studies was assessed using the Critical Appraisals Skills Programme and Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative research tools., Results: We analysed data from five studies published in nine reports that assessed a total of 284 participants. Published data were only available within North America, with no ethnic minority or other underserved groups included. In addition to sexual dysfunction, men with MH experienced adverse changes in physical strength, perceptions of masculinity, cognitive function, and quality of life. The experience of MH appeared dependent on the source(s) of educational material., Discussion: We propose a patient-centred approach to clinician interactions rather than focusing on discreet MH symptoms. Current evidence about the experience of MH is limited to North America and predominantly white ethnicity, which may not be broadly applicable to other geographic regions. Broadening our understanding of the MH experience may improve the targeting of information to patients. In addition, a multidisciplinary approach may better address symptoms neither attributable to MH nor alleviated by TRT., (© 2022 American Society of Andrology and European Academy of Andrology.)

Introduction: Food systems are challenged to provide healthy, sustainable and affordable foods. From a consumer perspective, identifying healthy, sustainable and affordable choices based on individual food products rather than diets could promote better shopping choices., Objective: To identify foods and drinks with the highest nutritional quality and lowest greenhouse gas emissions (GHGE) and price. We also assessed how a combination of these indicators (e.g., nutritional quality, GHGE and price) for food categories aligned with current United Kingdom dietary recommendations., Materials and Methods: We performed a secondary analysis of the National Diet and Nutrition Survey (NDNS) nutrient databank year 11 (2018/2019). Spearman correlation coefficients were used to assess the strength of relationships between nutritional quality, environmental impact and/or prices per 100 kcal. In addition, we developed an optimized nutritional quality, GHGE and price score for each food or drink item based on the overall medians for each of these indicators., Results: Median nutritional value was highest for fruit and vegetables, whilst median GHGE and price was lower for starchy carbohydrates, fats and items of which consumption should be limited. The relative proportions of foods considered the most nutritious and with a low GHGE and price in each of the food categories, on a per 100 kcal basis, were comparable to the proportions in the Eatwell Guide, except for the proportion of fruits and vegetables being smaller and the proportion of potatoes, bread, rice, pasta, and other starchy carbohydrates being larger in our analysis., Conclusion: Public health efforts should consider the impact of dietary choices not only in terms of nutritional quality but also in terms of environmental and economic impact. Our food-based analysis shows a large variation in nutritional quality, GHGE and price within and across food categories, which provides consumers with opportunities for "food swaps" that are more nutritious and have lower GHGE and price., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Aceves-Martins, Bates, Craig, Chalmers, Horgan, Boskamp and de Roos.)

Context: Sustained hyperglycemia triggers chronic disease, including type 2 diabetes. A considerable volume of research has explored the effects of brown seaweed on plasma glucose control, but equivocal findings have been reported., Objective: A systematic review and meta-analysis was conducted to assess the evidence from human randomized controlled trials (RCTs) on the effects of brown seaweed on plasma glucose in healthy, at-risk, and individuals with type 2 diabetes., Data Sources: MEDLINE/PubMed, EMBASE, and the Cochrane Library were searched for reports published between 2000 and 2020., Data Extraction: Population, intervention, comparator, outcome, and study design data were extracted., Data Analysis: Eighteen RCTs met our inclusion criteria. The reported results varied across and between populations. Meta-analyses showed a significant effect, favoring the intervention group for both fasting (mean difference -4.6 [95% CI -7.88, -1.33]) and postprandial (mean difference -7.1 [95% CI -7.4, -6.9]) plasma glucose., Conclusion: Brown seaweed and its extracts show potential for preventing and managing hyperglycemia. Our meta-analysis confirms that brown seaweed positively affects plasma glucose homeostasis, with particularly promising postprandial plasma glucose effects. However, further research is needed because no high-quality RCT was identified. Species-specific and dose-response research is also required., Systematic Review Registration: PROSPERO registration no. CRD42020187849., (© The Author(s) 2021. Published by Oxford University Press on behalf of the International Life Sciences Institute.)

Introduction: The coronavirus disease 2019 (COVID-19) led to the worldwide closure of dental practices or reduction of dental services. By the end of April 2020, governments and professional organisations were publishing recommendations or guidance for the reopening/restructuring of dental services. The aim of this study was to assess how dental aerosol-generating procedures (AGPs) were defined in international dental guidelines, what mitigation processes were advised, and whether they were linked to COVID-19 epidemiology., Methods: Electronic searches of a broad range of databases, along with grey literature searches, without language restriction were conducted up to 13 July 2020. Recommendations for the use of face masks and fallow times with patients without COVID-19 were assessed against the deaths per 1 million population in the included countries and country income level using Pearson Chi-squared statistics., Results: Sixty-three guidance documents were included. Most (98%) indicated that AGPs can be performed with patients without COVID-19 with caveats, including advice to restrict AGPs where possible, with 21% only recommending AGPs for dental emergencies. Face masks were recommended by most documents (94%), with 91% also specifying the use of goggles or face shields. Fallow periods for patients without COVID-19 were mentioned in 48% of documents, ranging from 2 to 180 minutes. There were no significant differences in recommendations for face masks or fallow time in patients without COVID-19 by country death rate (P = .463 and P = .901) or World Bank status (P = .504 and P = .835). Most documents recommended procedural or environmental mitigations such as preprocedural mouthwash (82%) and general ventilation (52%). Few documents provided underpinning evidence for their recommendations., Conclusions: While the amount of high-quality direct evidence related to dentistry and COVID-19 remains limited, it is important to be explicit about the considered judgements for recommendations as well as generate new evidence to face this challenge., Competing Interests: Conflicts of interest None disclosed., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Food-based analyses of the healthiness, environmental sustainability and affordability of processed and ultra-processed foods are lacking. This paper aimed to determine how ultra-processed and processed foods compare to fresh and minimally processed foods in relation to nutritional quality, greenhouse gas emissions and cost on the food and food group level. Data from the National Diet and Nutrition Survey nutrient databank year 11 (2018/2019) were used for this analysis. Median and bootstrapped medians of nutritional quality (NRF8.3 index), greenhouse gas emissions (gCO2-equivalents) and cost (in GBP) were compared across processing categories. An optimal score based on the medians was created to identify the most nutritional, sustainable, and affordable options across processing categories. On a per 100 kcal basis, ultra-processed and processed foods had a lower nutritional quality, lower greenhouse gas emissions, and were cheaper than minimally processed foods, regardless of their total fat, salt and/or sugar content. The most nutritious, environmentally friendly, and affordable foods were generally lower in total fat, salt, and sugar, irrespective of processing level. The high variability in greenhouse gas emissions and cost across food groups and processing levels offer opportunities for food swaps representing the healthiest, greenest, and most affordable options.

Context: Prevalence of overweight and obesity has been rising in the past 3 decades among Mexican children and adolescents., Objective: To systematically review experimental studies evaluating interventions to treat obesity in Mexican children and adolescents (≤18 years old)., Data Sources: For this study, 13 databases and 1 search engine were searched., Data Analysis: A total of 29 studies met the inclusion criteria. Overall, 2302 participants (age range, 8-16 years) from 11 states in Mexico were included. Most of the studies (n = 17 of 29) were provided in a clinical setting. A random-effect meta-analysis of 4 randomized controlled trials was conducted and a significant effect was found on body mass index reduction that favored the intervention group (-1.52; 95%CI, -2.15 to -0.89) for short-term (≤6 mo) interventions., Conclusions: A multicomponent, multidisciplinary, and individualized intervention that includes dietary modifications, physical activity practice, behavioral strategies, and active parental involvement might help treat childhood obesity in Mexico. However, long-term results need to be produced to identify effectiveness pointers that might help establish an integrated, long-lasting care model to treat obesity., (© The Author(s) 2021. Published by Oxford University Press on behalf of the International Life Sciences Institute.)

Context: The prevalence of cognitive and mental health disorders are growing, and existing drug therapies do not treat the underlying cause. Grapes are a flavonoid-rich soft fruit and may therefore be beneficial to cognitive and mental health., Objective: To systematically review evidence from randomized controlled trials investigating the acute and chronic effects of grape interventions on measures of cognition and mood in healthy participants and those with mild cognitive impairment., Data Sources: MEDLINE, The Cochrane Library and EMBASE were searched., Data Extraction and Analysis: Eight studies met the inclusion criteria: one considered acute interventions, 6 assessed chronic effects, and one assessed acute and chronic effects of grapes. The chronic studies found improvements in some cognitive domains (eg, memory, motor skills, or executive function). Acute studies found no consistent effect on memory but saw improvements in reaction time., Conclusions: Differences in study design, dosages, and outcome tests hindered between-study comparison. Even so, the results across studies show that grapes can enhance some aspects of cognition, after both acute and chronic interventions., Systematic Review Registration: PROSPERO registration no. CRD42020193062., (© The Author(s) 2021. Published by Oxford University Press on behalf of the International Life Sciences Institute.)

Background: Adolescents who participate as peer leaders can benefit and acquire competencies from their peer leadership experience., Objectives: To identify the competencies gained by adolescents who participated as peer leaders in a healthy lifestyle study and to determine whether the training characteristics were related to improvement in competencies., Design: The present study was part of the European Youth Tackling Obesity (EYTO) project, a multicentre social marketing intervention involving four European countries., Setting and Participants: Eighteen peer leaders (aged 13-15 years, three or five leaders per country) from disadvantaged neighbourhoods received training in designing and implementing activities for their peers., Measures: The peer leaders' confidence, experience and interest in 11 tasks related to lifelong learning competencies were assessed with questions rated on a colour scale at baseline and at the end of the study., Results: The peer leaders demonstrated improvements in experience, confidence and interest in different tasks, such as research, website or logo design, oral presentations, social media use and collaboration with people from other countries. They increased their confidence in management tasks (p = 0.03) and their confidence and experience in communication tasks (p = 0.01). The peer leaders from Spain and Portugal had greater improvements than those from the other countries., Conclusion: The peer leaders improved their confidence in management tasks and their confidence and experience in communication tasks. Slight differences were detected in improvement in competencies by country, likely due to the differences in the peer training applied. Recommendations for peer leader training are proposed, although these results should be verified with larger sample size., Patient or Public Contribution: The peer leaders contributed to the design and implementation of the training and intervention., (© 2021 The Authors. Health Expectations published by John Wiley & Sons Ltd.)

Background: Acute kidney injury is a serious complication that occurs in the context of an acute critical illness or during a postoperative period. Earlier detection of acute kidney injury may facilitate strategies to preserve renal function, prevent further disease progression and reduce mortality. Acute kidney injury diagnosis relies on a rise in serum creatinine levels and/or fall in urine output; however, creatinine is an imperfect marker of kidney function. There is interest in the performance of novel biomarkers used in conjunction with existing clinical assessment, such as NephroCheck ® (Astute Medical, Inc., San Diego, CA, USA), ARCHITECT ® urine neutrophil gelatinase-associated lipocalin (NGAL) (Abbott Laboratories, Abbott Park, IL, USA), and urine and plasma BioPorto NGAL (BioPorto Diagnostics A/S, Hellerup, Denmark) immunoassays. If reliable, these biomarkers may enable earlier identification of acute kidney injury and enhance management of those with a modifiable disease course., Objective: The objective was to evaluate the role of biomarkers for assessing acute kidney injury in critically ill patients who are considered for admission to critical care., Data Sources: Major electronic databases, conference abstracts and ongoing studies were searched up to June 2019, with no date restrictions. MEDLINE, EMBASE, Health Technology Assessment Database, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, Web of Science, World Health Organization Global Index Medicus, EU Clinical Trials Register, International Clinical Trials Registry Platform and ClinicalTrials.gov were searched., Review Methods: A systematic review and meta-analysis were conducted to evaluate the performance of novel biomarkers for the detection of acute kidney injury and prediction of other relevant clinical outcomes. Random-effects models were adopted to combine evidence. A decision tree was developed to evaluate costs and quality-adjusted life-years accrued as a result of changes in short-term outcomes (up to 90 days), and a Markov model was used to extrapolate results over a lifetime time horizon., Results: A total of 56 studies (17,967 participants), mainly prospective cohort studies, were selected for inclusion. No studies addressing the clinical impact of the use of biomarkers on patient outcomes, compared with standard care, were identified. The main sources of bias across studies were a lack of information on blinding and the optimal threshold for NGAL. For prediction studies, the reporting of statistical details was limited. Although the meta-analyses results showed the potential ability of these biomarkers to detect and predict acute kidney injury, there were limited data to establish any causal link with longer-term health outcomes and there were considerable clinical differences across studies. Cost-effectiveness results were highly uncertain, largely speculative and should be interpreted with caution in the light of the limited evidence base. To illustrate the current uncertainty, 15 scenario analyses were undertaken. Incremental quality-adjusted life-years were very low across all scenarios, ranging from positive to negative increments. Incremental costs were also small, in general, with some scenarios generating cost savings with tests dominant over standard care (cost savings with quality-adjusted life-year gains). However, other scenarios generated results whereby the candidate tests were more costly with fewer quality-adjusted life-years, and were thus dominated by standard care. Therefore, it was not possible to determine a plausible base-case incremental cost-effectiveness ratio for the tests, compared with standard care., Limitations: Clinical effectiveness and cost-effectiveness results were hampered by the considerable heterogeneity across identified studies. Economic model predictions should also be interpreted cautiously because of the unknown impact of NGAL-guided treatment, and uncertain causal links between changes in acute kidney injury status and changes in health outcomes., Conclusions: Current evidence is insufficient to make a full appraisal of the role and economic value of these biomarkers and to determine whether or not they provide cost-effective improvements in the clinical outcomes of acute kidney injury patients., Future Work: Future studies should evaluate the targeted use of biomarkers among specific patient populations and the clinical impact of their routine use on patient outcomes and management., Study Registration: This study is registered as PROSPERO CRD42019147039., Funding: This project was funded by the National Institute for Health Research (NIHR) Evidence Synthesis programme and will be published in full in Health Technology Assessment ; Vol. 26, No. 7. See the NIHR Journals Library website for further project information.

Background: Early and accurate acute kidney injury (AKI) detection may improve patient outcomes and reduce health service costs. This study evaluates the diagnostic accuracy and cost-effectiveness of NephroCheck and NGAL (urine and plasma) biomarker tests used alongside standard care, compared with standard care to detect AKI in hospitalised UK adults., Methods: A 90-day decision tree and lifetime Markov cohort model predicted costs, quality adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) from a UK NHS perspective. Test accuracy was informed by a meta-analysis of diagnostic accuracy studies. Clinical trial and observational data informed the link between AKI and health outcomes, health state probabilities, costs and utilities. Value of information (VOI) analysis informed future research priorities., Results: Under base case assumptions, the biomarker tests were not cost-effective with ICERs of £105,965 (NephroCheck), £539,041 (NGAL urine BioPorto), £633,846 (NGAL plasma BioPorto) and £725,061 (NGAL urine ARCHITECT) per QALY gained compared to standard care. Results were uncertain, due to limited trial data, with probabilities of cost-effectiveness at £20,000 per QALY ranging from 0 to 99% and 0 to 56% for NephroCheck and NGAL tests respectively. The expected value of perfect information (EVPI) was £66 M, which demonstrated that additional research to resolve decision uncertainty is worthwhile., Conclusions: Current evidence is inadequate to support the cost-effectiveness of general use of biomarker tests. Future research evaluating the clinical and cost-effectiveness of test guided implementation of protective care bundles is necessary. Improving the evidence base around the impact of tests on AKI staging, and of AKI staging on clinical outcomes would have the greatest impact on reducing decision uncertainty., (© 2021. The Author(s).)

Objectives: To determine the most cost-effective weight management programmes (WMPs) for adults, in England with severe obesity (BMI ≥ 35 kg/m 2 ), who are more at risk of obesity related diseases., Methods: An economic evaluation of five different WMPs: 1) low intensity (WMP1); 2) very low calorie diets (VLCD) added to WMP1; 3) moderate intensity (WMP2); 4) high intensity (Look AHEAD); and 5) Roux-en-Y gastric bypass (RYGB) surgery, all compared to a baseline scenario representing no WMP. We also compare a VLCD added to WMP1 vs. WMP1 alone. A microsimulation decision analysis model was used to extrapolate the impact of changes in BMI, obtained from a systematic review and meta-analysis of randomised controlled trials (RCTs) of WMPs and bariatric surgery, on long-term risks of obesity related disease, costs, quality adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) measured as incremental cost per QALY gained over a 30-year time horizon from a UK National Health Service (NHS) perspective. Sensitivity analyses explored the impact of long-term weight regain assumptions on results., Results: RYGB was the most costly intervention but also generated the lowest incidence of obesity related disease and hence the highest QALY gains. Base case ICERs for WMP1, a VLCD added to WMP1, WMP2, Look AHEAD, and RYGB compared to no WMP were £557, £6628, £1540, £23,725 and £10,126 per QALY gained respectively. Adding a VLCD to WMP1 generated an ICER of over £121,000 per QALY compared to WMP1 alone. Sensitivity analysis found that all ICERs were sensitive to the modelled base case, five year post intervention cessation, weight regain assumption., Conclusions: RYGB surgery was the most effective and cost-effective use of scarce NHS funding resources. However, where fixed healthcare budgets or patient preferences exclude surgery as an option, a standard 12 week behavioural WMP (WMP1) was the next most cost-effective intervention., (© 2021. The Author(s).)

Background: Different techniques and approaches have been used for substance use prevention worldwide. No reviews of prevention interventions in Africa exist; hence this study aimed to systematically review interventions undertaken in Sub-Saharan Africa to prevent substance use in children and young people., Methods: MEDLINE, EMBASE, Cochrane Central, CAB, PsycINFO, CINAHL, SCOPUS, ERIC, and Web of Science databases were searched. Studies were included if they evaluated a substance use prevention intervention for children and young people in a Sub-Saharan African Country between 2000 and 2020. A narrative synthesis was used to explore and describe the data., Results: Eighteen studies, mostly from South Africa, were included. Most (10/18) of the interventions were school-based. Only two of the included studies were considered having a strong quality concerning the risk of bias, and some studies poorly reported the interventions. School-based interventions, although successful in improving knowledge, had little or no effects on substance use. Overall, most studies that reported a statistically significant reduction in substance use-related outcomes were brief interventions, individual-focused, and involved participants who were already exposed to substance use. These were mostly delivered by trained professionals using motivational interviewing or cognitive behavioural therapy or both., Conclusion: School-based programs present an opportunity for substance use prevention efforts in the Sub-Saharan region in Africa. Such programs may benefit from an improved focus on individual students. There is a need for improving the quality of design, implementation, and reporting of substance use interventions within the region., Competing Interests: Declarations of Interest The authors report no conflict of interest., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: Poor retention of participants in randomised trials can lead to missing outcome data which can introduce bias and reduce study power, affecting the generalisability, validity and reliability of results. Many strategies are used to improve retention but few have been formally evaluated., Objectives: To quantify the effect of strategies to improve retention of participants in randomised trials and to investigate if the effect varied by trial setting., Search Methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Scopus, PsycINFO, CINAHL, Web of Science Core Collection (SCI-expanded, SSCI, CPSI-S, CPCI-SSH and ESCI) either directly with a specified search strategy or indirectly through the ORRCA database. We also searched the SWAT repository to identify ongoing or recently completed retention trials. We did our most recent searches in January 2020., Selection Criteria: We included eligible randomised or quasi-randomised trials of evaluations of strategies to increase retention that were embedded in 'host' randomised trials from all disease areas and healthcare settings. We excluded studies aiming to increase treatment compliance., Data Collection and Analysis: We extracted data on: the retention strategy being evaluated; location of study; host trial setting; method of randomisation; numbers and proportions in each intervention and comparator group. We used a risk difference (RD) and 95% confidence interval (CI) to estimate the effectiveness of the strategies to improve retention. We assessed heterogeneity between trials. We applied GRADE to determine the certainty of the evidence within each comparison., Main Results: We identified 70 eligible papers that reported data from 81 retention trials. We included 69 studies with more than 100,000 participants in the final meta-analyses, of which 67 studies evaluated interventions aimed at trial participants and two evaluated interventions aimed at trial staff involved in retention. All studies were in health care and most aimed to improve postal questionnaire response. Interventions were categorised into broad comparison groups: Data collection; Participants; Sites and site staff; Central study management; and Study design. These intervention groups consisted of 52 comparisons, none of which were supported by high-certainty evidence as determined by GRADE assessment. There were four comparisons presenting moderate-certainty evidence, three supporting retention (self-sampling kits, monetary reward together with reminder or prenotification and giving a pen at recruitment) and one reducing retention (inclusion of a diary with usual follow-up compared to usual follow-up alone). Of the remaining studies, 20 presented GRADE low-certainty evidence and 28 presented very low-certainty evidence. Our findings do provide a priority list for future replication studies, especially with regard to comparisons that currently rely on a single study., Authors' Conclusions: Most of the interventions we identified aimed to improve retention in the form of postal questionnaire response. There were few evaluations of ways to improve participants returning to trial sites for trial follow-up. None of the comparisons are supported by high-certainty evidence. Comparisons in the review where the evidence certainty could be improved with the addition of well-done studies should be the focus for future evaluations., (Copyright © 2021 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.)

Objectives: To improve our understanding of the acceptability of behavioural weight management programmes (WMPs) for adults with severe obesity., Design: A systematic review of qualitative evidence., Data Sources: Medline, Embase, PsycINFO, CINAHL, SCI, SSCI and CAB abstracts were searched from 1964 to May 2017., Eligibility Criteria: Papers that contained qualitative data from adults with body mass index (BMI) ≥35 kg/m 2 (and/or the views of providers involved in their care) and considered issues about weight management., Data Extraction and Synthesis: Two reviewers read and systematically extracted data from the included papers which were compared, and contrasted according to emerging issues and themes. Papers were appraised for methodological rigour and theoretical relevance using Toye's proposed criteria for quality in relation to meta-ethnography., Results: 33 papers met our inclusion criteria from seven countries published 2007-2017. Findings were presented from a total of 644 participants and 153 programme providers. Participants described being attracted to programmes that were perceived to be novel or exciting, as well as being endorsed by their healthcare provider. The sense of belonging to a group who shared similar issues, and who had similar physiques and personalities, was particularly important and seemed to foster a strong group identity and related accountability. Group-based activities were enjoyed by many and participants preferred WMPs with more intensive support. However, some described struggling with physical activities (due to a range of physical comorbidities) and not everyone enjoyed group interaction with others (sometimes due to various mental health comorbidities). Although the mean BMI reported across the papers ranged from 36.8 to 44.7 kg/m 2 , no quotes from participants in any of the included papers were linked to specific detail regarding BMI status., Conclusions: Although group-based interventions were favoured, people with severe obesity might be especially vulnerable to physical and mental comorbidities which could inhibit engagement with certain intervention components., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.)

Background: Encouraging healthy lifestyles in children is a challenge. This project aimed to improve lifestyles of younger peers by engaging adolescent creators (ACs) to design and implement peer-led and social marketing (SM) health-promoting activities., Methods: A 10-month parallel-cluster randomised controlled school-based pilot study was performed in disadvantaged neighbourhoods in Reus (Spain) spanning two academic years (2015-2016/2016-2017). Eight primary schools (n=375 children) and four high schools (n=94ACs) were randomly placed in the intervention group. The 94 ACs (12-14 years) designed and implemented four SM activities for their younger peers (9-11 years). Eight primary schools (n=327 children) and three high schools (n=98 adolescents) served as the control group and received no intervention. Primary (physical activity and fruit consumption) and secondary outcomes (screen time, vegetables, soft drinks, sweets and fast food consumptions) were assessed with validated questionnaires at baseline and at the end of the study., Results: After 10 months, fruit consumption and physical activity were maintained in the children who consumed ≥1 fruit/day and spent ≥6 hours/week physical activity. However, compared with the controls, the intervention significantly increased the physical activity of girls to 15.6 min/week, whereas the percentage of girls who consumed sweets, soft drinks and fast food decreased significantly by 8.4%, 14.5% and 5.9%, respectively. Additionally, the percentage of ≥2 hour/weekday of screen time by boys decreased significantly by 8.2%., Conclusion: The European Youth Tackling Obesity-Kids, SM and peer-led intervention, effectively increased physical activity hours/week in girls, but was not effective in improving the percentage of children who consumed the recommended fruit. Moreover, the percentages of girls who consumed sweets, soft drinks and fast food and boys screen time decreased., Trial Registration Number: NCT02702336; Pre-results., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Youth is a dynamic and complex transition period in life where many factors jeopardise its present and future health. Youth involvement enables young people to influence processes and decisions that affect them, leading to changes in themselves and their environment (e.g. peers, services, communities and policies); this strategy could be applied to improve health and prevent diseases. Nonetheless, scientific evidence of involving youth in health-related programmes is scarce. The aim of this paper is to describe youth involvement as a health promotion strategy and to compile practical recommendations for health promoters, researchers and policy-makers interested in successful involvement of young people in health-related programmes. These suggestions aim to encourage a positive working synergy between adults and youth during the development, implementation and evaluation of policies, research and/or health promotion efforts that target adolescents., (© The Author(s) 2018. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)