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By using our site, you agree to our collection of information through the use of cookies. To learn more, view our Privacy Policy. To browse Academia. Environmental interventions, i. Search methods We searched 11 general, specialist and regional databases from inception to 24 January We also searched trial registers, reference lists and citations, scanned websites of relevant organisations, and contacted study authors. Data collection and analysis Two review authors independently screened studies for inclusion, extracted data and assessed the risks of bias of included studies. Main results We identified 14, unique records, and assessed in full text for eligibility. The studies included children, teenagers and adults, and were implemented in a variety of settings, including schools, retailing and food service establishments. The studies examine a broad range of interventions, and we present results for these separately. Reported associations between improved availability of drinking water in schools and student body weight varied. Whole food supply interventions 3 studies : Reported associations between voluntary industry initiatives to improve the whole food supply and SSB sales varied. Reported associations between promotion of healthier beverages in vending machines and SSB intake or sales varied. For unrestricted food benefit programmes reported effects varied. Reported associations between trade and investment liberalisation and SSB sales varied. The certainty of evidence on adverse outcomes was low to very low for most outcomes. Authors' conclusions The evidence included in this review indicates that effective, scalable interventions addressing SSB consumption at a population level exist. Sugar sweetened beverages SSB constitute a large percentage of energy consumed by youth. This paper reviews the literature on school nutrition policies and price interventions directed at youth SSB consumption. By considering each of these links, we attempted to gauge the effect of policies directed at SSB consumption, as well as highlight areas that merit future research. We found that school nutrition and price policies reduce SSB consumption and that reduced SSB consumption is associated with a reduction in energy intake that can influence BMI. Policies directed at SSB consumption can play an important role in reducing youth overweight and obesity. This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effects of environmental interventions excluding taxation targeted at sugar-sweetened beverages or low-calorie alternatives to sugar-sweetened beverages on consumption levels, diet-related anthropometric measures and health outcomes, and on any reported unintended consequences or adverse outcomes. Despite extensive investment in these projects, there is limited empirical evidence on how various MEAL components impact project performance, particularly in the context of Kwale County, Kenya. This study aims to bridge this gap by analyzing the relationship between MEAL practices and project outcomes in this region. Objective: The primary objective of this research is to evaluate the influence of MEAL effectiveness, training quality, community involvement, and resource availability on the performance of donor-funded projects in Kwale County. By identifying key factors that drive project success, the study seeks to provide actionable insights for enhancing project management and implementation strategies. Methodology: The study employed a mixed-methods approach, incorporating both descriptive and inferential statistical techniques. A sample of five donor-funded projects across various sectors—agriculture, water and sanitation, health, and economic development—was selected for analysis. Data on MEAL effectiveness, training quality, community involvement, and resource availability were collected through surveys and project reports. Linear and multiple regression analyses were conducted to determine the impact of these variables on project outcomes. Findings: The analysis revealed that MEAL effectiveness is a significant predictor of project success, with a strong positive correlation between effective MEAL practices and improved project outcomes. Community involvement also demonstrated a positive impact, though its significance was marginal. Training quality and resource availability showed less impact on project performance, suggesting that while these factors are important, their effects may be secondary to MEAL effectiveness and community engagement. Conclusion: The study concludes that prioritizing MEAL effectiveness is crucial for enhancing the performance of donor-funded projects. While community involvement is also important, it requires further optimization. Training quality and resource management, though less directly impactful, remain essential components of successful project implementation. These findings underscore the need for donor agencies and project managers to focus on strengthening MEAL systems and involving communities more effectively to achieve better development outcomes. Recommendations: The study recommends enhancing MEAL frameworks, strengthening community engagement strategies, improving training programs, and optimizing resource management. It also suggests ongoing monitoring and adaptive management to address challenges and ensure project success. Future Research: Future studies should explore the impact of community involvement on different project types, conduct longitudinal assessments of MEAL practices, and compare findings across regions. In-depth case studies and exploration of additional variables affecting project performance are also recommended. Log in with Facebook Log in with Google. Remember me on this computer. Enter the email address you signed up with and we'll email you a reset link. Need an account? Click here to sign up. Evaluating a public health policy: the effect of a sugar-sweetened beverage portion cap on food and beverages purchased, calories consumed and consumer perception Sheri Volger. Can point-of-sale nutrition information encourage reduced preference for sugary drinks among adolescents? Helen Dixon. Factors associated with sugar-sweetened beverage intake among United States high school students Shirley James. A review of the literature on policies directed at the youth consumption of sugar sweetened beverages David Levy. Environmental interventions to reduce the consumption of sugar-sweetened beverages and their effects on health Protocol Peter von Philipsborn , Jan Marcel Stratil. Effects of an intervention aimed at reducing the intake of sugar-sweetened beverages in primary school children: a controlled trial Hein Raat. Design and methods for a community-based intervention to reduce sugar-sweetened beverage consumption among youth: H2GO!
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Official websites use. Share sensitive information only on official, secure websites. Edificio S. Elsevier hereby grants permission to make all its COVIDrelated research that is available on the COVID resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. Healthcare workers are at high risk of mental health problems during viral epidemic outbreaks. It identifies a number of factors sociodemographic, occupational and social associated with mental health problems. Interventional high-quality research is urgently needed to inform evidence-based policies for viral pandemics. Background: This study aimed at examining the impact of providing healthcare during health emergencies caused by viral epidemic outbreaks on healthcare workers' HCWs mental health; to identify factors associated with worse impact, and; to assess the available evidence base regarding interventions to reduce such impact. Method: Rapid systematic review. We pooled data using random-effects meta-analyses to estimate the prevalence of specific mental health problems, and used GRADE to ascertain the certainty of evidence. Results : We included studies. We identified factors associated with the likelihood of developing those problems, including sociodemographic younger age and female gender , social lack of social support, stigmatization , and occupational working in a high-risk environment, specific occupational roles, and lower levels of specialised training and job experience factors. Four studies reported interventions for frontline HCW: two educational interventions increased confidence in pandemic self-efficacy and in interpersonal problems solving very low certainty , whereas one multifaceted intervention improved anxiety, depression, and sleep quality very low certainty. Limitations: We only searched three databases, and the initial screening was undertaken by a single reviewer. Conclusion : Given the very limited evidence regarding the impact of interventions to tackle mental health problems in HCWs, the risk factors identified represent important targets for future interventions. Infectious disease outbreaks are relatively common, World Health Organization, a often prompting an international response involving thousands of healthcare workers HCWs Brooks et al. Providing frontline healthcare during infectious outbreaks increases the risk of HCWs developing mental health problems, both short and long-term Maunder et al. It has been suggested that specific occupational factors are associated with psychological outcomes of HCWs during an infectious disease outbreak. Working in a high-risk environment, adhering to quarantine, job-related stress, and belonging to a specific cadre were all considered to aggravate psychological outcomes. Perceived safety, namely through access to protective equipment, and specialised training, mitigated those outcomes Brooks et al. During December a new infectious disease outbreak was reported in Wuhan, Hubei province, China Wang et al. Early anecdotal evidence from Wuhan showed how this unprecedented situation impacted the mental health of frontline HCWs, who reported mental problems such as anxiety, depressive symptoms, anger, and fear Kang et al. These problems cannot only have a long-lasting effect on the mental health of HCWs, Maunder et al. Previous systematic reviews have explored social and occupational factors associated with psychological outcomes in HCW during an infectious disease outbreak Brooks et al. However, given the exponential proliferation of studies on this area during the last months, there is a need to synthesise the current body of knowledge. Moreover, the evidence base concerning the effectiveness of the interventions to ameliorate such impact has not been systematically assessed and reported. The aim of this rapid systematic literature review is threefold: i to examine the impact of health emergencies caused by a viral pandemic or epidemic outbreak on HCWs mental health; ii to identify factors associated with worse impact, and iii to assess the effectiveness of interventions to reduce such impact. We conducted a rapid systematic review following WHO guidelines Tricco et al. We searched databases from inception to 3 rd August , and checked the list of included studies of relevant systematic reviews Shaukat et al. We included empirical studies examining the impact on mental health of viral epidemic outbreaks on HCWs, and studies about interventions to reduce such impact. We included observational cross-sectional, case-control, and cohort studies , and experimental studies non-controlled before-after studies, controlled before-after studies, non-randomised controlled trials, and randomised controlled trials. We included studies on any type of health emergency caused by a viral epidemic outbreak or pandemic, and examining its impact on HCWs mental health during or after the crisis. For intervention studies, we included also those that examined interventions to protect mental health of HCWs prior, during or after the outbreak onset. All types of settings and healthcare professionals were accepted for inclusion. We included studies measuring any type of mental health problem or psychiatric morbidity. We excluded systematic reviews, narrative reviews, thesis, editorials, protocols, letters to the editor, and studies published in preprint servers but not in peer reviewed journals. We also excluded studies published in languages other than English, Spanish or Portuguese. We solved disagreements by consensus or by involving a third reviewer if needed. We used structured forms to extract relevant data, such as country, health emergency, setting, population, epidemiological design, number of participants, mental health conditions, clinical outcomes and their measurement tools, and main study results. For observational studies addressing the impact of health emergencies on HCWs mental health, we extracted the prevalence rate of the mental conditions examined in terms of the number of professionals suffering the condition numerator out of the total number of study participants denominator. If available, we extracted information about the risk factors. For intervention studies i. We assessed the risk of bias of observational studies i. We conducted a narrative and tabulated synthesis of the results, classifying the studies according to the type of study i. We adapted a taxonomy proposed in a previous study Brooks et al. Proportions were computed on the base of the Freeman-Tukey double arcsine transformation Freeman and Tukey, ; Miller, within a random effect model framework. We conducted subgroup analyses to explore potential differences in the prevalence of mental health disorders during vs. Where possible, subgroup analyses exploring gender differences were also undertaken. Publication bias was examined with funnel plots and presence of asymmetry tested with Begg Begg and Mazumdar, and Egger tests Egger et al. We used Stata, version Although we initially planned to pool the results from interventions to reduce mental health problems, this was finally not possible due to the scarcity of available data. Instead, we conducted a narrative and tabulated synthesis of the interventions and main results. The search resulted in a total of 3, records. After duplicates were removed, 3, records remained to be screened. We excluded 2, records based on title and abstract screening. After including seven additional studies identified from manual searches, published studies met the inclusion criteria for this systematic rapid review. Online Appendix 2 presents the excluded studies. This systematic review included , participants total. The mean number of participants was 1, range 26 to 21, Almost seven out of ten took place in the hospital setting. The characteristics of the included studies are summarised in Table 1. The results of the risk of bias assessment are provided in Online Appendix 3. Main sources of bias of the two uncontrolled before-after studies were bias in selection of participants, and bias in outcome measurement. The case-control study did not present serious risks of bias. The individual study characteristics and results are detailed in Online Appendix 4. The great majority of them reported clinically significant mental health symptoms, most frequently PTSD, anxiety, depression, acute stress and burnout. Prevalence forest plots are shown in Fig. No relevant differences were observed for the rest of mental health symptoms. No data was available to examine potential gender differences in the prevalence of the rest of burnout and acute stress disorders. Similarly, we could not conduct subgroups analyses to explore differences according to HCWs' age due to the lack of available data reported in a homogeneous format e. Begg's and Egger's tests suggested the absence of publication bias for all the meta-analyses conducted. Seventy studies examined occupational, sociodemographic and social factors associated with the likelihood of developing mental health problems while providing frontline healthcare during an infectious disease outbreak Online Appendix 4. The main occupational factors were working in a high-risk environment, higher perception of threat and risk, specialised training received, and specific occupational role. Working in a high risk environment was associated with different mental health problems, namely depression Lai et al. The definition of high risk environment varied across studies, but usually included being in direct contact with infected patients, either providing care Bukhari et al. Likewise, higher perception of threat and risk was also associated with a higher prevalence of a number of different mental health problems, including depression Liu et al. Lack of specialised training was a risk factor for anxiety Matsuishi et al. Some of the studies that recruited more than one cadre reported that specific HCWs were at higher risk of developing mental health problems. In terms of sociodemographic factors, younger age was a risk factor for depression Khanna et al. Female gender was consistently associated with higher levels of depression Dosil Santamaria et al. Feelings of social rejection or isolation and higher impact of the outbreak on daily life Styra et al. Lack of family and friends support were associated with burnout Kim and Choi, In addition, stigmatisation Koh et al. Four studies Aiello et al. None of them used an experimental design. Two studies in Canada evaluated two educational interventions for improving HCWs mental health by increasing resilience Aiello et al. Aiello and colleagues Aiello et al. The session focused on stressors associated with pandemic influenza and on organisational and individual approaches to building resilience and reducing stress. Maunder and colleagues conducted an uncontrolled before-after study to explore the impact of a computer-assisted resilience training to prepare HCWs for a potential pandemic influenza Maunder et al. The course consisted of modules incorporating different modalities of learning knowledge-based modules, relaxation skills, and self-assessment modules using questionnaires to characterize interpersonal problems and coping style. One cross-sectional study examined the impact of exercise interventions to relieve psychological stress and improve sleep status for frontline medical staff in the fight against COVID in China Wu and Wei, In comparison with the control group, participants in the intervention group experienced higher levels of anxiety We have very low confidence on the evidence of educational interventions for preventing the psychological impact of viral epidemic outbreaks in HCWs due to the study design uncontrolled before-after studies and very serious risk of bias regarding confounding and measurement of outcomes Online Appendix 7. One uncontrolled before-after study in Taiwan Chen et al. The intervention included in-service training, manpower allocation, gathering sufficient protective equipment, and establishment of a mental health team. The authors observed statistically significant improvements in nurses' anxiety and depression along with sleep quality at two weeks follow-up. Our confidence on the evidence for multifaceted interventions for preventing the psychological impact during viral epidemic outbreaks in HCWs was very low Online Appendix 7 due to limitations in the study design uncontrolled before after studies and very serious risk of bias high risk of selection bias and high risk of bias in measurement of outcomes. In this timely systematic rapid review, we synthesized evidence from studies examining the impact on mental health of providing frontline healthcare during viral epidemic outbreaks. We identified a broad number of risk factors for these conditions, including sociodemographic factors such as younger age and female gender, and social factors such as lack of social support, social rejection or isolation and stigmatization. Occupational factors entailed working in a high-risk environment frontline staff , specific occupational roles e. In contrast with the high number of studies examining impact on mental health, there is limited evidence regarding the impact of interventions to reduce mental health problems in this particularly vulnerable population, and overall its certainty is very low, mainly due to study design and serious risk of bias. Some of the risk factors associated with mental health problems while providing frontline care during viral epidemic outbreaks cannot be modified. In this way, working in a high risk environment increases the risk of developing clinically significant symptoms, namely depression Lai et al. Likewise, it seems like specific cadres are more likely to report mental health problems, namely PTSD Tang et al. However, this review also identified specific modifiable factors that can be addressed in advance and mitigate the risk brought by the aforementioned factors. Long-term institutional preparedness is possible for both factors, through the development and implementation of specialized training that includes infection prevention, diagnostics, patient care, staff, and communication de Rooij et al. Continuous communication between HCWs and managers, including the provision of up-to-date facts about the progression of the outbreak, can convey institutional support Marjanovic et al. Likewise, managers are essential to mitigate feelings of social isolation Lee et al. Although very limited, evidence from intervention studies indicates that educational interventions have the potential to increase knowledge and resilience Aiello et al. This is a timely and comprehensive rapid review of the current literature on the impact of viral epidemic outbreaks on the mental health of HCWs. We examined three relevant areas, namely the prevalence of mental health problems, factors associated with an increased likelihood of developing those problems, and the effects of interventions to improve mental health of HCWs. We followed the highest methodological standards when undertaking the current rapid review Tricco et al. There were also some limitations underlying this work. Despite searching three major databases and manually searching references of previously published systematic reviews, we did not examine grey literature. Moreover, the initial screening was undertaken by a single reviewer. Therefore, we cannot discard that relevant references may have been missed out. Despite the large number of studies identified in this systematic review, only four studies assessed the efficacy of interventions to ameliorate the impact of health emergencies on mental health of HCWs. None of them was a randomized controlled trial. To make progress in this area, future studies should address these limitations of the available literature. The use of validated measurement tools and more representative sample sizes are warranted in order to strengthen the quality of future cross-sectional studies. Robust trials are however much more needed to identify effective interventions to reduce mental health problems in HCWs. As observed in our review, the mental health burden for HCWs during pandemics is especially high both during and after the outbreak. We urge governments, policy-makers and relevant stakeholders to monitor and follow these outcomes and conduct scientifically sound interventional research, in order to mitigate mental health impact on HCWs. The physical health of HCWs is already at stake from the virus, and once we tackle the current pandemic, we will need to heal the healers, not only for the sake of having a prepared and resilient work-force, but to honour their tremendous sacrifices. If we want to address these concerns and be able to mitigate its impact, we need to act soon. IRC designed the search strategy. IRC did the data analysis. All authors interpreted the data analysis. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. IRC is the guarantor. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Supplementary material associated with this article can be found, in the online version, at doi This section collects any data citations, data availability statements, or supplementary materials included in this article. As a library, NLM provides access to scientific literature. J Affect Disord. Find articles by Maria J Serrano-Ripoll. Oslo, Norway. Find articles by Jose F Meneses-Echavez. Monforte de Lemos, Find articles by Ignacio Ricci-Cabello. Find articles by David Fraile-Navarro. Find articles by Maria A Fiol-deRoque. Campus Universitario de Cartuja. Cuesta del Observatorio, 4. Granada, Spain. Find articles by Guadalupe Pastor-Moreno. Carretera de Valldemossa, km 7. All rights reserved. Open in a new tab. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. Year of the study publication. Use of validated measures of mental health. Number of participants a. Mental health problems b. Area b.
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