Emily C. Clark

Background: Evaluating the methodological quality of primary studies is a crucial aspect of evidence syntheses, such as rapid reviews. Rapid reviews often include both randomised controlled trials (RCTs) and non-randomised studies (NRSIs) requiring multiple design-specific methodological quality assessment tools. This can complicate workflows and reduce efficiency. Unified tools, designed to assess methodological quality across diverse study designs, may offer a more consistent and streamlined approach. This scoping review aimed to comprehensively identify and describe unified tools for assessing methodological quality across both RCTs and NRSIs. Methods: The review followed JBI scoping review methodology and was reported in line with PRISMA-ScR guidance. Searches were conducted in MEDLINE (Ovid), Embase (Ovid), and CINAHL (EBSCO) from 1998 to 2024, alongside grey literature searches, citation tracking, targeted website searches, and consultation with experts in evidence synthesis. Study selection was performed by two independent reviewers. A tool was defined as any structured instrument developed to support users in assessing methodological quality. Results: A total of 55 publications were included, identifying 29 unique unified tools. These were categorized by structure: scales (n=14), checklists with judgment (n=7), simple checklists (n=5), domain-based tools (n=2), and other tools (n=1). All tools were designed to assess both RCTs and NRSIs. Of these, 13 focused exclusively on RCTs and NRSIs, while others extended to descriptive studies (n=15), case reports or series (n=9), qualitative research (n=7), and systematic reviews (n=3). Unified tools were developed using a mixture of approaches including literature reviewing (n=25), expert consensus (n=20), and stakeholder consultations (n=17). Reports of pilot testing was identified for 17 unified tools, and evaluation of psychometric properties was conducted to varying levels across different domains of validity and reliability. Conclusion: This review identified a diverse set of unified tools for assessing methodological quality across both RCTs and NRSIs. However, variation in tool structure, the availability of accompanying guidance, and the limited evaluation of psychometric properties, particularly interrater reliability and criterion validity, indicate potential issues for adoption in rapid reviews. Unified tools need further refinement and validation to be embedded in the rapid review process. Systematic review registration: https://osf.io/nyteu/

Objectives: Household food insecurity (HFI) is a social determinant of health globally. Rates of HFI have risen in many high-income countries in recent years, particularly in households with children. The health outcomes associated with HFI for children and adolescents have not been systematically synthesised. This review was conducted to support advocacy efforts for meaningful policy action to reduce HFI in households with children. Design: A systematic search was conducted in Medline, Embase and PsycInfo databases. Primary studies measuring the association between physical or mental health outcomes and HFI were included. Studies were appraised and population, setting, measures and outcomes were extracted. Findings were grouped by related outcomes. Due to heterogeneity, findings were synthesised narratively. Rapid review methodology was used to accommodate resource constraints. Setting: High-income countries. Participants: Youth aged less than 18 years. Results: Thirty-six studies were included. Most were cross-sectional studies conducted in the USA. Outcomes included general health, early childhood, cardiometabolic, asthma, dental caries, mental health, sleep, diet and anaemia. Despite substantial heterogeneity in HFI measures and analysis, findings support associations between HFI and negative outcomes for general health status, asthma, dental caries and mental health. Findings for other outcomes were mixed. Conclusions: This review clarifies the effects of HFI on children and adolescents. Findings highlight trends for negative physical and mental health outcomes associated with HFI during youth, particularly related to mental health, oral health, asthma and general health status. Policy-level action should address rising rates of HFI and long-term effects on these vulnerable populations.

Background: Health Evidence provides access to quality appraisals for >10,000 evidence syntheses on the effectiveness and cost-effectiveness of public health and health promotion interventions. Maintaining Health Evidence has become increasingly resource-intensive due to the exponential growth of published literature. Innovative screening methods using artificial intelligence (AI) can potentially improve efficiency. Objective: The objectives of this project are to: (1) assess the ability of AI-assisted screening to correctly predict nonrelevant references at the title and abstract level and investigate the consistency of this performance over time, and (2) evaluate the impact of AI-assisted screening on the overall monthly manual screening set. Methods: Training and testing were conducted using the DistillerSR AI Preview & Rank feature. A set of manually screened references (n=43,273) was uploaded and used to train the AI feature and assign probability scores to each reference to predict relevance. A minimum threshold was established where the AI feature correctly identified all manually screened relevant references. The AI feature was tested on a separate set of references (n=72,686) from the May 2019 to April 2020 monthly searches. The testing set was used to determine an optimal threshold that ensured >99% of relevant references would continue to be added to Health Evidence. The performance of AI-assisted screening at the title and abstract screening level was evaluated using recall, specificity, precision, negative predictive value, and the number of references removed by AI. The number and percentage of references removed by AI-assisted screening and the change in monthly manual screening time were estimated using an implementation reference set (n=272,253) from November 2020 to 2023. Results: The minimum threshold in the training set of references was 0.068, which correctly removed 37% (n=16,122) of nonrelevant references. Analysis of the testing set identified an optimal threshold of 0.17, which removed 51,706 (71.14%) references using AI-assisted screening. A slight decrease in recall between the 0.068 minimum threshold (99.68%) and the 0.17 optimal threshold (94.84%) was noted, resulting in four missed references included via manual screening at the full-text level. This was accompanied by an increase in specificity from 35.95% to 71.70%, doubling the proportion of references AI-assisted screening correctly predicted as not relevant. Over 3 years of implementation, the number of references requiring manual screening was reduced by 70%, reducing the time spent manually screening by an estimated 382 hours. Conclusions: Given the magnitude of newly published peer-reviewed evidence, the curation of evidence supports decision makers in making informed decisions. AI-assisted screening can be an important tool to supplement manual screening and reduce the number of references that require manual screening, ensuring that the continued availability of curated high-quality synthesis evidence in public health is possible.

Background: Public health surveillance plays a vital role in informing public health decision-making. The onset of the COVID-19 pandemic in early 2020 caused a widespread shift in public health priorities. Global efforts focused on COVID-19 monitoring and contact tracing. Existing public health programs were interrupted due to physical distancing measures and reallocation of resources. The onset of the COVID-19 pandemic intersected with advancements in technologies that have the potential to support public health surveillance efforts. Objective: This scoping review aims to explore emergent public health surveillance methods during the early COVID-19 pandemic to characterize the impact of the pandemic on surveillance methods. Methods: A scoping search was conducted in multiple databases and by scanning key government and public health organization websites from March 2020 to January 2022. Published papers and gray literature that described the application of new or revised approaches to public health surveillance were included. Papers that discussed the implications of novel public health surveillance approaches from ethical, legal, security, and equity perspectives were also included. The surveillance subject, method, location, and setting were extracted from each paper to identify trends in surveillance practices. Two public health epidemiologists were invited to provide their perspectives as peer reviewers. Results: Of the 14,238 unique papers, a total of 241 papers describing novel surveillance methods and changes to surveillance methods are included. Eighty papers were review papers and 161 were single studies. Overall, the literature heavily featured papers detailing surveillance of COVID-19 transmission (n=187). Surveillance of other infectious diseases was also described, including other pathogens (n=12). Other public health topics included vaccines (n=9), mental health (n=11), substance use (n=4), healthy nutrition (n=1), maternal and child health (n=3), antimicrobial resistance (n=2), and misinformation (n=6). The literature was dominated by applications of digital surveillance, for example, by using big data through mobility tracking and infodemiology (n=163). Wastewater surveillance was also heavily represented (n=48). Other papers described adaptations to programs or methods that existed prior to the COVID-19 pandemic (n=9). The scoping search also found 109 papers that discuss the ethical, legal, security, and equity implications of emerging surveillance methods. The peer reviewer public health epidemiologists noted that additional changes likely exist, beyond what has been reported and available for evidence syntheses. Conclusions: The COVID-19 pandemic accelerated advancements in surveillance and the adoption of new technologies, especially for digital and wastewater surveillance methods. Given the investments in these systems, further applications for public health surveillance are likely. The literature for surveillance methods was dominated by surveillance of infectious diseases, particularly COVID-19. A substantial amount of literature on the ethical, legal, security, and equity implications of these emerging surveillance methods also points to a need for cautious consideration of potential harm.

BACKGROUND Public health surveillance plays a vital role in informing public health decision-making. The onset of the COVID-19 pandemic in early 2020 caused a widespread shift in public health priorities. Global efforts focused on COVID-19 monitoring and contact tracing. Existing public health programs were interrupted due to physical distancing measures and reallocation of resources. The onset of the COVID-19 pandemic intersected with advancements in technologies that have the potential to support public health surveillance efforts. OBJECTIVE This scoping review aims to explore emergent public health surveillance methods during the early COVID-19 pandemic to characterize the impact of the pandemic on surveillance methods. METHODS A scoping search was conducted in multiple databases and by scanning key government and public health organization websites from March 2020 to January 2022. Published papers and gray literature that described the application of new or revised approaches to public health surveillance were included. Papers that discussed the implications of novel public health surveillance approaches from ethical, legal, security, and equity perspectives were also included. The surveillance subject, method, location, and setting were extracted from each paper to identify trends in surveillance practices. Two public health epidemiologists were invited to provide their perspectives as peer reviewers. RESULTS Of the 14,238 unique papers, a total of 241 papers describing novel surveillance methods and changes to surveillance methods are included. Eighty papers were review papers and 161 were single studies. Overall, the literature heavily featured papers detailing surveillance of COVID-19 transmission (n=187). Surveillance of other infectious diseases was also described, including other pathogens (n=12). Other public health topics included vaccines (n=9), mental health (n=11), substance use (n=4), healthy nutrition (n=1), maternal and child health (n=3), antimicrobial resistance (n=2), and misinformation (n=6). The literature was dominated by applications of digital surveillance, for example, by using big data through mobility tracking and infodemiology (n=163). Wastewater surveillance was also heavily represented (n=48). Other papers described adaptations to programs or methods that existed prior to the COVID-19 pandemic (n=9). The scoping search also found 109 papers that discuss the ethical, legal, security, and equity implications of emerging surveillance methods. The peer reviewer public health epidemiologists noted that additional changes likely exist, beyond what has been reported and available for evidence syntheses. CONCLUSIONS The COVID-19 pandemic accelerated advancements in surveillance and the adoption of new technologies, especially for digital and wastewater surveillance methods. Given the investments in these systems, further applications for public health surveillance are likely. The literature for surveillance methods was dominated by surveillance of infectious diseases, particularly COVID-19. A substantial amount of literature on the ethical, legal, security, and equity implications of these emerging surveillance methods also points to a need for cautious consideration of potential harm.

Background: Public health professionals are expected to use the best available research and contextual evidence to inform decision making. The National Collaborating Centre for Methods and Tools developed, implemented, and evaluated a Knowledge Broker mentoring program aimed at facilitating organization-wide evidence-informed decision making in ten public health units in Ontario, Canada. The purpose of this study was to pragmatically assess the impact of the program.Methods: A convergent mixed methods design was used to interpret quantitative results in the context of the qualitative findings. Quantitatively, participants’ knowledge and skills for finding, interpreting, and using evidence were measured before and after program completion via multiple-choice tests. Changes in scores were assessed using paired t-tests. Qualitatively, program participants and management at enrolled public health units were interviewed to explore the effect of program participation. A secondary analysis of these interviews was conducted to determine whether organizations met their evidence use goals set at baseline, and to identify key factors related to implementation of EIDM within the organization.Results: Post-program scores for knowledge and skills for EIDM were higher compared to pre-program scores (mean difference = 14.0%, 95% CI 8.2%, 19.8%). Organizations met their goals for evidence use to varying degrees. Key themes identified that support an organizational shift to EIDM include definitive plans for participants to share knowledge during and after program completion, embedding evidence into decision making processes, and supportive leadership with organizational investment of time and resources. The location, setting or size of health units was not associated with attainment of EIDM goals; small, rural health units were not at a disadvantage compared to larger, urban health units.Conclusions: The Knowledge Broker mentoring program effectively increased participants’ knowledge and skill, allowing them to share their learning and support change at their health units. When paired with organizational supports such as supportive leadership and resource investment, this program holds promise as an innovative knowledge translation strategy for organization wide EIDM among public health organizations.