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Food production is a major contributor to environmental damage. More environmentally sustainable foods could incur higher costs for consumers. In this review, we explore whether consumers are willing to pay (WTP) more for foods with environmental sustainability labels (‘ecolabels’). Six electronic databases were searched for experiments on consumers’ willingness to pay for ecolabelled food. Monetary values were converted to Purchasing Power Parity dollars and adjusted for country-specific inflation. Studies were meta-analysed and effect sizes with confidence intervals were calculated for the whole sample and for pre-specified subgroups defined as meat-dairy, seafood, and fruits-vegetables-nuts. Meta-regressions tested the role of label attributes and demographic characteristics on participants’ WTP. Forty-three discrete choice experiments (DCEs) with 41,777 participants were eligible for inclusion. Thirty-five DCEs (n = 35,725) had usable data for the meta-analysis. Participants were willing to pay a premium of 3.79 PPP$/kg (95%CI 2.7, 4.89, p ≤ 0.001) for ecolabelled foods. WTP was higher for organic labels compared to other labels. Women and people with lower levels of education expressed higher WTP. Ecolabels may increase consumers’ willingness to pay more for environmentally sustainable products and could be part of a strategy to encourage a transition to more sustainable diets.

Background Obesity accompanied by excess ectopic fat storage has been postulated as a risk factor for severe disease in people with SARS‐CoV‐2 through the stimulation of inflammation, functional immunologic deficit and a pro‐thrombotic disseminated intravascular coagulation with associated high rates of venous thromboembolism. Methods Observational studies in COVID‐19 patients reporting data on raised body mass index at admission and associated clinical outcomes were identified from MEDLINE, Embase, Web of Science and the Cochrane Library up to 16 May 2020. Mean differences and relative risks (RR) with 95% confidence intervals (CIs) were aggregated using random effects models. Results Eight retrospective cohort studies and one cohort prospective cohort study with data on of 4,920 patients with COVID‐19 were eligible. Comparing BMI ≥ 25 vs <25 kg/m2, the RRs (95% CIs) of severe illness and mortality were 2.35 (1.43‐3.86) and 3.52 (1.32‐9.42), respectively. In a pooled analysis of three studies, the RR (95% CI) of severe illness comparing BMI > 35 vs <25 kg/m2 was 7.04 (2.72‐18.20). High levels of statistical heterogeneity were partly explained by age; BMI ≥ 25 kg/m2 was associated with an increased risk of severe illness in older age groups (≥60 years), whereas the association was weaker in younger age groups (<60 years). Conclusions Excess adiposity is a risk factor for severe disease and mortality in people with SARS‐CoV‐2 infection. This was particularly pronounced in people 60 and older. The increased risk of worse outcomes from SARS‐CoV‐2 infection in people with excess adiposity should be taken into account when considering individual and population risks and when deciding on which groups to target for public health messaging on prevention and detection measures. Systematic review registration: PROSPERO 2020: CRD42020179783.

Aggressive/antisocial behaviors in children and youth may result in impairments in family, social, or academic functioning and lead to long‐term negative consequences for both the individual and society as a whole. The potential of healthy diet and nutritional supplements to reduce aggression and antisocial behavior is an active area of study in nutritional mental health sciences. The goal of this systematic review is to (1) investigate the effectiveness/efficacy of nutritional interventions (dietary manipulation, fortification or supplementation) in reducing excessive aggression, antisocial behaviors, and criminal offending in children/youth (systematic review and meta‐analysis); and (2) provide an overview of implementation barriers and facilitators regarding nutritional interventions in children/youth (qualitative/narrative synthesis). After consulting the Campbell Collaboration's methodological guidelines, a comprehensive search for published and unpublished papers on controlled intervention studies was performed (up to February 26, 2024) using both electronic databases (MEDLINE, Embase, Cochrane Library, APA PsycInfo, Scopus, and the Allied and Complementary Medicine Database) and other resources (e.g., Google Scholar, reference list of included studies and other reviews, websites of public health agencies). This study focuses on children and youth (up to the age of 24) presenting with an above‐average level of aggression/antisocial behavior. In terms of the intervention, we considered both dietary manipulation and nutritional supplementation with a duration long enough (minimum of 1 week) that a significant change in the individual's nutritional status could be expected. We included studies with a controlled design if, for outcomes, they reported on (1) behavioral‐level violence/aggression toward others in real‐life (non‐simulated) settings, (2) antisocial behaviors, or (3) criminal offending. Initial screening, checking for eligibility criteria, data extraction from, and risk of bias assessment for each eligible study were conducted independently by two reviewers. To perform the meta‐analysis, data from each original report were standardized (transformed into Hedges' g) so that results across studies could be meaningfully combined and interpreted. Data conversions, computation of pooled effect sizes, and estimation of publication bias were conducted using the Comprehensive Meta‐analysis software (Version 4). Altogether, 51 reports (describing 50 individual studies) met our inclusion criteria, and 72 effect sizes were extracted from these reports. Nutritional interventions with a broad target (e.g., broad‐spectrum micronutrient supplementation or general improvement in diet quality) had the most consistent and largest intervention benefit across all outcomes (aggression: k = 7, N = 797, g = −0.31, 95% CI = −0.50 to −0.12, p = 0.001; antisocial behavior: k = 13, N = 2109, g = −0.49, 95% CI = −0.73 to −0.24, p < 0.001; criminal offending: k = 2, N = 117, g = −1.25, 95% CI = −2.39 to −0.11, p = 0.031). These intervention benefits range from small (aggression) through medium (antisocial behavior) to large (offending), and for each outcome, dietary change was considerably more effective than supplementation. Eliminating studies with high risk of bias reduced the treatment benefit to close to zero regarding aggression and small in relation to antisocial behaviors. The most commonly studied narrow‐focused nutritional intervention was omega‐3 fatty acid supplementation with a small, beneficial effect and with less consistency in statistical reliability across outcomes (aggression: k = 9, N = 706, g = −0.33, 95% CI = −0.87 to 0.22, p = 0.240; antisocial behavior: k = 21, N = 2,081, g = −0.15, 95% CI = −0.26 to −0.03, p = 0.013). Eliminating studies with a high risk of bias did not change the small effect size related to aggression, but further reduced the negligibly small effect size regarding antisocial behavior. Pooled effect size for vitamin D supplementation showed small‐to‐moderate treatment benefit in terms of antisocial behaviors (k = 4, N = 226, g = −0.48, 95% CI = −0.74 to −0.22, p < 0.001). Elimination of studies with a high risk of bias reduced the effect size from moderate to small. The overall number of and sample size in some of the studies limit our confidence in the validity of the above meta‐analytic results. Further, prediction intervals always included the possibility of no effect, suggesting considerable heterogeneity in the data. While there were several studies on other narrow‐focused nutritional interventions, these were not studied frequently enough to allow the generation of even preliminary meta‐analytic conclusions. A large set of barriers and facilitators to the implementation of nutritional interventions was also identified and narratively summarized. While the evidence on nutritional interventions to reduce aggression/antisocial behaviors is not conclusive, these interventions are safe (especially compared to psychotropic medications), easy‐to‐implement (especially nutritional supplements), and cheap (especially on the societal level). These characteristics make such interventions feasible and desirable, especially as their benefits are not aggression‐specific: good nutritional status is the basis for both physical and mental health in general; and therefore, investment in – especially broad‐spectrum – nutritional interventions seems warranted.

This is a protocol for a Campbell systematic review of intervention effectiveness. The goal of this systematic review is to answer the following questions based on the available empirical evidence: Are there nutritional interventions (dietary manipulation, fortification or supplementation) that can reduce excessive aggression towards others in children/youth? If yes, how strong is their effect and is there a difference among the three intervention types? Are there nutritional interventions that can reduce antisocial behaviors in children/youth? If yes, how strong is their effect and is there a difference among the intervention types? Are there nutritional interventions that can reduce violent offending in children/youth? If yes, how strong is their effect and is there a difference among the intervention types? Are there nutritional interventions that can reduce non‐violent offending in children/youth? If yes, how strong is their effect and is there a difference among the intervention types? What implementation barriers and solutions to these exist in relation to the above nutritional interventions in children/youth?

In systematic reviews that lack data amenable to meta-analysis, alternative synthesis methods are commonly used, but these methods are rarely reported. This lack of transparency in the methods can cast doubt on the validity of the review findings. The Synthesis Without Meta-analysis (SWiM) guideline has been developed to guide clear reporting in reviews of interventions in which alternative synthesis methods to meta-analysis of effect estimates are used. This article describes the development of the SWiM guideline for the synthesis of quantitative data of intervention effects and presents the nine SWiM reporting items with accompanying explanations and examples.

Background The COVID-19 pandemic has highlighted health disparities affecting ethnic minority communities. There is growing concern about the lack of diversity in clinical trials. This study aimed to assess the representation of ethnic groups in UK-based COVID-19 randomised controlled trials (RCTs). Methods A systematic review and meta-analysis were undertaken. A search strategy was developed for MEDLINE (Ovid) and Google Scholar (1st January 2020–4th May 2022). Prospective COVID-19 RCTs for vaccines or therapeutics that reported UK data separately with a minimum of 50 participants were eligible. Search results were independently screened, and data extracted into proforma. Percentage of ethnic groups at all trial stages was mapped against Office of National Statistics (ONS) statistics. Post hoc DerSimonian-Laird random-effects meta-analysis of percentages and a meta-regression assessing recruitment over time were conducted. Due to the nature of the review question, risk of bias was not assessed. Data analysis was conducted in Stata v17.0. A protocol was registered (PROSPERO CRD42021244185). Results In total, 5319 articles were identified; 30 studies were included, with 118,912 participants. Enrolment to trials was the only stage consistently reported (17 trials). Meta-analysis showed significant heterogeneity across studies, in relation to census-expected proportions at study enrolment. All ethnic groups, apart from Other (1.7% [95% CI 1.1–2.8%] vs ONS 1%) were represented to a lesser extent than ONS statistics, most marked in Black (1% [0.6–1.5%] vs 3.3%) and Asian (5.8% [4.4–7.6%] vs 7.5%) groups, but also apparent in White (84.8% [81.6–87.5%] vs 86%) and Mixed 1.6% [1.2–2.1%] vs 2.2%) groups. Meta-regression showed recruitment of Black participants increased over time ( p  = 0.009). Conclusions Asian, Black and Mixed ethnic groups are under-represented or incorrectly classified in UK COVID-19 RCTs. Reporting by ethnicity lacks consistency and transparency. Under-representation in clinical trials occurs at multiple levels and requires complex solutions, which should be considered throughout trial conduct. These findings may not apply outside of the UK setting.

Digital health technologies (DHTs) play an ever-expanding role in health care management and delivery. Beyond their use as interventions, DHTs also serve as a vehicle for real-world data collection to characterize patients, their care journeys, and their responses to other clinical interventions. There is a need to comprehensively map the evidence-across all conditions and technology types-on DHT measurement of patient outcomes in the real world. We aimed to investigate the use of DHTs to measure real-world clinical outcomes using patient-generated data. We conducted this systematic scoping review in accordance with the Joanna Briggs Institute methodology. Detailed eligibility criteria documented in a preregistered protocol informed a search strategy for the following databases: MEDLINE (Ovid), CINAHL, Cochrane (CENTRAL), Embase, PsycINFO, ClinicalTrials.gov, and the EU Clinical Trials Register. We considered studies published between 2000 and 2022 wherein digital health data were collected, passively or actively, from patients with any specified health condition outside of clinical visits. Categories for key concepts, such as DHT type and analytical applications, were established where needed. Following screening and full-text review, data were extracted and analyzed using predefined fields, and findings were reported in accordance with established guidelines. The search strategy identified 11,015 publications, with 7308 records after duplicates and reviews were removed. After screening and full-text review, 510 studies were included for extraction. These studies encompassed 169 different conditions in over 20 therapeutic areas and 44 countries. The DHTs used for mental health and addictions research (111/510, 21.8%) were the most prevalent. The most common type of DHT, mobile apps, was observed in approximately half of the studies (250/510, 49%). Most studies used only 1 DHT (346/510, 67.8%); however, the majority of technologies used were able to collect more than 1 type of data, with the most common being physiological data (189/510, 37.1%), clinical symptoms data (188/510, 36.9%), and behavioral data (171/510, 33.5%). Overall, there has been real growth in the depth and breadth of evidence, number of DHT types, and use of artificial intelligence and advanced analytics over time. This scoping review offers a comprehensive view of the variety of types of technology, data, collection methods, analytical approaches, and therapeutic applications within this growing body of evidence. To unlock the full potential of DHT for measuring health outcomes and capturing digital biomarkers, there is a need for more rigorous research that goes beyond technology validation to demonstrate whether robust real-world data can be reliably captured from patients in their daily life and whether its capture improves patient outcomes. This study provides a valuable repository of DHT studies to inform subsequent research by health care providers, policy makers, and the life sciences industry. Open Science Framework 5TMKY; https://osf.io/5tmky/.

BackgroundDespite climate change being described as a code red for humanity, health systems have been particularly slow in both climate mitigation and adaptation responses. The effects of climate change on health and health systems will not be felt equally, with underserved and marginalised communities disproportionately impacted. The circumpolar region is warming at 3–4 times the global rate, amplifying already existing socioeconomic barriers and health inequities, with particular amplified effects for the substantial Indigenous population in the area.Objectives and settingWe therefore sought to explore perspectives of physicians around patient-planetary health (P-PH) co-benefit prescribing in a circumpolar region in the Northwest Territories (NWT), Canada, known to be one of the ground zero levels for climate change.MethodsThirteen semi-structured physician interviews were carried out in the NWT region between May 2022 and March 2023 using purposive sampling. Interviews were transcribed verbatim and reflexive thematic analysis was carried out to identify key themes.ResultsThere were three main themes identified including (1) current healthcare system does not support planetary health, (2) supporting patient-planetary health is currently difficult for clinicians and (3) considering change in the NWT to support patient-planetary health. Participants noted key opportunities to move planetary health forward, with the NWT having the potential to be an innovative model for planetary health-informed change for other health systems.ConclusionThe NWT health system has unique features due to its rural and remote nature and smaller population base. Despite this, our study identified some key opportunities for advancing P-PH co-benefit efforts. The identified opportunities may be considered in future intervention, organisational change and policy-making efforts with potential relevance in other settings.

Self-regulation for weight loss requires regular self-monitoring of weight, but the frequency of weight tracking commonly declines over time. This study aimed to investigate whether it is a decline in weight loss or a drop in motivation to lose weight (using physical activity tracking as a proxy) that may be prompting a stop in weight monitoring. We analyzed weight and physical activity data from 1605 Withings Health Mate app users, who had set a weight loss goal and stopped tracking their weight for at least six weeks after a minimum of 16 weeks of continuous tracking. Mixed effects models compared weight change, average daily steps, and physical activity tracking frequency between a 4-week period of continuous tracking and a 4-week period preceding the stop in weight tracking. Additional mixed effects models investigated subsequent changes in physical activity data during 4 weeks of the 6-week long stop in weight tracking. People lost weight during continuous tracking (mean -0.47 kg, SD 1.73) but gained weight preceding the stop in weight tracking (mean 0.25 kg, SD 1.62; difference 0.71 kg; 95% CI 0.60 to 0.81). Average daily steps (beta=-220 daily steps per time period; 95% CI -320 to -120) and physical activity tracking frequency (beta=-3.4 days per time period; 95% CI -3.8 to -3.1) significantly declined from the continuous tracking to the pre-stop period. From pre-stop to post-stop, physical activity tracking frequency further decreased (beta=-6.6 days per time period; 95% CI -7.12 to -6.16), whereas daily step count on the day's activity was measured increased (beta=110 daily steps per time period; 95% CI 50 to 170). In the weeks before people stop tracking their weight, their physical activity and physical activity monitoring frequency decline. At the same time, weight increases, suggesting that declining motivation for weight control and difficulties with making use of negative weight feedback might explain why people stop tracking their weight. The increase in daily steps but decrease in physical activity tracking frequency post-stop might result from selective measurement of more active days.

IntroductionPrevious trials finding an effect of self-monitoring on weight loss have considered the effect to be mediated by self-regulatory processes. However, a qualitative think-aloud study asking people to record thoughts and feelings during weighing showed that self-regulation occurs only rarely without further instruction. The aim of this trial is to test a novel intervention guiding people through the self-regulatory processes to see whether it facilitates weight loss.Methods and analysesA parallel group, randomised controlled trial will be conducted to test the concept that a self-regulation intervention for weight loss increases weight loss compared with daily self-weighing without further support. One hundred participants with a body mass index ≥30 kg/m2 will be randomised to either the control or intervention group. The control group will be asked to weigh themselves daily for 8 weeks, the intervention group will be encouraged to follow the self-regulation intervention. They will be prompted to weigh daily, track their weight using an app, plan daily actions for weight loss and reflect on their action plans on a weekly basis. This self-regulation cycle will allow them to experiment with different weight loss strategies and identify effective and sustainable actions. Primary and process outcomes will be measured at baseline and 8 weeks’ follow-up. Linear regression analysis of the primary outcome, weight change, will assess the early effectiveness of the intervention. The process outcomes liking, perceived effectiveness, as well as usage and barriers with regard to the self-regulation intervention, will be assessed through qualitative analysis of follow-up interviews and quantitative analysis of adherence rates and responses to a final questionnaire.Ethics and disseminationThis trial was reviewed and approved by the NHS National Research Ethics Committee and the Health Research Authority (reference number: 18/SC/0482). The findings of the trial will be published in peer reviewed journals and presented at conferences.Trial registration numberISRCTN14148239, prerecruitment.Protocol versionVersion 1.1, 7 December 2018.