Background: In the Sustainable Development Goals (SDGs) era, there is growing recognition of the responsibilities of non-health sectors in improving the health of children. Interventions to improve access to clean water, sanitation facilities, and hygiene behaviours (WASH) represent key opportunities to improve child health and well-being by preventing the spread of infectious diseases and improving nutritional status. Methods: We conducted a systematic review of studies evaluating the effects of WASH interventions on childhood diarrhea in children 0-5 years old. Searches were run up to September 2016. We screened the titles and abstracts of retrieved articles, followed by screening of the full-text reports of relevant studies. We abstracted study characteristics and quantitative data, and assessed study quality. Meta-analyses were performed for similar intervention and outcome pairs. Results: Pooled analyses showed diarrhea risk reductions from the following interventions: point-of-use water filtration (pooled risk ratio (RR): 0.47, 95% confidence interval (CI): 0.36-0.62), point-of-use water disinfection (pooled RR: 0.69, 95% CI: 0.60-0.79), and hygiene education with soap provision (pooled RR: 0.73, 95% CI: 0.57-0.94). Quality ratings were low or very low for most studies, and heterogeneity was high in pooled analyses. Improvements to the water supply and water disinfection at source did not show significant effects on diarrhea risk, nor did the one eligible study examining the effect of latrine construction. Conclusions: Various WASH interventions show diarrhea risk reductions between 27% and 53% in children 0-5 years old, depending on intervention type, providing ample evidence to support the scale-up of WASH in low and middle-income countries (LMICs). Due to the overall low quality of the evidence and high heterogeneity, further research is required to accurately estimate the magnitude of the effects of these interventions in different contexts.

Background: Internet gaming disorder (IGD) was included in the DSM-5 in 2013 as a condition requiring further research, and gaming disorder (GD) was included in the ICD-11 in 2018. Given the importance of including these conditions in diagnostic guidelines, a review was conducted to describe their prevalence. Methods: Using guidance from the Joanna Briggs Institute and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), we conducted a rapid scoping review. MEDLINE, Embase, PsycINFO, and the Cochrane library were searched for literature published from inception to July 2018. All review stages were pilot-tested to calibrate reviewers. The titles/abstracts and full-text articles were screened by one reviewer to include quantitative primary studies that reported GD or IGD prevalence. Excluded citations were screened by a second reviewer to confirm exclusion. Charting was conducted by one reviewer and verified by another, to capture relevant data. Results were summarized descriptively in tables or text. Results: We assessed 5550 potentially relevant citations. No studies on GD were identified. We found 160 studies of various designs that used 35 different methods to diagnose IGD. The prevalence of IGD ranged from 0.21-57.50% in general populations, 3.20-91.00% in clinical populations, and 50.42-79.25% in populations undergoing intervention (severe cases). Most studies were conducted in the Republic of Korea (n = 45), China (n = 29), and the USA (n = 20). Results are also presented for severe IGD and by geographic region, gender/sex, and age groups (child, adolescent, adult). The five most frequently reported health-related variables were depression (67 times), Internet addiction (54 times), anxiety (48 times), impulsiveness (37 times), and attention-deficit hyperactivity disorder (24 times). Conclusions: Due to the variability in diagnostic approaches, knowledge users should interpret the wide IGD prevalence ranges with caution. In addition to further research on GD, consensus on the definition of IGD and how it is measured is needed, to better understand the prevalence of these conditions.

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BACKGROUND: Increasing availability of competing biosimilar alternatives makes it challenging to make treatment decisions. The purpose of this review is to evaluate the comparative efficacy and safety of ultra-long-/ long-/intermediate-acting insulin products and biosimilar insulin compared to human/animal insulin in adults with type 1 diabetes mellitus (T1DM). METHODS: MEDLINE, EMBASE, CENTRAL, and grey literature were searched from inception to March 27, 2019. Randomized controlled trials (RCTs), quasiexperimental studies, and cohort studies of adults with T1DM receiving ultra-long-/long-/intermediate-acting insulin, compared to each other, as well as biosimilar insulin compared to human/animal insulin were eligible for inclusion. Two reviewers independently screened studies, abstracted data, and appraised risk-of-bias. Pairwise meta-analyses and network meta-analyses (NMA) were conducted. Summary effect measures were mean differences (MD) and odds ratios (OR). RESULTS: We included 65 unique studies examining 14,200 patients with T1DM. Both ultra-long-acting and long-acting insulin were superior to intermediate-acting insulin in reducing A1c, FPG, weight gain, and the incidence of major, serious, or nocturnal hypoglycemia. For fasting blood glucose, long-acting once a day (od) was superior to long-acting twice a day (bid) (MD -0.44, 95% CI: -0.81 to -0.06) and ultra-long-acting od was superior to long-acting bid (MD -0.73, 95% CI -1.36 to -0.11). For weight change, long-acting od was inferior to long-acting bid (MD 0.58, 95% CI: 0.05 to 1.10) and long-acting bid was superior to long-action biosimilar od (MD -0.90, 95% CI: -1.67 to -0.12). CONCLUSIONS: Our results can be used to tailor insulin treatment according to the desired results of patients and clinicians and inform strategies to establish a competitive clinical market, address systemic barriers, expand the pool of potential suppliers, and favor insulin price reduction.