Despite notable scientific and medical advances, broader political, socioeconomic and behavioural factors continue to undercut the response to the COVID-19 pandemic1,2. Here we convened, as part of this Delphi study, a diverse, multidisciplinary panel of 386 academic, health, non-governmental organization, government and other experts in COVID-19 response from 112 countries and territories to recommend specific actions to end this persistent global threat to public health. The panel developed a set of 41 consensus statements and 57 recommendations to governments, health systems, industry and other key stakeholders across six domains: communication; health systems; vaccination; prevention; treatment and care; and inequities. In the wake of nearly three years of fragmented global and national responses, it is instructive to note that three of the highest-ranked recommendations call for the adoption of whole-of-society and whole-of-government approaches1, while maintaining proven prevention measures using a vaccines-plus approach2 that employs a range of public health and financial support measures to complement vaccination. Other recommendations with at least 99% combined agreement advise governments and other stakeholders to improve communication, rebuild public trust and engage communities3 in the management of pandemic responses. The findings of the study, which have been further endorsed by 184 organizations globally, include points of unanimous agreement, as well as six recommendations with >5% disagreement, that provide health and social policy actions to address inadequacies in the pandemic response and help to bring this public health threat to an end.

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Background GPS alarms aim to support users in independent activities. Previous systematic reviews have reported a lack of clear evidence of the effectiveness of GPS alarms for the health and welfare of users and their families and for social care provision. As GPS devices are currently being implemented in social care, it is important to investigate whether the evidence of their clinical effectiveness remains insufficient. Standardized evidence frameworks have been developed to ensure that new technologies are clinically effective and offer economic value. The frameworks for analyzing existing evidence of the clinical effectiveness of GPS devices can be used to identify the risks associated with their implementation and demonstrate key aspects of successful piloting or implementation. Objective The principal aim of this study is to provide an up-to-date systematic review of evidence based on existing studies of the effects of GPS alarms on health, welfare, and social provision in the care of older adults compared with non–GPS-based standard care. In addition, the study findings were assessed by using the evidence standards framework for digital health technologies (DHTs) established by the National Institute for Health and Care Excellence (NICE) in the United Kingdom. Methods This review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Primary studies published in peer-reviewed journals and gray literature from January 2005 to August 2020 were identified through searches in 13 databases and several sources of gray literature. Included studies had individuals (aged ≥50 years) who were receiving social care for older adults or for persons with dementia; used GPS devices as an intervention; were performed in Canada, the United States, European Union, Singapore, Australia, New Zealand, Hong Kong, South Korea, or Japan; and addressed quantitative outcomes related to health, welfare, and social care. The study findings were analyzed by using the NICE framework requirements for active monitoring DHTs. Results Of the screened records, 1.6% (16/986) were included. Following the standards of the NICE framework, practice evidence was identified for the tier 1 categories Relevance to current pathways in health/social care system and Acceptability with users, and minimum evidence was identified for the tier 1 category Credibility with health, social care professionals. However, several evidence categories for tiers 1 and 2 could not be assessed, and no clear evidence demonstrating effectiveness could be identified. Thus, the evidence required for using DHTs to track patient location according to the NICE framework was insufficient. Conclusions Evidence of the beneficial effects of GPS alarms on the health and welfare of older adults and social care provision remains insufficient. This review illustrated the application of the NICE framework in analyses of evidence, demonstrated successful piloting and acceptability with users of GPS devices, and identified implications for future research.

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Background Health and welfare technologies (HWT) are becoming increasingly employed in the Nordic countries, and in Sweden in particular. The amount of HWT public procurement is likely increasing at a similar rate, but requirements for evidence for effectiveness placed on bidders during this process may be lacking. Method This study investigated the use of evidence as a requirement in public sector tendering process of HWT, and how it affected bidder attributes and procurement outcomes. A novel type of systematic review and content analysis of requests for tenders for HWT announced prior to June 2021 was therefore conducted in Swedish public procurement databases. Result Ninety requests for tenders for 11 types of HWT met the inclusion criteria for review, accounting for potential contracts worth 246 to 296 million EUR. Criteria requiring evidence for effectiveness were used in 16 requests for tenders, accounting for 183 million EUR in potential contracts. Eight of the requests referred to an established independent standard to confirm such evidence, such as CE standard of conformity, MDR and/or MDD. This prevalence appears to cut across all types of procuring organisations and all types of HWT. The use of any evidence criteria, or lack thereof, does not appear to affect the outcomes of the tendering process. Conclusion Criteria requiring evidence for effectiveness are used in less than a fifth of all public procurements of health- and welfare technologies in Sweden, and less than 10% refer to some form of independent standard as confirmation of such evidence. The procurement process therefore risks creating a legacy of sub-optimal technologies in health- and social care services. More prevalent and specific requirements for evidence and its continual generation in the procurement process are highly recommended. Recommendations for decision makers, procurement managers, and developers are provided.

Background Nocturnal digital surveillance technologies are being widely implemented as interventions for remotely monitoring elderly populations, and often replace person-based surveillance. Such interventions are often placed in care institutions or in the home, and monitored by qualified personnel or relatives, enabling more rapid and/or frequent assessment of the individual’s need for assistance than through on-location visits. This systematic review summarized the effects of these surveillance technologies on health, welfare and social care provision outcomes in populations ≥ 50 years, compared to standard care. Method Primary studies published 2005–2020 that assessed these technologies were identified in 11 databases of peer-reviewed literature and numerous grey literature sources. Initial screening, full-text screening, and citation searching steps yielded the studies included in the review. The Risk of Bias and ROBINS-I tools were used for quality assessment of the included studies. Result Five studies out of 744 identified records met inclusion criteria. Health-related outcomes (e.g. accidents, 2 studies) and social care outcomes (e.g. staff burden, 4 studies) did not differ between interventions and standard care. Quality of life and affect showed improvement (1 study each), as did economic outcomes (1 study). The quality of studies was low however, with all studies possessing a high to critical risk of bias. Conclusions We found little evidence for the benefit of nocturnal digital surveillance interventions as compared to standard care in several key outcomes. Higher quality intervention studies should be prioritized in future research to provide more reliable evidence.

Socioeconomic development initiatives (SDIs) have become a controversial issue. In giving skill trainings and credit supports, practitioners assume that SDI participation will enhance women’s income/dignity. Some studies have indicated that SDIs reduce women’s exposure to marital violence (MV), while others have shown that they increase spousal conflicts/MV. Our study explains how SDI participation may influence women’s marital life. This explorative study adopted a grounded theory design. Data included 17 participating-women’s interviews. It revealed that many women experienced further marital subordination, spousal conflicts, and MV. Yet women with strong motivation increased marital dignity/safety. Caring husbands facilitated this. If men can be involved in supporting women, impacts of SDIs will be substantial.

Keywords: comparative effectiveness research • evidence-based medicine • health technology assessmentReal world evidence (RWE) is defined as a form of evidence generated to answer a question or test a hypothesis using real world data (RWD) and using appropriate design and statistical analyses [1]. Others define RWE as the intersection between the randomized controlled trials (RCTs) and effectiveness of treatment in usual clinical practice [2]. To those with public health expertise, RWE is not totally a new phenomenon. Population-based studies using RWD are often conducted to evaluate the effectiveness and value of health programs and policies. Thus, RWE is an old wine in a new bottle. RWD characterized as patient registries have been a long tradition in the Nordic countries due to publicly financed healthcare and a unique person identifier, which enables linkage of data from different registries [3]. However, the impact of RWD/ RWE on health technology assessment (HTA) decision-making process regarding new treatments is not well assessed and the explanatory factors are not well known. Why RWE now?RWE has recently gained attention from patients, providers, payers, regulators and pharma industry. People are living longer in almost every part of the world with increasing demand for a healthy living. Technological advancement enables quick flow of data and information, thus increasing level of knowledge on health and on what works and what does not [4]. Patients have high expectations on health systems to offer safe and effective treatments.Parallel to this, global public health trends show increasing burden of noncommunicable diseases due to unhealthy lifestyle [5], implying a large proportion of people living a long unhealthy life about 30-40 years.Healthcare costs are rising at a much faster rate than gross domestic product (GDP), creating budget deficiencies [5]. This reinforces payers to ensure that they put money in treatments that are cost effective, add value to patients and improve population health.Thus, regulatory agencies begin to realize the benefit of RWE for regulatory decisionmaking for medicines and medical devices.Thus, in order for the industry to sell their products, they need RWE studies to address effectiveness, efficiency, value and safety of their products. Some companies have developed strategies to generate RWE, others are using ad hoc solutions, while the rest are waiting for the RWE wave to pass. Developing a new treatment is costly, yet a large proportion will never make it to the market. RWE is a potential cost-saver in various phases of the drug development lifecycle [6].RCTs are regarded as the gold standard for providing the scientific evidence of clinical Editorial Andersson & Kyhlstedt efficacy of treatments. However, evidence from the RCTs does not address real life conditions due to strict selection criteria with a limited study population, questionable external validity and generalizability [7]. RWE studies, on the other hand, demonstrate effectiveness in real world clinical pra...