With the increasing life expectancy and ageing population, long-term care has become an urgent policy issue worldwide. The informal care provided by family members, particularly adult children, is a key aspect of long-term care. However, socioeconomic transformations have resulted in changing family and demographic structures and increased geographic mobility, reducing the capacity of families to provide informal care and meet the caregiving needs of older adults. For ageing families, care preparation can be an effective method for coping with eldercare challenges, and care preparation is attracting increasing attention from researchers. This study seeks to conduct a systematic review for studies on caregiving preparation by adult children that were retrieved from six databases, to synthesise the available evidence, and to identify knowledge gaps and opportunities for future investigations. The characteristics and main themes of eighteen reviewed articles were identified and analysed. This study discussed various conceptualisations of caregiving preparation by adult children, the prevalence of caregiving preparation, the factors related to caregiving preparation, and the related consequences. On the basis of the systematic review findings, several limitations of the literature and directions for future research were proposed to promote care preparedness and the well-being of ageing families. Adult children are the most common source of assistance for older adults to achieve ageing-in-place . DrawingBoth anticipated and actual caregiving for parents can be sources of stress for adult-child caregivers. As the potential primary caregivers for their parents, adult children tend to be concerned about how much help they can provide in the future and whether they can manage the burden of providing care ,6. StudiStudies investigated the care preparation activities that older adults engage in as a proactive coping strategy, and they have identified their effectiveness for mitigating future long-term care challenges ,8,9. AppScholars have also suggested that adult children should prepare themselves for their future caregiving role and participate in care preparation activities for effectively reducing care anxiety and preventing their future caregiving burden. While studies on adult children’s caregiving preparation have been conducted for decades, there is currently no systematic review on this topic. This study seeks to fill this gap by conducting a comprehensive overview of the literature in this field, synthesising the available evidence, and identifying knowledge gaps and opportunities for future investigations.The following research questions will be addressed in the systematic review: (a) How have studies conceptualised the caregiving preparation of adult children since the emergence of this research topic? (b) To what extent do adult children engage in caregiving preparation? (c) What are the factors related to caregiving preparation and what are their possible effects?The EBSCOhost, PsycINFO, ProQuest, Web of Science, PubMed, and CNKI databases were systematically searched. A lexicon of keywords was generated after a pilot search of the selected databases. With the exception of CNKI, the following combinations of keywords were used to identify and retrieve studies on anticipatory care preparation from the databases: ‘adult child*’ AND  AND (‘prepare* OR ‘plan*’). For the search of the CNKI database, the following combinations of keywords were used: ‘子女’ (adult child) AND ‘养老照顾’ (care preparation) AND (‘准备’ (preparation) OR ‘计划’ (plan)). Relevant studies dated from the inception of the databases until November 2022 were identified and retrieved. This broad period was applied because few systematic reviews have explored this research topic since its emergence.Studies were included in the present review if they: (1) were reports, reviews, book chapters, conference papers, dissertations, or journal articles related to the caregiving preparation of adult children for their parents, (2) were published in English or Chinese, and (3) were published between the inception of the databases and November 2022. Studies were excluded if they were commentaries, unpublished reports, not empirical studies, or published in languages other than English or Chinese. Studies were also identified from the reference lists of the articles already included in the present review. The abstracts or summaries of all included studies were reviewed, and the eligibility of each study was determined by two researchers who evaluated the relevance of each study to the study topic.First, two researchers independently evaluated the quality of the extracted studies by using the Mixed-Methods Appraisal Tool, which has been widely used in systematic reviews to evaluate the quality of qualitative, quantitative, and mixed-methods studies. Inter-rater reliability was determined by calculating intraclass correlation coefficients, and the results indicated a high inter-rater reliability (0.823). All the studies yielded an overall score of 3 or higher, indicating an acceptable research quality. Next, thematic analysis was conducted to synthesise the findings of the reviewed studies. All studies were read by two researchers. Data on the sources of the literature, themes, research methods, participants, and key findings of the reviewed studies were coded and summarised. Data synthesis was conducted by comparing the findings of the included studies and identifying differences and similarities.Studies proposed various conceptualisations of the caregiving preparation of adult children. Of the 18 reviewed studies, 10 conceptualised it as a multiphase process. Bromley and Blieszner  identifiTwo studies specifically developed models for studying the caregiving preparation of adult children ,30. SöreOn the basis of Sörensen’s  frameworThe rest of the studies mainly examined caregiving preparation as a single-step event (e.g., anticipation ,16, consThe measurements of caregiving preparation were mostly self-developed questions, and few studies have validated the scales used. Several studies used scales developed for measuring older adults’ care preparation ,18,31 toBased on the self-report of 103 adult daughters aged between 30 and 55 years, Conway-Turner and Karasik  discoverBromley and Blieszner  surveyedThe age and gender of adult children are associated with their caregiving anticipation ,21. LiebFor adult daughters, the order of birth, the characteristics of the sibling network, the geographical proximity between mothers and daughters, and the health status of the daughters have been reported to be significantly related to their caregiving anticipation ,32. FiliIn a small sample of 33 three-generation families, Sörensen  discoverIn a sample of 165 women who were prospective caregivers, Paulson and Bassett  discoverHansson et al.  reportedFew studies investigated the consequences of caregiving preparation. In a qualitative study, Stolee et al.  revealedThe present study is the first to systematically review the literature on the caregiving preparation of adult children for their older parents, and synthesised research findings regarding the conceptualisation, prevalence, influencing factors, and potential consequences of caregiving preparation. The findings of the present study can provide future directions for this research topic and have implications for service providers and policymakers to design measures for supporting adult-child family caregivers.The findings of the systematic review revealed that most studies conceptualised caregiving preparation as a multistage process. These studies’ multidimensional conceptualisations generally corresponded to the key components in the Preparation for Future Care Needs Model ,12. TheyIt is noteworthy that majority of studies examining caregiving preparation explicitly or implicitly address the concepts of anticipatory role socialisation and proactive coping. These are two useful strategies for families to undergo transitions  and copeMoreover, according to proactive coping theory , people Future studies may consider systematically examining adult children’s caregiving preparation experiences from the perspective of anticipatory socialisation and proactive coping. A more comprehensive and theory-guided conceptualisation of caregiving preparation activities can help future research better investigate adult children’s essential involvement in the different stages of the caregiving preparation process and examine the relationships among different components of caregiving preparation and their impacts. Understanding the intrinsic connections and transitions between the different components can help provide targeted interventions to promote the development and maturation of the whole process. Additionally, attention should also be paid to the interactions and communications between adult children and older parents at multiple stages of the care preparation process. Although some studies highlighted the communication and discussion between adult children and older parents, few adopted an intergenerational perspective to understand their different roles, mutual influences, and practical initiatives to care preparation. Examining adult children’s caregiving preparation experiences from an intergenerational perspective can provide a more comprehensive overview of care preparation that considers the familial context and how different generations influence each other. This would help to develop customised intervention programmes to assist these two groups in overcoming difficulties they encountered in the care preparation process.The results of the systematic review also identified a lack of comprehensive and validated measurements for the entire care preparation process. Existing studies basically only assessed certain phases, especially the preliminary stage, such as the awareness of caregiving responsibility and how adult children consider providing care to their parents. The lacking evidence and assessment of subsequent stages, such as the final decision-making stage, leads to a lack of evaluation of the whole process. In view of the limitations in the validities of the measurements, future studies should consider developing and validating measures of comprehensive caregiving preparation activities of adult children.Although the reported prevalence of caregiving preparation cannot be compared between studies considering the variations in the types of activities examined, most studies reported a high prevalence of caregiving preparation. Studies also highlighted that many adult children were anticipating future caregiving needs and responsibilities, but few adult children were making definite plans ,33, as eThe influencing factors for caregiving preparation have rarely been explored from a theoretical perspective, with only a few studies applying attachment theory or role theory to guide their investigations. Furthermore, considering that all the reviewed studies had a cross-sectional design, limited knowledge is available regarding how the caregiving preparation of adult children progresses over time and what are the causal effects of the aforementioned influencing factors. Future studies should adopt an integrative framework, preferably combined with a longitudinal research design, to investigate the predictors of multistep care preparation activities among adult children.Notably, few studies examined the potential effects of the caregiving preparation of adult children. Although Western scholars have frequently discussed the potential benefits of care preparation in reducing the potential stress due to caregiving, there is limited empirical evidence supporting the role of care preparation in reducing the stress caused by anticipating or actually taking on the caregiving role among adult children. Thus, scholars should empirically investigate the potential effects of caregiving preparation, especially the reduction of caregiver stress, concerns about providing eldercare, and the enhancement of caregiving preparedness and other aspects of the well-being of adult children and their older parents.Overall, the literature on the caregiving preparation of adult children is still limited and primarily focused on Western countries, and few studies have examined the care preparation activities and processes of Asian adult children. Considering that Asian societies emphasise filial piety and filial care, adult children play a crucial role in meeting the caregiving needs of older adults, and they are more likely than Western adult children to become primary caregivers of older parents. Cultural sensitivity is crucial to care preparation activities in Asia. Therefore, scholars should further investigate the unique characteristics of care preparation of Asian adult children.The present study systematically reviewed the literature on the caregiving preparation of adult children for future eldercare needs. The identified studies have several limitations, including the lack of consistent conceptualisation of caregiving preparation, comprehensive examination of the process of caregiving preparation, intergenerational perspectives, validated measures, longitudinal research design, representative sampling, guiding frameworks for examining influencing factors and consequences, and the underrepresentation of Asian populations. Future studies should aim to address these research gaps to enhance the understanding of caregiving preparation and facilitate the development of interventions to promote care preparedness and well-being in ageing families.


Dear Editors,Immigration is an ongoing and emergent phenomenon worldwide. With 82 million subjects who have migrated from other countries, Europe is currently first at the global level as host of international migrants . In EuroIt is well known that the attitude toward post-mortem organ donation is complex and multifactorial and may be influenced by many intersecting factors requiring a socio-ecological approach  to enable understanding. This is especially relevant when it comes to considering the factors underlying the attitude of individuals who have migrated from other countries or who are from ethnic minorities. At the individual level, many factors may play a role. These factors include cultural and religious beliefs, language proficiency, socioeconomic status, and low health literacy. Further, lack of knowledge of organ donation and transplantation, lack of trust toward the healthcare system and healthcare professionals (HCP), and lack of familiarity with the complexity of the healthcare system may be influential. Additional factors may include also the individual reasons for and circumstances of migration, time elapsed since immigration as a potential proxy for acculturation and/or integration, and organ trafficking or corruption in healthcare systems being widespread practices in countries of origin. Besides, HCPs’ lack of training for the development of intercultural competences and communicative/relational abilities, and interpersonal dynamics between potential donors’ families and HCPs in intensive care units (ICU) may equally account for a portion of attitudes among immigrant donors’ families in ICUs. At the healthcare system level, the inability of institutional actors to communicate about organ donation and transplantation in a culturally sensitive fashion among the public and to reach out effectively to these communities by improved participation and involvement of local faith/community representatives may equally play a role. Availability of culturally competent and, more broadly, diversity sensitive healthcare services, administrative difficulties, poor care coordination among the actors involved, and other features at organizational, local levels and, finally, the broader societal context  also have the potential to stand among the contributing factors .We have extracted data on 24,222 donors between 1 January 2012 and 31 December 2021 from the Transplant Information System (SIT) of the Italian National Transplant Center (CNT). As in earlier studies , non-EU-allowing decisions to develop over time by jointly respecting clinical indications and individual … subjective considerations, values, needs, preferences, life circumstances and goals”) [We contend that it is an ethical duty and responsibility to foster shared decision-making   to enabl goals”) , 10. The goals”) . Future


In collaboration with local partners, we reviewed 18 national policy documents across two sub-Saharan African countries identified as pre-dividend nations by the World Bank in 2017: Nigeria and Tanzania. Our aim was to assess national policies in pre-dividend countries and to determine whether national strategies were primed to capitalize on changing demographic structures, maximally attain the demographic dividend, and augment socio-economic growth.We conducted policy reviews by focusing on five key sectors of the Gates Institute Demographic Dividend Framework: Family Planning, Maternal and Child Health, Education, Women’s Empowerment, and Labor Market. This framework was developed as a tool for countries to apply targeted policies for accelerating the demographic dividend based on their demographic structure. For each component we used a comprehensive list of indicators, defined via a systematic literature review, through which we assessed national policies aimed at maximizing the demographic dividend.Between the two countries, we observed persistent gaps in policies targeting family planning. Although more comprehensive, policies addressing maternal and child health, education, women’s empowerment, and labor market still lagged in their specificity and measurability. We identified specific policy amendments and alternatives that Nigeria and Tanzania could consider to mitigate these gaps. We also stress the importance of designing measurable policy initiatives across sectors.Based on these recommendations, as Nigeria, Tanzania, and other pre-dividend nations start experiencing rapid demographic changes, they may consider implementing routine policy reviews to strengthen policies across the five key sectors and harness the benefits of a demographic dividend.The online version contains supplementary material available at 10.1186/s12889-023-15690-z. In 2017, the African Union committed to “Harnessing the Demographic Dividend Through Investments in Youth”, prompting leaders across the continent to develop multisectoral policy roadmaps and action plans for attaining the demographic dividend . These bHowever, the demographic transition and subsequent dividends in economic growth are not automatic. Indeed the extent to which countries benefit from this demographic transition is highly dependent on the existence of policies that establish optimal conditions for capturing the full returns of the demographic dividend , 3, 6. MBloom and colleagues have previously described that investments in health, education, and the labor-market are key to capitalizing on the demographic transition . More spThe Population Reference Bureau (PRB) recently conducted a literature review to identify specific policy inputs conducive to achieving the demographic dividend . This reAlthough knowledge of evidence-based policies to realize the demographic dividend exists, the extent to which they are incorporated into national planning is not well understood. Discerning the degree to which these policies are embedded within policy frameworks requires a comprehensive review of the national policy landscape. This intensive process can be accomplished through an exhaustive review of national strategic frameworks and sector-specific policy documents. However, the scope and relevance of these policies may vary depending on which phase of the demographic transition a country is experiencing. For instance, most countries in sub-Saharan Africa are in the pre-demographic dividend phase, with total fertility rate (TFR) greater than four children per woman, or the early-demographic dividend phase, whereby TFR is below four children .Evidence suggests that pre-dividend countries should prioritize human development outcomes, with a goal towards accelerating the fertility decline, creating a population age structure with fewer dependents, and assisting a growing proportion of the population that is working age to develop the necessary skills to enter the labor market in the future. Conversely, early-dividend countries should prioritize accelerating job creation to ensure that the growing share of the working-age population remains employed to promote economic growth. The labor market must develop productive jobs to appropriately match labor supply with a growing labor demand. Regardless of demographic transition stage, countries adopt a multisectoral and integrated approach to ensure that the right supportive policies are in place to catalyze the demographic transition and translate it into concrete economic growth.While studies have suggested specific policy enactments for countries to capitalize on changing demographic structures, these suggestions were mostly generated from the experiences in Southeast Asian and European countries. Furthermore, there are no demographic dividend-favorable policies specific to stages of the demographic transition in African countries in the existing literature. Using the Demographic Dividend Framework, developed by the Gates Institute, we aimed to review the policy landscape of two pre-dividend African nations as case studies, and to identify existing evidence-based policies conducive to fostering a demographic dividend-favorable environment in the pre-dividend context of each country. We also assess existing national policies based on their degree of comprehensiveness and identify gaps. We subsequently make recommendations regarding policy amendments that both African nations could undertake to capitalize on their changing demographic structures to attain a demographic dividend, and boost their economies.The current stage of a country’s demographic transition largely influences how and why decision-makers prioritize the needs of the populations they serve. The Gates Institute developed the Demographic Dividend Framework Fig.  to highlGovernance and Economic Institutions as a critical component to develop a favorable policy environment. Countries need to be politically stable, have solid institutions, and a favorable macroeconomic environment. While the Governance and Economic Institutions sector is an important component of the Demographic Dividend Framework, we focused our policy review on the remaining five sectors, given the cross-cutting nature of this sector.Each sector of the Demographic Dividend Framework encompasses a wide array of strategic interventions, initiatives, or indicators that have proven effective for promoting per capita economic growth . At the Family Planning input of the Demographic Dividend Framework addresses interventions that facilitate the realization of various benefits of family planning programs, accounting for the local cultural and social context while engaging local communities and promoting accessible and affordable modern contraceptive methods. The Maternal and Child Health input is focused on identifying interventions highlighting the importance of breastfeeding, safe motherhood initiatives, vaccinations, child nutrition programs, and case management of childhood illness. The Education input underscores interventions and policies that invest in universal primary education, ensure high quality education, and provide vocational training. The Women’s Empowerment sector highlights policies that prevent child marriage, protect women’s health, education, and human rights, and facilitate women’s access to the labor market. Finally, the Labor Market sector of the Demographic Dividend Framework includes initiatives to address unemployment rates, track and promote savings in various economic areas, encourage foreign investment, and develop the financial sector. More details for each of the sectors described, and their subsequent key strategic interventions, are described in detail elsewhere [The lsewhere .The analytic framework to assess policy documents was based on the Demographic Dividend Framework. We identified relevant policy documents by following an inductive search strategy of open resources. We first searched for the most recent long-term vision plans and mid-term national strategic development plans issued by each country’s government that could be accessed online. In most cases, long-term plans covered ten years, while mid-term plans covered five years. We purposefully searched for long- and mid-term strategic planning documents and national policies developed by different sectors, reflecting the five inputs of the Demographic Dividend Framework on which we based our review Fig. . We seleAlthough global guidance specifies that pre-dividend countries should prioritize decreasing national fertility rates , we asseWheel of Prosperity, which was developed by the Gates Institute in conjunction with the Demographic Dividend Framework, and provides a detailed breakdown of key interventions of each of the sectors of the Demographic Dividend Framework [We reviewed the full text of each policy document from the final document list and extracted relevant text using a data extraction template that classified policies following different sectors of the Demographic Dividend Framework. We present an example of the template in Supplemental Figure A  and measurable . Being either not specific or not measurable, the policy is categorized as “Policy Mentions”. If there are no specific contents relating to the key intervention in the documents reviewed from the country’s full list, this intervention in the given country is determined as not mentioned in the reviewed documents.Ethics approval for this study was waived by the institutional review boards of the Johns Hopkins Bloomberg School of Public Health in Baltimore, MD, USA and the Bill and Melinda Gates Foundation. This study was designated as non-human subjects research given its use of publicly available data.or comprehensively address each of the interventions of the Demographic Dividend Framework. Summary of country-specific findings by sector are provided in Table We reviewed a total of 18 long-term and mid-term plan, sectoral strategy, and policy-specific documents from both pre-dividend nations, Nigeria and Tanzania. Country-specific documents identified as the fundamental materials for this policy review are listed in Table Nigeria and Tanzania provide policy mentions for two and three out of the four interventions of Family Planning, respectively. Family planning is mainly emphasized in Nigeria’s National Health Policy (NHP) 2016. The cultural and social contexts and cost reduction and product availability are integrated in the policy objectives and orientation section, but only limited to policy mentions. Benefits of family planning programs or community engagement are not covered. Specific policy orientation and initiatives address accounting for cultural and social context by promoting implementation of legislations that mitigate harmful cultural practices, such as female genital mutilation. Policy initiatives also emphasize reducing costs and ensuring product availability by promoting mechanisms to ensure access to quality reproductive health services, integration of reproductive maternal, neonatal, and child and adolescent health services.ensure sustainable development of the people and promote gender equality and the empowerment of women”. Specifically, the Policy defined objectives with policy directions as follows:Account for cultural and social context by sponsoring public awareness of sexual and reproductive health and rights for all, promoting measures to eradicate harmful traditional practices , and encouraging men to participate in reproductive health programs;Reduce costs and ensure product availability by expanding quality, and strengthening delivery, of reproductive health services, including addressing problems such as infertility, cancers of the reproductive system, post-natal care, post abortion complications, and fistulae;Encourage community engagement by promoting and expanding quality reproductive health services and counselling for adolescents, men and women, and fostering participation and involvement of communities in provision of reproductive health services.In Tanzania, family planning is a core topic of the section of reproductive health in the 2006 revised National Population Policy, of which the goal is to coordinate and influence other policies, strategies, and programs that “Reproductive health is further emphasized in Tanzania with special focus on strengthening the health system to provide quality services to contribute to ending preventable, maternal, newborn and child deaths and ensuring universal access to sexual, reproductive, and adolescent health services. Tanzania has clear targets for increasing uptake of family planning methods nationally from 27.4% to 60% in 2020 among married women (aged 15 to 49) and reducing adolescent fertility rates from 11.6% to less than 10% in 2020. The Plan also considers product availability and affordable prices, with emphasis on employing media campaigns and community outreach to improve adolescent and adult access to services.Population oriented, scheduled routine immunizations to improve vaccination coverage;Family-oriented community-based services that promote breastfeeding practices;Policies that promote clean delivery and cord care;Population-oriented scheduled services to provide vitamin A supplementation for children under five;Family-oriented, community-based services to address malnutrition by supplementary feeding and follow-up management of severe acute malnutrition;A series of population-oriented, scheduled services that focus on preventing mother to child transmission of HIV via implementation of cotrimoxazole prophylaxis for HIV-positive mothers, adults, and children of HIV-positive mothers.Nigeria comprehensively addresses all indicators of the Maternal and Child Health input of the Demographic Dividend Framework with two documents related to maternal and child health: the National Strategic Health Development Plan (NSHDP) and the National Health Policy (NHP). One of the strategic goals of the NSHDP 2010–2015 is to increase universal availability and access to an essential package of primary health care services with focus on particularly vulnerable groups including those of low socio-economic status and marginalized geographical areas. The essential package of care is grouped into three service delivery modes: “family-oriented, community-based services”; “population-oriented, schedulable services”; and “individually oriented clinical services”. The targeted elements of the framework include:Nigeria further incorporates a system of accountability for routine immunization and ensuring vaccine security by establishing standards for injection safety and disposal and cold chain equipment; promoting comprehensive obstetrics care to reduce risks associated with pregnancy and childbirth; promoting awareness and strengthening the capacity of prevention, management and control of nutritional disorders with emphasis on facilitating community participation in nutrition interventions; promoting implementation of child survival strategies including provision of essential care services for the new-born; and providing universal access to comprehensive and quality HIV prevention, treatment care and support services.Improve vaccination coverage to over 90% in 90% of all districts by ensuring accessibility and utilization of immunization services through outreach and other programs.Implement clean umbilical cord care by increasing the proportion of skilled birth attendance to over 80% and continuing to expand provision of services during pregnancy, childbirth, and the post-natal period.Essential Nutrition Action Approach aims to reduce the percentage of underweight children from 16 to 11% in 2020, and to reduce the percentage of stunting children from 42 to 27% in 2020.Promote nutrition programs by ensuring food security at national and household levels and eradicating cultural barriers to improving community nutritional status. In addition, the Scale up application of a protocol to address integrated management of childhood illnesses, including building capacity of health care workers.Prevent mother-to-child transmission of HIV by ensuring all eligible patients receive Prevention of mother-to-child transmission (PMTCT) by 2020.Policies in Tanzania comprehensively cover four of the seven indicators: vaccination coverage, implementing clean umbilical cord care, implementing nutritional programs, and preventing mother-to-child transmission of HIV. In the Health Sector Strategic Plan 2015–2020 (HSSP IV), the Nutrition Services section and the Reproductive, Maternal, Newborn, Child and Adolescent Health section provide a set of strategies to improve maternal and child health in the five-year period of 2015–2020, guided by National Five-Year Development Plan and National Population Policy. Promotion of exclusive breastfeeding is briefly mentioned in reference to scaling up newborn, infant, and young child feeding services. At the community level, health programs aim to improve community mobilization, advocate utilization of the available services and stimulate families to seek early medical assistance. Specific initiatives and goals in each aspect are listed as follows:We assessed policies targeting the Education component of the Demographic Dividend Framework using three key indicators: implementing universal primary education, ensuring the quality of education, and providing vocational and technical training. Nigeria proposes national policies that effectively address all indicators of the Education input of the Demographic Dividend Framework. The importance of education is highlighted in Nigeria Vision 20:2020—the first pillar of Vision 20:2020 is guaranteeing the productivity and wellbeing of the people. The strategic orientation on education is to reform the educational system to enforce completion of mandatory nine-year universal basic education, while simultaneously building capacity in technical and vocational education.Other national plans guarantee access to basic education for all and map out methods to improve the quality of secondary and tertiary education and encourages students to enroll in science, technology, engineering, and math (STEM) courses. Detailed strategies ensure quality of education by improving teacher quality, improving quality of education, and improving funding mechanisms to incentivize education performance and increase access. Strategies also provide vocational and technical training by building collaborative partnerships between partner, private, and state governments to establish vocational and technical institutes and increasing investment in STEM education.Education policies are well-developed throughout Tanzania’s policy documents, while only primary education has specific targets under the Tanzania Development Vision 2025. The country has policy goals of implementing universal primary education by increasing net enrolment rates in primary school to 99% by 2012 and by providing special needs educational services to vulnerable children. Similarly, to Nigeria, additional Tanzanian policies entail ensuring quality education by providing satellite schools in remote areas and increasing the number of available teachers, educators, and instructors to reach optimal teacher to pupil ratios. Finally, Tanzania prioritizes providing vocational and technical training via strengthening knowledge and skills provision to children out of school, vulnerable groups , youths, and adult men and women in rural and urban areas.Among the two countries, Nigeria and Tanzania provide policy mentions for all indicators of the Women’s Empowerment component of the Demographic Dividend Framework. Key indicators with additional comprehensive policy coverage include preventing child marriage and enhancing women’s and girls’ education (Nigeria) and facilitating women’s access to the labor market (Tanzania).th objective of the National Youth Policy of 2019 provides further protections for youth by advocating for and supporting the prevention of child marriage. Comprehensive policies to enhancing women’s and girls’ education included promoting equal access to basic education, designing, and organizing trainings for rural women to expand skill development, and establishing a National Empowerment Fund to endorse activities for women entrepreneurs. Key activities include constructing schools for girls in 13 states, constructing classroom blocks and schools that accommodate nomadic education-based learning across states.In Nigeria, prevention of child marriage is emphasized in the country’s national strategy, which specifies the age of marriage as 18 years old. Furthermore, the 18Nigeria and Tanzania also mention policies encouraging women’s participation in local governance, ending or criminalizing harmful practices such as child marriage and/or female genital mutilation, and promoting equal access to basic education. Both countries incorporate elements of gender equity in national vision plans.Community Engagement Centers across all governmental districts to aid job seekers in rural and urban communities. However, policies promoting job creation efforts or Community Engagement Centers are not described in measurable terms.Nigeria and Tanzania provide policy mentions for all four indicators of the Labor Market. Key indicators with additional comprehensive policy coverage are “attracting foreign direct investments” (Nigeria) and “developing the financial sector” (Tanzania). Nigeria’s Economic Growth Recovery Plan 2017 emphasizes the importance of improving the capital account balance by attracting foreign capital into the economy, particularly foreign direct investment. This Plan aims to incentivize the inflow of foreign direct investment portfolio investments and remittances by approximately USD 7 billion by 2020. Nigeria’s National Employment Policy 2017 underscores job creation across various economic sectors, with special emphasis on creating and retaining jobs for vulnerable groups such as youth, women, and disabled persons, and ensuring greater participation of women in the workforce. This policy also strives to establish new interventions to enable Tanzania industrialize in a way that will transform its economy and its society”. The Plan describes a strategy to finance its agenda including (i) scaling up domestic revenue mobilization; (ii) increasing private sector participation; (iii) developing the domestic financial market; (iv) leveraging public sector resources to engage private sector in development projects; and (v) building strong debt management practices at the governmental level.The policies of Tanzania comprehensively address developing the financial sector. The National Five-Year Development Plan 2016–2021 outlines “Tanzania also has policies promoting savings. Although not comprehensively addressed, Tanzania’s Vision 2025 emphasizes developing a national culture of saving and investing productively to generate wealth for individuals.This policy analysis indicates that the study countries—Nigeria and Tanzania—have substantial policies in place to catalyze and accelerate the demographic transition and to accrue the potential benefits of the demographic dividend. Each country has adopted a multisectoral and integrated approach in developing strategies across health, education, economy, and gender equity sectors. Although these countries are different in terms of their economic and demographic characteristics, both have been classified as pre-dividend countries based on their TFR and projected share of working age population according to the demographic dividend typology developed by Ahmed and colleagues . EstimatAmong the two countries, both have Family Planning policies that accounted for cultural and social contexts and that focused on ensuring access to quality family planning services, while maintaining affordable costs. These are key pillars for achieving high uptake of family planning services . CountriTanzania also mentions policies that encouraged community engagement in efforts to increase uptake of family planning services. Family planning programs have a stronger impact when the local cultural and social context is factored into policy development and community members are involved , 26. ThiNigeria and Tanzania comprehensively address, or mention, all indicators of the Maternal and Child Health input of the Demographic Dividend Framework. Both countries have comprehensive policies to improve child vaccination coverage. The differentiating factor is that Nigeria has specific and measurable policy directives and strategies in place to address all indicators of Maternal and Child Health. Although policy mentions are necessary, they are not sufficient to ensure that strategies are implemented as outlined in strategic and planning documents. Policies should be written with measurable goals at the design stage to ensure their success. Having specific and measurable policy goals also fosters a system of accountability and of making evidence-based decisions regarding resource allocation to address policy gaps.Education policies generally focus on ensuring universal primary education by either increasing the availability and access of schools to all children, with particular focus on young girls and other vulnerable populations. Special attention is paid to hiring and training teachers, with an emphasis on teacher certification standards. Other policies include promoting education at secondary, university, and adult learning levels. Maximizing educational attainment and skill building at all levels, in particular for children and adolescents, is an integral component to reaping the full rewards of the demographic dividend. Some studies suggest that declines in fertility rates alone may not sufficiently maximize the demographic dividend without additional investments in education for the working age population . PolicieRelatedly, both countries have several policies targeting Women’s Empowerment. Many of these policies attempt to discourage harmful practices such as child marriage and female circumcision. Several also promote women’s participation in governance and have instated policies, protocols, and metrics to promote and track women’s engagement across different sectors. Supporting women’s and girls’ education are key factors in minimizing fertility rates and have been shown to affect other factors such as age at marriage, family size, and socio-economic status , 30. HowAlthough not at the first tier of priority sectors for pre-dividend nations, as outlined in the Demographic Dividend Framework, we reviewed national documents for policies addressing the Labor Market. Meeting employment needs is critical to economic development, and in conjunction with family planning and education policies, can work to reduce the employment gap , 31. EstBoth countries also outlined policies to attract foreign direct investments and develop the financial sector to support economic growth and the ability to enact policies as described. Based on our review, only Tanzania has policies that promote savings. The experience of East Asian tigers—namely South Korea, Taiwan, Hong Kong, and Singapore—suggests three mechanisms through which a changing age structure can promote economic growth, including increases in the labor force, the savings rate, and the investment rate . EstimatOur policy review has some limitations. First, our review did not address policies relevant to local governance, a critical component of the Demographic Dividend Framework. Fostering good governance lays the foundations for establishing demographic dividend-favorable policies Fig.  and is tIn addition, we may have concluded that policies addressing specific components of the Demographic Dividend Framework are not mentioned in national documents, while the strategies targeting these components are in place currently. Moreover, we did not focus our review on whether policies are being enforced. For instance, it is possible that activities related to specific components of Family Planning are taking place in-country but are not explicitly mentioned in national guidelines and planning documents. Similarly, we recognize that the years by which we bound our search criteria may have excluded policies that are being newly implemented or included policies that are out of date. While we acknowledge these limitations, we emphasize the important role that national documents play in ensuring that policies are implemented in accordance with a country’s goals and strategic plans, as well as their crucial role in guiding resource allocations. Existing documents provide a framework from which to identify and address policy gaps. Moreover, official documentation of policy strategies and targets creates a system of accountability and facilitates tracking of progress towards attaining and sustaining a demographic dividend-favorable policy environment.Finally, an integral element of ensuring that the demographic dividend is fully realized, is investing in resources to improve data collection and to facilitate access and availability to quality data for decision making purposes. Our review process does not evaluate implementation of country commitments. Doing so requires establishment of monitoring and evaluation systems to track inputs and progress towards policy goals, an important component of the policy-implementation cycle . AlthougA unique strength of this policy review is its focus on two pre-dividend African nations. Previous policy reviews have been all-encompassing in nature and not specific to countries undergoing different stages in their demographic transition , 14, 32.Taken together, we recommend that Nigeria and Tanzania, two pre-dividend nations, (1) expand targeted policies and initiatives to address family planning, with emphasis on promoting the benefits of these programs and of attaining the desired family size, and fostering community engagement, (2) incorporate policies that further women’s empowerment across all sectors, and (3) ensure that all policies are specific and measurable, with special focus on policies aimed at improving maternal and child health, maximizing educational attainment, and advancing women’s empowerment. In addition, both countries may consider policies that improve the quality of education and training of youth to respond to future labor market needs. It is our hope that other pre-dividend nations and development partners may use our methods to conduct similar policy reviews and possibly to implement a series of policy amendments to capitalize on their demographic dividend potential.As African countries recommit to improving socio-economic development and move forward with implementing demographic dividend roadmaps and strategies, it is important to continuously review existing policies for their relevance. We developed a systematic and simple way to comprehensively assess the policy environment of two pre-dividend nations, with specific consideration towards identifying demographic dividend-favorable policies. Through our policy review, we identified strategic policy amendments that both pre-dividend countries could undertake to capitalize on their demographic dividend. Countries with similar demographic structures may consider conducting similar review to close existing policy gaps and accrue the full potential of the demographic dividend. By ensuring the establishment of prudent and timely policies that promote health, education, gender equity, and well-functioning financial and labor markets, African countries can realize a demographic dividend and uphold sustainable levels of economic growth and development.Additional file 1. Data extraction template for the review of national policy documents.Additional file 2. List of policy documents reviewed by country: Nigeria (B1) and Tanzania (B2).Additional file 3. Review of national policy documents from Nigeria.Additional file 4. Review of national policy documents from Tanzania.


The Enhanced Recovery After Surgery (ERAS) program is a paradigm shift from traditional perioperative management initiated by Kehlet in 1997The main objectives of the ERAS program are to accelerate functional recovery, improve postoperative outcomes, shorten the length of stay (LOS) in the hospital, reduce the overall health care costs, and improve the satisfaction of the patients without increasing complications and/or hospital readmission rates.http://erassociety.org). Its mission is to develop perioperative care and to improve recovery through research, education, auditing and implementation of evidence-based practices. Throughout its history, the ERAS Society has developed and published numerous evidence-based protocols and implementation programs worldwide to enhance recovery after surgery. This society conducts structured implementation programs that are currently in use in more than 20 countries. The ERAS Society group published in 2016 the guidelines for pre- and intraoperative care in gynecologic oncology surgery.The ERAS Society is an international nonprofit professional society that promotes, develops, and implements ERAS programs, publishes updated guidelines for many operations, and was officially registered in 2010 in Sweden , increased American Society of Anesthesiologists (ASA) physical status, being African American, and increased length of procedure were significantly associated with readmissions after laparoscopic hysterectomies for benign and malignant conditions performed following an ERAS pathway.The implementation of ERAS protocols for women undergoing major gynecologic surgery has been associated with a substantial decrease in intravenous fluid and morphine administration combined with a reduction in the LOS, improved patient satisfaction, and decreased hospital costs.The ERAS principles are applied across all surgical specialties, and ongoing innovation must continue to enable the processes to improve.The essential aspect in changing the practice and implementing an ERAS pathway is forming a team composed of key individuals from each involved unit.The program brings together best practices, organization of care and clinical management.The implementation ERAS in gynecologic surgery involves four essential stages: the preadmission, preoperative, intraoperative, and postoperative stages.The recommendations of the perioperative enhanced recovery pathway for gynecologic surgeries are shown in The prophylaxis against thromboembolism includes well-fitting compression stockings and intermittent pneumatic compression. Extended prophylaxis (28 days) should be given to patients after laparotomy for abdominal or pelvic malignancies. The key postoperative protocol elements are early feeding , early mobilization and opioid-sparing analgesia. A multimodal approach to postoperative nausea and vomiting with antiemetic agents should be used for patients undergoing gynecologic procedures. The patient should ambulate 8 times per day, have all meals sitting in a chair, and stay out of bed at least 8 hours per day.The implementation of the ERAS program represents a paradigm change in the perioperative management of the surgical patient, and is a multidisciplinary approach based on scientific evidence management.


The world’s reptiles and amphibians are experiencing dramatic and ongoing losses in biodiversity, changes that can have substantial effects on ecosystems and human health. In 2022, the first Global Amphibian and Reptile Disease Conference was held, using One Health as a guiding principle. The conference showcased knowledge on numerous reptile and amphibian pathogens from several standpoints, including epidemiology, host immune defenses, wild population effects, and mitigation. The conference also provided field experts the opportunity to discuss and identify the most urgent herpetofaunal disease research directions necessary to address current and future threats to reptile and amphibian biodiversity. The One Health definition recently developed by the One Health High-Level Expert Panel states: “One Health is an integrated, unifying approach that aims to sustainably balance and optimize the health of people, animals and ecosystems” (Although the connection of herpetofauna (reptiles and amphibians) to One Health may not be immediately clear, those vertebrate animals are essential components of ecosystems and are experiencing broad and unprecedented losses in biodiversity  Conference was organized in Knoxville, Tennessee, USA, using One Health approaches as a guiding principle. More than 250 participants representing 25 countries on 6 continents participated in the hybrid conference, which included in-person activities and an online platform for virtual participants  than on reptile pathogens (16%), which might reflect current funding biases.The program was divided into 8 topic-focused sessions, each ending with a moderated panel discussion to identify information gaps and urgent research needs on herpetofaunal diseases. Diseases receiving the greatest attention during the conference included amphibian chytridiomycosis (56%), amphibian and reptile ranavirosis (11%), and snake ophidiomycosis (8%). However, other unique or emerging diseases, including amphibian perkinsiosis, reptile invasive pentastomiasis caused by We identified 4 primary disease categories covered during 2022 GARD Conference: epidemiology, host immune defenses, wild population effects, and mitigation. We summarize the most urgent research directions that were discussed in these areas and offer some considerations for future wildlife health policy and funding.Batrachochytrium salamandrivorans and ranaviruses can contribute substantially to postmortem transmission to susceptible hosts. In light of those findings, the importance of implementing good practices to prevent the further spread of pathogens into naive populations was regarded as a high priority. Bridging that knowledge gap will require collaboration among experimentalists, field biologists, diagnosticians, and modelers to combine laboratory and mesocosm results, longitudinal surveillance data, and epidemiologic models, embodying the tenets of a One Health approach.The epidemiology of most reptile and amphibian diseases remains poorly understood. During the conference, participants emphasized the need to rigorously study pathogen spread across countries and ecological barriers to prevent further spread. Indirect transmission pathways, spread of pathogens through fomites, introduction of novel pathogens into naive environments, and sustained transmission events even as populations decline were seen as important areas for study. For example, presentations highlighted that several herpetofaunal pathogens have environmental reservoirs and can exist outside the host for days to months. In addition, some pathogens, such as chytrid fungi and iridoviruses, can persist on or in nonherpetofaunal hosts, such as invertebrates and fish. Carcasses infected with Because pathogen growth, survival, and transmission often are affected by the external environment, shifting environmental conditions caused by climate change and other factors must be considered when predicting future herpetofaunal health  trade and a preference for improved prevention of pathogen spread and testing over regulations that ban the trade of herpetofauna  in Malaysia in August 2024 (A postconference survey deemed the first GARD Conference a success. Greater inclusion of reptile diseases and newly discovered pathogens were suggestions for future conferences. The next GARD Conference will be held in association with the 10th World Congress of Herpetology (


The goal of the Patient-Centered Outcomes Research Partnership was to prepare health care professionals and researchers to conduct patient-centered outcomes and comparative effectiveness research (CER). Substantial evidence gaps, heterogeneous health care systems, and decision-making challenges in the USA underscore the need for evidence-based strategies.We engaged five community-based health care organizations that serve diverse and underrepresented patient populations from Hawai’i to Minnesota. Each partner nominated two in-house scholars to participate in the 2-year program. The program focused on seven competencies pertinent to patient-centered outcomes and CER. It combined in-person and experiential learning with asynchronous, online education, and created adaptive, pragmatic learning opportunities and a Summer Institute. Metrics included the Clinical Research Appraisal Inventory (CRAI), a tool designed to assess research self-efficacy and clinical research skills across 10 domains.We trained 31 scholars in 3 cohorts. Mean scores in nine domains of the CRAI improved; greater improvement was observed from the beginning to the midpoint than from the midpoint to conclusion of the program. Across all three cohorts, mean scores on 52 items (100%) increased (p ≤ 0.01), and 91% of scholars reported the program improved their skills moderately/significantly. Satisfaction with the program was high (91%).Investigators that conduct patient-centered outcomes and CER must know how to collaborate with regional health care systems to identify priorities; pose questions; design, conduct, and disseminate observational and experimental research; and transform knowledge into practical clinical applications. Training programs such as ours can facilitate such collaborations. Health care systems face complex issues that raise difficult questions and create challenges in providing high-quality care in a resource-constrained environment. Are we generating and effectively using evidence on the relative benefits and harms of clinical and public health interventions? How certain are we that our health care and behavioral decisions improve a population’s health? How quickly can the research community adapt to new challenges, such as those posed by the COVID-19 pandemic? Answering these questions requires high-quality, multidisciplinary research focused on outcomes that matter to patients and other stakeholders, such as providers and policymakers. To achieve these ends, the USA must nurture and invest in a cadre of new investigators as well as those already in the health care workforce who can design and conduct innovative, pragmatic, patient-centered outcomes research (PCOR) and comparative effectiveness research (CER). Further, training diverse investigators and integrating health equity into learning health systems research is imperative , offers a wide range of health and wellness services for Alaska Native and American Indian people living in Anchorage and the Matanuska-Susitna Borough and nearby villages. Southcentral Foundation also serves residents of 55 rural villages in the Anchorage Service Unit, a geographical area stretching 107,400 square miles across Southcentral Alaska from the Canadian border on the east to the Aleutian Chain and Pribilof Islands on the west. Community members are referred to as customer owners, demonstrating the organization’s commitment to inclusivity in all aspects of care. Swedish Health Services  is the largest nonprofit health care provider in the Seattle metropolitan area. It operates five hospital campuses and ambulatory care centers and includes the Swedish Medical Group, a network of more than 100 primary care and specialty clinics. Through research and education, the Department of Native Hawaiian Health at the University of Hawai’i at Mānoa in Honolulu comprises a comprehensive program that addresses the health and health care needs of Native Hawaiian and Pacific Islander people. Based in Sioux Falls, South Dakota, Sanford Health, the largest rural health system in the USA, is dedicated to the integrated delivery of world-class health care to more than one million patients across 250,000 square miles. Sanford Health comprises 47 hospitals, 2,800 physicians, and more than 200 senior care locations in 26 states and 10 countries [https://www.sanfordhealth.org/]. The MultiCare Health System is a not-for-profit US health care organization based in Tacoma, Washington. Founded in 1882, MultiCare provides health care services at 504 locations, including 11 hospitals, across Washington state. Through the UW’s Institute of Translational Health Sciences, an NIH-funded Clinical and Translational Science Award, community-based faculty from partner organizations and programs in the WWAMI region could participate in PCORP. These included the WWAMI region Practice and Research Network and the Northwest Participant and Clinical Interactions Network, which connect diverse populations to local, high-quality clinical research.PCORP was a stakeholder-driven educational and experiential training program designed to train scientists, clinicians, and other health care professionals involved in quality improvement, research, and evaluation initiatives. Two critical and unique features of PCORP were an emphasis on the specific needs of the partner organizations and its focus on the underserved populations of American Indian, Alaska Native, Native Hawaiian, and Pacific Islander peoples. PCORP scholars came from five community organizations located over vast geographic areas with large rural and minority populations. The PCORP planned to enroll two scholars from each partner organization in each of 3 cohorts, totaling 24 scholars. Candidates primarily had masters or doctoral-level training  and included both clinicians and nonclinicians. Six months before the program began, applicants submitted a research idea of interest to their home organization that could be addressed by PCOR and CER and identified potential local mentors. Potential PCORP scholars were required to choose feasible topics that were expected to be unsolved for the next 2 years  and have 10% time covered by their partner organizations to complete the PCORP program. They also submitted a one-page statement of purpose, a two-page research plan, a CV, and two letters of support, including one from a leader in their institution supporting the applicant and confirming the research idea was a priority for the health system. The application process considered the qualifications of the candidates, their role in the partner organization, and the reasons for their interest in PCOR and CER. The organizational letters of support were evaluated by the PCORP Advisory Board and in at least two instances they were the reason an application was not seemed acceptable.The PCORP Advisory Board, composed of representatives from each of our partner organizations and three UW faculty with expertise in PCOR and CER, reviewed candidate applications. Inclusion of partner organizations on the evaluation panel ensured engagement and selection of projects meaningful to the organization. The Board considered: 1) readiness to conduct research; 2) understanding of the tools needed to conduct interdisciplinary PCOR and CER; 3) strength of applicant’s research idea; and 4) importance of the research question to the community-based organization to ensure support for the applicant’s project and experiential PCORP training. Successful candidates were selected based on the strength of their applications while striving for diversity in gender, race and ethnicity, and academic discipline.The PCORP program was designed to help scholars acquire seven fundamental competencies: 1) describe health services research, evidence-based medicine, and the historical and regulatory evolution of PCOR and CER; 2) articulate methods, findings, and implications of PCOR and CER; 3) critically appraise PCOR and CER studies; 4) identify relevant data sources and their strengths and weaknesses; 5) apply results of PCOR and CER to clinical domains; 6) describe quality metrics and their use in health care and payment models; and 7) describe diverse stakeholders and best practices for engaging patients and stakeholders in all phases of PCOR and CER. Because program partners had different goals and projects, proactively engaging patients in PCORP was difficult. We, therefore, offered an in-person PCORP session that convened a panel on the importance of patient engagement in PCOR projects and encouraged scholars to incorporate patient input into their individual projects. The latter is exemplified by the work of one of our scholars on a national registry .Core program components comprised a tailored PCOR and CER curriculum, offered during an intensive, week-long, in-person institute, augmented by self-paced online-training modules Table . PCORP’sNext, scholars participated in a week-long PCORP Summer Institute that provided didactic sessions on study design and analytic methods, evidence synthesis, stakeholder engagement, economic analysis, and patient-centered and patient-reported outcomes. It also offered small-group sessions in which panels of experts working in relevant fields discussed topics such as quality improvement data for research, and panels of patient, clinician, administrative, and senior stakeholders elucidated issues they face. Group exercises were used throughout the Institute to provide hands-on experience in PCOR and CER methods relevant to scholars’ projects. In addition, scholars’ projects were extensively and iteratively reviewed by their peers and PCORP faculty during the Summer Institute. Networking during the PCORP Summer Institute was encouraged as the peer review sessions helped strengthen each pilot project’s design and served as an intentional educational tool. Daily feedback sessions and iterative revisions culminated in a final presentation by each scholar describing the revised project proposed as the foundation for their subsequent training.After the Summer Institute, scholars continued to meet with their home institution, UW, and WSU mentors at least quarterly to ensure adequate progress toward completing the program by the end of their second year. During the second year of scholars’ experiential training, we also developed two modules covering research approaches to working with underrepresented populations and statistical methods and approaches used in PCOR and CER. Scholar assignments after the Summer Institute included additional online modules tailored to their needs, such as PCOR and CER among disadvantaged populations. Examples of scholars’ pilot projects included suicide prevention among Alaska Native people at Southcentral Foundation; health guides to reduce high health care utilization at Sanford Health; and psychosocial aspects of adolescent and young adult cancer survivorship at MultiCare Health System , augmented by a comprehensive module on PCOR and CER skills and competencies developed by PCORP faculty. The CRAI is an 88-item self-report questionnaire specifically designed to assess research self-efficacy and the unique clinical research skills required of physician and clinician scientists across 10 domains . The invBased on the literature, we added 14 items constructed in the same format as other CRAI items to measure specific PCOR and CER competencies not covered by the CRAI ,22. We eResponses to the tailored CRAI from three cohorts were combined into one data set for a total sample of 21 matched responses . Only matched responses from all three questionnaire administrations, namely, beginning (T1), midpoint (T2), and conclusion (T3), were included in the analysis. SPSS was used to conduct a Within Sample T-test to compare each of the 52 item scores and 10 subscale scores of the CRAI at all 3 administrations, including between T1 and T2, T1 and T3, and T2 and T3. A two-tailed p-value of p ≤ 0.01 was used to test for significant mean differences.PCORP originally sought to train 24 scholars; however, we were able to expand to 31 scholars in the first 3 cohorts. Three scholars left the program due to position changes, making their projects no longer viable. PCORP attracted physicians, nurses, pharmacists, PhD researchers from the social sciences and psychology, and master’s level health professionals in a variety of positions . In many cases, their projects were integrated into their job responsibilities, which further enhanced their experiential training. Table p ≤ 0.01).Overall, 21 out of 28 scholars (75%) completed the CRAI. Table Overall, 32% of scholars reported that PCORP improved their skills significantly and 59% reported moderate improvement. PCORP’s overall usefulness to the scholars personally was rated as very good by 36%, as good by 46%, and as fair by 18%. Satisfaction with the overall experience in PCORP was rated as very satisfied by 32%, satisfied by 59%, and dissatisfied by 9%. Scholars strongly agreed/agreed that the three program components that contributed most to their research skill development were their individual project, the Summer Institute, and peer networking . The academic mentor was also highly rated at 76.19% as were the online learning activities . Ratings for individual faculty and presenters varied considerably (data not shown). The organizational mentors, though generally rated well, were not as highly rated as other PCORP components, likely because of turn over and limited capacity to provide scholar’s support.PCORP addressed the aims of the R25 funding opportunity announcement to build national capacity in the scientific workforce, expand capacity for conducting PCOR and CER studies into new fields, address health disparities, and form meaningful partnerships with organizations committed to PCOR and CER to inform health care decisions. We collAlthough we used a tailored version of the CRAI that cannot be directly compared to other studies, it demonstrated that PCORP was effective in training and educating scholars about PCOR and CER across many domains. CRAI scores increased most between the first and second year likely due to the intensive training in the Summer Institute, which focused on areas that the CRAI measures. These included self-reported improvements related to PCOR and CER methods, such as articulating methods, critically appraising studies, identifying data sources, describing methods, and describing quality metrics. Our program also improved other essential domains such as designing and implementing a study, collaborating with others, and collecting, recording, and analyzing data, thereby providing a strong foundation for scholars’ future PCOR and CER and evaluation endeavors.Our focus on Native groups posed unique challenges, not only due to distances, but also because this R25 program neither supported scholars’ travel to training sites nor compensated them for time spent on PCORP pilot projects. PCORP required the home institution to support 10% of the scholars’ effort to conduct their pilot projects, rather than simply provide release-time to scholars for training. For organizations primarily focused on clinical care, especially those serving Native peoples, training programs that do not offer such support can be exigent. In addition, at Southcentral Foundation, challenges resulted from the central and vital role of customer-owners, as their potential contributions to research and the impact of the research on the organization are assessed for each project, thereby extending the time needed to complete scholars’ projects.We encountered several organizational-level challenges. Rapidly responding to changes in organizational priorities were difficult, such as losing an orthopedic project when collaborators at a scholar’s home institution were no longer interested in her topic (that they had both suggested and endorsed at the time of application). More widespread organizational problems included shifting priorities in busy health care systems and personnel turnover including changing roles for PCORP scholars. The 2-year period for project deliverables was too long for organizations to wait for answers that they deemed pressing and important to the organization. Barriers to project completion and challenges in stakeholder engagement in PCOR research have been noted by others. FurtherMore generally, we recognized that addressing complex changes in health care delivery requires building sustainable infrastructures for community–academic partnerships and including patients and stakeholders in the organization and community . ConsistSeveral key lessons for future PCOR and CER training efforts emerged from our experience and appear consistent with the move to a learning health systems paradigm ,28. FirsIn summary, given the evidence gaps, heterogeneous health and clinical systems, and myriad decision-making challenges in the complex US health care system, strategies to improve clinical and health care system decision-making based on high-quality evidence are needed. Creating adaptive, hands-on, and nontraditional experiential learning experiences is an important pathway to support resource-constrained health systems managing challenging and competitive environments. Investigators and health systems that conduct PCOR and CER need to know how to identify, recruit, and collaborate with stakeholders to identify priorities; conceive critical questions and develop hypotheses; design, conduct, and disseminate observational and experimental research; and transform knowledge into practical applications in dynamic clinical settings. Developing these skills requires multidisciplinary training, practical experience, and strong mentorship. However, the literature on how to achieve these desirable training outcomes is evolving and the number of sufficiently qualified PCOR and CER investigators continues to be insufficient. The abs


Convent2Given the need for precision pest and disease control, this special topic was organized which collected several research papers, covering pest and disease monitoring, detection and classification methods, as well as the development of control systems, with a strong focus on disease detection.2.1Fu et al. proposed a maize spectral recovery disease detection framework based on HSCNN+ and maize disease detection CNN to complete low-cost and high-precision maize disease detection. They found an ideal spectral recovered model to reconstruct HSI data from the raw maize RGB data. Haque et al. presented a lightweight CNN model to classify different severity stages of Maydis leaf blight disease. Their results showed that the proposed model outperformed most of the commonly used pretrained models in terms of classification accuracy. Similarly, Albahli and Masood presented an end-to-end learning CNN architecture, namely EANet, to identify multi-class maize diseases. An attention mechanism was used to improve the performance of recognizing multiple diseases. Results showed that the proposed method was able to classify maize leaf diseases in complex background settings. Researchers also demonstrated pest and disease monitoring and recognition methods for rice crops and jujube trees. Li et al. developed an intelligent monitoring system to detect the disease and pest lesions on the rice canopy. They proposed an improved YOLO-DPD model to capture the features of rice disease and pest lesions. Wu et al. used hyperspectral remote sensing images from UAVs to recognize and monitor spider mite infestations in jujube trees. The recognition model combined spectral features and spatial information, and has performed well in the experiments.Maize disease detection and classification has attracted great attention. 2.2Li et al. developed a real-time target spraying system based on an improved CNN model. Field tests demonstrated that their spraying system could accurately hit target weeds. Jiang et al. studied the wetting and deposition mechanism of spraying droplet. They found the best nozzle type, spray pressure and wind speed settings for spray coverage and droplet density.In addition to detection and monitoring, researchers also showed recent developments for pest and disease control system. 3The editorials suggest that further research and technology application should be conducted in the following areas:3.1The editorial team suggests that we should focus on the lack of accurate monitoring and early warning technologies for major pests and diseases in agriculture, and develop core key technologies such as intelligent pest and disease identification and automatic counting technology, and machine learning-based image recognition technology. We should research and develop key technologies, core equipment, and imaging acquisition standards for ground-based camera capture, low-altitude unmanned aerial vehicle remote sensing, and high-altitude radar monitoring of pests and diseases, and establish a massive high-quality image database. We should also develop big data collection, multi-source information processing and transmission, and rapid monitoring and evaluation technologies based on the Internet of Things and cloud computing, and establish a nationwide database of agricultural and forestry pest and disease occurrence and their suitable environments. We should break through the large-scale intelligent identification and quantification extraction method based on machine vision, establish a multi-temporal comprehensive forecasting and warning model based on multi-source information on the occurrence and breeding dynamics of major pests and diseases, host growth conditions, and meteorological adaptation. Finally, we should develop an integrated and map-based analysis platform for real-time accurate monitoring, early warning and efficient information dissemination of emerging pest and disease outbreaks, and construct a spatiotemporal dynamic visualization and intelligent monitoring and warning system for pest and disease populations.3.2The editorial team recommends research in four areas to develop new strategies and techniques for pest and disease control:Firstly, researchers should investigate the mechanisms of signal communication during major pest and disease outbreaks in crops and analyze the information exchange between individual pests and diseases that lead to such outbreaks.Secondly, researchers should elucidate the mechanisms of identification, decoding, and transmission of inter-species information flow between pests, diseases, and crops.Thirdly, researchers should explore the defense responses and regulatory mechanisms of crops against pest and disease infestations.Finally, to develop new strategies and techniques for pest and disease control, researchers should also actively develop high-throughput screening methods to identify chemical communication substances and their analogues, design target-releasing and enhancing agents, and research and develop pest and disease control products for field use based on the interactions between biological information flows.3.3The editorial team believes that in order to combat important pests and pathogens that pose a serious threat to major crops such as rice, corn, cotton, and vegetables worldwide, we need to conduct risk assessments and interactive resistance studies on these pests and their resistance to new drug agents. We need to analyze the molecular mechanisms of resistance formation from aspects such as target mutation and detoxification metabolism enhancement. Research is needed on the genetic diversity and adaptive evolution mechanisms of resistance genes. The causes and evolutionary laws of multidrug resistance should also be studied. Furthermore, we should develop resistance diagnosis, monitoring, warning, and control technologies based on key resistance genes.3.4The editorial team proposes urgent research to address the major challenges presented by the catastrophic mechanisms and control techniques associated with serious pest and disease outbreaks, including the Yangtze River Delta beetle, canker disease, and other serious pests and diseases that pose a major threat to the safety of key protected forests worldwide. The effects of industrial structure adjustment and climate change on the succession patterns of major pests and diseases, such as diamondback moth, tobacco whitefly, root-knot nematode, and viral diseases, are examined to clarify their harmful rules and mechanisms. This includes investigating the adaptation, harmful variation, regional disasters, and periodic outbreak mechanisms of pests and diseases under changing climatic conditions; conducting health evaluations, precise monitoring, and big data forecasting of protective forests, and researching the autonomous pest resistance of main afforestation species and its induced enhancement techniques; integrating and optimizing the diverse and coordinated application technologies of different pest control technologies and products such as lures, natural enemies, microorganisms, and natural active substances; developing natural pest and disease control techniques that focus on forest optimization, nurturing, and renewal measures; and constructing integrated green pest and disease control technology schemes for multiple pest and disease types throughout the entire growth cycle.3.5The editorial team points out the current shortage of important biological control products for pest and disease management. To address this issue, we need to focus on major crops such as grains, oilseeds, economic crops, and forest and grassland plants, and screen for highly efficient biocontrol microbial strains. We advocate for scholars to study the persistence and control mechanisms of biocontrol microbes, identify new functional genes of biocontrol strains, use modern biological breeding technology to modify production strains, enhance product biocontrol activity, broaden the spectrum of insecticidal and fungicidal activities, and improve stress resistance. We aim to overcome the three waste problems of biocontrol microbial fermentation, develop efficient green production processes and supporting equipment, create new formulations and products for important pests and diseases and corresponding application technologies that are suitable for the planting technology system. We aim to reveal the pathogenic mechanisms of microbial pathogens and plant immune defense mechanisms, develop new strategies and technologies for plant disease control, analyze the interactions among plants, pests, and natural enemies, and the impact mechanisms of multiple ecological factors such as microbes and the environment, and develop new green pest control technologies for agriculture and forestry.All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication.


Oppressed peoples are always being asked to stretch a little more, to bridge the gap between blindness and humanity.– Audre LordeBecause of discrimination and exclusion, historically marginalized populations continue to experience disparities in health, wealth, education, housing, and employment and have been described as “vulnerable” in the research context . ResearcAlthough translational science demonstrates that payments themselves are successful in increasing recruitment , there iAnnals of Family Medicine, Annals of Internal Medicine, American Journal of Emergency Medicine, and American Journal of Obstetrics and Gynecology), which publish clinical and translational research to inform clinical practice. Among 519 articles reviewed, 203 studies included human participants whose participation ranged from surveys or interviews to multiple blood draws and medical procedures. Only 5.4% (11 of 203) described a payment for research participation; and of these, only 9 provided information regarding payment types and structure  studies are not publishing payment information or 2) studies are underutilizing payments in recruitment. Clinical and translational science research studies should adopt more rigorous reporting guidelines regarding payment of research participants so we can determine which of these conclusions is correct.Failure to publish payment information prevents us from understanding the use of payment in research and whether it is effective and equitable. Standardized clinical research guidelines increase reproducibility and enable fellow researchers to better understand methodological approaches. A standardized approach to describing payments may provide utility in contextualizing a study’s findings. Current guidelines such as the Consolidated Standards of Reporting Trials (CONSORT) do not include reporting of participant payments. We specifically recommend that researchers describe four features of payment structure: amount, rationale, mechanism, and timing. Our recommendation extends the 2019 Secretary’s Advisory Committee on Human Research Protections recommendation [To better understand the inclusion of populations, studies should also describe limitations of the study’s payment structure. None of the studies here described how the process of payment, such as collecting social security numbers, excludes vulnerable populations. This practice limits inclusion of populations who do not have access to federal identification systems, such as homeless individuals or undocumented workers. Vulnerable populations already have higher levels of mistrust in medical research . RequiriUnderutilization of payments in recruitment may slow research progress, but if, as our sample suggests, patient and community participants are least likely to receive payment, these practices may undermine efforts for more inclusive research. Mistrust is not only an antecedent of research participation but also a potential outcome. How participants feel about payment structures, including underpayment, may reinforce some of the ideas and beliefs that underlie mistrust .Given the historical context and untrustworthy behavior by US public health systems to vulnerable groups, we must be cognizant of how researchers are perceived by populations of interest for recruitment . CriticaThe appropriateness of compensation and judgments of inconvenience or disruption can differ depending on the cultural values and perspectives of participants . For insDue to the dearth of information about payment processes, it is unclear the extent to which researchers are engaging in these activities or how they have done so effectively. Future research should further elaborate on participant payments and consider participants as co-researchers  in human


The WHO fungal priority pathogens list (FPPL) is the first global effort to systematically prioritize fungal pathogens, considering the unmet research and development (R&D) needs and the perceived public health importance. The WHO FPPL aims to focus and drive further research and policy interventions to strengthen the global response to fungal infections and antifungal resistance.Fungal pathogens are a major threat to public health as they are becoming increasingly common and resistant to treatment with only four classes of antifungal medicines currently available, and few candidates in the clinical pipeline. Most fungal pathogens lack rapid and sensitive diagnostics and those that exist are not widely available or affordable globally.The invasive forms of these fungal infections often affect severely ill patients and those with significant underlying immune system related conditions. Populations at greatest risk of invasive fungal infections include those with cancer, HIV/AIDS, organ transplants, chronic respiratory disease, and post-primary tuberculosis infection.Emerging evidence indicates that the incidence and geographic range of fungal diseases are both expanding worldwide due to global warming and the increase of international travel and trade. During the COVID-19 pandemic, the reported incidence of invasive fungal infections increased significantly among hospitalized patients. As the fungi that cause common infections  become increasingly resistant to treatment, risks for the development of more invasive forms of infections in the general population are also growing.“Emerging from the shadows of the bacterial antimicrobial resistance pandemic, fungal infections are growing, and are ever more resistant to treatments, becoming a public health concern worldwide” said Dr Hanan Balkhy, WHO Assistant Director-General, Antimicrobial Resistance (AMR).Despite the growing concern, fungal infections receive very little attention and resources, leading to a scarcity of quality data on fungal disease distribution and antifungal resistance patterns. As a result, the exact burden of fungal diseases and antifungal resistance, are unknown, and the response is therefore undermined.Three priority categoriesThe WHO FPPL list is divided into three categories: critical, high and medium priority. The fungal pathogens of in each priority category are so ranked primarily due to their public health impact and/or emerging antifungal resistance risk. While recognizing these critical pathogens as of public health concern globally, WHO emphases that the FPPL must be interpreted and contextualized carefully, as some endemic pathogens could be of more concern in their respective regional or local contexts.Need for more evidence and priority areas for actionThe authors of the report stress the need for more evidence to inform the response to this growing threat and to better understand the burden – both of disease and antifungal resistance. The report also highlights the urgent need for coordinated action to address the impact of antifungal use on resistance across the One Health spectrum and calls for expanding equitable access to quality diagnostics and treatments.“We need more data and evidence on fungal infections and antifungal resistance to inform and improve response to these priority fungal pathogens” said Dr Haileyesus Getahun, WHO Director, AMR Global Coordination Department.The FPPL report underscores strategies for policymakers, public health professionals and other stakeholders. The strategies proposed in the report are collectively aimed at generating evidence and improving response to these fungal priority pathogens including preventing the development of antifungal drug resistance. The primary recommended actions are focused on: (1) strengthening laboratory capacity and surveillance; (2) sustaining investments in research, development, and innovation; and (3) enhancing public health interventions for prevention and control.“Countries are encouraged to follow a stepwise approach, starting with strengthening their fungal disease laboratory and surveillance capacities, and ensuring equitable access to existing quality therapeutics and diagnostics, globally” added Dr Haileyesus Getahun.Resistance to antifungal medicines is partly driven by inappropriate antifungal use across the One Health spectrum. For example, injudicious use of antifungals in agriculture was linked to the rising rates of azole-resistant Aspergillus fumigatus infections. The report also calls for fostering WHO’s collaborative effort with the Quadripartite organizations and other partners, to address the impact of antifungal use on resistance across the One Health spectrum.https://www.who.int/news/item/25-10-2022-who-releases-first-ever-list-of-health-threatening-fungiAvailable from: