Suchergebnisse

The paper aims to collect and systemize the data of the Kazakh archives on placement, keeping and features of the stay of the deported peoples of the North Caucasus on the territory of Kazakhstan. The author limited the scope of research to residents of the republics of the North Caucasus, since the largest number of deportations were from Karachay-Cherkessia and Chechen-Ingushetia republics. Consideration of all aspects of the deportation of Crimean Tatars, Greeks from the Crimean Autonomous Republic, Meskhetian Turks, Khemshins from Georgia requires separate research. The object of the author's research was the issues of deportation, accommodation and keep of the peoples of the North Caucasus in 1944 to Kazakhstan. On the basis of a scientific analysis of the materials of a number of archival documents – various resolutions, directives, certificates, reports, the author traces the processes of resettlement and control over the arriving representatives of the deported peoples. The resettled families were specially distributed by the authorities to various regions of the vast territory of the republic. A considerable number of deportees ended up in political camps set up at factories, or were sent to build complex engineering structures. When conducting a scientific analysis, the author of the article used data from documents from Kazakhstani archives and collections of documents on the subject. As the main materials of the study, party documents, directives of the NKVD bodies, materials from the archives of the Prosecutor General's Office, the Ministry of Internal Affairs and the KNB of the Republic of Kazakhstan were involved. The author reveals that the very Stalinist policy of deportation of peoples was carried out on the basis of the narrow framework of party instructions of the Bureau of the Central Committee of the All-Union Communist Party of Bolsheviks. All these resolutions and instructions are found everywhere in investigation cases or indictments found by the author in archival funds. The main results of the study are the identification of valuable documentary information on such issues as the definition of the regions of Kazakhstan involved in the resettlement process, indicating the number of resettled, the conditions of detention and adaptation of the deported.

The European Parliament has approved new legislation, the Digital Services Act (DSA) and Digital Markets Act (DMA) to improve the functioning of the internal market of intermediary services in the European Union (EU) where there is a risk that the major so-called gatekeeper companies can exercise unfair control of core platform services. The purpose of this study was to investigate, what health information systems could be in the scopes of these acts and what requirements the acts may have for the production, the sale and the use of health information systems.
The act texts were examined bearing in mind what types of health information systems exist and what their user bases are. Those health information systems that can belong or do not belong to the groups of systems regulated by the DMA and DSA were identified. The most relevant requirements for these systems were also identified from these acts.
The result of the study is that these acts have only minor consequences for the healthcare information systems sector as they are not often intermediary (hosting) services in the meaning of the DSA or gatekeepers in the meaning of the DMA. The emerging digital healthcare platforms are most affected by the new DSA and secondly such peer support patient portals where patients can supply content for others to see. Apparently, no digital healthcare platform has yet reached such a size or a dominant role within the EU that it would fall under the scope of the DMA.
The two above mentioned healthcare related intermediary services have due diligence obligations to remove illegal contents from their services and to treat their business and consumer customers fairly. The obligations include clear and fair terms and conditions, the provision of a single point of contact for users and authorities, content moderation, complaint handling, marking advertising clearly, annual reporting, and responding to the contacts from the authorities. The obligations increase when the size of the enterprise increases.
It is still too early to produce healthcare information systems specific guidance to support the implementation of these two acts as the acts themselves and potential upcoming general guidance documents can serve the health information systems community sufficiently well.

Digital transformation in health and social care is a fast-growing sector globally. Multidisciplinary professionals are needed in the development of digital health and social care services. This study aimed to evaluate the self-assessments of students participating in specialisation education on the importance of multidisciplinary digital competences, focusing on competence in the digitalisation of social and health care and how they assess their own competences at the beginning of their education. The purpose was to describe the multidisciplinary competences in this area at EQF level 6 by using a self-assessment tool.
Data were collected from 274 specialised education students in the years 2021 and 2022 from 14 universities of applied sciences. The background information included participants' years of work experience, professional education area and study credits. There were nine competence areas. The survey contains 61 Likert scale questions. Cronbach's alpha was 0.962 (N=126). The paired t-test was used for statistical analyses to determine the relationship between the importance of a competence and students' current levels of competence. For each pair, the arithmetic mean for the how important variable was higher than the current competence variable. The average means of all competences' differences was 1.04 between how important the competence was to the students and their current understanding of their own level of the particular competence. Service design competences have both the highest average level of student competence and variance in competence. The second-largest variance was in online guiding competences, which is one of the clearest competences for students to understand the content. These results may be explained by expert bias, where a person with a lot of knowledge rates their own level of knowledge lower, while a person with less knowledge does the opposite. The gap between current competence level and the assessed importance of the particular competence shows that there is a need for specialisation education in multidisciplinary competences for developing digital health and social care services. The overall result is a self-assessment tool that can be used to assess the level of competences in different competence areas in specialisation education. It is important for health and social care organisations to manage the competences and continuing education of their professionals.

Context With the ongoing biodiversity crisis and the continued loss of species, it becomes crucial to find practical solutions to monitor threatened animal populations for wildlife conservation and management. However, in practice, monitoring is especially challenging for elusive, rare, and wide-ranging species, where estimating abundance is often expensive and time-consuming. Alternatively, estimating occupancy (i.e. detection/non-detection data) may be less resource-intensive, while still providing useful information for monitoring population trends. Aims We aimed to describe a new field method, the random walk grid survey, to conduct a habitat selection study on elusive diurnal forest-dwelling primates. We explored how to improve occupancy estimates when detection probability is low and determined the minimal effort needed for reasonable estimates on the species habitat selection by using site-occupancy models. Methods We collected data to assess the northern pigtailed macaques' (Macaca leonina) occupancy and detection probability using a random walk survey of degraded forest fragments in Sakaerat Biosphere Reserve in Northeast Thailand. We ran simulations to identify what is required for minimum survey efforts to obtain reasonable estimates of occupancy and detection probability on small or relatively large spatial scales, covering a small primate community in Southeast Asia. Key results Simulations showed that the probability of detecting macaques increased dramatically with an increased survey effort. However, compared with similar line-transect survey methods, the random walk grid survey was less time-consuming. Additionally, the occupancy and habitat selection estimates were similar to our knowledge of macaque distribution within the study area. Conclusions Our findings suggest that the new random walk grid survey method is effective to assess the elusive northern pigtailed macaques' occupancy, and to provide reliable data on habitat selection where there is low macaque abundance and detection probability in a degraded forest fragment. Implications Our survey protocol could be used as a starting point to target high location occupancy to start habituation processes, but also for further intensive studies on primate behaviour and habitat use of primate communities. Finally, combining the random walk grid survey with automated recording devices (e.g. camera traps or passive acoustic surveys) could help improve occupancy and detection probability estimates for long-term monitoring programs and over large spatial scales.

Introduction
Pragmatic clinical trials (PCTs) are designed to connect researchers with clinicians to assess the real-world effectiveness and feasibility of interventions, treatments, or health care delivery strategies in routine practice. Within PCTs larger, more representative sampling is possible to improve the external validity of the research. Older adults from underrepresented groups can benefit from PCTs given their historically lower engagement in clinical research. The current article focuses on older Hispanic adults with Alzheimer disease and related dementias (ADRDs). Older Hispanic adults represent 19% of the US population and have a higher prevalence of ADRDs than Whites. We provide data from 2 PCTs about the recruitment of older Hispanics with ADRDs and discuss unique challenges associated with conducting PCTs and propose strategies to overcome challenges.


Data and Methods
The first PCT outlined is the Patient Priorities Care for Hispanics with Dementia (PPC-HD) trial. PPC-HD is testing the feasibility of implementing a culturally adapted version of the Patient Priorities Care approach for older Hispanic adults with multiple chronic conditions and dementia. The second PCT is the Dementia Care (D-CARE) Study, which is a multisite pragmatic study comparing the effectiveness of a health care system–based approach and a community-based approach to dementia care to usual care in patients with ADRDs and their family caregivers.


Lessons Learned and Recommendations for Future Studies
The lessons learned are summarized according to the various stakeholders that need to work together to effectively recruit diverse participants for PCTs: individuals, health care systems, research teams, and communities. Individual-level considerations include communication, priorities, and flexibility. Health care system–level considerations are grounded in 4 principles of Community-Based Participatory Research and include collaboration/partnership, available resources, priorities of the health care system, and sustainability. Research team–level considerations include team members, intentionality, and communication. Community-level considerations highlight the importance of partnerships, community members, and appropriate incentives.


Discussion
PCTs provide a unique and potentially impactful opportunity to test interventions in real-world settings that must be culturally appropriate to reach underrepresented groups. Collectively, considering variables at multiple levels to address the needs of older adults with ADRDs is crucial, and the examples and suggestions provided in this report are a foundation for future research.

Abstract
A long-term goal for warning-message designers is to determine the most effective type of message that can instruct individuals to act quickly and prevent loss of life and/or injury when faced with an imminent threat. One likely way to increase an individual's behavioral intent to act when they are faced with risk information is to provide protective action information or guidance. This study investigated participant perceptions (understanding, believing, personalizing, deciding, milling, self-efficacy, and response efficacy) in response to the National Weather Service's experimental product Twitter messages for three hazard types (tornado, snow squall, and dust storm), with each message varying by inclusion and presentation of protective action information placed in the tweet text and the visual graphic. We also examine the role of prior hazard warning experience on message perception outcomes. To examine the effects, the experiment used a between-subjects design in which participants were randomly assigned to one hazard type and received one of four warning messages. Participants then took a post-test measuring message perceptions, efficacy levels, prior hazard warning experience, and demographics. The results showed that, for each hazard and prior hazard experience level, messages with protective action guidance in both the text and graphic increase their understanding, belief, ability to decide, self-efficacy, and response efficacy. These results reinforce the idea that well-designed messages that include protective action guidance work well regardless of hazard type or hazard warning experience.

Significance Statement
Preventing injury and/or loss of life during a hazardous event is a prime concern for disaster communicators. The study provides insights to practitioners on how to effectively communicate protective actions to audiences with varying familiarity with the hazard through Twitter posts. We experimented with tweet message design and content for three hazards: tornado, snow squall, and dust storm, to find that posts that include protective action guidance in both the text and image increase participant perceptions that they could perform the suggested protective actions, regardless of hazard type or hazard warning experience. Given our findings, practitioners should consider including protective action guidance in message text and graphic to warn members of the public with varied prior warning experience.

Abstract
Research has found that people who know the least about a topic are often very overconfident of their knowledge, while those who know the most often underestimate their knowledge. This finding, known as the Dunning–Kruger effect (DKE) has recently been shown to occur in knowledge of severe weather as well. The current study investigated whether being overconfident in one's knowledge might translate into a tendency to make poorer sheltering decisions when faced with severe weather. Participants took two severe weather quizzes, one of perceived knowledge and one of objective knowledge. Participants also predicted their performance on both quizzes. The participants then saw four wireless emergency tornado warning alerts on a simulated smartphone screen, along with a tornado scenario, and then made two protective action decisions: one about immediately sheltering in place and the other the likelihood they would drive away. The results revealed that the participants did exhibit the DKE: those with the lowest levels of knowledge exhibited the most overconfidence while those with the highest levels of knowledge underestimated their performance. Also, in comparison with individuals with the most knowledge, those with the least knowledge were the most likely to state that they would not shelter immediately and that they would get in their car and drive away. Although more education is needed, the findings suggest a conundrum: those who know the least about severe weather, thinking they know a lot, are probably those individuals least likely to seek out additional education on the topic.

Significance Statement
Tornadoes are common in many states, and the National Weather Service issues tornado warnings in the hopes that individuals will take protective action. Previous research has found that people with low levels of knowledge (such as knowledge of severe weather) are often overconfident of their knowledge. This study explores whether those with low (as compared with high) severe weather knowledge make poorer decisions to a tornado warning. The findings show that those with the lowest knowledge were indeed overconfident and that they were less likely to shelter and more likely to drive away than those with high knowledge. The findings highlight that more severe weather education, although a worthy goal, might be difficult to implement if knowledge confidence is already high.

Formulation of the problem. A fairy tale as a folk-narrative or literary work about fictional events, fictional persons, events with the participation of fantastic persons [9, p. 71], reveals in its text the peculiarities of mentality and folk thinking in the field of economic activity of the people in general and representatives of this people in particular. The Ukrainian fairy tale builds a special philosophical attitude to labor on earth. The study of a folk tale provides an opportunity to understand the peculiarities of the economic mentality of a single nation. The subject of research there is a folk tale as an oral work that reflects the mentality of the nation, in particular the economic component of the mentality itself. The purpose of this study is a consideration of a folk tale, which in its text reveals aspects of the economic mentality of the people, as well as the formation of a person's economic outlook from early childhood. In addition, to find out the peculiarities of the national formation of the economic outlook of the individual. The methodological basis research is a comparative, historical, analytical, comparative and statistical method. Research results. consider the issue of the formation of the economic mentality of the representatives of the nation. In particular, we are talking about the Ukrainian nation. In particular, attention was paid to the attitude of Ukrainians to the land as a resource for production and labor on the land. Field of application. The results of the article can be used in higher education institutions, research institutions, students, graduate students, teachers. Conclusions. A consideration of a folk tale, in particular a Ukrainian one, reveals the specificity of the attitude of the people in general and the individual in particular to work, to natural resources used in the economic process. It is also obvious that Ukrainian fairy tales are dominated by the cult of the land and labor on the land, that this resource is the main source of wealth. Ukrainians appears in these texts as a farming nation. At the same time, in the moral and ethical aspect, work is revealed as a human virtue, and idleness is condemned. In principle, a folk tale makes it clear how the economic worldview of an individual and a nation is formed.

The purpose of the publication is to highlight the process of performing religious rites in the Pereyaslav Zemstvo Hospital, the Pereyaslav County Almshouse, and the Pereyaslav Prison Castle in the second half of the 19th and early 20th centuries in the context of the development of the Zemstvo self-government in Ukraine and the consequences of the social and economic reforms of the imperial era. The relevance of the research was determined by the lack of complex scientific works devoted to this problem. The scientific novelty lies in the fact that for the first time this topic has become the object of an independent, comprehensive study. Interest in the performance of religious rites in the Zemstvo institutions of the city of Pereyaslava is caused by their role in the legislative and religious spheres. The importance of the problem and its poor study determine the relevance of the research. The main source for him were the materials of the resolutions and reports of the Pereyaslav district zemstvo assemblies for the period of the end of the 19th and the beginning of the 20th centuries. The methodological basis of the work is the combined application of general scientific principles of historicism, objectivity, and systematicity. The information introduced into scientific circulation is important for deepening further research into the history of everyday life of the population of Pereyaslav and Pereyaslav District. It was revealed that on the basis of the provisions of the Zemstvo reforms of the 60s of the 18th century and according to the church charter, clergymen of the parishes of the city of Pereyaslav and the county were obliged to perform a wide variety of religious rites for the faithful, including the performance of religious rites (confession, communion, repentance, anointing, synod, etc.) at Pereyaslav Zemstvo Hospital, Pereyaslav County Almshouse, Pereyaslav Prison Castle. It was established that for the sick and dying, this procedure ("sacrament of healing the soul and body") had great moral power, as it gave spiritual healing, even if physical recovery did not accompany it. It is shown that for single and poor patients of the Pereyaslav Zemstvo Hospital, the performance of the Holy Sacraments was free of charge.

The article deals with the problem of relations and social interaction of Ukrainian communities (primarily burghers and peasants) with the Jewish population of the Volyn Voivodeship in the 1st half of the 17th cent. The author pays attention to the relevance of an objective analysis of this problem in view of false stereotypes about the deep traditions of Ukrainian anti-Semitism and insufficient attention of domestic scientists to the study of the experience of social interaction of Jews and Christians in Volyn during the Lithuanian-Polish era. The most important studies and publications, in which the solution of the problem was initiated, were analysed, the priority directions of further studies related to this topic were emphasized.
The article raises the issue of the specifics of conflicts between Christians and Jews in Volyn. At the same time, it was emphasized that relatively few conflict situations related to national-religious misunderstandings were found. At the same time, in a number of cases, their analysis makes it possible to obtain (as background information) information about the cooperation of representatives of the Christian and Jewish communities.
When presenting the main material, four episodes from the history of Ukrainian-Jewish relations were analysed, which testified to the cooperation of representatives of these communities in the realities of everyday life in Volyn in the 1st half of the 17th cent. In particular, the practice of inviting Ukrainian burghers and peasant women to Jewish families as babysitters was noted; at the same time, it was emphasized that the mentioned cooperation had a long history and was practiced in Volyn despite an explicit prohibition in the II Lithuanian Statute. Cases of reactions of Ukrainian peasants and townspeople in crisis situations were also analysed, when Jews were saved from robbers and a mob that intended to commit lynching by their efforts.
As a result it is possible to confirm the fact that the national-religious boundaries between Jews and Ukrainians were blurred in the everyday conditions of the first half of the 17th cent., already stated in the works of domestic researchers. This was confirmed not only by the example of the communication of Jews with the nobility, but also at the level of other classes, namely burghers and peasants. It was emphasized that the myth of the systemic anti-Semitism of Ukrainians is not confirmed in the sources, so the study of real conflicts between Ukrainians and Jews requires new approaches.

AbstractIntroductionIn people living with human immunodeficiency virus (PLHIV), traditional cardiovascular risk factors, exposure to HIV per se and antiretroviral therapy (ART) are assumed to contribute to cardiometabolic diseases. Nevertheless, controversy exists on the relationship of HIV and ART with diabetes. To clarify the relationship between HIV and type 2 diabetes, this review determined, in PLHIV in Africa, diabetes and prediabetes prevalence, and the extent to which their relationship was modified by socio‐demographic characteristics, body mass index (BMI), diagnostic definitions used for diabetes and prediabetes, and HIV‐related characteristics, including CD4 count, and use and duration of ART.MethodsFor this systematic review and meta‐analysis (PROSPERO registration CRD42021231547), a comprehensive search of major databases (PubMed‐MEDLINE, Scopus, Web of Science, Google Scholar and WHO Global Health Library) was conducted. Original research articles published between 2000 and 2021 in English and French were included, irrespective of study design, data collection techniques and diagnostic definitions used. Observational studies comprising at least 30 PLHIV and reporting on diabetes and/or prediabetes prevalence in Africa were included. Study‐specific estimates were pooled using random effects models to generate the overall prevalence for each diagnostic definition. Data analyses used R statistical software and "meta" package.ResultsOf the 2614 records initially screened, 366 full‐text articles were assessed for eligibility and 61 were selected. In the systematic review, all studies were cross‐sectional by design and clinic‐based, except for five population‐based studies. Across studies included in the meta‐analysis, the proportion of men was 16–84%. Mean/median age was 30–62 years. Among 86,412 and 7976 participants, diabetes and prediabetes prevalence rates were 5.1% (95% CI: 4.3–5.9) and 15.1% (9.7–21.5). Self‐reported diabetes (3.5%) was lower than when combined with biochemical assessments (6.2%; 7.2%).DiscussionWhile not statistically significant, diabetes and prediabetes were higher with greater BMI, in older participants, urban residents and more recent publications. Diabetes and prediabetes were not significantly different by HIV‐related factors, including CD4 count and ART.ConclusionsAlthough HIV‐related factors did not modify prevalence, the diabetes burden in African PLHIV was considerable with suboptimal detection, and likely influenced by traditional risk factors. Furthermore, high prediabetes prevalence foreshadows substantial increases in future diabetes in African PLHIV.

AbstractIntroductionCouple HIV testing and counselling (CHTC) is associated with measurable benefits for HIV prevention and treatment. However, the uptake remains limited in much of sub‐Saharan Africa, despite an expanded range of strategies designed to promote access.MethodsFollowing PRIMSA guidelines, we conducted a systematic review to characterize CHTC uptake strategies. Five databases were searched. Full‐text articles were included if they were: conducted in sub‐Saharan Africa during the study period (1980–2019), targeted heterosexual couples, reported at least one strategy to promote CHTC and provided a quantifiable measure of CHTC uptake. After the initial and full‐text screening, key features of the studies were abstracted and synthesized.ResultsOf the 6188 unique records found in our search, 365 underwent full‐text review with 29 distinct studies included and synthesized. Most studies recruited couples through antenatal care (n = 11) or community venues (n = 8) and used provider‐based HIV testing (n = 25). The primary demand creation strategies included home‐based CHTC (n = 7); integration of CHTC into clinical settings (n = 4); distribution of HIV self‐testing kits (n = 4); verbal or written invitations (n = 4); community recruiters (n = 3); partner tracing (n = 2); relationship counselling (n = 2); financial incentives (n = 1); group education with CHTC coupons (n = 1); and HIV testing at other community venues (n = 1). CHTC uptake ranged from negligible to nearly universal.DiscussionWe thematically categorized a diverse range of strategies with varying levels of intensity and resources used across sub‐Saharan Africa to promote CHTC. Offering CHTC within couples' homes was the most common approach, followed by the integration of CHTC into clinical settings. Due to heterogeneity in study characteristics, we were unable to compare the effectiveness across studies, but several trends were observed, including the high prevalence of CHTC promotion strategies in antenatal settings and the promising effects of home‐based CHTC, distribution of HIV self‐tests and integration of CHTC into routine health services. Since 2019, an updated literature search found that combining partner notification and secondary distribution of HIV self‐test kits may be an additionally effective CHTC strategy.ConclusionsThere are many effective, feasible and scalable approaches to promote CHTC that should be considered by national programmes according to local needs, cultural context and available resources.

Research on political incivility in social media has primarily been focused on the types and frequency of impolite or uncivil language used to attack politicians. However, there is so far little evidence on the uncivil use of organic targeting tactics. We define organic targeting tactics as the ways through which users can utilize the Twitter tagging conventions (hashtags and mentions) and its "reply" feature to target specific publics and accounts other than those in their followers' list. In the discussion on the study of political incivility on Twitter we introduce organic targeting tactics as another critical element of political incivility which may involve the violation of several political civility norms or essentially alter the intensity of their violation. Based on data from Greek Twitter this paper identifies and explores how users exploited the hashtag, mention, and reply feature of Twitter to target political out- and in-group politicians and publics and wide audiences with uncivil political messages. The dataset includes 101.512 tweets containing the "Syriza_xeftiles" hashtag posted during the period between January 2015 and early June 2019, obtained from the Twitter Search API. The dataset contains only tweets from Twitter user accounts that have posted at least 30 #Syriza_xeftiles tweets during the period under study. Analyses organic targeting tactics were based on an inductive lexicon-based approach. Evidence presented in this paper indicated that Twitter users gradually learned how to weaponize the hashtag, reply, and mention features of Twitter to target more and more regularly a variety of political accounts, publics, and audiences in Greek Twitter with uncivil political narratives. The weaponization of these Twitter features often involved the combination of several political incivility dimensions, which apart from the use of insulting utterances included the use of deception through hashjacking and the discursive dimension, which in effect constituted space violations, interruptions, and discussion prevention. We argue that this practice is indicative of a qualitatively different kind of political incivility because it does not simply aspire to establish ad-hoc political publics where incivility is the norm but also to deliberately expose other political and non-political publics to uncivil political narratives. Therefore, the deliberate use of organic targeting tactics can have far wider implications on affective polarization and ultimately on democratic processes.

Purpose
The continuous increase in the negative gap between biocapacity and ecological footprint has remained globally persistent since early 1970. The purpose of this study is to examine the effect of foreign capital, domestic capital formation, institutional quality and democracy on ecological footprint within a global panel of 101 countries from 1995 to 2017.


Design/methodology/approach
The empirical procedure is based on data mix. To this end, this study uses a battery of testing and estimation approaches both conventional (no cross-sectional dependence [CD]) and novel approaches (accounting for CD). Among the battery of estimation techniques used, there are the dynamic ordinary least square, the mean group, the common correlation effect mean group technique, the augmented mean group technique, the Pooled mean group and the dynamic common correlation effect technique with the desire to obtain outcomes robust to heteroskedasticity, endogeneity, cross-correlation and CD among others.


Findings
The estimated outcomes indicate that using different estimators' domestic capital formation consistently degrades the environment through an increase in ecological footprint, while institutional quality consistently enhances the quality of the environment. Further, the outcome reveals that, though foreign capital inflow degrades the environment, the time period is essential, as it shows a short-run environmental improvement and a long-run environmental degradation. Democratic activities show a mixed outcome with short-run degrading effect and a long-run enhancement effect on environmental quality.


Practical implications
Green investment should be the policy target of all economies, and these policies should be adopted to target both domestic capital and foreign capital alike. Second, the adoption of democratic practices will produce good leaders that will not just design short-term policies to blindfold the populace temporary but those that will produce long-term-oriented practices that will better and enhance the quality of the environment through the reduction of the global footprint. Equally, enhancing the institutional framework like respect for the rule of law in matters of abatement should be encouraged.


Originality/value
Although much research on the role of macroeconomic indicators on environmental quality has been done this far, democratic practices, intuitional quality and domestic capital have been given little attention. This research fills this gap by considering robust empirical techniques.

AbstractIntroductionTenofovir alafenamide (TAF) is approved for paediatric use in fixed‐dose combination tablets, but efficacy and safety data in children are limited. We conducted a systematic review on the efficacy/effectiveness and safety of TAF in infants, children and adolescents living with HIV.MethodsWe searched MEDLINE, Embase, the Cochrane Library, clinical trial registries, reference lists and relevant conferences to identify literature published January 2009–March 2021. We included clinical trials and observational studies assessing the efficacy/effectiveness or safety of TAF through ≥6 months of treatment in participants aged 0–19 years.Results and discussionOverall 3626 abstracts and 371 full papers were screened. Four single‐arm, innovator‐funded trials (341 participants) and a pooled analysis of those trials were identified. All four trials included treatment‐experienced and virally suppressed children or adolescents. One trial also included treatment‐naïve adolescents with baseline viral load >1000 copies/ml. The risk of bias was rated as low in one study and unclear in the other three owing to missing data on study design (all conference presentations). At 48 weeks, 92% (46/50) of treatment‐naïve participants were virally suppressed (one trial). Among treatment‐experienced participants with viral load at 48 weeks, 214 of 224 participants were virally suppressed. Across the studies, one grade 3/4 adverse event was considered drug‐related (intermediate uveitis). There were three discontinuations for adverse events (grade 2 anxiety and insomnia, grade 1 iridocyclitis [drug‐related] and grade 1 pulmonary tuberculosis [unrelated to treatment]). One accidental death occurred across the four studies. In the pooled analysis of 223 participants, the median change in bone mineral density z‐score (height‐ and age‐adjusted) from baseline to 48 weeks was −0.12 (interquartile range [IQR] −0.46, 0.17) to 0.05 (IQR not reported) for spine, and −0.09 (IQR −0.33, 0.07) to 0.09 (IQR not reported) for total body less head. Weight‐for‐age z‐scores increased by 0.25 from baseline to 48 weeks.ConclusionsFour single‐arm trials were identified in this systematic review, with initial evidence suggesting good viral suppression and no obvious safety concerns in children and adolescents on TAF‐containing regimens over 24–48 weeks. However, further comparative and longer‐term safety data are needed in children and adolescents, including on weight and metabolic changes.