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BACKGROUND: Adolescents comprise one-sixth of the world's population, yet there is no clear understanding of the features that promote adolescent-friendly services (AFS). The lack of clarity and consistency around a definition presents a gap in health services. METHODS: The review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. We conducted a scoping review of peer-reviewed empirical studies to explore AFS in low-income and middle-income countries (LMICs) published between January 2000 and December 2022. The databases searched were CAB Direct (n=11), CINAHL (n=50), Cochrane Databases (n=1103), Embase (n=1164), Global Health Medicus (n=3636) and PsycINFO (n=156). The title, abstract and full text were double screened by three independent reviewers. Three independent reviewers assessed the study's quality using the Joanna Briggs Initiative Quality Appraisal and Cochrane Risk of Bias 2 tools. RESULTS: We identified the key components, barriers and facilitators of AFS. The following emerged from our review: a non-judgmental environment, culturally appropriate and responsive interventions and a focus on supporting marginalised communities often living in high-poverty settings. Using these components, we have extended guidance around a possible framework and tool assessing quality of AFS. INTERPRETATION: As LMICs are heterogeneous and unique, it was assumed that the operational definition of 'adolescent-friendly' might vary depending on different contexts, but there must be core components that remain consistent. Possible limitations of our review include a lack of grey literature. Potential future implications include training healthcare providers, testing these attributes for service improvement and future development and localisation of policy guidelines. KEY HIGHLIGHTS: Our review has mapped the research framing of AFS and provided a comprehensive review of barriers and facilitators to implementing a holistic outlook of AFS set-up in a tightly controlled research and real-world context. Our paper is one of the few efforts to synthesise behavioural and mental health elements underpinning AFS.

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INTRODUCTION: The opioid epidemic in the United States continues to result in an increasing number of deaths and is increasingly dominated by fentanyl and fentanyl analogs. As a result, first responders are likely to come into contact with fentanyl-containing substances daily. Concerns persist regarding occupational exposure resulting in intoxication. We performed a systematic review to describe occupational illnesses from fentanyl and its analogs. METHODS: We conducted a systematic review of the literature following the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to assess the danger of occupational exposure to fentanyl. The PubMed, EMBASE, Google Scholar, SCOPUS, CINAHL, and National Institute for Occupational Safety and Health databases were queried to identify occupational fentanyl exposures. Studies included were single case reports, case series, observational studies, controlled studies, and abstracts from scientific presentations. We reviewed articles meeting the eligibility criteria and abstracted outcome data. Outcomes included study design, number of study subjects and study demographics, description of exposure, personal protective equipment used, duration of symptoms, illness developed, medical evaluation performed, treatment provided, hospitalizations, deaths, drug testing performed, and any situation review performed to prevent illness, analytical confirmation of the identity of culprit agent, and concentrations of drug in serum/blood. RESULTS: Our search yielded 454 citations after deduplication. After abstract and text review, 12 unique reports met the inclusion criteria. All identified studies were observational studies. Ten of the 12 were Health Hazard Evaluation reports from the National Institute for Occupational Safety and Health; two reports describe the same exposure case. There were no reported instances of comprehensive drug testing using liquid chromatography-mass spectrometry or gas chromatography-mass spectrometry in exposed first responders. Among first responders possibly exposed to fentanyl or fentanyl analogs, none were admitted to the hospital, and only three first responders received naloxone. The three officers who received naloxone lacked recommended personal protective equipment and had subjective improvement of symptoms following naloxone. There were no instances of severe respiratory depression requiring assisted ventilation or hospital admission. Among forensic laboratory technicians, only one instance of detectable concentrations of fentanyl in urine was reported, and there were no instances of symptomatic cases. CONCLUSIONS: Among published reports of 27 first responders with symptoms after possible ambient fentanyl exposure, symptoms, recorded physical findings, and vital signs were inconsistent with acute opioid toxicity. Breaches in the recommended use of personal protective equipment appeared common. Only three persons received naloxone, although none had plausible effects of fentanyl. No suspected exposure to fentanyl led to hospitalization or death. Based on these low-quality data, there were no plausible opioid effects from ambient exposure to suspected fentanyl.

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Background: Interventions targeting combined sexual and reproductive health, Human Immunodeficiency Virus (HIV) management and mental health care in sub-Saharan Africa (SSA) are few. There is a need to address common determinants of poor mental, psychosocial and sexual and reproductive health and rights (SRHR) through multimodal and multipronged interventions for adolescents. The main objective of this study was to identify whether and how interventions targeting adolescent SRHR and HIV with a focus on pregnant and parenting adolescents in SSA include mental health components and how these components and their outcomes have been reported in the literature. Methods: We carried out a two process scoping review approach between 01.04.2021 and 23.08.2022. In the first stage, we searched the PubMed database to identify studies focusing on adolescents and young people aged 10 to 24 from 2001 to 2021. We identified studies focusing on HIV and SRHR that had mental health and psychosocial aspects to the interventions. Our search yielded 7025 studies. Of these 38 were eligible based on our screening criteria that covered interventions, and on further scrutiny, using PracticeWise, an established coding system, we identified select problems and practices to provide a more granular assessment of how interventions developed for this context mapped on to specific problems. At this second stage process, we selected 27 studies for inclusion as actual interventional designs for further systematic scoping of their findings and we used the Joanna Briggs Quality Appraisal checklist to rate these studies. This review was registered within the International Prospective Register of Systematic Reviews (PROSPERO), number CRD42021234627. Findings: Our first set of findings is that when coding problems and solutions, mental health concerns were the least common category of problems targeted in these SRHR/HIV interventions; nevertheless, psychoeducation and cognitive behavioral strategies such as improved communication, assertiveness training, and informational support were offered widely. Of the 27 interventional studies included in the final review, 17 RCTs, 7 open trials, and 3 mixed designs, represented nine countries of the 46 countries in SSA. Intervention types included peer, community, family, digital, and mixed modality interventions. Eight interventions focused on caregivers and youth. Social or community ecology associated problems (being an orphan, sexual abuse, homelessness, negative cultural norms) were the most common risk factors and were more frequent than medical issues associated with HIV exposure. Our findings highlight the relevance and centrality of social issues related to adolescent mental and physical health along with the need to strengthen multimodal interventions along the lines of problems we have identified in our review. Interpretation: Combined interventions jointly addressing adolescent SRHR, HIV, and mental health have been relatively understudied, despite evidence that adverse social and community factors are rampant in this population. Funding: MK was funded by Fogarty International CenterK43 TW010716-05 and lead the initiative.

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The Whole School, Whole Community, Whole Child (WSCC) model is a student-centered approach that focuses on a culture of health to support student success. Despite its use, the empirical evidence supporting the model is unclear. We conducted a scoping review to understand the research supporting WSCC as a model for student/school health. The search included studies published in English language peer-reviewed journals from 2014 to 2020. Eight articles met criteria for review. Overall, findings from this review reveal a relatively small body of research specific to the WSCC model. Because WSCC is presented as a model for schools throughout the United States, the development of a larger body of research supporting the model as an evidence-based framework will enhance credibility and confidence in the model. School nurses, as leaders, coordinators, and advocates, are well positioned to test and disseminate the model to those seeking to introduce WSCC in their school or district.

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