Browsing by Subject "scoping review"

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    Investigating strategies for addressing child and adolescent mental health following exposure to extreme weather events in low- and middle-income countries: A scoping review
    (2022) Kadota, Molly Kaelin; Rother, Hanna-Andrea; Jagarnath, Meryl
    The inevitability of an increase in extreme weather events (EWE) due to climate change will likely influence every determinant of human health and wellbeing. Children and adolescents, defined as anyone under the age of 19, are among the most susceptible because of their unique vulnerabilities (i.e. physiologically, developmentally, biologically, and behaviourally) and lifespans. The effects on physical health are generally well documented, and many climate change adaptation strategies have begun to include them in their considerations. However, the implications of EWE exposure on mental health are less understood, particularly within low- and middle-income countries (LMICs). Populations residing in LMICs are especially vulnerable because of pre-existing conditions like already extreme weather, lack of resources, poor economic conditions, weak health systems, high burden of disease, and poor governance. Therefore, children and adolescents in LMICs maintain a heightened vulnerability to experiencing adverse effects. In Part A, a preliminary literature review determined the breadth of information documenting child and adolescent mental health outcomes following exposure to EWE. Research, mainly from high-income countries (HICs) or international organisations, demonstrating an association between mental health impacts and climate change, focused primarily on adult populations, has increased substantially over the last few years. Experiencing an EWE in childhood or adolescence likely leads to direct (e.g. anxiety, post-traumatic stress disorder, depression, behavioural disorders, and suicidal ideations), indirect (e.g. displacement, loss of sense of place, violence, malnutrition, developmental delays, and disruption of education), and overarching (e.g. general climate anxiety about impending threats) mental health impacts, presenting in both the short- and long-term. The goals of adaptation and mitigation strategies were also presented in the protocol to determine the potential for specific mental health strategies. In Part B, then, a scoping review was conducted to provide a narrative of where adaptation, resilience, and mitigation strategies in LMICs address, and where they do not, child and adolescent mental health impacts following exposures to EWE. A search conducted in June-August 2021 of 12 online databases from the Pubmed, EBSCOhost, and Scopus platforms and grey literature sites like Google Scholar, Microsoft Academic, and NGO pages identified 5,073 relevant records. Search results were limited to documents written in English and filtered by a 2000-2021 date range. In the current LMICs climate change strategies, the review highlighted a general lack of consideration for child and adolescent mental health and resilience. Therefore, eight main themes recurring in the literature were identified as integral components for including child and adolescent mental health in future national strategies and policymaking discussions. The themes provide general guidance, but their addition necessitates country-specific conceptualisation to determine technical considerations (e.g. funding and responsibility) and relevance. This review, therefore, emphasised the necessity for LMICs to begin including child and adolescent mental health in climate change strategies, highlighted key recommendations that were applicable in the LMICs context, and illuminated still existing gaps in the literature and potential areas for future research.
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    Open Access
    Prehospital pain management in mass casualty scenarios: a scoping review
    (2025) Morris, Christopher; Hodkinson, Peter
    Background: Effective pain management in mass casualty scenarios (MCS) is critical due to the high prevalence of severe pain and its association with increased morbidity. MCS, defined as incidents where patient care needs exceed available resources, pose unique challenges for prehospital care providers. This scoping review aims to synthesize existing evidence on prehospital pain management strategies, identify gaps, and inform future research and policy development. Methods: Following PRISMA-ScR guidelines, a comprehensive literature search was conducted across major medical databases (PubMed/MEDLINE, EMBASE, CINAHL, Scopus, and Web of Science) and grey literature repositories, covering studies published from 2005 to 2024. Inclusion criteria encompassed English-language studies addressing prehospital pain management in MCS, reporting on pain assessment, pharmacological/non-pharmacological interventions, or resource limitations. Excluded were hospital-based studies and non-evidence-based publications. Data were charted and synthesized into thematic categories. Results: The review included 22 studies, highlighting significant gaps in standardised pain management protocols and documentation. Key findings revealed underutilisation of analgesics, with only 3.2% of MCS cases receiving pain medication. Ketamine and regional anaesthesia emerged as viable options, particularly in resource-limited settings, while novel delivery systems like autoinjectors showed promise. Major barriers included resource shortages, provider training gaps, and limited integration of pain management in triage systems. Conclusion: Prehospital pain management in MCS requires scalable, evidence-based protocols emphasising early analgesic administration, particularly ketamine and multimodal strategies. Systemic barriers, including inadequate training and documentation, hinder effective implementation. Addressing these gaps through improved training, simplified protocols, and better resource planning can enhance patient outcomes and disaster response capabilities. Future research should prioritise paediatric care and standardised outcome measures to further refine pain management in diverse MCS contexts.