PURPOSE:Evaluate the effectiveness of a Web-based Early intervention for Children using multimodAl REhabilitation (WECARE) in improving the performance of children (aged 3-8 years) with motor difficulties. METHOD:This pragmatic randomized control trial divided 118 families of children with motor difficulties into the control or WECARE group. WECARE was delivered via a web-based platform; the control group received usual care. The primary outcome assessed children's performance on parent-identified goals (COPM). Secondary outcomes included parents' knowledge and skills (PKSQ) and satisfaction with supports received. Mixed modelling was used for analysis. RESULTS:No statistical significance between-group differences were found in the proportion of overall goals (adjusted mean differences, 7.9; 95%CI, -0.2 to 16.0; p = 0.06) and motor goals achieved (adjusted mean differences, 6.7; 95%CI, -2.1 to 15.4; p = 0.14). Parents in the WECARE group scored statistically significantly higher on the PKSQ (adjusted mean differences, 0.40; 95%CI [0.09-0.70]; p = 0.01) and on satisfaction (mean difference 10.35; 95%CI [7.03-13.66]; p < 0.001). CONCLUSION:Although no significant between-group differences were observed in children's motor goal performance, the WECARE intervention significantly improved parents' knowledge, skills, and satisfaction with the support received, highlighting its clinical value in supporting parents of children with motor difficulties.

BACKGROUND:This study investigated the impact of changes in health state duration in a discrete choice experiment where duration is an attribute (DCETTO). METHODS:A sample of the general population in Quebec, Canada, completed DCETTO in two phases using SF-6Dv2. In the first phase (DCEoriginal), participants were presented with binary choice sets, each containing two health states and associated durations. In the second phase (DCEchanged), they completed the same choice sets as before, but with modified durations. Adjustments were made based on participants' initial responses. Durations were 1, 4, 7, 10, 14, and 20 years. McNemar's Test was used to evaluate the change in respondents' choices before and after the duration modification. RESULTS:A total of 411 participants were included. Significant increases in duration of the option not chosen (by a factor of two or more) led it to become the preferred option (p < 0.05). A decrease in the duration of the option chosen could still lead to its acceptance. Overall, participants showed a strong anchoring effect of their initial choice, while changes in duration had a moderate positive effect on the likelihood of switching choices. CONCLUSIONS:Findings highlight non-linear effects of time on preferences and have important implications for the design of DCETTO studies.

Understanding the pathways of high-cost use patients can help better guide health policy The idea of healthcare spending being concentrated among a minority of users is well documented. Understanding this particularly heavy use of healthcare services is essential for helping to better guide public policy. Using longitudinal medical-administrative data from the TorSaDE cohort, the authors of this study offer an original contribution with a Quebec context. They analyze high-use patients’ activities and identify the main factors associated with their care pathways. The study highlights the diversity and complexity of these individuals’ needs. The findings call for a rethinking of current strategies and in particular, a shift toward personalized approaches that anticipate needs, better support individuals and improve the system’s efficiency. This study serves as a highly strategic tool for healthcare planning in Quebec. The early identification of high-risk trajectory profiles enables upstream action through targeted interventions before overuse becomes entrenched.

Comprendre les trajectoires des grands utilisateurs pour mieux orienter les politiques de santé La concentration des dépenses de santé au sein d’une minorité d’usagers est un phénomène bien documenté. Comprendre les trajectoires de soins de ces grands utilisateurs des services de santé est essentiel pour mieux orienter les politiques publiques. En exploitant les données médico-administratives longitudinales de la cohorte TorSaDE, les auteurs d’une étude CIRANO (Laberge et al., 2025) apportent une contribution originale dans le contexte québécois. Ils analysent les profils d’utilisation des grands utilisateurs et identifient les principaux facteurs associés à leurs trajectoires de soins. L’étude met en évidence la diversité des parcours et la complexité des besoins de ces personnes. Les constats appellent à repenser les stratégies actuelles et à privilégier des approches personnalisées permettant d’anticiper les besoins, de mieux accompagner les personnes et d’améliorer l’efficience du système. Cette étude est un outil hautement stratégique pour la planification des soins au Québec. L’identification précoce des profils de trajectoires à risque permet d’agir en amont, en proposant des interventions ciblées avant que la surutilisation ne s’installe.

To empirically assess the impact of immediate death as an alternative or an attribute on health utilities using discrete choice experiment with duration (DCETTO). Three DCETTO approaches were developed using the SF-6Dv2 to assess the impact of immediate death on health preferences in an online sample of the general adult population in Quebec, Canada. The first approach combined DCETTO with a probability of immediate death (POD) as an attribute, referred to as DCEPOD. The second approach combined DCETTO within a best-worst scaling with duration (BWSTTO) including immediate death as an alternative, referred to as DCEBWS. The third approach was a standard DCETTO model (used for a reference). Mixed logit models were used to analyze data. The models’ performance in estimating values was assessed based on parameters’ logical consistency, the significance of levels, and an analysis of the range of estimated values. A total of 369 participants were included for analysis. The number of parameters with inconsistent orders and non-significant coefficients was lower in DCEPOD compared to DCETTO and DCEBWS. The dimensions of mental health and social functioning provided the largest and smallest decrements in all approaches, respectively. DCEPOD produced a wider range of values (-2.393 to 1) compared to DCETTO (-1.959 to 1) and DCEBWS (-1.474 to 1). The findings demonstrated that when the probability of immediate death was designed as an attribute in DCEPOD, it decreased health utility values and produced a broader value set, while when immediate death was presented as an alternative in BWSTTO, it increased health utility values and provided a narrower value set.

Quality-adjusted life expectancy (QALE) provides a comprehensive measure of population health. Despite its value, QALE norms are not available for the Canadian population. This study aimed to develop age- and sex-specific QALE norms using both the 5-level version of EQ-5D (EQ-5D-5L) and version 2 of SF-6D (SF-6Dv2) instruments. EQ-5D-5L and SF-6Dv2 data from 3,844 individuals in a national survey (2024) were used to derive health utility scores. These scores were then combined with official life tables from the Office for National Statistics (2021–2023) using the Sullivan method to calculate age- and sex-specific QALE. Estimates were produced for both undiscounted and discounted values (1.5

Background The COVID-19 pandemic has profoundly disrupted social and public health systems worldwide, with emerging evidence indicating a surge in intimate partner violence (IPV) and a decline in health-related quality of life (HRQoL). In Canada, the link between pandemic-related stressors, IPV, and HRQoL remains insufficiently characterized. This study aimed to assess the prevalence, frequency, and directionality of IPV during the COVID-19 pandemic in Quebec, Canada, and to evaluate its impact on HRQoL and mental health.Methods A population-based survey was conducted online and IPV was assessed using a revised New Zealand Crime and Victims Survey (NZCVS2) instrument, capturing psychological, physical, and sexual violence.Results The prevalence and frequency of IPV peaked during the initial lockdown period (January-June 2020), with physical and sexual violence prevalence reaching 11% and 5%, respectively, while psychological violence approached 23%. Psychological and physical violence constituted nearly three quarters of these acts. IPV was frequently bidirectional, particularly for psychological violence. Men reported higher rates of psychological and physical victimization, while sexual victimization was predominantly reported by women. Individuals experiencing IPV reported significantly lower HRQoL scores, and higher psychological distress compared to those not exposed to IPV. Younger age, urban residence, and lower household income were identified as significant risk factors for both perpetrating and sustaining IPV. The COVID-19 pandemic was associated with a substantial increase in IPV and a concomitant decline in HRQoL in Quebec.Conclusion These findings underscore the necessity for integrated public health strategies that address violence prevention, mental health support, and social inequalities, particularly during periods of societal crisis.

OBJECTIVES:Quality-adjusted life expectancy (QALE) is a composite indicator integrating life expectancy and health utility values. Most studies have used the Sullivan method to calculate QALE, whereas Markov modeling offers a more flexible alternative simulating health transitions over time. The primary objective of this study was to estimate age- and sex-specific QALE for Quebec and to compare results across 4 methodological approaches: Sullivan versus Markov modeling, each with and without cubic polynomial fit of age-specific utilities. METHODS:We analyzed 4803 EQ-5D-5L records from 2016 to 2024 health surveys and pooled 2021 to 2023 life tables. Age-specific utilities were smoothed using cubic polynomial regression. Age- and sex-specific QALE norms were estimated using both Sullivan method and a stochastic 2-state Markov microsimulation, with Monte Carlo simulations applied to both methods to quantify uncertainty. Sensitivity analyses assessed the impact of reducing the Markov cycle length from 1 year to 0.5 year for the combined population, and differences between methods were evaluated using a 1-sample t test. RESULTS:Cubic polynomial regressions produced smooth age-utility curves with excellent fit for the combined population (R2 = 0.86), males (R2 = 0.96), and females (R2 = 0.92). Smoothed utilities modestly reduced uncertainty, particularly at older ages. Total QALE estimates from the Sullivan and Markov approaches were highly consistent, with small absolute differences (0.28-0.32 QALE) and strong correlation (R2 = 0.99) over the full remaining lifetime. The 1-sample t test showed that Markov QALE estimates were slightly higher than Sullivan estimates (mean difference 0.315 QALE, 95% CI 0.308-0.322; t = 85.47, P < .001), though the absolute differences were minor relative to overall QALE. Sensitivity analyses demonstrated that reducing the Markov cycle length had minimal impact on QALE estimates (differences ≤0.29 QALE), confirming robustness. CONCLUSIONS:These findings support the use of either method for population health assessment and health technology evaluation because both produce valid and reliable QALE estimates.

Oncology teams operate in highly demanding clinical environments marked by recurrent acute and chronic stressors that can impair optimal quality of care. Although the practice environment is known to influence team processes, the specific contribution of team resilience at work to team effectiveness remains insufficiently delineated in oncology. This cross-sectional study investigated whether team resilience at work mediates the associations between the teamwork practice environment and two core indicators of team effectiveness: team functioning and team cohesion. A total of 189 oncology team members in Québec (Canada) completed an e-questionnaire between February 2022 and June 2023. Structural equation modeling was conducted to assess an evidence-informed mediation model. The tested model revealed acceptable fit. Findings showed significant indirect effects consistent with a mediating role of team resilience at work in the relationships between the teamwork practice environment and team functioning and team cohesion. Some dimensions—resourcefulness, alignment, efforts to understand problems, wellness awareness and being proud to work in the team—loaded strongly on the resilience concept. These results highlight the relevance of reinforcing team resilience capacities to sustain high-quality care in oncology settings. Interventions aiming to enhance team effectiveness may benefit from explicitly integrating strategies designed to strengthen resilience-related dimensions within oncology teams.

Background Medical oxygen is essential in modern medicine.Aims This study analyzes the pricing policies and costs of medical oxygen in Quebec, provides elements of international comparison, and explores the potential savings through the optimization of oxygen therapy practices.Materials and Methods It combines a narrative literature review, an analysis of administrative and financial documents, as well as administrative data obtained from representatives of the healthcare sector in Quebec.Results The literature review highlights the challenges of producing, storing, and distributing medical oxygen, which have been accentuated by the COVID-19 pandemic. A very large disparity in pricing policies is also noted among healthcare systems, especially when cylinders are predominantly used. In Quebec, costs vary according to production methods, logistics, and contractual clauses. Optimizing oxygen therapy practices would allow significant savings, particularly by reducing oxygen consumption through various strategies.Discussion The study shows the complexity of managing medical oxygen costs, amplified by limited competition and rigid contractual clauses. International comparison highlights the importance of infrastructure, while optimizing oxygen therapy practices offers significant savings potential. To reduce costs, it is recommended to improve distribution management, adopt more flexible contractual clauses, and strengthen competition.Conclusion To optimize medical oxygen use, actions to undertake from managers and clinicians are highlighted.

(Abstracted from BJOG 2025;132:805-815) Approximate 1 in 200 neonates in Canada is born with congenital cytomegalovirus (cCMV). CMV is an infection that can cause neurodevelopmental disability in children, including deafness, visual impairment, or cognitive delay.

BackgroundThe COVID-19 pandemic necessitated the rapid availability of evidence to respond in a timely manner to the needs of practice settings and decision-makers in health and social services. Now that the pandemic is over, it is time to put in place actions to improve the capacity of systems to meet knowledge needs in a situation of crisis. The main objective of this project was thus to develop an action plan for the rapid syntheses of evidence in times of health crisis in Quebec (Canada).MethodsWe conducted a three-phase collaborative research project. First, we carried out a survey with producers and users of rapid evidence syntheses (n = 40) and a group interview with three patient partners to prioritize courses of action. In parallel, we performed a systematic mapping of the literature to identify rapid evidence synthesis initiatives developed during the pandemic. The results of these two phases were used in a third phase, in which we organized a deliberative workshop with 26 producers and users of rapid evidence syntheses to identifying strategies to operationalize priorities. The data collected at each phase were compared to identify common courses of action and integrated to develop an action plan.ResultsA total of 14 specific actions structured into four main axes were identified over the three phases. In axis 1, actions on raising awareness of the importance of evidence-informed decision-making among stakeholders in the health and social services network are presented. Axis 2 includes actions to promote optimal collaboration of key stakeholders in the production of rapid evidence synthesis to support decision-making. Actions advocating the use of a variety of rapid evidence synthesis methodologies known to be effective in supporting decision-making are presented in axis 3. Finally, axis 4 is about actions on the use of effective knowledge translation strategies to promote the use of rapid evidence synthesis products to support decision-making.ConclusionsThis project led to the development of a collective action plan aimed at preparing the Quebec ecosystem and other similar jurisdictions to meet knowledge needs more effectively in times of health emergency. The implementation of this plan and its evaluation will enable us to continue to fine-tune it.

Developing and implementing effective surveillance programs for infectious diseases (ID) and antimicrobial resistance (AMR) requires the integration of information across relevant disciplines and sectors. Yet, establishing and sustaining collaboration at each step of the surveillance process, and modalities to translate integrated surveillance results into actions, are not well understood. This systematic review was designed to map and explore peer-reviewed tools that were either designed or used for evaluation of integrated surveillance systems for ID or AMR, and to identify the limitations of these tools and remaining methodological or knowledge gaps. A systematic search was conducted using keywords related to: “Evaluation”, “Surveillance” and “One Health” in four databases (Medline, Embase, Web of Science and CAB abstract) up to the 28th of October 2022. Articles were selected if they presented an evaluation tool for integrated surveillance systems for ID or AMR (methodological study) or an application of such a tool (case study). All selected articles went through a quality check using the MetaQAT tool. Of 25 articles retrieved, 13 presented a methodological study, while 12 described a case study. Three main types of evaluation were identified through 17 tools: theoretical, process and impact evaluations. Both methodological and case study papers predominantly considered organizational and operational aspects in their evaluation. Although costs and/or impacts were discussed in some case studies, only one article reported an economic impact analysis. Evaluation of One Health integration and multisectoral collaboration was included in four methodological and four case study articles. One major challenge identified in this systematic review is the lack of clear guidance and standardized criteria for the comprehensive evaluation of complex integrated surveillance systems. To overcome this, it is essential to develop, validate, and apply methodologies adapted to these evaluation needs.

To evaluate the psychometric properties of EQ-5D-5L and SF-6Dv2 in a group of patients with breast or colorectal cancer. EQ-5D-5L, SF-6Dv2, and QLQ-C30 were completed at baseline and follow-up by patients with breast or colorectal cancer in Quebec, Canada. Ceiling effect was assessed by calculating the percentage of respondents reporting the best health state. Agreement between EQ-5D-5L and SF-6Dv2 was evaluated using intraclass correlation coefficients (ICC) and the Bland–Altman plot. Convergent validity for both instruments was assessed using the Spearman rank correlation coefficient (r) with QLQ-C30 serving as a calibration standard. Known-group validity was evaluated by comparing the scores of patients with different health conditions, while sensitivity was further assessed within these known groups using relative efficiency (RE). Finally, test–retest reliability and responsiveness were tested using ICC and the area under the receiver operating characteristic curve (AUC), respectively. 204 patients were enrolled at baseline and 103 were followed up. No ceiling effect was found for SF-6Dv2 compared to 16.67

Background: Clinician wellbeing is important for optimal health system performance. To improve their wellbeing and resilience, the National Academy of Medicine (NAM) recommends addressing upstream drivers, detailed in their framework of both external ( learning and practice environment, organisational factors, healthcare responsibilities, society and culture, and rules and regulations ) and individual ( personal factors, skills and abilities) factors that influence clinician wellbeing. Qualitative research that reports clinician self-reported experiences can provide insight into the factors that contribute to their wellbeing. Extant qualitative literature reviews report on work-related experiences affecting the wellbeing of specific types of clinicians in specific contexts, but none captures a holistic picture of clinician experiences in providing care. Objective: Map qualitative evidence on primary care clinician self-reported experiences related to wellbeing to the NAM framework factors, and create an interactive database to support future evidence syntheses and interventions. Methods: Using an evidence and gap map approach, we searched MEDLINE, Embase, PsycINFO, and CINAHL (2013–2023) for qualitative and mixed-methods studies. We included studies from Canada, Australia, Belgium, or France that described self-reported experiences of primary care clinicians (family physicians and general practitioners, nurses and nurse practitioners, pharmacists, midwives, social workers). We coded the experiences in each study according to reporting clinician type and NAM factors. We generated the interactive map, with integrated bibliographic database, using EPPI-Reviewer and EPPI-Mapper. Results: From 6,133 records we included 652 publications. Most were Australian (54%) or Canadian (34%). The majority (57%) reported experiences of family physicians/general practitioners, while social workers and midwives were underrepresented (3% and 2%, respectively). Clinician-reported experiences focused mainly on learning and practice environment , organisational , and healthcare responsibilities factors. Experiences related to skills and abilities , society and culture , personal factors , and rules and regulations , were less common, with slight variations across clinician groups. Conclusions: This evidence and gap map provides a comprehensive overview of qualitative evidence of primary care clinician-reported experiences related to wellbeing. External factors were more frequently mentioned, offering insight that can inform system-level interventions. Future qualitative syntheses of the mapped evidence can inform research and policy that better support clinician wellbeing.

This study was conducted to demonstrate the impact of a software-based cost awareness intervention on the reduction of cost of surgical disposables used in thoracic, gynecological, colorectal and plastic surgery. We used a prospective, non-randomized, pre-post trial in video assisted thoracic surgery (VATS) lobectomy, total laparoscopic hysterectomy, laparoscopic low anterior resection, and deep inferior epigastric perforator (DIEP) flap breast reconstruction. Overall, 775 cases performed between February 2021 and August 2023 were included in the study, 521 for VATS lobectomy (control n = 164), 127 for laparoscopic total hysterectomy (control n = 19), 48 for laparoscopic colorectal surgery (control n = 8), and 79 for DIEP flap breast reconstruction (control n = 53). Average age was 63 years with 67

Background:We aimed to summarize the evidence on the use of discrete choice experiments (DCEs) and conjoint analyses to quantify stakeholders' preferences for screening programs for type 2 diabetes (T2D) and liver diseases, with a specific focus on metabolic dysfunction-associated steatotic liver disease (MASLD). Methods:For this scoping review, five databases (MEDLINE [PubMed], PubMed Central, EMBASE [Ovid], Europe PMC, Google Scholar) were searched with the assistance of a librarian, and deduplicated records were screened by two independent reviewers. Inclusion criteria: using DCE/CA, addressing screening programs for T2D and liver disease, published in English, French, or Spanish after January 1990. Results:Among 2,282 studies, 9 (7 from high- and 2 from low-income countries) elicited preferences for screening for liver disease (n = 1), hepatitis C (n = 1), hepatitis B (n = 1), hepatocellular carcinoma (n = 2), noncommunicable diseases (n = 2), diabetic retinopathy (n = 1), and cardiovascular diseases (n = 1). No studies addressed MASLD screening in T2D. Stakeholders included patients (n = 3), health care providers (n = 1), patients plus health care providers (n = 1), and the general population (n = 3). Studies used 18 structure, 6 process, and 4 outcome attributes. Screening sensitivity, setting, duration, provider, and cost were the most important structure attributes in participant choices. Physician support for treatment was the preferred process attribute. Outcome attributes were the least used, but of major importance (screening adherence followed by treatment) when considered. Conclusions:With no study focusing on MASLD screening in T2D, our scoping review highlights the need to develop a DCE addressing this topic to better design a patient-centred continuum of care.

To develop algorithms mapping the Functional Assessment of Cancer Therapy—General Scale (FACT-G) onto the EuroQol 5-Dimension 5-level (EQ-5D-5 L) and the Short-Form Six-Dimension version 2 (SF-6Dv2) for patients with breast or colorectal cancers. An online survey was conducted to collect responses to FACT-G, EQ-5D-5L, and SF-6Dv2 from cancer patients in Quebec, Canada (N = 202). Linear models including ordinary least squares (OLS), Censored Least Absolute Deviations (CLAD), the robust MM-estimator model (MM), as well as mixture models including two-part model (TPM), and beta-based mixture (betamix) model were used. Mean absolute error (MAE), root mean squared error (RMSE), R2, Bayesian information criteria (BIC), and limits of agreement (LOA) calculated using the five cross-validation to assess the predictive ability of the models. Furthermore, the distribution of observed versus predicted values was assessed using Bland-Altman plot. Based on RMSE and MAE, mixture models better performed than linear models. The betamix model with truncation that included domains and squared terms was the best-performing algorithm for EQ-5D-5 L (MAE = 0.0518, RMSE = 0.0744, R2 = 46.40

BACKGROUND:A key challenge in ordinal methods is to anchor estimated health utility values onto the full health-dead scale. This study assessed five methods of anchoring. METHODS:Data were collected between 2016 and 2020 through two surveys conducted in the Quebec general population, with 1,176 and 908 respondents. Health utilities for the Short-Form 6-Dimension version 2 (SF-6Dv2) were estimated using ranking, composite time trade-off (cTTO), discrete choice experiment without (DCE) and with duration (DCETTO) methods. Anchoring was performed using five approaches: the dead state for ranking (Rank), linear mapping for DCE (DCEMapping), mean value for the worst health state (DCEWHS), hybrid modeling (DCEHybrid), and duration (DCETTO). Conditional logit was used for rank and DCE approaches, while a hybrid model and generalized least squares (GLS) were applied for the DCEHybrid and cTTO methods, respectively. Approaches were compared based on the sign and ordering of their coefficients, the mean absolute difference (MAD) between the observed mean cTTO values and the estimates of models, and the overall pattern of their estimations. RESULTS:A total of 17,200, 59,960, 8,500, and 16,464 observations were included for the DCETTO, ranking, cTTO, and DCE methods, respectively. The DCEHybrid method achieved the lowest MAD (0.056) from observed cTTO values, while DCETTO method had the highest (MAD = 0.423). Ranking and DCEMapping tended to underestimate utilities for better health states and overestimate for severe ones, while DCEWHS and DCETTO underestimated health utilities for all health states. Visual comparisons confirmed that predictions from models closely aligned with observed cTTO values for better health states. CONCLUSION:Hybrid anchoring method demonstrated better performance in predicting observed cTTO values, whereas DCETTO model showed greater deviations and a tendency to underestimate health state values. Hybrid anchoring method also appeared as the most appropriate and reliable approach for anchoring ordinal utility data to the full health-dead scale.

General practitioners (GPs) extensively used synchronous teleconsultation (STC) during the COVID-19 pandemic. Although this utilization decreased after the state of sanitary emergency was lifted, it remains higher than pre-pandemic levels. The aim is to summarize the scientific evidence on the factors influencing GPs’ decision to conduct STC instead of face-to-face consultation. We conducted a systematic review and reported our results following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. We searched four electronic databases: MEDLINE, Cumulative Index of Nursing Literature and allied health, Web of Science and the Cochrane Central Register of Controlled Trials and conducted the last search on March 23, 2023. Two independent reviewers selected English/French articles reporting on GPs’ use, attitude, satisfaction, and experience with STC. We assessed the studies’ quality using the Mixed Methods Appraisal Tool, and a narrative approach was performed to synthesize findings. The screening of 9,288 references resulted in the inclusion of 34 studies, for a total of 5,563 participants. Results show that GPs’ decision to use STC is influenced by six categories of factors: (1) consultation, such as consultation purpose (e.g., follow-up care, administrative requests); (2) information and communication technology, such as quality of equipment and bandwidth (internet connection and the effectiveness of the hardware and software); (3) GP, such as convenience (the flexibility offered by the STC); (4) patient, such as access barriers (ex., physical, geographical, financial); (5) GP-patient relationship, such as ease of diagnosis; and (6) the institution, such as organizational and peer support. Lack of a reliable internet connection, need for physical exams, and limited visual cues were the main barriers to using STC. GPs’ utilization of STC depends on the interplay of six categories of factors, the most important being the purpose of consultation. Equity in access and a fair payment model are key elements to consider in designing health policies aimed at supporting adoption and appropriate use of STC. PROSPERO CRD42024505744