There are over 250,000 international treaties that aim to foster global cooperation. But are treaties actually helpful for addressing global challenges? This systematic field-wide evidence synthesis of 224 primary studies and meta-analysis of the higher-quality 82 studies finds treaties have mostly failed to produce their intended effects. The only exceptions are treaties governing international trade and finance, which consistently produced intended effects. We also found evidence that impactful treaties achieve their effects through socialization and normative processes rather than longer-term legal processes and that enforcement mechanisms are the only modifiable treaty design choice with the potential to improve the effectiveness of treaties governing environmental, human rights, humanitarian, maritime, and security policy domains. This evidence synthesis raises doubts about the value of international treaties that neither regulate trade or finance nor contain enforcement mechanisms.

BackgroundIn recent years, there have been numerous calls for global institutions to develop and enforce new international laws. International laws are, however, often blunt instruments with many uncertain benefits, costs, risks of harm, and trade-offs. Thus, they are probably not always appropriate solutions to global health challenges. Given these uncertainties and international law’s potential importance for improving global health, the paucity of synthesized evidence addressing whether international laws achieve their intended effects or whether they are superior in comparison to other approaches is problematic.MethodsTen electronic bibliographic databases were searched using predefined search strategies, including MEDLINE, Global Health, CINAHL, Applied Social Sciences Index and Abstracts, Dissertations and Theses, International Bibliography of Social Sciences, International Political Science Abstracts, Social Sciences Abstracts, Social Sciences Citation Index, PAIS International, and Worldwide Political Science Abstracts. Two reviewers will independently screen titles and abstracts using predefined inclusion criteria. Pairs of reviewers will then independently screen the full-text of articles for inclusion using predefined inclusion criteria and then independently extract data and assess risk of bias for included studies. Where feasible, results will be pooled through subgroup analyses, meta-analyses, and meta-regression techniques.DiscussionThe findings of this review will contribute to a better understanding of the expected benefits and possible harms of using international law to address different kinds of problems, thereby providing important evidence-informed guidance on when and how it can be effectively introduced and implemented by countries and global institutions.Systematic review registrationPROSPERO CRD42015019830Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-016-0238-0) contains supplementary material, which is available to authorized users.

Introduction: In March 2021, the Governor of Washington declared a youth mental health crisis. State data revealed high rates of youth suicide and inadequate access to services. This mixed-methods study examines youth and adult perspectives on mental health service gaps and opportunities in Seattle by assessing needs, feasibility, and acceptability of interventions to support youth mental health. Methods: We interviewed 15 key informants to identify the contextual, structural, and individual-level factors that increase the risk of poor mental health and deter access to care among young people. We complimented these data with a cross-sectional 25-item survey of 117 participants in King County to assess the feasibility and acceptability of interventions for youth mental health. We conducted an inductive thematic qualitative analysis of the interviews and performed descriptive analyses of the quantitative data, using t-tests and χ2 tests to summarize and compare participant characteristics stratified by age group. Results: Qualitative informants attributed challenges to youth mental health to social and relational problems. Example interventions included creating environments that increase belonging and implementation of culturally congruent mental health services. Quantitative study participants rated all evidence-based mental health interventions presented as highly acceptable. However, youth preferred interventions promoting social connectedness, peer support, and holistic approaches to care, while non-youth preferred interventions focused on suicide, alcohol, and substance abuse prevention. Both key informants and survey participants identified schools as the highest priority setting for mental health interventions. There were no significant differences among quantitative outcomes. Conclusion: Our findings highlight the need for reducing social isolation and increasing social connectedness to support youth mental health. Schools and digital tools were preferred platforms for implementation. Engaging multiple stakeholders, especially young people, and addressing cultural needs and accessibility of mental health resources are important pre-implementation activities for youth mental health intervention in a US city.

71 Background: Medication reconciliation (MR) in outpatient clinics has been under-evaluated. We postulated that cancer patients would benefit from MR done by a pharmacist as these patients have many care providers, many medications, and are at high risk of drug-drug interactions (DDIs). Hence, we conducted a quality initiative evaluating the role of a pharmacist in the ambulatory clinics. Methods: One pharmacist prospectively rotated amongst four oncology clinics four days a week from June 3 to September 18, 2008. The pharmacist performed MR, and as a consultant developed therapeutic plans related to drug therapeutic problems (DTPs) including adverse reactions and DDIs. Patient medication lists were retrospectively analyzed using Micromedex and DDIs were categorized by frequency, severity and evidence level. A monthly survey (Likert scale) evaluating pharmacist contributions to each clinic team was completed by physicians and nurses. Results: A total of 158 patients were seen in 227 patient visits. The pharmacist identified 141 DTPs in 60 patients across 74 visits. The most frequently observed were no drug for a medical problem (51.1%), dose too low (12.8%), wrong drug (9.9%), and adverse drug reactions (9.2%). In response, 174 therapeutic plans were made. The most frequently recommended actions were drug added (40.8%), dose changed (13.2%), drug discontinued (9.2%), and interval/duration changed (7.5%). A total of 414 DDIs were identified in 110 patients, across 149 patient visits. On average, 2.62 DDIs were reported per patient, and 1.82 DDIs per visit. By severity, 139 (33.6%) major, 258 (62.3%) moderate, 16 (3.9%) minor and 1 (0.2%) contraindicated DDIs were documented. By level of evidence, 46 (11.1%) DDIs were excellent, and 236 (57%) were good. Survey results showed that doctors and nurses agreed/strongly agreed that pharmacist presence was valuable. The most useful contributions identified were consultation regarding DDIs, adverse drug effects, and medication efficacy decisions. Conclusions: DDI rates are high and most are moderate or major in severity. There is a clear benefit from the integration of a pharmacist to the clinics with an improvement in patient safety and quality of care.