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Public Health Jun 2021The objective of this study is to estimate the pooled uptake of cervical cancer screening and identify its predictors in Sub-Saharan Africa. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
The objective of this study is to estimate the pooled uptake of cervical cancer screening and identify its predictors in Sub-Saharan Africa.
STUDY DESIGN
Systematic review and meta-analysis.
METHODS
We searched PubMed, EMBASE, CINAHL, African Journals OnLine, Web of Science and Scopus electronic databases from January 2000 to 2019. All observational studies published in the English language that reported cervical cancer uptake and/or predictors in Sub-Saharan Africa were initially screened. We assessed methodological quality using the Newcastle-Ottawa Scale. An inverse variance-weighted random-effects model meta-analysis was performed to estimate the pooled uptake and odds ratio (OR) of predictors with a 95% confidence interval (CI). The I test statistic was used to check between-study heterogeneity, and the Egger's regression statistical test was used to check publication bias.
RESULTS
We initially screened 3537 citations and subsequently 29 studies were selected for this review, which included a total of 36,374 women. The uptake of cervical cancer screening in Sub-Saharan Africa was 12.87% (95% CI: 10.20, 15.54; I = 98.5%). A meta-analysis of seven studies showed that knowledge about cervical cancer increased screening uptake by nearly five times (OR: 4.81; 95% CI: 3.06, 7.54). Other predictors of cervical screening uptake include educational level, age, Human Immune deficiency Virus (HIV) status, contraceptive use, perceived susceptibility and awareness about screening locations.
CONCLUSIONS
Cervical screening uptake is low in Sub-Saharan Africa as a result of several factors. Health outreach and promotion programmes to target these identified predictors are required.
Topics: Africa South of the Sahara; Early Detection of Cancer; Female; HIV Infections; Humans; Mass Screening; Uterine Cervical Neoplasms
PubMed: 34082174
DOI: 10.1016/j.puhe.2021.04.014 -
PloS One 2015Diagnosing obstructive sleep apnea (OSA) is clinically relevant because untreated OSA has been associated with increased morbidity and mortality. The STOP-Bang... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Diagnosing obstructive sleep apnea (OSA) is clinically relevant because untreated OSA has been associated with increased morbidity and mortality. The STOP-Bang questionnaire is a validated screening tool for OSA. We conducted a systematic review and meta-analysis to determine the effectiveness of STOP-Bang for screening patients suspected of having OSA and to predict its accuracy in determining the severity of OSA in the different populations.
METHODS
A search of the literature databases was performed. Inclusion criteria were: 1) Studies that used STOP-Bang questionnaire as a screening tool for OSA in adult subjects (>18 years); 2) The accuracy of the STOP-Bang questionnaire was validated by polysomnography--the gold standard for diagnosing OSA; 3) OSA was clearly defined as apnea/hypopnea index (AHI) or respiratory disturbance index (RDI) ≥ 5; 4) Publications in the English language. The quality of the studies were explicitly described and coded according to the Cochrane Methods group on the screening and diagnostic tests.
RESULTS
Seventeen studies including 9,206 patients met criteria for the systematic review. In the sleep clinic population, the sensitivity was 90%, 94% and 96% to detect any OSA (AHI ≥ 5), moderate-to-severe OSA (AHI ≥15), and severe OSA (AHI ≥30) respectively. The corresponding NPV was 46%, 75% and 90%. A similar trend was found in the surgical population. In the sleep clinic population, the probability of severe OSA with a STOP-Bang score of 3 was 25%. With a stepwise increase of the STOP-Bang score to 4, 5, 6 and 7/8, the probability rose proportionally to 35%, 45%, 55% and 75%, respectively. In the surgical population, the probability of severe OSA with a STOP-Bang score of 3 was 15%. With a stepwise increase of the STOP-Bang score to 4, 5, 6 and 7/8, the probability increased to 25%, 35%, 45% and 65%, respectively.
CONCLUSION
This meta-analysis confirms the high performance of the STOP-Bang questionnaire in the sleep clinic and surgical population for screening of OSA. The higher the STOP-Bang score, the greater is the probability of moderate-to-severe OSA.
Topics: Humans; Mass Screening; Polysomnography; Reproducibility of Results; Severity of Illness Index; Sleep Apnea, Obstructive; Surveys and Questionnaires
PubMed: 26658438
DOI: 10.1371/journal.pone.0143697 -
JAMA Pediatrics May 2023Exome sequencing is a first-tier diagnostic test for individuals with neurodevelopmental disorders, including intellectual disability/developmental delay and autism... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Exome sequencing is a first-tier diagnostic test for individuals with neurodevelopmental disorders, including intellectual disability/developmental delay and autism spectrum disorder; however, this recommendation does not include cerebral palsy.
OBJECTIVE
To evaluate if the diagnostic yield of exome or genome sequencing in cerebral palsy is similar to that of other neurodevelopmental disorders.
DATA SOURCES
The study team searched PubMed for studies published between 2013 and 2022 using cerebral palsy and genetic testing terms. Data were analyzed during March 2022.
STUDY SELECTION
Studies performing exome or genome sequencing in at least 10 participants with cerebral palsy were included. Studies with fewer than 10 individuals and studies reporting variants detected by other genetic tests were excluded. Consensus review was performed. The initial search identified 148 studies, of which 13 met inclusion criteria.
DATA EXTRACTION AND SYNTHESIS
Data were extracted by 2 investigators and pooled using a random-effects meta-analysis. Incidence rates with corresponding 95% CIs and prediction intervals were calculated. Publication bias was evaluated by the Egger test. Variability between included studies was assessed via heterogeneity tests using the I2 statistic.
MAIN OUTCOMES AND MEASURES
The primary outcome was the pooled diagnostic yield (rate of pathogenic/likely pathogenic variants) across studies. Subgroup analyses were performed based on population age and on the use of exclusion criteria for patient selection.
RESULTS
Thirteen studies were included consisting of 2612 individuals with cerebral palsy. The overall diagnostic yield was 31.1% (95% CI, 24.2%-38.6%; I2 = 91%). The yield was higher in pediatric populations (34.8%; 95% CI, 28.3%-41.5%) than adult populations (26.9%; 95% CI, 1.2%-68.8%) and higher among studies that used exclusion criteria for patient selection (42.1%; 95% CI, 36.0%-48.2%) than those that did not (20.7%; 95% CI, 12.3%-30.5%).
CONCLUSIONS AND RELEVANCE
In this systematic review and meta-analysis, the genetic diagnostic yield in cerebral palsy was similar to that of other neurodevelopmental disorders for which exome sequencing is recommended as standard of care. Data from this meta-analysis provide evidence to support the inclusion of cerebral palsy in the current recommendation of exome sequencing in the diagnostic evaluation of individuals with neurodevelopmental disorders.
Topics: Child; Adult; Humans; Cerebral Palsy; Autism Spectrum Disorder; Exome Sequencing; Genetic Testing; Genomics
PubMed: 36877506
DOI: 10.1001/jamapediatrics.2023.0008 -
Clinical Oral Investigations Dec 2021The survival rate of indirect partial adhesive restorations on vital versus endodontically treated teeth is still controversial. The hypothesis is that there may be a... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
The survival rate of indirect partial adhesive restorations on vital versus endodontically treated teeth is still controversial. The hypothesis is that there may be a difference in the survival rate of partial adhesive restorations performed on non-vital teeth compared to vital teeth.
MATERIALS AND METHODS
This systematic review was conducted following the PRISMA guidelines. The considered clinical studies investigated the outcomes of adhesive inlays, onlays, and overlays conducted over the past 40 years, focusing on Kaplan-Meier survival curves to calculate the hazard ratio (primary objective) and the survival rate (secondary objective) between vital and non-vital teeth. The risk of bias was assessed using the Newcastle-Ottawa Scale. Studies included in the review were identified through bibliographic research on electronic databases ("PubMed," "Scopus," "Cochrane Central Register of Controlled Trial," and "Embase"). The K agreement between the two screening reviewers was evaluated.
RESULTS
A total of 55,793 records were identified on PubMed, Scopus, and other bibliographic sources, and after the application of the eligibility and inclusion criteria, eight articles were included for qualitative analysis and six for quantitative analysis. The meta-analysis of the primary and secondary outcomes demonstrated that hazard ratios (HR = 8.41, 95% CI: [4.50, 15.72]) and survival rates (OR = 3.24, 95% CI: [1.76, 5.82]) seemed more favorable for indirect partial adhesive restorations on vital teeth than for those on endodontically treated teeth.
CONCLUSIONS
Within the limits of this study, these findings suggest that the risk of failure of indirect partial adhesive restorations on endodontically treated teeth is higher than on vital teeth.
CLINICAL RELEVANCE
The use of partial adhesive restorations on vital and endodontically treated teeth showed different long-term clinical outcomes.
Topics: Composite Resins; Dental Restoration Failure; Dental Restoration, Permanent; Humans; Inlays; Kaplan-Meier Estimate; Mass Screening; Tooth, Nonvital
PubMed: 34628547
DOI: 10.1007/s00784-021-04187-x -
JAMA Jun 2020The Patient Health Questionnaire depression module (PHQ-9) is a 9-item self-administered instrument used for detecting depression and assessing severity of depression.... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
The Patient Health Questionnaire depression module (PHQ-9) is a 9-item self-administered instrument used for detecting depression and assessing severity of depression. The Patient Health Questionnaire-2 (PHQ-2) consists of the first 2 items of the PHQ-9 (which assess the frequency of depressed mood and anhedonia) and can be used as a first step to identify patients for evaluation with the full PHQ-9.
OBJECTIVE
To estimate PHQ-2 accuracy alone and combined with the PHQ-9 for detecting major depression.
DATA SOURCES
MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, PsycINFO, and Web of Science (January 2000-May 2018).
STUDY SELECTION
Eligible data sets compared PHQ-2 scores with major depression diagnoses from a validated diagnostic interview.
DATA EXTRACTION AND SYNTHESIS
Individual participant data were synthesized with bivariate random-effects meta-analysis to estimate pooled sensitivity and specificity of the PHQ-2 alone among studies using semistructured, fully structured, or Mini International Neuropsychiatric Interview (MINI) diagnostic interviews separately and in combination with the PHQ-9 vs the PHQ-9 alone for studies that used semistructured interviews. The PHQ-2 score ranges from 0 to 6, and the PHQ-9 score ranges from 0 to 27.
RESULTS
Individual participant data were obtained from 100 of 136 eligible studies (44 318 participants; 4572 with major depression [10%]; mean [SD] age, 49 [17] years; 59% female). Among studies that used semistructured interviews, PHQ-2 sensitivity and specificity (95% CI) were 0.91 (0.88-0.94) and 0.67 (0.64-0.71) for cutoff scores of 2 or greater and 0.72 (0.67-0.77) and 0.85 (0.83-0.87) for cutoff scores of 3 or greater. Sensitivity was significantly greater for semistructured vs fully structured interviews. Specificity was not significantly different across the types of interviews. The area under the receiver operating characteristic curve was 0.88 (0.86-0.89) for semistructured interviews, 0.82 (0.81-0.84) for fully structured interviews, and 0.87 (0.85-0.88) for the MINI. There were no significant subgroup differences. For semistructured interviews, sensitivity for PHQ-2 scores of 2 or greater followed by PHQ-9 scores of 10 or greater (0.82 [0.76-0.86]) was not significantly different than PHQ-9 scores of 10 or greater alone (0.86 [0.80-0.90]); specificity for the combination was significantly but minimally higher (0.87 [0.84-0.89] vs 0.85 [0.82-0.87]). The area under the curve was 0.90 (0.89-0.91). The combination was estimated to reduce the number of participants needing to complete the full PHQ-9 by 57% (56%-58%).
CONCLUSIONS AND RELEVANCE
In an individual participant data meta-analysis of studies that compared PHQ scores with major depression diagnoses, the combination of PHQ-2 (with cutoff ≥2) followed by PHQ-9 (with cutoff ≥10) had similar sensitivity but higher specificity compared with PHQ-9 cutoff scores of 10 or greater alone. Further research is needed to understand the clinical and research value of this combined approach to screening.
Topics: Adult; Depressive Disorder, Major; Female; Humans; Interviews as Topic; Male; Mass Screening; Patient Health Questionnaire; ROC Curve; Sensitivity and Specificity
PubMed: 32515813
DOI: 10.1001/jama.2020.6504 -
Genes Jun 2023In spinal muscular atrophy, clinical trial results indicated that disease-modifying treatments are highly effective when given prior to symptom onset, which has prompted... (Review)
Review
BACKGROUND
In spinal muscular atrophy, clinical trial results indicated that disease-modifying treatments are highly effective when given prior to symptom onset, which has prompted newborn screening programs in growing number of countries. However, prognosis of those patients cannot be inferred from clinical trials conducted in presymptomatic individuals, as in some cases disease presents very early.
METHODS
we conducted a systematic review of articles published up to January 2023.
RESULTS
Among 35 patients with three copies treated before 42 days of age and followed-up for at least 18 months, all but one achieved autonomous ambulation. Of 41 patients with two copies, who were non-symptomatic at treatment initiation, all achieved a sitting position independently and 31 were able to walk. Of 16 patients with two copies followed-up for at least 18 months who presented with symptoms at treatment onset, 3 achieved the walking milestone and all but one were able to sit without support.
CONCLUSIONS
evaluation of data from 18 publications indicates that the results of early treatment depend on the number of copies and the initial neurological status of the patient.
Topics: Infant, Newborn; Humans; Neonatal Screening; Muscular Atrophy, Spinal; Prognosis; Time
PubMed: 37510282
DOI: 10.3390/genes14071377 -
Annals of Internal Medicine Feb 2016In 2009, the U.S. Preventive Services Task Force recommended biennial mammography screening for women aged 50 to 74 years and selective screening for those aged 40 to 49... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
In 2009, the U.S. Preventive Services Task Force recommended biennial mammography screening for women aged 50 to 74 years and selective screening for those aged 40 to 49 years.
PURPOSE
To review studies of the effectiveness of breast cancer screening in average-risk women.
DATA SOURCES
MEDLINE and Cochrane databases to 4 June 2015.
STUDY SELECTION
English-language randomized, controlled trials and observational studies of screening with mammography, magnetic resonance imaging, and ultrasonography that reported breast cancer mortality, all-cause mortality, or advanced breast cancer outcomes.
DATA EXTRACTION
Investigators extracted and confirmed data and dual rated study quality; discrepancies were resolved through consensus.
DATA SYNTHESIS
Fair-quality evidence from a meta-analysis of mammography trials indicated relative risks (RRs) for breast cancer mortality of 0.92 for women aged 39 to 49 years (95% CI, 0.75 to 1.02) (9 trials; 3 deaths prevented per 10,000 women over 10 years); 0.86 for those aged 50 to 59 years (CI, 0.68 to 0.97) (7 trials; 8 deaths prevented per 10,000 women over 10 years); 0.67 for those aged 60 to 69 years (CI, 0.54 to 0.83) (5 trials; 21 deaths prevented per 10,000 women over 10 years); and 0.80 for those aged 70 to 74 years (CI, 0.51 to 1.28) (3 trials; 13 deaths prevented per 10,000 women over 10 years). Risk reduction was 25% to 31% for women aged 50 to 69 years in observational studies of mammography screening. All-cause mortality was not reduced with screening. Advanced breast cancer was reduced for women aged 50 years or older (RR, 0.62 [CI, 0.46 to 0.83]) (3 trials) but not those aged 39 to 49 years (RR, 0.98 [CI, 0.74 to 1.37]) (4 trials); less evidence supported this outcome.
LIMITATIONS
Most trials used imaging technologies and treatments that are now outdated, and definitions of advanced breast cancer were heterogeneous. Studies of effectiveness based on risk factors, intervals, or other modalities were unavailable or methodologically limited.
CONCLUSION
Breast cancer mortality is generally reduced with mammography screening, although estimates are not statistically significant at all ages and the magnitudes of effect are small. Advanced cancer is reduced with screening for women aged 50 years or older.
PRIMARY FUNDING SOURCE
Agency for Healthcare Research and Quality.
Topics: Age Factors; Aged; Breast Neoplasms; Early Detection of Cancer; Female; Humans; Mammography; Mass Screening; Middle Aged; Risk Factors; Time Factors
PubMed: 26756588
DOI: 10.7326/M15-0969 -
Chest Jul 2016Hospitalizations for aspiration pneumonia have doubled among older adults. Using a bedside water swallow test (WST) to screen for swallowing-related aspiration can be... (Review)
Review
BACKGROUND
Hospitalizations for aspiration pneumonia have doubled among older adults. Using a bedside water swallow test (WST) to screen for swallowing-related aspiration can be efficient and cost-effective for preventing additional comorbidities and mortality. We evaluated screening accuracy of bedside WSTs used to identify patients at risk for dysphagia-associated aspiration.
METHODS
Sixteen online databases, Google Scholar, and known content experts through May 2015 were searched. Only prospective studies with patients ≥ 18 years of age given WST screenings validated against nasoendoscopy or videofluoroscopy were included. Data extraction used dual masked extraction and quality assessment following Meta-analysis of Observational Studies in Epidemiology guidelines.
RESULTS
Airway response (eg, coughing/choking) with or without voice changes (eg, wet/gurgly voice quality) was used to identify aspiration during three different bedside WSTs. Pooled estimates for single sip volumes (1-5 mL) were 71% sensitive (95% CI, 63%-78%) and 90% specific (95% CI, 86%-93%). Consecutive sips of 90 to 100 mL trials were 91% sensitive (95% CI, 89%-93%) and 53% specific (95% CI, 51%-55%). Trials of progressively increasing volumes of water were 86% sensitive (95% CI, 76%-93%) and 65% specific (95% CI, 57%-73%). Airway response with voice change improved overall accuracy in identifying aspiration.
CONCLUSIONS
Currently used bedside WSTs offer sufficient, although not ideal, utility in screening for aspiration. Consecutive sips with large volumes in patients who did not present with overt airway responses or voice changes appropriately ruled out risk of aspiration. Small volumes with single sips appropriately ruled in aspiration when clinical signs were present. Combining these bedside approaches may offer improved screening accuracy, but further research is warranted.
Topics: Adult; Deglutition Disorders; Endoscopy; Humans; Mass Screening; Photofluorography; Pneumonia, Aspiration; Point-of-Care Testing; Respiratory Aspiration; Sensitivity and Specificity
PubMed: 27102184
DOI: 10.1016/j.chest.2016.03.059 -
La Clinica Terapeutica 2020The aim of this systematic review was to summarize the scientific literature concerning the use of the Precede-Proceed model (PPM) applied to educational programs and...
OBJETCTIVE
The aim of this systematic review was to summarize the scientific literature concerning the use of the Precede-Proceed model (PPM) applied to educational programs and health screenings contextsV.
STUDY DESIGN
Systematic review.
METHODS
The search process was based on a selection of publications listed in Medline and Scopus. The keywords used were "Precede-Proceed" AND ("screening" OR "educational programs"). Studies included in the systematic review were subdivided into those applying the model in a screening context, and those applying it within educational programs.
RESULTS
Twenty-seven studies were retrieved, mostly performed in the USA and, generally, the promoting center was the University. In the context of cancer screening, the PPM model was most of all applied to Mammography Screening (5 of 13 studies in cancer screening), and Cervical Cancer Screening (5 of 13). Another three studies within the cancer field investigated Menopause-Inducing Cancer Treatments, Oral cancer prevention, and cancer screening in general. In the remaining studies, the model was applied in various screening areas, particularly chronic and degenerative diseases. There were many different study designs, most of which cross-sectional (8), though several RTCs (8) and focus groups (5) were also found. For the cross-sectional studies the methodological quality varied between 3/10 and 9/10, whilst for the RCTs it ranged from 2/5 to 3/5.
CONCLUSIONS
The PPM provides an excellent framework for health intervention programs especially in screening contexts, and could improve the understanding of the relationship between variables such as knowledge and screening. Given the complexity of a behavioral change process, certain important predisposing factors could be measured in future studies, and during health intervention planning.
Topics: Biobehavioral Sciences; Cross-Sectional Studies; Early Detection of Cancer; Humans; Mass Screening; Neoplasms; Public Health
PubMed: 32141490
DOI: 10.7417/CT.2020.2208 -
Genetics in Medicine : Official Journal... Nov 2019For neurodevelopmental disorders (NDDs), etiological evaluation can be a diagnostic odyssey involving numerous genetic tests, underscoring the need to develop a... (Meta-Analysis)
Meta-Analysis
PURPOSE
For neurodevelopmental disorders (NDDs), etiological evaluation can be a diagnostic odyssey involving numerous genetic tests, underscoring the need to develop a streamlined algorithm maximizing molecular diagnostic yield for this clinical indication. Our objective was to compare the yield of exome sequencing (ES) with that of chromosomal microarray (CMA), the current first-tier test for NDDs.
METHODS
We performed a PubMed scoping review and meta-analysis investigating the diagnostic yield of ES for NDDs as the basis of a consensus development conference. We defined NDD as global developmental delay, intellectual disability, and/or autism spectrum disorder. The consensus development conference included input from genetics professionals, pediatric neurologists, and developmental behavioral pediatricians.
RESULTS
After applying strict inclusion/exclusion criteria, we identified 30 articles with data on molecular diagnostic yield in individuals with isolated NDD, or NDD plus associated conditions (such as Rett-like features). Yield of ES was 36% overall, 31% for isolated NDD, and 53% for the NDD plus associated conditions. ES yield for NDDs is markedly greater than previous studies of CMA (15-20%).
CONCLUSION
Our review demonstrates that ES consistently outperforms CMA for evaluation of unexplained NDDs. We propose a diagnostic algorithm placing ES at the beginning of the evaluation of unexplained NDDs.
Topics: Autism Spectrum Disorder; Developmental Disabilities; Diagnostic Tests, Routine; Exome; Genetic Testing; Humans; Intellectual Disability; Neurodevelopmental Disorders; Exome Sequencing
PubMed: 31182824
DOI: 10.1038/s41436-019-0554-6