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Journal of Medical Internet Research Dec 2015Direct-to-consumer genetic tests (DTC-GT) are easily purchased through the Internet, independent of a physician referral or approval for testing, allowing the retrieval... (Review)
Review
BACKGROUND
Direct-to-consumer genetic tests (DTC-GT) are easily purchased through the Internet, independent of a physician referral or approval for testing, allowing the retrieval of genetic information outside the clinical context. There is a broad debate about the testing validity, their impact on individuals, and what people know and perceive about them.
OBJECTIVE
The aim of this review was to collect evidence on DTC-GT from a comprehensive perspective that unravels the complexity of the phenomenon.
METHODS
A systematic search was carried out through PubMed, Web of Knowledge, and Embase, in addition to Google Scholar according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist with the key term "Direct-to-consumer genetic test."
RESULTS
In the final sample, 118 articles were identified. Articles were summarized in five categories according to their focus on (1) knowledge of, attitude toward use of, and perception of DTC-GT (n=37), (2) the impact of genetic risk information on users (n=37), (3) the opinion of health professionals (n=20), (4) the content of websites selling DTC-GT (n=16), and (5) the scientific evidence and clinical utility of the tests (n=14). Most of the articles analyzed the attitude, knowledge, and perception of DTC-GT, highlighting an interest in using DTC-GT, along with the need for a health care professional to help interpret the results. The articles investigating the content analysis of the websites selling these tests are in agreement that the information provided by the companies about genetic testing is not completely comprehensive for the consumer. Given that risk information can modify consumers' health behavior, there are surprisingly few studies carried out on actual consumers and they do not confirm the overall concerns on the possible impact of DTC-GT. Data from studies that investigate the quality of the tests offered confirm that they are not informative, have little predictive power, and do not measure genetic risk appropriately.
CONCLUSIONS
The impact of DTC-GT on consumers' health perceptions and behaviors is an emerging concern. However, negative effects on consumers or health benefits have yet to be observed. Nevertheless, since the online market of DTC-GT is expected to grow, it is important to remain aware of a possible impact.
Topics: Adult; Direct-To-Consumer Screening and Testing; Genetic Testing; Humans; Internet; Male
PubMed: 26677835
DOI: 10.2196/jmir.4378 -
BMJ Open Nov 2021To map evidence on the implementation of the WHO's collaborative framework for the management of tuberculosis (TB) and diabetes mellitus (DM) comorbidity, globally. (Review)
Review
OBJECTIVE
To map evidence on the implementation of the WHO's collaborative framework for the management of tuberculosis (TB) and diabetes mellitus (DM) comorbidity, globally.
DESIGN
Scoping review.
METHODS
Guided by Arksey and O'Malley's scoping review framework, this review mapped literature on the global implementation of the framework for the management of TB and DM comorbidity, globally. An extensive literature search for peer-reviewed studies, theses, studies in the press and a list of references from the selected studies was conducted to source-eligible studies. PubMed, Google Scholar, Web of Science, Science Direct, the EBSCOhost platform (academic search complete, health source: nursing/academic edition, CINAHL with full text), Scopus and the WHO library were used to source the literature. We performed title screening of articles using keywords in the databases, after which two independent reviewers (RS and PV) screened abstracts and full articles. Studies from August 2011 to May 2021 were included in this review and the screening was guided by the inclusion and exclusion criteria. Findings were analysed using the thematic content analysis approach and results presented in the form of a narrative report. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension was used as a checklist and for explaining the scoping review process.
RESULTS
This review found evidence of the WHO TB-DM collaborative framework's implementation in 35 countries across the globe. TB-DM comorbidity was identified in patients through bidirectional screening of both patients with TB and patients with DM in rural and urban settings.
CONCLUSION
Due to the paucity of evidence on mechanisms of collaboration, we recommend further research in other implementing countries to identify techniques used for diagnosis and integration of TB and DM services, in order to ensure that effective and joint management of TB-DM comorbidity in populations is achieved.
Topics: Delivery of Health Care; Diabetes Mellitus; Humans; Mass Screening; Tuberculosis; World Health Organization
PubMed: 34789489
DOI: 10.1136/bmjopen-2020-047342 -
International Journal of Environmental... Jan 2018Diabetic Retinopathy is a microvascular complication of diabetes, that can go undetected and unnoticed until irreversible damage and even blindness has occurred.... (Review)
Review
Diabetic Retinopathy is a microvascular complication of diabetes, that can go undetected and unnoticed until irreversible damage and even blindness has occurred. Effective screening for diabetic retinopathy has been proven to reduce the risk of sight loss. The National Health Service (NHS) which provides healthcare for all UK citizens, implemented systematic retinal screening for diabetic retinopathy in England in 2003, with the aim of identifying and treating all patients with sight threatening retinopathy. Crucial to this is patients partaking in the programme. Therefore, increasing screening uptake has been a major focus of the programme. This review explores the views of people living with diabetes who do not attend retinal screening, their characteristics, concerns, experiences of retinal screening and their understanding of the risks of diabetic retinopathy. All studies that satisfied the study inclusion criteria on 'patients' non-attendance at retinal screening', between 2003 to 2017 were included after extensive database search. A total of 16 studies were included in the review. Findings showed that socio-economic deprivation was a major risk factor for non-attendance, about 11.5-13.4% of the screened population had sight threatening retinopathy (STDR), repeated nonattendance was linked to sight threatening diabetic retinopathy, and that certain factors, could be barriers or incentives for screening uptake. Some of those factors are modifiable whilst others are not.
Topics: Diabetic Retinopathy; England; Female; Humans; Male; Mass Screening; Motivation; National Health Programs; Patient Compliance; Poverty
PubMed: 29351207
DOI: 10.3390/ijerph15010157 -
The Journal of Surgical Research Feb 2023Timely colorectal cancer (CRC) screening has been shown to improve CRC-related morbidity and mortality rates. However, even with this preventative care tool, CRC... (Review)
Review
INTRODUCTION
Timely colorectal cancer (CRC) screening has been shown to improve CRC-related morbidity and mortality rates. However, even with this preventative care tool, CRC screening rates remain below 70% among eligible United States (US) adults, with even lower rates among US immigrants. The aim of this scoping review is to describe the barriers to CRC screening faced by this unique and growing immigrant population and discuss possible interventions to improve screening.
METHODS
Four electronic databases were systematically searched for all original research articles related to CRC screening in US immigrants published after 2010. Following a full-text review of articles for inclusion in the final analysis, data extraction was conducted while coding descriptive themes. Thematic analysis led to the organization of this data into five themes.
RESULTS
Of the 4637 articles initially identified, 55 met inclusion criteria. Thematic analysis of the barriers to CRC screening identified five unique themes: access, knowledge, culture, trust, health perception, and beliefs. The most cited barriers were in access (financial burden and limited primary care access) and knowledge (CRC/screening knowledge).
CONCLUSIONS
US immigrants face several barriers to the receipt of CRC screening. When designing interventions to increase screening uptake among immigrants, gaps in physician and screening education, access to care, and trust need to be addressed through culturally sensitive supports. These interventions should be tailored to the specific immigrant group, since a one-size-fits approach fails to consider the heterogeneity within this population.
Topics: Adult; United States; Humans; Early Detection of Cancer; Emigrants and Immigrants; Colorectal Neoplasms; Mass Screening
PubMed: 36257164
DOI: 10.1016/j.jss.2022.08.024 -
European Journal of Psychotraumatology 2022An unprecedentedly large number of people worldwide are forcibly displaced, of which more than 40 percent are under 18 years of age. Forcibly displaced children and... (Review)
Review
An unprecedentedly large number of people worldwide are forcibly displaced, of which more than 40 percent are under 18 years of age. Forcibly displaced children and youth have often been exposed to stressful life events and are therefore at increased risk of developing mental health issues. Hence, early screening and assessment for mental health problems is of great importance, as is research addressing this topic. However, there is a lack of evidence regarding the reliability and validity of mental health assessment tools for this population. The aim of the present study was to synthesise the existing evidence on psychometric properties of patient reported outcome measures [PROMs] for assessing the mental health of asylum-seeking, refugee and internally displaced children and youth. Systematic searches of the literature were conducted in four electronic databases: MEDLINE, PsycINFO, Embase and Web of Science. The methodological quality of the studies was examined using the COSMIN Risk of Bias checklist. Furthermore, the COSMIN criteria for good measurement properties were used to evaluate the quality of the outcome measures. The search yielded 4842 articles, of which 27 met eligibility criteria. The reliability, internal consistency, structural validity, hypotheses testing and criterion validity of 28 PROMs were evaluated. Based on the results with regard to validity and reliability, as well as feasibility, we recommend the use of several instruments to measure emotional and behavioural problems, PTSD symptoms, anxiety and depression in forcibly displaced children and youth. However, despite a call for more research on the psychometric properties of mental health assessment tools for forcibly displaced children and youth, there is still a lack of studies conducted on this topic. More research is needed in order to establish cross-cultural validity of mental health assessment tools and to provide optimal cut-off scores for this population. HIGHLIGHTS Research on the psychometric properties of mental health screening and assessment tools for forcibly displaced children and youth is slowly increasing.However, based on the current evidence on the validity and reliability of screening and assessment tools for forcibly displaced children, we are not able to recommend a core set of instruments. Instead, we provide suggestions for best practice.More research of sufficient quality is important in order to establish crsoss-cultural validity and to provide optimal cut-off scores in mental health screening and assessment tools for different populations of forcibly displaced children and youth.
Topics: Adolescent; Child; Humans; Mass Screening; Mental Health; Psychometrics; Refugees; Reproducibility of Results
PubMed: 36212114
DOI: 10.1080/20008066.2022.2126468 -
Journal of the American Medical... Jul 2022We aim to investigate the application and accuracy of artificial intelligence (AI) methods for automated medical literature screening for systematic reviews. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
We aim to investigate the application and accuracy of artificial intelligence (AI) methods for automated medical literature screening for systematic reviews.
MATERIALS AND METHODS
We systematically searched PubMed, Embase, and IEEE Xplore Digital Library to identify potentially relevant studies. We included studies in automated literature screening that reported study question, source of dataset, and developed algorithm models for literature screening. The literature screening results by human investigators were considered to be the reference standard. Quantitative synthesis of the accuracy was conducted using a bivariate model.
RESULTS
Eighty-six studies were included in our systematic review and 17 studies were further included for meta-analysis. The combined recall, specificity, and precision were 0.928 [95% confidence interval (CI), 0.878-0.958], 0.647 (95% CI, 0.442-0.809), and 0.200 (95% CI, 0.135-0.287) when achieving maximized recall, but were 0.708 (95% CI, 0.570-0.816), 0.921 (95% CI, 0.824-0.967), and 0.461 (95% CI, 0.375-0.549) when achieving maximized precision in the AI models. No significant difference was found in recall among subgroup analyses including the algorithms, the number of screened literatures, and the fraction of included literatures.
DISCUSSION AND CONCLUSION
This systematic review and meta-analysis study showed that the recall is more important than the specificity or precision in literature screening, and a recall over 0.95 should be prioritized. We recommend to report the effectiveness indices of automatic algorithms separately. At the current stage manual literature screening is still indispensable for medical systematic reviews.
Topics: Algorithms; Artificial Intelligence; Humans; Mass Screening; Publications
PubMed: 35641139
DOI: 10.1093/jamia/ocac066 -
BMC Psychiatry Feb 2022Cognitive disorders and dementia have an important effect on individual independence and orientation. According to the Alzheimer's Disease International (ADI) 75% of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Cognitive disorders and dementia have an important effect on individual independence and orientation. According to the Alzheimer's Disease International (ADI) 75% of people with dementia are not diagnosed; this may be as high as 90% in some low- and middle-income countries. This systematic review and meta-analysis aimed to identify the test performance of screening tools and compare them pairwise. The findings of our study can support countries in planning to establish and care for mild cognitive impairment in primary health centers.
METHODS
Medline (PubMed), Scopus, Cochrane, Dare, All EBM Reviews, CRD (OVID), and Proquest were searched from 2012 to November 2021. The risk of bias was assessed through the QUADAS-2 instrument. Given the high heterogeneity between studies, a random-effects model was used to calculate the pooled effect sizes for diagnostic accuracy measures (sensitivity, specificity, and area under curve indices). I test was used for assessing heterogeneity and predefined subgroup analyses were performed using participants' age, country's income, and sample size of studies.
RESULTS
A systematic search identified 18,132 records, of which, 20 studies were included in the quality assessment, and six were included in quantitative analysis. None of the studies had examined the feasibility or efficiency of mass screening. According to a pairwise comparison, IQCODE, AD8 and GPCOG showed equal or better diagnostic performance relative to the MMSE in terms of sensitivity and specificity. The random-effect model for the MMSE showed the pooled sensitivity equal to 0.73 (95% CI 0.57-0.90), the pooled specificity equal to 0.83 (95% CI 0.75-0.90), and the pooled AUC equal to 0.88 (95% CI 0.83-0.93).
CONCLUSION
Several benefits have been attached to short tests making them a suitable choice for use in primary healthcare settings. Considering factors such as accuracy, time of application, ease of scoring, and utilization charges, tests such as IQCODE, AD8, and GPCOG or appropriate combination with counterpart tools seem to be good alternatives to the use of the MMSE in primary care.
Topics: Cognition Disorders; Cognitive Dysfunction; Dementia; Humans; Mass Screening; Primary Health Care
PubMed: 35139803
DOI: 10.1186/s12888-022-03730-8 -
Fertility and Sterility Aug 2023Noninvasive and minimally invasive preimplantation genetic testing for aneuploidy (PGT-A) is a tool that may one day become the gold standard for embryonic chromosomal...
Noninvasive and minimally invasive preimplantation genetic testing for aneuploidy (PGT-A) is a tool that may one day become the gold standard for embryonic chromosomal screening. Investigations on this topic have ranged from studying the culture media of embryos to the fluid inside the blastocoel, all in an attempt to find a reliable source of DNA without the need to biopsy the embryo. There is great interest across the board, both from those for and against biopsy, in a reliable test process that would give the patient and provider the same information possible from a biopsy without the risk. We aim to explore the current available research to better understand the utility and accuracy of PGT-A with these new sampling techniques. General concordance rates in comparison with biopsy-based PGT-A are promising, but it is clear that additional research and understanding are needed before adopting noninvasive and minimally invasive PGT-A as a widely used tool with strong clinical utility.
Topics: Pregnancy; Female; Humans; Preimplantation Diagnosis; Genetic Testing; Aneuploidy; Blastocyst; Culture Media; Fertilization in Vitro
PubMed: 37356468
DOI: 10.1016/j.fertnstert.2023.06.013 -
BMJ Open Ophthalmology 2022To conduct a systematic review to identify and critically appraise clinical practice guidelines on the assessment, diagnosis and management of childhood glaucoma.
OBJECTIVE
To conduct a systematic review to identify and critically appraise clinical practice guidelines on the assessment, diagnosis and management of childhood glaucoma.
METHODS AND ANALYSIS
A systematic literature search of databases and professional websites for clinical practice guidelines published on eye conditions between 2010 and April 2020 in English was conducted. Identified guidelines were screened for relevance to childhood glaucoma and exclusion criteria applied. Guidelines that passed the screening and quality appraisal with the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool and, if they achieved a mean score of ≥45 and ≥3 on subsets of 9 and 5 AGREE II items, respectively, were selected for inclusion and data extracted using a standardised form.
RESULTS
Following screening and critical appraisal, three guidelines were included for data extraction. None of the three guidelines was specifically developed for childhood glaucoma. A consistent recommendation was that children should undergo some form of eye screening examination or a comprehensive eye assessment to detect paediatric eye disease. Children at high risk of childhood glaucoma should undergo additional screening. One clinical practice guideline recommended interventions for childhood glaucoma consisting of tube surgery and topical beta-blockers or carbonic anhydrase inhibitors. Recommended interventions for childhood glaucoma were based on low-quality to moderate-quality evidence or expert opinion.
CONCLUSION
Based on our selection criteria, we did not identify any high-quality clinical practice guidelines specifically targeted at childhood glaucoma. This is compounded by the lack of high-quality evidence on childhood glaucoma.
Topics: Child; Glaucoma; Humans; Mass Screening; Practice Guidelines as Topic
PubMed: 35136841
DOI: 10.1136/bmjophth-2021-000933 -
Annals of Internal Medicine Dec 2014Previous research has supported screening for gonorrhea and chlamydia in asymptomatic, sexually active women (including pregnant women) who are younger than 25 years or... (Review)
Review
BACKGROUND
Previous research has supported screening for gonorrhea and chlamydia in asymptomatic, sexually active women (including pregnant women) who are younger than 25 years or at increased risk but not in other patient populations.
PURPOSE
To update the 2005 and 2007 systematic reviews for the U.S. Preventive Services Task Force on screening for gonorrhea and chlamydia in men and women, including pregnant women and adolescents.
DATA SOURCES
MEDLINE (1 January 2004 to 13 June 2014), Cochrane databases (May 2014), ClinicalTrials.gov, and reference lists.
STUDY SELECTION
English-language trials and observational studies about screening effectiveness, test accuracy, and screening harms.
DATA EXTRACTION
Extracted study data were confirmed by a second investigator, and study quality and applicability were dual-rated using prespecified criteria.
DATA SYNTHESIS
Screening a subset of asymptomatic young women for chlamydia in a good-quality trial did not significantly reduce the incidence of pelvic inflammatory disease over the following year (relative risk, 0.39 [95% CI, 0.14 to 1.08]); however, 1 previous trial reported a reduction. An observational study evaluating a risk prediction tool to identify persons with chlamydia in high-risk populations had low predictive ability and applicability. In 10 new studies of asymptomatic patients, nucleic acid amplification tests demonstrated sensitivity of 86% or greater and specificity of 97% or greater for diagnosing gonorrhea and chlamydia, regardless of specimen type or test.
LIMITATIONS
There were few relevant studies of screening benefits and harms. Only screening tests and methods cleared by the U.S. Food and Drug Administration for current clinical practice were included to determine diagnostic accuracy.
CONCLUSION
Chlamydia screening in young women may reduce the incidence of pelvic inflammatory disease. Nucleic acid amplification tests are accurate for diagnosing gonorrhea and chlamydia in asymptomatic persons.
PRIMARY FUNDING SOURCE
Agency for Healthcare Research and Quality.
Topics: Asymptomatic Diseases; Bacteriological Techniques; Chlamydia Infections; Female; Gonorrhea; Humans; Male; Mass Screening; Nucleic Acid Amplification Techniques; Risk Factors
PubMed: 25244000
DOI: 10.7326/M14-1022