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Annals of Internal Medicine Mar 2016Major depressive disorder (MDD) is common among children and adolescents and is associated with functional impairment and suicide. (Review)
Review
BACKGROUND
Major depressive disorder (MDD) is common among children and adolescents and is associated with functional impairment and suicide.
PURPOSE
To update the 2009 U.S. Preventive Services Task Force (USPSTF) systematic review on screening for and treatment of MDD in children and adolescents in primary care settings.
DATA SOURCES
Several electronic searches (May 2007 to February 2015) and searches of reference lists of published literature.
STUDY SELECTION
Trials and recent systematic reviews of treatment, test-retest studies of screening, and trials and large cohort studies for harms.
DATA EXTRACTION
Data were abstracted by 1 investigator and checked by another; 2 investigators independently assessed study quality.
DATA SYNTHESIS
Limited evidence from 5 studies showed that such tools as the Beck Depression Inventory and Patient Health Questionnaire for Adolescents had reasonable accuracy for identifying MDD among adolescents in primary care settings. Six trials evaluated treatment. Several individual fair- and good-quality studies of fluoxetine, combined fluoxetine and cognitive behavioral therapy, escitalopram, and collaborative care demonstrated benefits of treatment among adolescents, with no associated harms.
LIMITATION
The review included only English-language studies, narrow inclusion criteria focused only on MDD, high thresholds for quality, potential publication bias, limited data on harms, and sparse evidence on long-term outcomes of screening and treatment among children younger than 12 years.
CONCLUSION
No evidence was found of a direct link between screening children and adolescents for MDD in primary care or similar settings and depression or other health-related outcomes. Evidence showed that some screening tools are accurate and some treatments are beneficial among adolescents (but not younger children), with no evidence of associated harms.
PRIMARY FUNDING SOURCE
Agency for Healthcare Research and Quality.
Topics: Adolescent; Child; Depressive Disorder, Major; Humans; Mass Screening; Primary Health Care; Suicide; United States
PubMed: 26857836
DOI: 10.7326/M15-2259 -
Sexually Transmitted Infections Jun 2006To review systematically and critically, evidence used to derive estimates of costs and cost effectiveness of chlamydia screening. (Review)
Review
OBJECTIVE
To review systematically and critically, evidence used to derive estimates of costs and cost effectiveness of chlamydia screening.
METHODS
Systematic review. A search of 11 electronic bibliographic databases from the earliest date available to August 2004 using keywords including chlamydia, pelvic inflammatory disease, economic evaluation, and cost. We included studies of chlamydia screening in males and/or females over 14 years, including studies of diagnostic tests, contact tracing, and treatment as part of a screening programme. Outcomes included cases of chlamydia identified and major outcomes averted. We assessed methodological quality and the modelling approach used.
RESULTS
Of 713 identified papers we included 57 formal economic evaluations and two cost studies. Most studies found chlamydia screening to be cost effective, partner notification to be an effective adjunct, and testing with nucleic acid amplification tests, and treatment with azithromycin to be cost effective. Methodological problems limited the validity of these findings: most studies used static models that are inappropriate for infectious diseases; restricted outcomes were used as a basis for policy recommendations; and high estimates of the probability of chlamydia associated complications might have overestimated cost effectiveness. Two high quality dynamic modelling studies found opportunistic screening to be cost effective but poor reporting or uncertainty about complication rates make interpretation difficult.
CONCLUSION
The inappropriate use of static models to study interventions to prevent a communicable disease means that uncertainty remains about whether chlamydia screening programmes are cost effective or not. The results of this review can be used by health service managers in the allocation of resources, and health economists and other researchers who are considering further research in this area.
Topics: Adolescent; Adult; Aged; Bacteriological Techniques; Chlamydia Infections; Chlamydia trachomatis; Contact Tracing; Cost-Benefit Analysis; Female; Humans; Male; Mass Screening; Middle Aged
PubMed: 16731666
DOI: 10.1136/sti.2005.017517 -
Health Expectations : An International... Jun 2001To report data relating to the informed uptake of screening tests. (Review)
Review
OBJECTIVE
To report data relating to the informed uptake of screening tests.
SEARCH STRATEGY
Electronic databases, bibliographies and experts were used to identify relevant published and unpublished studies up until August 2000.
INCLUSION CRITERIA
RCTs, quasi-RCTs and controlled trials of interventions aimed at increasing the informed uptake of screening. All participants were eligible as defined by the entry criteria of individual programmes. Studies had to report actual uptake and meet three out of four criteria used to define informed uptake.
DATA EXTRACTION AND SYNTHESIS
Relevant studies were identified, data extracted and their validity assessed by two reviewers independently. Outcome data included screening uptake, knowledge, informed decision-making and attitudes to screening. A random-effects model was used to calculate individual relative risks and 95% confidence intervals.
MAIN RESULTS
Six controlled trials (five RCTs and one quasi-RCT), focusing on antenatal and prostate specific antigen screening, were included. All reported risks/benefits of screening and assessed knowledge. Two also assessed decision-making. Two reported risks/benefits to all randomized groups and evaluated different ways of presenting information. Neither found that interventions such as videos, information leaflets with decision trees, or touch screen computers conveyed any additional benefits over well-prepared leaflets.
CONCLUSIONS
There is some evidence to suggest that changing the format of informed choice interventions in screening does not alter knowledge, satisfaction or decisions about screening. It is not clear whether informed choice in screening affects uptake. More well-designed RCTs are required and further research should also be directed towards the development of a valid instrument for measuring all components of informed choice in screening.
Topics: Attitude to Health; Decision Making; Female; Humans; Informed Consent; Male; Mass Screening; Pregnancy; Prenatal Diagnosis; Prostate-Specific Antigen; Randomized Controlled Trials as Topic; Risk Factors
PubMed: 11359542
DOI: 10.1046/j.1369-6513.2001.00143.x -
Systematic Reviews Jun 2023Cervical cancer is a major global health issue, with 89% of cases occurring in low- and middle-income countries (LMICs). Human papillomavirus (HPV) self-sampling tests... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Cervical cancer is a major global health issue, with 89% of cases occurring in low- and middle-income countries (LMICs). Human papillomavirus (HPV) self-sampling tests have been suggested as an innovative way to improve cervical cancer screening uptake and reduce the burden of disease. The objective of this review was to examine the effect of HPV self-sampling on screening uptake compared to any healthcare provider sampling in LMICs. The secondary objective was to estimate the associated costs of the various screening methods.
METHOD
Studies were retrieved from PubMed, Embase, CINAHL, CENTRAL (by Cochrane), Web of Science, and ClinicalTrials.gov up until April 14, 2022, and a total of six trials were included in the review. Meta-analyses were performed mainly using the inverse variance method, by pooling effect estimates of the proportion of women who accepted the screening method offered. Subgroup analyses were done comparing low- and middle-income countries, as well as low- and high-risk bias studies. Heterogeneity of the data was assessed using I. Cost data was collected for analysis from articles and correspondence with authors.
RESULTS
We found a small but significant difference in screening uptake in our primary analysis: RR 1.11 (95% CI: 1.10-1.11; I = 97%; 6 trials; 29,018 participants). Our sensitivity analysis, which excluded one trial that measured screening uptake differently than the other trials, resulted in a clearer effect in screening uptake: RR: 1.82 (95% CI: 1.67-1.99; I = 42%; 5 trials; 9590 participants). Two trials reported costs; thus, it was not possible to make a direct comparison of costs. One found self-sampling more cost-effective than the provider-required visual inspection with acetic acid method, despite the test and running costs being higher for HPV self-sampling.
CONCLUSION
Our review indicates that self-sampling improves screening uptake, particularly in low-income countries; however, to this date, there remain few trials and associated cost data. We recommend further studies with proper cost data be conducted to guide the incorporation of HPV self-sampling into national cervical cancer screening guidelines in low- and middle-income countries.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO CRD42020218504.
Topics: Female; Humans; Uterine Cervical Neoplasms; Early Detection of Cancer; Developing Countries; Papillomavirus Infections; Mass Screening; Health Personnel
PubMed: 37349822
DOI: 10.1186/s13643-023-02252-y -
CoDAS 2014To perform a systematic review of screening instruments for dysphagia available in the literature. (Review)
Review
PURPOSE
To perform a systematic review of screening instruments for dysphagia available in the literature.
METHODS
For the selection of studies, the following descriptors were used: "questionários", "questionnaires", "transtornos de deglutição", "deglutition disorders", "programas de rastreamento", and "mass screening". The online databases used for the research were Virtual Health Library (LILACS, IBECS, MEDLINE, Cochrane Library, SciELO) and PubMed. The research was performed from April to June 2013. Selection criteria articles in English, Portuguese, and Spanish, regardless of the year of publication, whose title, abstract, or text had any relation to the purpose of the research. After reading the articles in their entirety, identification data and method of the articles were extracted for later analysis.
RESULTS
The research carried out from the proposed descriptors produced 1,012 articles. After reviewing the titles, summaries, and fully reading the articles, 20 studies were chosen. The publications on instruments for the identification of dysphagic patients started in 1999, and 50% of the analyzed studies were carried out in the USA. The methods used on the instruments were questionnaires, observation of patient's clinical signals and symptoms, the request for execution of some orofacial movements, and swallowing test with water or food.
CONCLUSION
Screening instruments in dysphagia are fairly heterogeneous and have been developed for different audiences with the main objective of identifying patients with swallowing disorders.
Topics: Deglutition Disorders; Humans; Mass Screening; Sensitivity and Specificity; Surveys and Questionnaires
PubMed: 25388065
DOI: 10.1590/2317-1782/20142014057 -
Osteoporosis International : a Journal... May 2015We performed a systematic review and meta-analysis of the performance of clinical risk assessment instruments for screening for DXA-determined osteoporosis or low bone... (Meta-Analysis)
Meta-Analysis Review
UNLABELLED
We performed a systematic review and meta-analysis of the performance of clinical risk assessment instruments for screening for DXA-determined osteoporosis or low bone density. Commonly evaluated risk instruments showed high sensitivity approaching or exceeding 90% at particular thresholds within various populations but low specificity at thresholds required for high sensitivity. Simpler instruments, such as OST, generally performed as well as or better than more complex instruments.
INTRODUCTION
The purpose of the study is to systematically review the performance of clinical risk assessment instruments for screening for dual-energy X-ray absorptiometry (DXA)-determined osteoporosis or low bone density.
METHODS
Systematic review and meta-analysis were performed. Multiple literature sources were searched, and data extracted and analyzed from included references.
RESULTS
One hundred eight references met inclusion criteria. Studies assessed many instruments in 34 countries, most commonly the Osteoporosis Self-Assessment Tool (OST), the Simple Calculated Osteoporosis Risk Estimation (SCORE) instrument, the Osteoporosis Self-Assessment Tool for Asians (OSTA), the Osteoporosis Risk Assessment Instrument (ORAI), and body weight criteria. Meta-analyses of studies evaluating OST using a cutoff threshold of <1 to identify US postmenopausal women with osteoporosis at the femoral neck provided summary sensitivity and specificity estimates of 89% (95%CI 82-96%) and 41% (95%CI 23-59%), respectively. Meta-analyses of studies evaluating OST using a cutoff threshold of 3 to identify US men with osteoporosis at the femoral neck, total hip, or lumbar spine provided summary sensitivity and specificity estimates of 88% (95%CI 79-97%) and 55% (95%CI 42-68%), respectively. Frequently evaluated instruments each had thresholds and populations for which sensitivity for osteoporosis or low bone mass detection approached or exceeded 90% but always with a trade-off of relatively low specificity.
CONCLUSIONS
Commonly evaluated clinical risk assessment instruments each showed high sensitivity approaching or exceeding 90% for identifying individuals with DXA-determined osteoporosis or low BMD at certain thresholds in different populations but low specificity at thresholds required for high sensitivity. Simpler instruments, such as OST, generally performed as well as or better than more complex instruments.
Topics: Bone Density; Humans; Mass Screening; Osteoporosis; Risk Assessment; Sensitivity and Specificity
PubMed: 25644147
DOI: 10.1007/s00198-015-3025-1 -
BMJ Open Oct 2015Chronic obstructive pulmonary disease (COPD) is widely underdiagnosed. A number of studies have evaluated the accuracy of screening tests for COPD, but their findings... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Chronic obstructive pulmonary disease (COPD) is widely underdiagnosed. A number of studies have evaluated the accuracy of screening tests for COPD, but their findings have not been formally summarised. We therefore sought to determine and compare the diagnostic accuracy of such screening tests in primary care.
METHODS
Systematic review and meta-analysis of the diagnostic accuracy of screening tests for COPD confirmed by spirometry in primary care. We searched MEDLINE, EMBASE and other bibliographic databases from 1997 to 2013 for diagnostic accuracy studies that evaluated 1 or more index tests in primary care among individuals aged ≥35 years with no prior diagnosis of COPD. Bivariate meta-analysis of sensitivity and specificity was performed where appropriate. Methodological quality was assessed independently by 2 reviewers using the QUADAS-2 tool.
RESULTS
10 studies were included. 8 assessed screening questionnaires (the COPD Diagnostic Questionnaire (CDQ) was the most evaluated, n=4), 4 assessed handheld flow meters (eg, COPD-6) and 1 assessed their combination. Among ever smokers, the CDQ (score threshold ≥19.5; n=4) had a pooled sensitivity of 64.5% (95% CI 59.9% to 68.8%) and specificity of 65.2% (52.9% to 75.8%), and handheld flow meters (n=3) had a sensitivity of 79.9% (95% CI 74.2% to 84.7%) and specificity of 84.4% (68.9% to 93.0%). Inadequate blinding between index tests and spirometry was the main risk of bias.
CONCLUSIONS
Handheld flow meters demonstrated higher test accuracy than the CDQ for COPD screening in primary care. The choice of alternative screening tests within whole screening programmes should now be fully evaluated.
PROSPERO REGISTRATION NUMBER
CRD42012002074.
Topics: Diagnostic Techniques, Respiratory System; Humans; Mass Screening; Primary Health Care; Pulmonary Disease, Chronic Obstructive; Reproducibility of Results; Surveys and Questionnaires
PubMed: 26450427
DOI: 10.1136/bmjopen-2015-008133 -
Revista Da Associacao Medica Brasileira... May 2017Identify factors related to the health system that lead to a late diagnosis of breast cancer in Brazil. (Review)
Review
OBJECTIVE:
Identify factors related to the health system that lead to a late diagnosis of breast cancer in Brazil.
METHOD:
We performed a systematic review in the PubMed and LILACS databases using as keywords "Breast cancer," "system of health" and "Brazil or Brasil." We evaluated the content of the articles using the PRISMA methodology based on PICTOS. The final date was 12/16/2015. We were able to identify 94 publications in PubMed and 43 publications in LILACS. After assessing the title and summary, and excluding 21 repeated publications, we selected 51 publications for full evaluation. At this stage, we excluded 21 articles, with 30 publications remaining for study.
RESULTS:
The population coverage is low, and there are problems related to the quality of mammography. Patients with lower income, nonwhite and less educated are more vulnerable. We observed punctual and initial experiences in breast cancer screening. Diagnosis and treatment flows must be improved. The inequality in mortality reflects the differences related to screening structure and treatment. Better results are observed in well-structured services.
CONCLUSION:
There are several barriers in the health system leading to advanced stage at diagnosis and limiting the survival outcomes. The establishment of a rapid and effective order for diagnosis and treatment, based on hierarchical flow, are important steps to be improved in the public health context.
Topics: Age Factors; Brazil; Breast Neoplasms; Early Detection of Cancer; Female; Health Services Accessibility; Healthcare Disparities; Humans; Mammography; Mass Screening; National Health Programs; Socioeconomic Factors
PubMed: 28724046
DOI: 10.1590/1806-9282.63.05.466 -
The Medical Journal of Malaysia Dec 2010A systematic review on the effectiveness and cost-effectiveness of school scoliosis screening programme was carried out. A total of 248 relevant titles were identified,... (Review)
Review
A systematic review on the effectiveness and cost-effectiveness of school scoliosis screening programme was carried out. A total of 248 relevant titles were identified, 117 abstracts were screened and 28 articles were included in the results. There was fair level of evidence to suggest that school scoliosis screening programme is safe, contributed to early detection and reduction of surgery. There was also evidence to suggest that school-based scoliosis screening programme is cost-effective. Based on the above review, screening for scoliosis among school children is recommended only for high risk group such as girls at twelve years of age.
Topics: Adolescent; Child; Cost-Benefit Analysis; Female; Humans; Male; Mass Screening; School Health Services; Scoliosis
PubMed: 21901941
DOI: No ID Found -
BMC Public Health Mar 2013In many countries, low Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) screening rates among young people in primary-care have encouraged screening programs... (Review)
Review
BACKGROUND
In many countries, low Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) screening rates among young people in primary-care have encouraged screening programs outside of clinics. Nucleic acid amplification tests (NAATs) make it possible to screen people in homes with self-collected specimens. We systematically reviewed the strategies and outcomes of home-based CT/NG screening programs.
METHODS
Electronic databases were searched for home-based CT and/or NG screening studies published since January 2005. Screening information (e.g. target group, recruitment and specimen-collection method) and quantitative outcomes (e.g. number of participants, tests and positivity) were extracted. The screening programs were classified into seven groups on the basis of strategies used.
RESULTS
We found 29 eligible papers describing 32 home-based screening programs. In seven outreach programs, people were approached in their homes: a median of 97% participants provided specimens and 76% were tested overall (13717 tests). In seven programs, people were invited to receive postal test-kits (PTKs) at their homes: a median of 37% accepted PTKs, 79% returned specimens and 19% were tested (46225 tests). PTKs were sent along with invitation letters in five programs: a median of 33% returned specimens and 29% of those invited were tested (15126 tests). PTKs were requested through the internet or phone without invitations in four programs and a median of 32% returned specimens (2666 tests). Four programs involved study personnel directly inviting people to receive PTKs: a median of 46% accepted PTKs, 21% returned specimens and 9.1% were tested (341 tests). PTKs were picked-up from designated locations in three programs: a total of 6765 kits were picked-up and 1167 (17%) specimens were returned for screening. Two programs used a combination of above strategies (2395 tests) but the outcomes were not reported separately. The overall median CT positivity was 3.6% (inter-quartile range: 1.7-7.3%).
CONCLUSIONS
A variety of strategies have been used in home-based CT/NG screening programs. The screening strategies and their feasibility in the local context need to be carefully considered to maximize the effectiveness of home-based screening programs.
Topics: Chlamydia Infections; Gonorrhea; Home Care Services; Humans; Mass Screening; Outcome Assessment, Health Care
PubMed: 23496833
DOI: 10.1186/1471-2458-13-189