| 1. |
- Andiné, Peter, et al.
(författare)
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Behandling och bedömning i rättspsykiatrisk vård – En kartläggning av systematiska översikter : SBU Kartlägger • Rapport 264/2017
- 2017
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Statens beredning för medicinsk och social utvärdering (SBU) har gjort denna kartläggning för att ta reda på inom vilka områden det finns behov av kunskap kring insatser i rättspsykiatrisk vård. Uppdraget kommer från Socialdepartementet som efterlyser ökad kunskap om evidensläget för rättspsykiatrisk vård. Kartläggningen visar att behovet av väl genomförd forskning är stort för behandlingar i rättspsykiatrisk vård. Samtliga domäner som SBU har kartlagt saknar tillförlitligt sammanställd forskning specifikt för personer som vårdas inom rättspsykiatri.
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| 2. |
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| 3. |
- Arnberg, Filip K, 1981-, et al.
(författare)
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Internet-delivered psychological treatments for mood and anxiety disorders : a systematic review of their efficacy, safety, and cost-effectiveness
- 2014
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 9:5, s. e98118-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Greater access to evidence-based psychological treatments is needed. This review aimed to evaluate whether internet-delivered psychological treatments for mood and anxiety disorders are efficacious, noninferior to established treatments, safe, and cost-effective for children, adolescents and adults.METHODS: We searched the literature for studies published until March 2013. Randomized controlled trials (RCTs) were considered for the assessment of short-term efficacy and safety and were pooled in meta-analyses. Other designs were also considered for long-term effect and cost-effectiveness. Comparisons against established treatments were evaluated for noninferiority. Two reviewers independently assessed the relevant studies for risk of bias. The quality of the evidence was graded using an international grading system.RESULTS: A total of 52 relevant RCTs were identified whereof 12 were excluded due to high risk of bias. Five cost-effectiveness studies were identified and three were excluded due to high risk of bias. The included trials mainly evaluated internet-delivered cognitive behavioral therapy (I-CBT) against a waiting list in adult volunteers and 88% were conducted in Sweden or Australia. One trial involved children. For adults, the quality of evidence was graded as moderate for the short-term efficacy of I-CBT vs. waiting list for mild/moderate depression (d = 0.83; 95% CI 0.59, 1.07) and social phobia (d = 0.85; 95% CI 0.66, 1.05), and moderate for no efficacy of internet-delivered attention bias modification vs. sham treatment for social phobia (d = -0.04; 95% CI -0.24, 0.35). The quality of evidence was graded as low/very low for other disorders, interventions, children/adolescents, noninferiority, adverse events, and cost-effectiveness.CONCLUSIONS: I-CBT is a viable treatment option for adults with depression and some anxiety disorders who request this treatment modality. Important questions remain before broad implementation can be supported. Future research would benefit from prioritizing adapting treatments to children/adolescents and using noninferiority designs with established forms of treatment.
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| 4. |
- Domeij, Helena, et al.
(författare)
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Experiences of living with fetal alcohol spectrum disorders : a systematic review and synthesis of qualitative data
- 2018
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Ingår i: Developmental Medicine & Child Neurology. - : Wiley. - 0012-1622 .- 1469-8749. ; 60:8, s. 741-
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Forskningsöversikt (refereegranskat)abstract
- Aim: To identify and assess available evidence from qualitative studies exploring experiences of individuals living with fetal alcohol spectrum disorders (FASD) or those living with a child with FASD, as well as experiences of interventions aimed at supporting individuals with FASD and their families.Method: A systematic literature search was conducted in six electronic databases: PubMed, Embase, Cochrane Library, CINAHL, PsycINFO, and Scopus. Included studies were analysed using manifest content analysis. Methodological limitations and confidence in the evidence were assessed using a modified version of the Critical Appraisal Skills Programme and the Grading of Recommendations, Assessment, Development and Evaluation–Confidence in the Evidence from Reviews of Qualitative Research approach respectively.Results: Findings from 18 studies show that individuals with FASD experience a variation of disabilities, ranging from somatic problems, high pain tolerance, destructive behaviour, hyperactivity, and aggressiveness, to social problems with friendship, school attendance, and maintenance of steady employment. Most studies reported parents’ experiences with FASD; parenting was viewed as a lifelong engagement and that the whole family is isolated and burdened because of FASD. People with FASD feel that their difficulties affect their daily life in a limiting way and make them feel different from others.Interpretation: From the perspective of primarily parents, individuals with FASD and their parents face many different difficulties, for which they need societal support.
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| 5. |
- Eriksson, Anders, et al.
(författare)
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Diagnostic accuracy of postmortem imaging vs autopsy : a systematic review
- 2017
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Ingår i: European Journal of Radiology. - : ELSEVIER IRELAND LTD. - 0720-048X .- 1872-7727. ; 89, s. 249-269
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Forskningsöversikt (refereegranskat)abstract
- Background Postmortem imaging has been used for more than a century as a complement to medico-legal autopsies. The technique has also emerged as a possible alternative to compensate for the continuous decline in the number of clinical autopsies. To evaluate the diagnostic accuracy of postmortem imaging for various types of findings, we performed this systematic literature review. Data sources The literature search was performed in the databases PubMed, Embase and Cochrane Library through January 7, 2015. Relevant publications were assessed for risk of bias using the QUADAS tool and were classified as low, moderate or high risk of bias according to pre-defined criteria. Autopsy and/or histopathology were used as reference standard. Findings The search generated 2600 abstracts, of which 340 were assessed as possibly relevant and read in full-text. After further evaluation 71 studies were finally included, of which 49 were assessed as having high risk of bias and 22 as moderate risk of bias. Due to considerable heterogeneity - in populations, techniques, analyses and reporting - of included studies it was impossible to combine data to get a summary estimate of the diagnostic accuracy of the various findings. Individual studies indicate, however, that imaging techniques might be useful for determining organ weights, and that the techniques seem superior to autopsy for detecting gas Conclusions and Implications In general, based on the current scientific literature, it was not possible to determine the diagnostic accuracy of postmortem imaging and its usefulness in conjunction with, or as an alternative to autopsy. To correctly determine the usefulness of postmortem imaging, future studies need improved planning, improved methodological quality and larger materials, preferentially obtained from multi-center studies.
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| 6. |
- Heintz, Emelie, et al.
(författare)
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FRAMEWORK FOR SYSTEMATIC IDENTIFICATION OF ETHICAL ASPECTS OF HEALTHCARE TECHNOLOGIES: THE SBU APPROACH
- 2015
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Ingår i: International Journal of Technology Assessment in Health Care. - : Cambridge University Press. - 0266-4623 .- 1471-6348. ; 31:3, s. 124-130
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Assessment of ethical aspects of a technology is an important component of health technology assessment (HTA). Nevertheless, how the implementation of ethical assessment in HTA is to be organized and adapted to specific regulatory and organizational settings remains unclear. The objective of this study is to present a framework for systematic identification of ethical aspects of health technologies. Furthermore, the process of developing and adapting the framework to a specific setting is described. Methods: The framework was developed based on an inventory of existing approaches to identification and assessment of ethical aspects in HTA. In addition, the framework was adapted to the Swedish legal and organizational healthcare context, to the role of the HTA agency and to the use of non-ethicists. The framework was reviewed by a group of ethicists working in the field as well as by a wider set of interested parties including industry, interest groups, and other potential users. Results: The framework consists of twelve items with sub-questions, short explanations, and a concluding overall summary. The items are organized into four different themes: the effects of the intervention on health, its compatibility with ethical norms, structural factors with ethical implications, and long term ethical consequences of using the intervention. Conclusions: In this study, a framework for identifying ethical aspects of health technologies is proposed. The general considerations and methodological approach to this venture will hopefully inspire and present important insights to organizations in other national contexts interested in making similar adaptations.
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| 7. |
- Helgesson, Gert, et al.
(författare)
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Ethical aspects of diagnosis and interventions for children with fetal alcohol Spectrum disorder (FASD) and their families
- 2018
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Ingår i: BMC Medical Ethics. - : BIOMED CENTRAL LTD. - 1472-6939. ; 19
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Tidskriftsartikel (refereegranskat)abstract
- Background: Fetal alcohol spectrum disorders (FASD) is an umbrella term covering several conditions for which alcohol consumption during pregnancy is taken to play a causal role. The benefit of individuals being identified with a condition within FASD remains controversial. The objective of the present study was to identify ethical aspects and consequences of diagnostics, interventions, and family support in relation to FASD.Methods: Ethical aspects relating to diagnostics, interventions, and family support regarding FASD were compiled and discussed, drawing on a series of discussions with experts in the field, published literature, and medical ethicists.Results: Several advantages and disadvantages in regards of obtaining a diagnosis or description of the condition were identified. For instance, it provides an explanation and potential preparedness for not yet encountered difficulties, which may play an essential role in acquiring much needed help and support from health care, school, and the socia ! services. There are no interventions specifically evaluated for FASD conditions, but training programs and family support for conditions with symptoms overlapping with FASD, e.g. ADHD, autism, and intellectual disability, are likely to be relevant. Stigmatization, blame, and guilt are potential downsides. There might also be unfortunate prioritization if individuals with equal needs are treated differently depending on whether or not they meet the criteria for a specific condition. Conclusions: The value for the concerned individuals of obtaining a FASD-related description of their condition - for instance, in terms of wellbeing - is not established. Nor is it established that allocating resources based, on whether individuals fulfil FASD-related criteria is justified, compared to allocations directed to the most prominent specific needs.
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| 8. |
- Hellberg, Lena, et al.
(författare)
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Ett nationellt sammanhållet system för kunskapsbaserad vård : ett system, många möjligheter
- 2020
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Bok (övrigt vetenskapligt/konstnärligt)abstract
- Utredningens förslag har primärt två syften. Förslagen syftar dels till att öka förutsättningarna för staten att göra de insatser som mest effektivt bidrar till att målen med hälso- och sjukvården nås, dels till att öka förutsättningarna för hälso- och sjukvårdens professioner att arbeta kunskapsbaserat.Hälso- och sjukvården är en komplex verksamhet med många olika aktörer. För att få ihop hälso- och sjukvården till en fungerande helhet behövs strukturer och väl fungerande samarbeten.Utredningens uppdrag handlar i grunden om att utveckla och stärka strukturer, förutsättningar och samarbeten för att nå en god vård. Utredningens samlade förslag, bedömningar och rekommendationer bidrar till bättre förutsättningar för en långsiktig utveckling där staten, regionerna och kommunerna kan arbeta tillsammans mot målen med hälso- och sjukvården och därmed skapa värde för patienten. Detta görs genom att:• underlätta för regeringen att styra mer strategiskt, kunskapsbaserat och långsiktigt hållbart. En förbättrad uppföljning av statliga initiativ och ett mer strukturerat samarbete mellan myndigheterna bidrar till att skapa ett utvecklat underlag för regeringens beslut om nya insatser.• förutsättningar för att arbeta kunskapsbaserat lokalt i regioner och kommuner stärks bl.a. genom att staten fortsätter att utveckla sitt stöd. Mer fokus än i dag läggs på stöd till den kommunala hälso- och sjukvården.• ett nationellt sammanhållet system för kunskapsbaserad vård får långsiktiga förutsättningar att utvecklas genom att en överenskommelse sluts mellan stat, regioner och kommuner. Principer och strukturer för ett långsiktigt samarbete läggs fast där några centrala utgångspunkter är en gemensam målbild samt principer för prioriterings- och arbetsprocesser.
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| 9. |
- Hildingsson, Ingegerd, et al.
(författare)
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Support interventions to reduce psychological distress in families experiencing stillbirth in high income countries : a systematic review
- 2024
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Ingår i: Women and Birth. - : Elsevier. - 1871-5192 .- 1878-1799. ; 37:2, s. 296-302
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Forskningsöversikt (refereegranskat)abstract
- Background: Previous research indicates disparities in the care of bereaved parents and siblings following a stillbirth in the family. The aim of this systematic review was to assess the effects of interventions aimed at reducing psychological distress among parents or siblings in high-income countries after experiencing a stillbirth.Methods: The databases CINAHL, Medline, PsycInfo, Cochrane Library, and EMBASE were searched in August 2022.Results: Four intervention studies from the United States (US), the United Kingdom (UK), Finland, and Australia, met the inclusion criteria. The interventions comprised a perinatal grief support team; a perinatal counselling service; a grief support program; and a support package including contacts with peer supporters and health care staff. No studies of interventions for siblings were found. The results could not be synthesised due to disparities in interventions and outcome measures. The risk of bias was assessed as high in all four studies and the certainty for all outcomes was rated as very low.Conclusion: More controlled trials with rigorous methods are needed to evaluate the effect of bereavement support interventions in parents and siblings after stillbirth. Future studies should include a core outcome set to make them more comparable. Most of the studies in this review were assessed to have an overall high risk of bias, mainly due to problems with missing outcome data; thus, future studies could specifically target this problem.
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| 10. |
- Hultcrantz, Monica, et al.
(författare)
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From evidence to policy on a national level : supporting the government’s role in a learning healthcare system
- 2020
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Ingår i: Cochrane Database of Systematic Reviews. - 1469-493X. ; 9, s. 190-190
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Tidskriftsartikel (refereegranskat)abstract
- Background: In August 2018, the Swedish government appointed a special investigator to support a national ecosystem for evidence-based healthcare. In November 2019, the inquiry received an additional task now focusing on follow-up to enable a more strategic, evidence-based and long-term sustainable management of health care on a national level. Since healthcare systems around the world face similar challenges, we believe the results of the investigation are highly relevant for a broader audience.Objectives: To analyze how governmental agencies can better support a comprehensive follow-up of health care and thereby create a learning system on a national level. This includes following the effects of the government’s initiatives and reforms and analyzing where future governmental interventions are needed.Methods: The investigator and her team have worked with an expert committee including representatives of governmental agencies, healthcare professions and healthcare providers, as well as a reference group of patient representatives. Additional information has been collected through questionnaires, workshops and meetings with stakeholders and other governmental inquiries working on related topics. Background information was collected from published research, governmental reports, existing regulations etc.Results: Although roughly estimated more than 1000 full-time government employees work with followup in Sweden, the quality, effectiveness and equity in health care is not improving at the anticipated rate. Our findings suggest that a co-ordination of the different initiatives is a prerequisite for creating a learning system on a national level. Key challenges arise in the interface between evidence and policy. At the Colloquium, we will present possible solutions to these challenges using the Swedish healthcare system as an example.Conclusions: Although a lot of efforts are made in conducting and developing methods for evidence generation, implementation and follow-up, it is apparent that the full value for patients is not reached. Facilitators are needed for a learning system on a national level, where the government’s initiatives efficiently contribute to an increased quality, effectiveness and equity in health care. Sharing experiences from national efforts can be one way of increasing the understanding of what these facilitators are. Patient or healthcare consumer involvement: We have received valuable input through regular meetings with a reference group of six representatives from different patient organizations throughout the work. The expert committee linked to the investigation also included a patient representative adding important perspectives to the discussions.
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| 11. |
- Hultcrantz, Monica
(författare)
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Interferons in antiviral defense and autoimmunity : focus on type 1 diabetes
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Type 1 diabetes (T1D) is a disease characterized by the loss of insulin producing beta-cells in the pancreatic islets of Langerhans. Interferons (IFNs), produced by immune cells and infected parenchymal cells, may be protective or damaging in the pathogenesis of T1D. An intact beta-cell response to IFNs is critical for beta-cell survival and protection from diabetes during a Coxsackievirus B (CVB) infection, a virus associated with T1D in humans. It has also been suggested that IFNs may protect from natural killer (NK) cell dependent destruction. Importantly, while being protective during infection with CVB, the pancreatic beta-cell response to cytokines is crucial for the development of type 1 diabetes (T1D) in the non-obese diabetic (NOD) mouse. NOD mice overexpressing the Suppressor of Cytokine Signaling 1 (SOCS-1) specifically in the beta-cells are protected from spontaneous diabetes. The work in this thesis focuses on the mechanisms behind the protective and damaging effects of IFNs in the pathogenesis of T1D. Moreover, it identifies a possible source of IFNgamma during CVB infection. This thesis shows that IFNs trigger an antiviral state in mouse and human islets. Both the RNase L and the dsRNA-dependent protein kinase (PKR) pathways are induced by IFNs in mouse islets and play important roles in providing unique and complementary antiviral activities that regulate the outcome of CVB infection. Moreover, this thesis shows that human islet cells also respond to IFNs by expressing signature genes of antiviral defense. It further demonstrates that human islets express three intracellular sensors for viral RNA, the toll like receptor 3 (TLR3) gene, the retinoic acid-inducible gene I (RIG-I) and the melanoma differentiation-associated gene-5 (MDA-5), which contribute to the production of type I IFN in infected cells. These observations suggest that human islet cells have the possibility to detect an invading virus and to produce type I IFNs during an infection. The work presented in this thesis identifies the NK cell as a possible contributor of IFNgamma during CVB infection: it shows that CVB interferes with the expression of NK cell receptor ligands on infected cells and that IFNgamma production, rather than cytotoxicity, marks the early human NK cell response to CVB infection. Finally, this thesis gives new insights into how IFNs, by acting directly on beta-cells, contribute to disease development in the NOD mouse. It demonstrates that the beta-cell, by responding to thepro-inflammatory pancreas milieu, strongly influences the percentage of self-reactive CD8 T-cells in the pancreas. In conclusion, this thesis supports the notion that cytokine-exposed islet cells affect islet infection and inflammation, highlighting an important role for the beta-cell in the local regulation of the diabetogenic process. By providing a basic understanding for how beta-cells respond to IFNs, and how this relates to their defense against CVB and to the accumulation of pathogenic cells in the pancreas, it may contribute to a future unraveling of the mechanisms underlying beta-cell loss in T1D.
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| 12. |
- Hultcrantz, Monica, et al.
(författare)
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Interferons induce an antiviral state in human pancreatic islet cells
- 2007
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Ingår i: Virology. - : Elsevier BV. - 0042-6822 .- 1096-0341. ; 367:1, s. 92-101
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Tidskriftsartikel (refereegranskat)abstract
- Enterovirus infections, in particular those with Coxsackieviruses, have been linked to the development of type 1 diabetes (T1D). Although animal models have demonstrated that interferons (IFNs) regulate virus-induced T1D by acting directly on the beta cell, little is known on the human pancreatic islet response to IFNs. Here we show that human islet cells respond to IFNs by expressing signature genes of antiviral defense. We also demonstrate that they express three intracellular sensors for viral RNA, the toll like receptor 3 (TLR3) gene, the retinoic acid-inducible gene I (RIG-I) and the melanoma differentiation-associated gene-5 (MDA-5), which induce type I IFN production in infected cells. Finally, we show for the first time that the IFN-induced antiviral state provides human islets with a powerful protection from the replication of Coxsackievirus. This may be critical for beta cell survival and protection from virus-induced T1D in humans.
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| 13. |
- Hultcrantz, Monica, et al.
(författare)
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The GRADE Working Group clarifies the construct of certainty of evidence
- 2017
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Ingår i: Journal of Clinical Epidemiology. - : Pergamon Press. - 0895-4356 .- 1878-5921. ; 87, s. 4-13
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To clarify the grading of recommendations assessment, development and evaluation (GRADE) definition of certainty of evidence and suggest possible approaches to rating certainty of the evidence for systematic reviews, health technology assessments, and guidelines. Study Design and Setting: This work was carried out by a project group within the GRADE Working Group, through brainstorming and iterative refinement of ideas, using input from workshops, presentations, and discussions at GRADE Working Group meetings to produce this document, which constitutes official GRADE guidance. Results: Certainty of evidence is best considered as the certainty that a true effect lies on one side of a specified threshold or within a chosen range. We define possible approaches for choosing threshold or range. For guidelines, what we call a fully contextualized approach requires simultaneously considering all critical outcomes and their relative value. Less-contextualized approaches, more appropriate for systematic reviews and health technology assessments, include using specified ranges of magnitude of effect, for example, ranges of what we might consider no effect, trivial, small, moderate, or large effects. Conclusion: It is desirable for systematic review authors, guideline panelists, and health technology assessors to specify the threshold or ranges they are using when rating the certainty in evidence. (C) 2017 The Authors. Published by Elsevier Inc.
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| 14. |
- Jonsson, Ulf, 1974-, et al.
(författare)
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Internet-delivered psychological treatment as an add-on to treatment as usual for common mental disorders : A systematic review with meta-analysis of randomized trials
- 2023
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Ingår i: Journal of Affective Disorders. - : Elsevier. - 0165-0327 .- 1573-2517. ; 322, s. 221-234
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Forskningsöversikt (refereegranskat)abstract
- BACKGROUND: Psychological treatments for common mental disorders are increasingly being delivered remotely via the internet. Evidence suggests that internet-delivered cognitive behavioural therapy (iCBT) is superior to waitlist. However, the benefits are unclear of using this treatment modality as an add-on to treatment as usual (TAU) in regular healthcare.METHODS: The literature was systematically searched up to August 2021 for randomized trials of internet-delivered psychological treatments using TAU as the comparator. Eligible participants were diagnosed with depressive, anxiety, obsessive-compulsive, or trauma- and stress-related disorders. Outcomes of interest were symptoms, functioning, quality of life, healthcare utilization, and negative effects. Results were synthesized using random-effects meta-analyses. Quality of evidence was assessed using GRADE.RESULTS: The included studies evaluated iCBT for adults with depression (k = 9), depressive or anxiety disorders (k = 4), and post-traumatic stress disorder (k = 2) and were conducted in primary care or similar settings. For depression, low-certainty evidence suggested beneficial short-term effects on symptoms (g = -0.23; 95 % CI: = -0.37, -0.09), response rate (OR = 2.46; 1.31, 4.64), and remission (OR = 1.70; 1.19, 2.42;). The certainty of evidence was very low for long-term effects, other outcomes, and other disorders.LIMITATIONS: TAU varied across studies and was often insufficiently described.CONCLUSIONS: iCBT as a complement to usual care for adult with depression may result in a small incremental effect, which potentially could be clinically important. Studies are lacking for several common disorders and for children, adolescents, and the elderly. More robust studies of long-term effects are also needed, to better inform clinical decision-making.
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| 15. |
- Persson, Margareta, et al.
(författare)
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Care and support when a baby is stillborn : A systematic review and an interpretive meta-synthesis of qualitative studies in high-income countries
- 2023
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 18:8
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Forskningsöversikt (refereegranskat)abstract
- IntroductionApproximately 2 million babies are stillborn annually worldwide, most in low- and middle-income countries. Present review studies of the parental and healthcare providers' experiences of stillbirth often include a variety of settings, which may skew the findings as the available resources can vary considerably. In high-income countries, the prevalence of stillbirth is low, and support programs are often initiated immediately when a baby with no signs of life is detected. There is limited knowledge about what matters to parents, siblings, and healthcare providers when a baby is stillborn in high-income countries. ObjectivesThis systematic review and interpretive meta-synthesis aim to identify important aspects of care and support for parents, siblings, and healthcare professionals in high-income countries from the diagnosis of stillbirth throughout the birth and postpartum period. MethodsA systematic review and qualitative meta-synthesis were conducted to gain a deeper and broader understanding of the available knowledge about treatment and support when stillbirth occurred. Relevant papers were identified by systematically searching international electronic databases and citation tracking. The quality of the included studies was assessed, and the data was interpreted and synthesised using Gadamer's hermeneutics. The review protocol, including qualitative and quantitative study approaches, was registered on PROSPERO (CRD42022306655). ResultsSixteen studies were identified and included in the qualitative meta-synthesis. Experiences of care and support were interpreted and identified as four fusions. First, Personification is of central importance and stresses the need to acknowledge the baby as a unique person. The parents became parents even though their baby was born dead: The staff should also be recognised as the individuals they are with their personal histories. Second, the personification is reinforced by a respectful attitude where the parents are confirmed in their grief; the baby is treated the same way a live baby would be. Healthcare professionals need enough time to process their experiences before caring for other families giving birth. Third, Existential issues about life and death become intensely tangible for everyone involved, and they often feel lonely and vulnerable. Healthcare professionals also reflect on the thin line between life and death and often question their performance, especially when lacking collegial and organisational support. Finally, the fusion Stigmatisation focused on how parents, siblings, and healthcare professionals experienced stigma expressed as a sense of loneliness, vulnerability, and being deviant and marginalised when a baby died before or during birth. GRADE CERQual ratings for the four fusions ranged from moderate to high confidence. ConclusionsThe profound experiences synthesised in the fusions of this meta-synthesis showed the complex impacts the birth of a baby with no signs of life had on everyone involved. These fusions can be addressed and supported by applying person-centred care to all individuals involved. Hence, grief may be facilitated for parents and siblings, and healthcare professionals may be provided with good conditions in their professional practice. Furthermore, continuing education and support to healthcare professionals may facilitate them to provide compassionate care and support to affected parents and siblings. The fusions should also be considered when implementing national recommendations, guidelines, and clinical practice.
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| 16. |
- Rondung, Elisabet, 1980-, et al.
(författare)
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Identification of depression and anxiety during pregnancy: A systematic review and meta-analysis of test accuracy
- 2024
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Ingår i: ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA. - : Wiley. - 0001-6349 .- 1600-0412. ; 103:3, s. 423-436
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Forskningsöversikt (refereegranskat)abstract
- Depression and anxiety are significant contributors to maternal perinatal morbidity and a range of negative child outcomes. This systematic review and meta-analysis aimed to review and assess the diagnostic test accuracy of selected screening tools (Edinburgh Postnatal Depression Scale [EPDS], EPDS-3A, Patient Health Questionnaire [PHQ-9]-, PHQ-2, Matthey Generic Mood Question [MGMQ], Generalized Anxiety Disorder scale [GAD-7], GAD-2, and the Whooley questions) used to identify women with antenatal depression or anxiety in Western countries.Material and methodsOn January 16, 2023, we searched 10 databases (CINAHL, Cochrane Library, CRD Database, Embase, Epistemonikos, International HTA Database, KSR Evidence, Ovid MEDLINE, PROSPERO and PsycINFO); the references of included studies were also screened. We included studies of any design that compared case-identification with a relevant screening tool to the outcome of a diagnostic interview based on the Diagnostic and Statistical Manual of Mental Disorders, fourth or fifth edition (DSM-IV or DSM-5), or the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10). Diagnoses of interest were major depressive disorder and anxiety disorders. Two authors independently screened abstracts and full-texts for relevance and evaluated the risk of bias using QUADAS-2. Data extraction was performed by one person and checked by another team member for accuracy. For synthesis, a bivariate model was used. The certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Registration: PROSPERO CRD42021236333.ResultsWe screened 8276 records for eligibility and included 16 original articles reporting on diagnostic test accuracy: 12 for the EPDS, one article each for the GAD-2, MGMQ, PHQ-9, PHQ-2, and Whooley questions, and no articles for the EPDS-3A or GAD-7. Most of the studies had moderate to high risk of bias. Ten of the EPDS articles provided data for synthesis at cutoffs >= 10 to >= 14 for diagnosing major depressive disorder. Cutoff >= 10 gave the optimal combined sensitivity (0.84, 95% confidence interval [CI]: 0.75-0.90) and specificity (0.87, 95% CI: 0.79-0.92).ConclusionsFindings from the meta-analysis suggest that the EPDS alone is not perfectly suitable for detection of major depressive disorder during pregnancy. Few studies have evaluated the other instruments, therefore, their usefulness for identification of women with depression and anxiety during pregnancy remains very uncertain. At present, case-identification with any tool may best serve as a complement to a broader dialogue between healthcare professionals and their patients. In this systematic review of 16 original articles, the Edinburgh Postnatal Depression Scale was the most frequently validated tool for identification of women with possible antenatal depression or anxiety. Our meta-analyses indicated a low pooled sensitivity, emphasizing the importance of combining questionnaire screening with other identification methods.
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| 17. |
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