AIM: To identify which interventions are supported by evidence and the quality of that evidence in very young children with or at high likelihood for autism spectrum disorder (ASD) to improve child outcomes. METHOD: We conducted an overview of reviews to synthesize early intervention literature for very young children with or at high likelihood for ASD. Cochrane guidance on how to perform overviews of reviews was followed. Comprehensive searches of databases were conducted for systematic reviews and meta-analyses between January 2009 and December 2020. Review data were extracted and summarized and methodological quality was assessed. Primary randomized controlled trial evidence was summarized and risk of bias assessed. This overview of reviews was not registered. RESULTS: From 762 records, 78 full texts were reviewed and seven systematic reviews and meta-analyses with 63 unique studies were identified. Several interventional approaches (naturalistic developmental behavioral intervention, and developmental and behavioral interventions) improved child developmental outcomes. Heterogeneity in design, intervention and control group, dose, delivery agent, and measurement approach was noted. Inconsistent methodological quality and potential biases were identified. INTERPRETATION: While many early interventional approaches have an impact on child outcomes, study heterogeneity and quality had an impact on our ability to draw firm conclusions regarding which treatments are most effective. Advances in trial methodology and design, and increasing attention to mitigating measurement bias, will advance the quality of the ASD early intervention evidence base. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
Síntesis amplia/ Revisión panorámica de revisiones sistemáticas
BACKGROUND: The underuse or overuse of knowledge products leads to waste in healthcare, and primary care is no exception.
OBJECTIVE: We aimed to characterize which knowledge products are frequently implemented, the implementation strategies used in primary care, and the implementation outcomes that are measured.
METHODS: We performed a systematic review of systematic reviews (SR) using the Cochrane systematic approach to include eligible SR. The inclusion criteria were: any primary care contexts; healthcare professionals and patients; any EPOC implementation strategies of specified knowledge products; any comparator; and any implementation outcomes based on the Proctor framework. We searched the Medline, EMBASE, CINAHL, Ovid PsycINFO, Web of Science, and Cochrane Library databases from their inception to October 2019, without any restriction. We searched the references of the included SR. Pairs of reviewers independently performed selection, data extraction and methodological quality assessment with AMSTAR 2. Data extraction was informed by EPOC taxonomy for implementation strategies and the Proctor framework for implementation outcomes. We performed a descriptive analysis and summarized the results using a narrative synthesis.
RESULTS: Of the 11,101 records identified, 81 SR were included. Forty-seven SR involved healthcare professionals alone. Fifteen SR were of high or moderate methodological quality. Most of them addressed one type of knowledge product (56/81), common clinical practice guidelines (26/56) or management, and behavioural or pharmacological health interventions (24/56). Mixed strategies were used for implementation (67/81), predominantly educational-based (meetings in 60/81, materials distribution in 59/81, and academic detailing in 45/81), reminder (53/81) and audit and feedback (40/81) strategies. Education meetings (P=.13) and academic detailing (P=.11) seem to be more used when the population is composed of Healthcare professionals alone. The improvement of the adoption of knowledge products was the most commonly measured outcome (72/81). The evidence level was reported in 10/81 SR on 62 outcomes (including 48 improvement of adoption), of which 16 outcomes were of moderate or high level.
CONCLUSIONS: Clinical practice guidelines and management, behavioural or pharmacological health interventions are the most commonly implemented knowledge products through the mixed use of educational, reminders and audit and feedback strategies. There is need for a strong methodology for the SR of RCTs to explore their effectiveness and the whole cascade of implementation outcomes.
CLINICALTRIAL: Not applicable.
Síntesis amplia/ Revisión panorámica de revisiones sistemáticas
ABSTRACT CONTEXT AND OBJECTIVE: Autism spectrum disorders (ASDs) include autistic disorder, Asperger’s disorder and pervasive developmental disorder. The manifestations of ASDs can have an important impact on learning and social functioning that may persist during adulthood. The aim here was to summarize the evidence from Cochrane systematic reviews on interventions for ASDs. DESIGN AND SETTING: Review of systematic reviews, conducted within the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo. METHODS: We included and summarized the results from Cochrane systematic reviews on interventions for ASDs. RESULTS: Seventeen reviews were included. These found weak evidence of benefits from acupuncture, gluten and casein-free diets, early intensive behavioral interventions, music therapy, parent-mediated early interventions, social skill groups, Theory of Mind cognitive model, aripiprazole, risperidone, tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRI); this last only for adults. No benefits were found for sound therapies, chelating agents, hyperbaric oxygen therapy, omega-3, secretin, vitamin B6/magnesium and SSRI for children. CONCLUSION: Acupuncture, gluten and casein-free diets, early intensive behavioral interventions, music therapy, parent-mediated early interventions, social skill groups and the Theory of Mind cognitive model seem to have benefits for patients with autism spectrum disorders (very low to low-quality evidence). Aripiprazole, risperidone, tricyclic antidepressants and SSRI (this last only for adults) also showed some benefits, although associated with higher risk of adverse events. Experimental studies to confirm a link between probable therapies and the disease, and then high-quality long-term clinical trials, are needed.
Síntesis amplia/ Revisión panorámica de revisiones sistemáticas
We conducted an overview of systematic reviews about child and adolescent anxiety treatment options (psychosocial; medication; combination; web/computer-based treatment) to support evidence informed decision-making. Three questions were addressed: (i) Is the treatment more effective than passive controls? (ii) Is there evidence that the treatment is superior to or non-inferior to (i.e., as good as) active controls? (iii) What is the quality of evidence for the treatment? Pre-specified inclusion criteria identified high quality systematic reviews (2000-2015) reporting treatment effects on anxiety diagnosis and symptom severity. Evidence quality (EQ) was rated using Oxford evidence levels [EQ1 (highest); EQ5 (lowest)]. Twenty-two of 39 eligible reviews were high quality (AMSTAR score≥3/5). CBT (individual or group, with or without parents) was more effective than passive controls (EQ1). CBT effects compared to active controls were mixed (EQ1). SSRI/SNRI were more effective than placebo (EQ1) but comparative effectiveness remains uncertain. EQ for combination therapy could not be determined. RCTs of web/computer-based interventions showed mixed results (EQ1). CBM/ABM was not more efficacious than active controls (EQ1). No other interventions could be rated. High quality RCTs support treatment with CBT and medication. Findings for combination and web/computer-based treatment are encouraging but further RCTs are required. Head-to-head comparisons of active treatment options are needed.
OBJETIVO: Llevar a cabo una revisión de alcance y mapear la investigación en el área de uso de los medios digitales en la salud pública.
Diseño del estudio: revisión de alcance.
MÉTODOS: PubMed, PsycINFO, Google y los principales libros de texto de la comunicación en salud pública y la psicología de la salud en busca de estudios primarios o revisiones sistemáticas que examinan el uso de los medios digitales en un contexto de salud. Búsquedas centraron en estudios publicados entre el comienzo de 2000 y finales de junio de 2013. Los resúmenes de las revisiones de las intervenciones de salud pública fueron examinados con respecto a los grupos, tema de salud, características de la intervención, los medios utilizados, el diseño del estudio, cuestiones de calidad y ética, y los resultados objetivo. Para asignar esta área de trabajo completamente, esta información se complementa con la adición de información de los estudios primarios. Se identificaron áreas donde la evidencia revisión sistemática era escasa o inexistente, comparando el mapa final con información de las revisiones analizados.
RESULTADOS: 221 revisiones sistemáticas relacionadas con el uso de medios digitales en un contexto de salud pública se incluyeron. Opiniones más incluyeron estudios con un diseño experimental y general "en riesgo" las poblaciones objetivo. Ajustes específicos no se especificaron en la mayoría de las críticas. Una gran variedad de temas de salud estaban cubiertos. Cerca de un cuarto de comentarios no especificó un tema de salud, pero se referían a cuestiones más generales de promoción de la salud, prevención de enfermedades, o educación para la salud. Más de la mitad de las críticas se centraron en la sanidad electrónica y la telemedicina, y otro tercio se referían a los medios de comunicación - marketing social. Comentarios más frecuentemente informaron resultados relacionados con el comportamiento o realizan algún tipo de análisis o análisis de la utilización de medios de comunicación determinados contenidos. Se identificaron brechas en la investigación relativa a la investigación basada en la comunidad, la participación y el empoderamiento, el uso de medios activo (especialmente con respecto a los medios de comunicación visual und uso de metodologías visuales específicos), y el uso de enfoques basados en activos salutogénica o.
CONCLUSIÓN: La investigación disponible sobre el uso de los medios digitales en la salud pública está dominada por los estudios relacionados con la salud en línea, telesalud o marketing social; haciendo hincapié en la recepción pasiva de mensajes y un enfoque en los enfoques individuales de cambio de comportamiento. Las cuestiones de la calidad y la ética deben ser tomadas en cuenta de manera más consistente. Se necesitan más investigaciones con respecto a los métodos más participativos, en particular los que se trate de utilizar los medios digitales como un medio para aprovechar los activos individuales y comunitarios.
ANTECEDENTES: Varios paquetes de terapia de comportamiento cognitivo informatizado (CCBT) están ahora disponibles para el tratamiento de la depresión leve a moderada, con o sin ansiedad. Estos han sido por lo general han revisado junto CCBT para una amplia gama de problemas psicológicos. En este sentido, destacar los resultados de estas revisiones de los trastornos mentales más comunes, la depresión leve a moderada. El objetivo de este trabajo es evaluar la calidad de las revisiones existentes y permitir comparaciones confiables de paquetes informáticos alternativos para el mismo grupo de pacientes.
Métodos: Se realizó una búsqueda exhaustiva y análisis de las revisiones de la eficacia de CCBT publicados entre 1999 y febrero de 2011.
RESULTADOS: La búsqueda arrojó doce revisiones sistemáticas de diez estudios que abarcan depresión. Su metodología se aprecia y los resultados seleccionados se presentan aquí.
CONCLUSIONES: El meta-análisis apoya la eficacia de CCBT para el tratamiento de la depresión, sin embargo, hay poca información sobre los diferentes enfoques, cuya rentabilidad relativa está por demostrar. Se hacen sugerencias para futuros estudios en este campo.
To identify which interventions are supported by evidence and the quality of that evidence in very young children with or at high likelihood for autism spectrum disorder (ASD) to improve child outcomes.
METHOD:
We conducted an overview of reviews to synthesize early intervention literature for very young children with or at high likelihood for ASD. Cochrane guidance on how to perform overviews of reviews was followed. Comprehensive searches of databases were conducted for systematic reviews and meta-analyses between January 2009 and December 2020. Review data were extracted and summarized and methodological quality was assessed. Primary randomized controlled trial evidence was summarized and risk of bias assessed. This overview of reviews was not registered.
RESULTS:
From 762 records, 78 full texts were reviewed and seven systematic reviews and meta-analyses with 63 unique studies were identified. Several interventional approaches (naturalistic developmental behavioral intervention, and developmental and behavioral interventions) improved child developmental outcomes. Heterogeneity in design, intervention and control group, dose, delivery agent, and measurement approach was noted. Inconsistent methodological quality and potential biases were identified.
INTERPRETATION:
While many early interventional approaches have an impact on child outcomes, study heterogeneity and quality had an impact on our ability to draw firm conclusions regarding which treatments are most effective. Advances in trial methodology and design, and increasing attention to mitigating measurement bias, will advance the quality of the ASD early intervention evidence base. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
