ABSTRACT
COVID-19 lockdowns have led to significant disruptions in preventative health services worldwide. This review aims to assess the impact of COVID-19 lockdowns on worldwide preventive cancer screening participation. Major medical databases were searched using the keywords 'lockdown,' 'cancer,' and 'screening or diagnosis,' and relevant articles were evaluated against inclusion and exclusion criteria. The final review consisted of 38 studies. The impact of COVID-19 on screening uptake was categorized based on cancer type. All types of screening had decreased participation during or around the lockdown period. Racial and socioeconomic disparities, provider-related barriers, and patient attitudes about service disruptions during the pandemic were also highlighted in this review. Future research should focus on data from low- and middle-income countries to obtain a more comprehensive picture of the problem. Policy interventions that adopt self-screening or different screening intervals can also be considered to reduce impacts in future crises. Insights from existing studies and future research will allow for more proactive measures to manage future disruptions.
ABSTRACT
The advent of stepped-care and the need to disseminate cognitive behavioral therapy for insomnia (CBT-I) has led to novel interventions, which capitalize on non-specialist venues and/or health personnel. However, the translatability of these CBT-I programs into practice is unknown. This review evaluates the current state of CBT-I programs that are directly implemented in primary care and/or community settings. A literature search was conducted through major electronic databases (N = 840) and through snowballing (n = 8). After removing duplicates, 104 full-texts were extracted and evaluated against our initial inclusion criteria. Twelve studies including data from 1625 participants were subsequently evaluated for its study design and methodological quality. CBT-I program components varied across studies and included cognitive therapy (n = 6), relaxation (n = 7), sleep restriction therapy (n = 9), stimulus control therapy (n = 11) and sleep psychoeducation (n = 12). The respective interventions produced small to moderate post-treatment weighted effect sizes for the Insomnia Severity Index (0.40), Pittsburgh Sleep Quality Index (0.37), sleep efficiency (0.38), sleep onset latency (0.38), and wake time after sleep onset (0.46) but total sleep time (0.10) did not reach statistical significance. While non-specialist community settings can potentially address the demands for CBT-I across clinical contexts, intervention heterogeneity precluded the full impact of the 12 CBT-I programs to be evaluated.
