Completeness of intervention reporting of nutrition-focused weight management interventions adjunct to metabolic and bariatric surgery: effect of the TIDieR checklist.

Nutrition-focused interventions are essential to optimize the bariatric care process and improve health and weight outcomes over time. Clear and detailed reporting of these interventions in research reports is crucial for understanding and applying the findings effectively in clinical practice and research replication. Given the importance of reporting transparency in research, this study aimed to use the Template for Intervention Description and Replication (TIDieR) checklist to evaluate the completeness of intervention reporting in nutritional weight management interventions adjunct to metabolic and bariatric surgery (MBS). The secondary aim was to examine the factors associated with better reporting. A literature search in PubMed, PsychINFO, EMBASE, Scopus, and the Cochrane Controlled Register of Trials was conducted to include randomized controlled trials (RCT), quasi-RCTs and parallel group trials. A total of 22 trials were included in the final analysis. Among the TIDieR 12 items, 6.6 ± 1.9 items were fully reported by all studies. None of the studies completely reported all intervention descriptors. The main areas where reporting required improvement were providing adequate details of the materials and procedures of the interventions, intervention personalization, and intervention modifications during the study. The quality of intervention reporting remained the same after vs. before the release of the TIDieR guidelines. Receiving funds from industrial organizations (p = 0.02) and having the study recorded within a registry platform (p = 0.08) were associated with better intervention reporting. Nutritional weight management interventions in MBS care are still below the desirable standards for reporting. The present study highlights the need to improve adequate reporting of such interventions, which would allow for greater replicability, evaluation through evidence synthesis studies, and transferability into clinical practice.

Identifying priority questions regarding rapid systematic reviews' methods: protocol for an eDelphi study.

INTRODUCTION: Rapid systematic reviews (RRs) have the potential to provide timely information to decision-makers, thus directly impacting healthcare. However, consensus regarding the most efficient approaches to performing RRs and the presence of several unaddressed methodological issues pose challenges. With such a large potential research agenda for RRs, it is unclear what should be prioritised. OBJECTIVE: To elicit a consensus from RR experts and interested parties on what are the most important methodological questions (from the generation of the question to the writing of the report) for the field to address in order to guide the effective and efficient development of RRs. METHODS AND ANALYSIS: An eDelphi study will be conducted. Researchers with experience in evidence synthesis and other interested parties (eg, knowledge users, patients, community members, policymaker, industry, journal editors and healthcare providers) will be invited to participate. The following steps will be taken: (1) a core group of experts in evidence synthesis will generate the first list of items based on the available literature; (2) using LimeSurvey, participants will be invited to rate and rank the importance of suggested RR methodological questions. Questions with open format responses will allow for modifications to the wording of items or the addition of new items; (3) three survey rounds will be performed asking participants to re-rate items, with items deemed of low importance being removed at each round; (4) a list of items will be generated with items believed to be of high importance by ≥75% of participants being included and (5) this list will be discussed at an online consensus meeting that will generate a summary document containing the final priority list. Data analysis will be performed using raw numbers, means and frequencies. ETHICS AND DISSEMINATION: This study was approved by the Concordia University Human Research Ethics Committee (#30015229). Both traditional, for example, scientific conference presentations and publication in scientific journals, and non-traditional, for example, lay summaries and infographics, knowledge translation products will be created.

Long-term effectiveness of COVID-19 vaccines against infections, hospitalisations, and mortality in adults: findings from a rapid living systematic evidence synthesis and meta-analysis up to December, 2022.

BACKGROUND: Synthesising evidence on the long-term vaccine effectiveness of COVID-19 vaccines (BNT162b2 [Pfizer-BioNTech], mRNA-1273 [Moderna], ChAdOx1 nCoV-19 [AZD1222; Oxford-AstraZeneca], and Ad26.COV2.S [Janssen]) against infections, hospitalisations, and mortality is crucial to making evidence-based pandemic policy decisions. METHODS: In this rapid living systematic evidence synthesis and meta-analysis, we searched EMBASE and the US National Institutes of Health's iSearch COVID-19 Portfolio, supplemented by manual searches of COVID-19-specific sources, until Dec 1, 2022, for studies that reported vaccine effectiveness immediately and at least 112 days after a primary vaccine series or at least 84 days after a booster dose. Single reviewers assessed titles, abstracts, and full-text articles, and extracted data, with a second reviewer verifying included studies. The primary outcomes were vaccine effectiveness against SARS-CoV-2 infections, hospitalisations, and mortality, which were assessed using three-level meta-analytic models. This study is registered with the National Collaborating Centre for Methods and Tools, review 473. FINDINGS: We screened 16 696 records at the title and abstract level, appraised 832 (5·0%) full texts, and initially included 73 (0·4%) studies. Of these, we excluded five (7%) studies because of critical risk of bias, leaving 68 (93%) studies that were extracted for analysis. For infections caused by any SARS-CoV-2 strain, vaccine effectiveness for the primary series reduced from 83% (95% CI 80-86) at baseline (14-42 days) to 62% (53-69) by 112-139 days. Vaccine effectiveness at baseline was 92% (88-94) for hospitalisations and 91% (85-95) for mortality, and reduced to 79% (65-87) at 224-251 days for hospitalisations and 86% (73-93) at 168-195 days for mortality. Estimated vaccine effectiveness was lower for the omicron variant for infections, hospitalisations, and mortality at baseline compared with that of other variants, but subsequent reductions occurred at a similar rate across variants. For booster doses, which covered mostly omicron studies, vaccine effectiveness at baseline was 70% (56-80) against infections and 89% (82-93) against hospitalisations, and reduced to 43% (14-62) against infections and 71% (51-83) against hospitalisations at 112 days or later. Not enough studies were available to report on booster vaccine effectiveness against mortality. INTERPRETATION: Our analyses indicate that vaccine effectiveness generally decreases over time against SARS-CoV-2 infections, hospitalisations, and mortality. The baseline vaccine effectiveness levels for the omicron variant were notably lower than for other variants. Therefore, other preventive measures (eg, face-mask wearing and physical distancing) might be necessary to manage the pandemic in the long term. FUNDING: Canadian Institutes of Health Research and the Public Health Agency of Canada.

Evolution of depressive symptoms from before to 24 months after bariatric surgery: A systematic review and meta-analysis.

AIMS: Depression after bariatric surgery can lead to suboptimal health outcomes. However, it is unclear how depressive symptoms evolve over the 24 months after surgery. We determined the extent depressive symptoms changed up to 24 months after bariatric surgery and how this was impacted by measurement tool and surgical procedure. METHODS: We conducted a systematic review and meta-analysis, searching five databases from database inception to June 2021 for studies that prospectively measured depressive symptoms before and up to 24 months after bariatric surgery. Change scores were converted to Hedge's g, and analyses were performed using mixed-effects models. Subgroup analyses examined differences across time of follow-up, measurement tool, and surgical procedure. FINDINGS: Forty-six studies met inclusion criteria (32,342 patients). Meta-analysis indicated a postsurgical reduction in depressive symptom scores that were significant (large effect, g = 0.804; 95% CI: 0.73-0.88, I2  = 95.7%). Subgroup analyses found that symptom reductions did not differ between the timing of follow-up periods, measurement tool, and surgical procedure. CONCLUSIONS: Depressive symptom scores reduced substantially following surgery; comparable decreases occurred 6 through 24 months after surgery. These findings can help inform practitioners of the typical evolution of depressive symptoms following surgery and where deviations from this may require additional intervention.

Adult height and risk of gastric cancer: a pooled analysis within the Stomach cancer Pooling Project.

BACKGROUND: The association between height and risk of gastric cancer has been studied in several epidemiological studies with contrasting results. The aim of this study is to examine the association between adult height and gastric cancer within a large pooled analysis of case-control studies members of the Stomach cancer Pooling (StoP) Project consortium. METHODS: Data from 18 studies members of the StoP consortium were collected and analyzed. A multivariable logistic regression model was used to estimate the study-specific odds ratios (ORs) and 95% confidence intervals (CIs) for the association between 10-cm increase in height and risk of gastric cancer. Age, sex, tobacco smoking, alcohol consumption, social class, geographical area and Helicobacter pylori (H. pylori ) status were included in the regression model. Resulting estimates were then pooled with random-effect model. Analyses were conducted overall and in strata of selected variables. RESULTS: A total of 7562 cases and 19 033 controls were included in the analysis. The pooled OR was 0.96 (95% CI 0.87-1.05). A sensitivity analysis was performed restricting the results to the studies with information on H. pylori status, resulting in an OR of 0.97 (95% CI 0.79-1.20). CONCLUSION: Our study does not support a strong and consistent association between adult height and gastric cancer.

Survey of Professionals of the European Public Health Association (EUPHA) towards Direct-to-Consumer Genetic Testing.

BACKGROUND: The increasing availability of Direct-to-Consumer Genetic Tests (DTC-GTs) has great implications for public health (PH) and requires literate healthcare professionals to address the challenges they pose. We designed and conducted a survey to assess the state of knowledge, attitudes and behaviours of PH professionals members of the European Public Health Association (EUPHA) towards DTC-GTs. METHODS: EUPHA members were invited to participate and fill in the survey. We performed multivariable logistic regression to evaluate associations between selected covariates and knowledge, attitudes and behaviours of healthcare professionals towards DTC-GT. RESULTS: Three hundred and two professionals completed the survey, 66.9% of whom were not involved in genetics or genomics within their professional activities. Although 74.5% of respondents were aware that DTC-GTs could be purchased on the web, most of them reported a low level of awareness towards DTC-GTs applications and regulatory aspects. The majority did not approve the provision of DTC-GTs without consultation of a healthcare professional (91.4%), were doubtful about the test utility and validity (61%) and did not feel prepared to address citizens' questions (65.6%). Predictors of knowledge on DTC-GT were the involvement in genetics/genomics and receiving training during the studies (P < 0.0001 and P = 0.043). Predictors of attitudes were medical degree and knowledge about DTC-GTs (P = 0.006 and P = 0.027). CONCLUSIONS: Our results revealed a high level of awareness of DTC-GT web purchasing and a moderate to low level of awareness towards their applications. Despite the overall positive attitudes, PH professionals reported a high need for strengthening regulatory aspects of DTC-GTs provision process.

How well do covariates perform when adjusting for sampling bias in online COVID-19 research? Insights from multiverse analyses.

COVID-19 research has relied heavily on convenience-based samples, which-though often necessary-are susceptible to important sampling biases. We begin with a theoretical overview and introduction to the dynamics that underlie sampling bias. We then empirically examine sampling bias in online COVID-19 surveys and evaluate the degree to which common statistical adjustments for demographic covariates successfully attenuate such bias. This registered study analysed responses to identical questions from three convenience and three largely representative samples (total N = 13,731) collected online in Canada within the International COVID-19 Awareness and Responses Evaluation Study ( www.icarestudy.com ). We compared samples on 11 behavioural and psychological outcomes (e.g., adherence to COVID-19 prevention measures, vaccine intentions) across three time points and employed multiverse-style analyses to examine how 512 combinations of demographic covariates (e.g., sex, age, education, income, ethnicity) impacted sampling discrepancies on these outcomes. Significant discrepancies emerged between samples on 73% of outcomes. Participants in the convenience samples held more positive thoughts towards and engaged in more COVID-19 prevention behaviours. Covariates attenuated sampling differences in only 55% of cases and increased differences in 45%. No covariate performed reliably well. Our results suggest that online convenience samples may display more positive dispositions towards COVID-19 prevention behaviours being studied than would samples drawn using more representative means. Adjusting results for demographic covariates frequently increased rather than decreased bias, suggesting that researchers should be cautious when interpreting adjusted findings. Using multiverse-style analyses as extended sensitivity analyses is recommended.

Understanding national trends in COVID-19 vaccine hesitancy in Canada: results from five sequential cross-sectional representative surveys spanning April 2020-March 2021.

OBJECTIVE: To examine rates of vaccine hesitancy and their correlates among Canadian adults between April 2020 and March 2021. DESIGN: Five sequential cross-sectional age, sex and province-weighted population-based samples who completed online surveys. SETTING: Canada. PARTICIPANTS: A total of 15 019 Canadians aged 18 years and over were recruited through a recognised polling firm (Leger Opinion). Respondents were 51.5% female with a mean age of 48.1 (SD 17.2) years (range 18-95 years) and predominantly white (80.8%). PRIMARY AND SECONDARY OUTCOME MEASURES: Rates of vaccine hesitancy over the five surveys (time points) and their sociodemographic, clinical and psychological correlates. RESULTS: A total of 42.2% of respondents reported some degree of vaccine hesitancy, which was lowest during surveys 1 (April 2020) and 5 (March 2021) and highest during survey 3 (November 2020). Fully adjusted multivariate logistic regression analyses revealed that women, those aged 50 and younger, non-white, those with high school education or less, and those with annual household incomes below the poverty line in Canada were significantly more likely to report vaccine hesitancy, as were essential and healthcare workers, parents of children under the age of 18 and those who do not get regular influenza vaccines. Endorsing prevention behaviours as important for reducing virus transmission and high COVID-19 health concerns were associated with 77% and 54% reduction in vaccine hesitancy, respectively. Having high personal financial concerns was associated with 1.33 times increased odds of vaccine hesitancy. CONCLUSIONS: Results highlight the importance of targeting vaccine efforts to specific groups by emphasising the outsized health benefits compared with risks of vaccination. Future research should monitor changes in vaccine intentions and behaviour to better understand underlying factors.

Food Addiction and Binge Eating Impact on Weight Loss Outcomes Two Years Following Sleeve Gastrectomy Surgery.

BACKGROUND: Emerging evidence suggest that problematic eating behaviors such as food addiction (FA) and binge eating (BE) may alter following bariatric surgery (BS) and impact weight outcomes. We aimed to examine the prevalence of FA and BE and their associations with weight outcomes 2 years post-sleeve gastrectomy (SG). METHODS: Forty-five women (mean age 32.4 ± 10.9 years) who underwent SG and completed 24 months of follow-up were evaluated prospectively at pre-, 3-, 6-, 12-, and 24-month post-SG. Data collected included anthropometrics, nutritional intake, and lifestyle patterns. The Yale Food Addiction Scale (YFAS) and the Binge Eating Scale (BES) were used to characterize FA and BE, respectively. RESULTS: Pre-surgery FA and BE were identified in 40.0% and 46.7% of participants, respectively. Following SG, FA and BE prevalence was 10.0%, 5.0%, 29.4%, and 14.2% (P = 0.007), and 12.5%, 4.9%, 18.4%, and 19.4% (P < 0.001) at 3, 6, 12, and 24 months, respectively. Women with BE at baseline gained significantly more weight from the nadir compared to non-BE women at baseline (P = 0.009). There was no relationship between FA at baseline and weight (P = 0.090). Weight regained from the nadir positively correlated with BES scores at baseline (r = 0.374, P = 0.019). CONCLUSIONS: FA and BE tend to decrease during the early postoperative period, but remains in a notable rates return by 2 years post-SG. Moreover, pre-surgical BE was related to higher weight-regain. Proper management pre-BS should include a comprehensive eating pathologies assessment, as these pathologies may remain or re-emerge post-surgery and lead to worse weight outcomes.

Core Competencies in Cancer Genomics for Healthcare Professionals: Results From a Systematic Literature Review and a Delphi Process.

The continuous development and use of genomic sequencing requires healthcare professionals to constantly integrate these advancements into their clinical practice. There is a documented lack of cancer genomics contents in the teaching and learning programs. We aimed to identify the core competencies in cancer genomics for non-genetic healthcare professionals. We performed a literature review in PubMed, SCOPUS, and Web of Science databases to retrieve articles published from 2000 to 2018, in English or Italian language. We included articles that reported the competencies for non-genetic healthcare professionals in cancer genomics. A web-based modified Delphi survey was conducted, aiming to define, through consensus, a set of core competencies that should be covered in the curricula. The international expert panel included specialists in genetics, genomics, oncology, and medical specialists. In the literature review, we retrieved nine articles, from which we identified core competencies for general physicians and nurses. The competencies were organized in three main domains: knowledge, attitudes, and practical abilities. In the second round of Delphi survey, consensus of 83.3% was reached for the definition of the core competencies. Thirty-seven items were defined as the competencies required for physicians and forty-two items for nurses. Through a consensus-based approach, a set of core competencies in cancer genomics for non-genetic healthcare professionals has been identified. Our findings could benchmark standards for curriculum development and future educational strategies.

Public perceptions and behavioural responses to the first COVID-19 pandemic wave in Italy: results from the iCARE study.

BACKGROUND: Italy was the first European country to be affected by COVID-19. Considering that many countries are currently battling the second wave of the pandemic, understanding people's perceptions and responses to government policies remain critical for informing on-going mitigation strategies. We assessed attitudes towards COVID-19 policies, levels of adherence to preventive behaviours, and the association between COVID-19 related concerns and adherence levels. METHODS: We recruited a convenience sample of Italian individuals from an international cross-sectional survey (www.icarestudy.com) from 27 March to 5 May 2020. Multivariate regression models were used to test the association between concerns and the adoption of preventive measures. RESULTS: The survey included 1332 participants [female (68%), younger than 25 (57%)] that reported high awareness (over 96%) and perceived importance (88%) of policies. We observed varied levels of adherence to: hand-washing (96%), avoiding social gatherings (96%), self-isolation if suspected or COVID-19 positive (77%). Significantly lower adherence to self-isolation was reported by individuals with current employment. High levels of concerns regarding health of other individuals and country economy were reported. Only health concerns for others were significantly associated with higher adherence to hand-washing behaviour. CONCLUSIONS: In order to inform current/future government strategies, we provide insights about population's responses to the initial pandemic phase in Italy. Communication approaches should consider addressing people's concerns regarding the health of other individuals to motivate adherence to prevention measures. Provision of social and economic support is warranted to avoid unequal impacts of governmental policies and allow effective adherence to self-isolating measures.

Global Trends and Correlates of COVID-19 Vaccination Hesitancy: Findings from the iCARE Study.

The success of large-scale COVID-19 vaccination campaigns is contingent upon people being willing to receive the vaccine. Our study explored COVID-19 vaccine hesitancy and its correlates in eight different countries around the globe. We analyzed convenience sample data collected between March 2020 and January 2021 as part of the iCARE cross-sectional study. Univariate and multivariate statistical analyses were conducted to explore the correlates of vaccine hesitancy. We included 32,028 participants from eight countries, and observed that 27% of the participants exhibited vaccine hesitancy, with increases over time. France reported the highest level of hesitancy (47.3%) and Brazil reported the lowest (9.6%). Women, younger individuals (≤29 years), people living in rural areas, and those with a lower perceived income were more likely to be hesitant. People who previously received an influenza vaccine were 70% less likely to report COVID-19 vaccine hesitancy. We observed that people reporting greater COVID-19 health concerns were less likely to be hesitant, whereas people with higher personal financial concerns were more likely to be hesitant. Our findings indicate that there is substantial vaccine hesitancy in several countries, with cross-national differences in the magnitude and direction of the trend. Vaccination communication initiatives should target hesitant individuals (women, younger adults, people with lower incomes and those living in rural areas), and should highlight the immediate health, social and economic benefits of vaccination across these settings. Country-level analyses are warranted to understand the complex psychological, socio-environmental, and cultural factors associated with vaccine hesitancy.

Coding Public Health Interventions for Health Technology Assessments: A Pilot Experience With WHO's International Classification of Health Interventions (ICHI).

Introduction: An important requirement for successful public health interventions is a standardized classification in order to make these health technologies comparable in all contexts and recognized by all parties. The WHO International Classification of Health Interventions (ICHI), including an integrated public health component, has been developed to propose such an international standard. Methods: To test (a) the translation of public health interventions to ICHI codes and (b) the technical handling and general coding in public health, we used a set of public health interventions from a recent cross-sectional survey among Health Technology Assessment professionals. Results: Our study showed that handling of the ICHI interface is stable, that there is a need for specificity and adequate detail of intervention descriptions and desired outcomes to code adequately with ICHI and that the professional background of the coder, as well as his/her sex might influence the selection of codes. Conclusion: International Classification of Health Interventions provides a good coverage of public health interventions. However, the broader character of system wide interventions, often involving a variety of institutions and stakeholders, may present a challenge to the application of ICHI coding. Based on this experience, we would tailor future surveys more specifically to the needs of the classification and we advise training for health professionals before coding with ICHI. Standards of reporting will likely strengthen insights about the efficiency of primary prevention interventions and thus benefit long-term health of populations and structured HTA reporting process.

COVID-19 Is Not the Flu: Four Graphs From Four Countries.

Background: COVID-19 has caused a global public health emergency. Government mitigation strategies included a series of behavior-based prevention policies that had a likely impact on the spread of other contagious respiratory illnesses, such as seasonal influenza. Our aim was to explore how 2019-2020 influenza tracked onto COVID-19 pandemic and its mitigation methods. Materials and Methods: We linked the WHO FluNet database and COVID-19 confirmed cases (Johns Hopkins University) for four countries across the northern (Canada, the United States) and southern hemispheres (Australia, Brazil) for the period 2016-2020. Graphical presentations of longitudinal data were provided. Results: There was a notable reduction in influenza cases for the 2019-2020 season. Northern hemisphere countries experienced a quicker ending to the 2019-2020 seasonal influenza cases (shortened by 4-7 weeks) and virtually no 2020 fall influenza season. Countries from the southern hemisphere experienced drastically low levels of seasonal influenza, with consistent trends that were approaching zero cases after the introduction of COVID-19 measures. Conclusions: It is likely that the COVID-19 mitigation measures played a notable role in the marked decrease in influenza, with little to no influenza activity in both the northern and southern hemispheres. In spite of this reduction in influenza cases, there was still community spread of COVID-19, highlighting the contagiousness of SARS-CoV-2 compared to influenza. These results, together with the higher mortality rate from SARS-CoV-2 compared to influenza, highlight that COVID-19 is a far greater health threat than influenza.

International assessment of the link between COVID-19 related attitudes, concerns and behaviours in relation to public health policies: optimising policy strategies to improve health, economic and quality of life outcomes (the iCARE Study).

INTRODUCTION: In the context of a highly contagious virus with only recently approved vaccines and no cure, the key to slowing the spread of the COVID-19 disease and successfully transitioning through the phases of the pandemic, including vaccine uptake, is public adherence to rapidly evolving behaviour-based public health policies. The overall objective of the iCARE Study is to assess public awareness, attitudes, concerns and behavioural responses to COVID-19 public health policies, and their impacts, on people around the world and to link behavioural survey data with policy, mobility and case data to provide behavioural science, data-driven recommendations to governments on how to optimise current policy strategies to reduce the impact of the COVID-19 pandemic. METHODS AND ANALYSES: The iCARE study (www.icarestudy.com) uses a multiple cross-sectional survey design to capture self-reported information on a variety of COVID-19 related variables from individuals around the globe. Survey data are captured using two data capture methods: convenience and representative sampling. These data are then linked to open access data for policies, cases and population movement. ETHICS AND DISSEMINATION: The primary ethical approval was obtained from the coordinating site, the Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal (REB#: 2020-2099/03-25-2020). This study will provide high-quality, accelerated and real-time evidence to help us understand the effectiveness of evolving country-level policies and communication strategies to reduce the spread of the COVID-19. Due to the urgency of the pandemic, results will be disseminated in a variety of ways, including policy briefs, social media posts, press releases and through regular scientific methods.

Evaluating Public Health Interventions: A Neglected Area in Health Technology Assessment.

Introduction: Public health (PH) interventions are crucial for ensuring sustainable healthcare services. Nevertheless, they represent a neglected area in the field of health technology assessment (HTA) due to various methodological issues and their complex design that goes beyond clinical setting. The present study provides an environmental scan of HTA initiatives related to the assessment of PH technologies on a global level. Methods: We conducted a cross-sectional survey among 85 HTA-related European and international societies, health bodies, and networks from September 2018 to January 2019. The questionnaire contained four sections and 18 questions regarding activities related to the evaluation of PH technologies, information on existing PH technologies, and methodologies of assessment as well as barriers and facilitators to reaching a decision and implementing a PH technology. Results: Among 52 survey responses, the majority of the respondents came from European countries (35%), followed by North American (27%), and South American (19%) countries. The main type of organizations covered by our survey included HTA agencies, public administrations, and research institutes. Seventy-one % of the institutions reported engagement in any aspect of HTA in the area of PH (N = 37). Among those, 81% evaluated less than 5 PH technologies from 2013 to 2018. The most common barriers for reaching a decision on PH technologies were lack of data, conflicting stakeholder priorities, and methodological issues. A total of 76 PH interventions were reported, and most cited initiatives were related to chronic disease screening, prevention of infectious diseases, and maternal, prenatal, and neonatal screening. Conclusion: Our survey reported a rather limited involvement of HTA in the evaluation of PH technologies. In particular, an evaluation of behavioral and lifestyle interventions remains extremely rare. The implementation of collaborative HTA approaches in the setting of PH practice and policy needs to be prioritized and further strengthened. Moreover, ensuring reliable data structures and consolidation of HTA methods for the evaluation of PH technologies will be crucial for tackling the enormous burden of non-communicable diseases in societies.

European citizens' perspectives on direct-to-consumer genetic testing: an updated systematic review.

BACKGROUND: Direct-to-consumer genetic tests (DTC-GTs) are genetic tests for a medical or non-medical trait that are sold directly to the public, usually ordered without the engagement of a healthcare professional. Our aim was to explore the knowledge, attitudes and behaviors toward DTC-GTs among European citizens. METHODS: We updated the most recent systematic review on citizens' perspectives toward DTC-GTs. Relevant English language studies were searched on PubMed, ISI Web of Science, Scopus, Embase and Google Scholar from October 2014 to April 2019. We extended our search on Scopus without publication date restriction, since it was not included in the former review. Eligible studies were conducted in European countries and reported original data. The quality of the studies was evaluated using a checklist developed by Kmet et al. RESULTS: We included six studies conducted in European countries between 2015 and 2018. The studies were performed among general population in the Netherlands, students in Italy and Greece, laypeople in Germany and older adults in Switzerland. The level of awareness, in overall low, differed by country and population group. Most of the participants were interested in undergoing a DTC-GT, mainly for knowing the risk predisposition to a common disease. Concerns were raised about tests' validity and utility and data privacy. CONCLUSIONS: Our review shows that European citizens, overall, have a low level of knowledge on DTC-GTs and a high interest in their purchase. This understanding might contribute to the development of educational programs in order to the increase of general public capabilities to make appropriate health decisions.

MicroRNAs expression profiles as diagnostic biomarkers of gastric cancer: a systematic literature review.

OBJECTIVE: The early identification of gastric cancer (GC) represents a major clinical challenge. We conducted a systematic review of studies evaluating the miRNA expression profiling as a diagnostic tool in GC. METHODS: We performed a search of PubMed, ISI Web of Science and SCOPUS databases for studies on diagnostic miRNAs and GC, published in English up to October 2017. Eligibility criteria included case-control studies evaluating blood or tissue-based miRNA expression profiles, and incorporating at least two detection phases (screening and validation). RESULTS: We included 27 eligible studies, that reported on 97 deregulated miRNAs either in blood or tissue, out of which 30 were reported in at least two studies. Among 22 studies on tissue-diagnostic miRNAs, 13 consistently upregulated miRNAs (miR-214, miR-21, miR-103, miR-107, miR-196a, miR-196b, miR-7, miR-135b, miR-222, miR-23b, miR-25, miR-92 and miR-93), and six consistently downregulated miRNAs (miR-148a, miR-375, miR-133b, miR-30a, miR-193a and miR-204) were reported. Ten miRNAs with inconsistent direction of expression in tissues were identified. Among the five studies performed on blood samples, only one miRNA was consistently upregulated (miR-20a). CONCLUSIONS: This review shows that some tissue or blood miRNAs may be considered as potential biomarkers for GC diagnosis, that urgently needs to be confirmed from large prospective studies.