Search

Objectives To assess the impact of restricting systematic reviews of conventional or alternative medical treatments or diagnostic tests to English-language publications. Study design and setting We systematically searched MEDLINE (Ovid), the Science Citation Index Expanded (Web of Science), and Current Contents Connect (Web of Science) up to April 24, 2020. Eligible methods studies assessed the impact of restricting systematic reviews to English-language publications on effect estimates and conclusions. Two reviewers independently screened the literature; one investigator performed the data extraction, a second investigator checked for completeness and accuracy. We synthesized the findings narratively. Results Eight methods studies (10 publications) met the inclusion criteria; none addressed language restrictions in diagnostic test accuracy reviews. The included studies analyzed nine to 147 meta-analyses and/or systematic reviews. The proportions of non-English-language publications ranged from 2% to 100%. Based on five methods studies, restricting literature searches or inclusion criteria to English-language publications led to a change in statistical significance in 23/259 meta-analyses (9%). Most commonly, the statistical significance was lost, but had no impact on the conclusions of systematic reviews. Conclusion Restricting systematic reviews to English-language publications appears to have little impact on the effect estimates and conclusions of systematic reviews.

Zusammenfassung Ziel Im Zuge der COVID-19-Pandemie benötigen viele gesundheitsrelevante Fragestellungen rasche Antworten. Im Kompetenznetz Public Health zu COVID-19, das im März 2020 von Vertreter:innen mehrerer wissenschaftlicher Fachgesellschaften gegründet wurde, werden vielfach Rapid Reviews erstellt, um rasch evidenzbasierte, für politische Entscheidungsträger:innen nutzbare Antworten zu generieren. Ziel dieses Beitrags ist es, die praktischen Erfahrungen bei der Durchführung von Rapid Reviews im Rahmen des Kompetenznetzes Public Health zu reflektieren. Auf dieser Grundlage sollen Methoden zur qualitativ hochwertigen und praktikablen Durchführung von Rapid Reviews entwickelt werden, die insbesondere auch zur raschen Evidenzgenerierung auf der Grundlage von Beobachtungsstudien anwendbar sind. Methodik Unter Nutzung des von Tricco et al. [1] vorgeschlagenen 8-schrittigen Vorgehens werden die aktuellen Herausforderungen beschrieben, die sich im Kompetenznetz Public Health zu COVID-19 bei der Durchführung von Rapid Reviews zu Public Health-bezogenen Fragen der COVID-19-Pandemie ergeben haben. Die 8 Schritte lauten: 1. Formulierung der Fragestellung, 2. Literatursuche, 3. Titel-Abstract- und Volltextsichtung, 4. Datenextraktion, 5. Risk of Bias-Bewertung, 6. Evidenzsynthese, 7. Dissemination, 8. Aktualisierung. Zudem werden Lösungsvorschläge im Expert:innenkonsens der Mitglieder (n=42 zum 28.01.2021) der Querschnitts-AG Rapid Reviews des Kompetenznetzes Public Health zu COVID-19 entwickelt. Ergebnisse Vorgelegt und zur Diskussion gestellt wird ein standardisiertes Vorgehen, das sich eng an das Vorgehen der Cochrane Rapid Reviews Methods Group anlehnt und den besonderen Anforderungen von ätiologisch orientierten, häufig auch ökologischen Beobachtungsstudien zu COVID-19 Rechnung trägt. Schlussfolgerungen Das vorgeschlagene Vorgehen bei der Durchführung von Rapid Reviews kann – ggf. über Fragestellungen zu COVID-19 hinaus – eine wichtige Grundlage einer evidenzbasierten Politikberatung bilden. Zur kurzfristigen Realisierung von methodisch hochwertigen Rapid Reviews zu neuen Fragestellungen sollten flexible und kurzfristig aktivierbare Förderkonzepte bereitgestellt werden. Wissenschaftliche Kooperationen bei der Durchführung von Rapid Reviews sollten ausgebaut werden, dabei sollten verstärkt methodisch hochwertige Ansätze wie bspw. prospektive Metaanalysen Anwendung finden.

Zusammenfassung Ziel Ziel dieses Artikels ist es, eine detaillierte Anleitung zu geben, wie Gerechtigkeit im Gesundheitswesen bei der Erstellung von Empfehlungen nach GRADE (Grading of Recommendations, Assessment, Development and Evaluation) einbezogen werden kann. Studiendesign und Setting Wir haben diese Anleitung basierend auf dem GRADE-Ansatz „von der Evidenz zur Empfehlung“ entwickelt. Die Anleitung entstand in einem iterativen Prozess, Entwurfe wurden personlich mit Projektgruppenmitgliedern besprochen und die Beitrage anderer Mitglieder der GRADE Arbeitsgruppe wurden berucksichtigt. Die vorliegende Arbeit ist eine deutsche Ubersetzung der englischsprachigen Originalpublikation. Ergebnisse Sowohl generelle Leitlinien als auch Leitlinien, die sich auf benachteiligte Bevolkerungsgruppen konzentrieren, sollten Uberlegungen dahingehend anstellen, welchen Einfluss die Empfehlungen auf Gerechtigkeit im Gesundheitswesen haben konnen. Wir schlagen zwei Ansatze vor, um Gerechtigkeitsuberlegungen einzubeziehen: (1) Bewertung der potenziellen Auswirkungen von Interventionen auf die Gerechtigkeit und (2) Einbeziehung von Gerechtigkeitsuberlegungen bei der Beurteilung oder Abwagung der einzelnen Kriterien im „Evidence-to-decision (EtD)-Prozess“. Wir stellen eine Anleitung und illustrierende Beispiele bereit. Schlussfolgerung Leitliniengremien sollten die Auswirkungen der Empfehlungen auf die Gerechtigkeit im Gesundheitswesen unter Berucksichtigung von abgelegenen und unterversorgten Settings und benachteiligten Bevolkerungsgruppen prufen. Leitliniengremien konnen die Einschatzung zur Gerechtigkeit auch im Rahmen des EtD-Prozesses berucksichtigen. Dies ist der vierte und letzte Artikel in einer Serie uber die Berucksichtigung von Gerechtigkeit im Gesundheitswesen im Entwicklungsprozess von GRADE-Leitlinien. Diese Serie stammt aus der GRADE-Gruppe zu Gerechtigkeit im Gesundheitswesen.

Zusammenfassung Hintergrund Trotz beachtlicher Fortschritte im Kampf gegen Tuberkulose, stellt diese nach wie vor die am häufigsten zum Tode führende bakterielle Infektionskrankheit weltweit dar. Jedes Jahr versterben weltweit nach wie vor bis zu 10 Mio. Menschen an Tuberkulose. Die World Health Assembly hat es sich zum Ziel gesetzt die Zahl der Tuberkulose-Toten bis zum Jahr 2030 um 90% zu senken, die Zahl der Neuansteckungen um 80%. Hierbei sollte besonderes auf Maßnahmen zur Prävention und Infektionskontrolle in öffentlichen Gesundheitseinrichtungen und überall dort, wo das Übertragungsrisiko für das Tuberkulose-Bakterium „Mycobacterium tuberculosis“ hoch ist, gesetzt werden. Zielsetzung Ziel ist es aktualisierte und evidenzbasierte Empfehlungen für Public Health Maßnahmen zu geben, um die Ausbreitung des Tuberkulose-Bakteriums im klinischen Setting und im Tuberkulose-Management vorzubeugen. Methodik Die Leitlinie wurde von der Weltgesundheitsorganisation (WHO) gemäß der im WHO Handbuch zur Leitlinienentwicklung empfohlene Methode umgesetzt. Die vorliegende Publikation fasst die wichtigsten Punkte der Leitlinie zusammen und wurde von Mitarbeiterinnen und Mitarbeitern des WHO Collaborating Centre an der Donau-Universität Krems (Österreich) auf Deutsch übersetzt. Ergebnisse Diese Leitlinie berücksichtigt die aktuelle Studienlage und gibt Empfehlungen und Anmerkungen zur Umsetzung von Tuberkuloseprävention- und kontrolle auf Ebene von Gesundheitseinrichtungen sowie auf nationaler Ebene.

Zusammenfassung Ziel Ziel dieses Artikels ist es, einen konzeptionellen Rahmen fur die Berucksichtigung der Gerechtigkeit im Gesundheitswesen bei der Entwicklung von GRADE-Leitlinien zu beschreiben. Studiendesign und Setting Konsensorientierte Anleitung wurde von den Mitgliedern der GRADE-Arbeitsgruppe und anderen Methodikerinnen und Methodikern entwickelt. Die vorliegende Arbeit ist eine deutsche Ubersetzung der englischsprachigen Originalpublikation. Ergebnisse Wir haben eine konsensorientierte Anleitung entwickelt, die helfen sollen, die Gerechtigkeit im Gesundheitswesen bei der Einschatzung der Vertrauenswurdigkeit der synthetisierten Evidenz (bzw. Qualitat der Evidenz) zu berucksichtigen. Wenn festgestellt wird, dass gesundheitliche Ungerechtigkeit ein Anliegen der Interessengruppen ist, schlagen wir funf Methoden zur expliziten Bewertung der Gerechtigkeit im Gesundheitswesen vor: (1) die Gerechtigkeit im Gesundheitswesen als Endpunkt einbeziehen; (2) patientenrelevante Endpunkte, die fur die Gerechtigkeit im Gesundheitswesen relevant sind, berucksichtigen; (3) Unterschiede in der relativen Effektgrose der Behandlung bewerten; (4) Unterschiede im Basisrisiko und die unterschiedlichen Auswirkungen auf die absoluten Effekte bewerten; und (5) die Ubertragbarkeit von Evidenz fur benachteiligte Bevolkerungsgruppen und/oder Settings zu bewerten. Fazit Die wichtigste Prioritat fur die Forschung uber gesundheitliche Ungerechtigkeit und Leitlinien besteht darin, Beispiele zu identifizieren und zu dokumentieren, bei denen die Gerechtigkeit im Gesundheitswesen in den Leitlinien explizit berucksichtigt wurde. Auch wenn es eine schwache wissenschaftliche Evidenzgrundlage fur die Bewertung der gesundheitlichen Chancengleichheit gibt, sollte dies nicht davon abhalten, ausdrucklich zu prufen, wie sich Leitlinien und Empfehlungen auf die am starksten gefahrdeten Mitglieder der Gesellschaft auswirken.

COVID-19 (coronavirus disease 2019) is a new, rapidly emerging zoonotic infectious disease, that was reported to the World Health Organization for the first time on 31 December 2019. Currently, no effective pharmacological interventions or vaccines are available to treat or prevent COVID-19, therefore nonpharmacological public health measures are more in focus.The aim was to assess the effects of quarantine - alone or in combination with other measures - during coronavirus outbreaks.Because of the current COVID-19 pandemic, WHO commissioned a rapid review. To save time, the method of systematic reviews was slightly and with caution modified. This publication is a summary of the most important aspects of the rapid review, translated into German by members of the WHO Collaborating Centre at the Danube University Krems (Austria).Overall, 29 studies were included. Ten modeling studies focused on COVID-19, 4 observational studies and 15 modeling studies focused on SARS and MERS. The modeling studies consistently reported a benefit of the simulated quarantine measures. For example, the models estimated that quarantine of people exposed to confirmed or suspected cases of COVID-19 prevented between 44 and 81% of the cases that would otherwise have happened and 31 to 63% of the deaths, when compared to no such measures. In regard to costs, the earlier the quarantine measures are implemented, the greater the cost savings will be.Our confidence in the evidence is very limited. This is mainly because the COVID-19 studies based their models on the limited data that have been available in the early weeks of the pandemic and made different assumptions about the virus. The studies of SARS and MERS are not completely generalizable to COVID-19. Despite only having limited evidence, all the studies found quarantine to be important for controlling the spread of severe coronavirus diseases. Looking to the coming months, in order to maintain the best possible balance of measures, decision makers must continue to constantly monitor the outbreak situation and the impact of the measures they implement.Die Coronavirus-Krankheit COVID-19 ist eine neue, sich rasch ausbreitende zoonotische Infektionskrankheit, die der Weltgesundheitsorganisation (WHO) erstmals am 31. Dezember 2019 gemeldet wurde. Da zurzeit keine wirksamen Medikamente oder Impfstoffe zur Behandlung oder Prävention von COVID-19 zur Verfügung stehen, rücken nicht-pharmakologische Public-Health-Maßnahmen zur Eindämmung der COVID-19 Pandemie stärker in den Fokus.Ziel dieses Rapid Reviews war es, den Effekt von Quarantäne – alleine oder in Kombination mit weiteren Public-Health-Maßnahmen – zur Eindämmung von COVID-19 zu untersuchen.Der vorliegende Rapid Review wurde von der WHO in Auftrag gegeben. Um der Dringlichkeit der Anfrage gerecht zu werden, wurde die Methodik eines systematischen Reviews punktuell abgeändert. Die vorliegende Publikation umfasst die wichtigsten Aspekte des Rapid Reviews und wurde vom WHO Collaborating Centre an der Donau Universität Krems (Österreich) auf Deutsch übersetzt.Insgesamt wurden 29 Studien eingeschlossen. Zehn Modellierungsstudien befassten sich direkt mit COVID-19, 15 weitere Modellierungsstudien und 4 Beobachtungsstudien lieferten indirekte Evidenz zu SARS und MERS. Die Studien zeichneten alle ein ähnliches Bild – einen Vorteil von Quarantäne. Beispielsweise schätzten Modellierungsstudien, dass durch Quarantäne von Personen, die Kontakt mit Infizierten hatten 44–81% neuer Fälle und 31–63% an Todesfällen verhindert werden können, im Vergleich zu keinen Maßnahmen. Zwei Studien zu SARS zeigten, dass Quarantäne effektiver war und weniger kostete, je früher sie startete. Alleinige Quarantäne von Personen, die Kontakt mit Infizierten hatten, würde aber wahrscheinlich nicht ausreichen, um den Ausbruch von COVID-19 einzudämmen. Die Kombination mit anderen Maßnahmen wie physische Distanzierung oder Schulschließungen zeigte größere Effekte als Quarantäne alleine. Bei der individuellen Quarantäne für Rückkehrende aus Risikogebieten fand der Review vergleichsweise geringe Effekte.Die Vertrauenswürdigkeit der Evidenz ist niedrig bzw. sehr niedrig, da die einzigen Studien zu COVID-19 Modellierungsstudien sind, die zwar aktuelle aber noch unsichere und unterschiedliche Parameter zur Modellberechnung verwendeten. Die indirekte Evidenz von SARS und MERS ist nur begrenzt auf COVID-19 übertragbar. Trotz dieser Limitationen, kommen alle Studien zu dem Schluss, dass Quarantäne eine wichtige Maßnahme ist, um die Pandemie einzudämmen. Im Hinblick auf die kommenden Monate ist es wichtig, das Infektionsgeschehen sowie die Auswirkungen der Maßnahmen genau zu überwachen, um die bestmögliche Balance der Maßnahmen zu finden.

Zusammenfassung Ziel Bereitstellen einer Handlungsempfehlung zur Einschatzung des Risikos fur Bias von nicht-randomisierten Interventionsstudien mittels ROBINS-I (Risk Of Bias In Nonrandomized Studies of Interventions) im Rahmen der Bewertung der Vertrauenswurdigkeit der Evidenz mit GRADE. Der Artikel richtet sich an Autorinnen und Autoren systematischer Reviews, Entwicklerinnen und Entwickler von Leitlinien sowie Beschaftigte im Bereich Health Technology Assessment (HTA). Studiendesign und Setting Es wurden iterative Diskussionen, Testungen im Rahmen von systematischen Reviews sowie Prasentationen im Rahmen von GRADE-Arbeitsgruppentreffen mit Feedback durch die Mitglieder der GRADE-Arbeitsgruppe eingesetzt. Ergebnisse Es wird beschrieben, auf welcher Stufe die Bewertung eines Evidenzkorpers bei der Anwendung von ROBINS-I beginnt und welche finale Bewertung der Vertrauenswurdigkeit der Evidenz vermutlich daraus resultieren wird. GRADE berucksichtigt Aspekte, die die Bedenken bezuglich Confounding und Selektionsbias abschwachen, indem Domanen zum Heraufstufen eingefuhrt wurden: Grose Effeke, Dosis-Wirkungsbeziehung und die Erhohung der Vertrauenswurdigkeit durch plausible residuale Confounder oder andere Verzerrungen. Diese Domanen mussen bei der Bewertung eines Evidenzkorpers berucksichtigt werden, wenn ROBINS-I verwendet wird. Schlussfolgerung Die Anwendung von ROBINS-I im Rahmen von GRADE kann eine bessere Vergleichbarkeit von Evidenz aus randomisierten kontrollierten Studien (RCTs) und nicht-randomisierten Studien (NRSs) ermoglichen, da ein gemeinsamer Referenzstandard fur die Bewertung des Risikos fur Bias verwendet wird. Herausfordernd bleibt weiterhin unter anderem, wie Evidenz aus RCTs und NRSs zur Entscheidungsfindung angemessen dargestellt werden kann und wie RCTs und NRSs innerhalb einer Evidenzbewertung optimal integriert werden konnen.

Objectives: We aimed to assess whether limiting the inclusion criteria solely to English-language publications affected the overall conclusions of evidence syntheses.Study Design and Setting: Our analyses used a dataset of a previous methods study that included 59 randomly selected Cochrane intervention reviews with no language restrictions. First, we ascertained the publication language of all 2,026 included publications. Next, we excluded studies based on the following criteria: (1) publication solely in non-English language, or (2) main publication (in case of multiple publications of the same study) in non-English language. We then re-calculated meta-analyses for outcomes that were presented in the main summary of findings tables of the Cochrane reports. If the direction of the effect estimate or the statistical significance changed, authors of the respective Cochrane reviews were consulted to assess whether the new evidence base would have changed their conclusions. The primary outcome of our analyses examined the proportion of conclusions that would change with the exclusion of non-English publications. We set the threshold for the approach as noninferior if the upper limit of the 95% confidence interval of the proportion of changed conclusions did not cross a margin of 10%.Results: Across all 59 Cochrane reviews, 29 (49%) included 80 non-English publications. For 16 (27%) of these Cochrane reviews, the exclusion of non-English publications resulted in the exclusion of at least one study. In the remaining 13 Cochrane reviews, the non-English publications were not the only or main publication of the study or they did not contribute to the main summary of the findings table, so their exclusion did not result in an exclusion of the study.Overall, the exclusion of non-English publications led to the exclusion of 31 studies contributing to 40 outcomes. For 38 of the 40 outcomes, the exclusion of non-English studies did not markedly alter the size or direction of effect estimates or statistical significance. In two outcomes, the statistical significance changed, but authors would have still drawn the same conclusion, albeit with less certainty. Thus, the proportion of changed conclusions in our sample was 0.0% (95% CI 0.0-0.6), which indicated the noninferiority of the approach. However, the majority of excluded studies were small.Conclusion: Exclusion of non-English publications from systematic reviews on clinical interventions had a minimal effect on overall conclusions and could be a viable methodological shortcut, especially for rapid reviews. (C) 2019 Elsevier Inc. All rights reserved.

Zusammenfassung Hintergrund Stillen ist eine wichtige Grundlage für die Gesundheit und Entwicklung eines Kindes, in manchen Teilen der Welt auch für das Überleben eines Kindes. Trotz umfangreicher Belege dafür, dass Nicht-Stillen global mit erhöhter Mortalität und langfristigen gesundheitsschädlichen Auswirkungen assoziiert ist, werden weniger als die Hälfte aller Kinder weltweit in den ersten 6 Monaten ausschließlich gestillt. Stillberatung ist eine maßgebliche Intervention, um die Stillraten zu erhöhen. Zielsetzung Ziel dieser Leitlinie ist es, Empfehlungen zur Umsetzung von Stillberatung zu geben, um die Stillpraktiken von Müttern zu verbessern. Methodik Die Leitlinie wurde von der Weltgesundheitsorganisation (WHO) gemäß der im WHO-Handbuch zur Leitlinienentwicklung empfohlenen Methode umgesetzt. Die vorliegende Publikation umfasst die wichtigsten Aspekte der Leitlinie und wurde vom WHO Collaborating Centre an der Donau-Universität Krems (Österreich) auf Deutsch übersetzt. Ergebnisse/Schlussfolgerungen Diese Leitlinie berücksichtigt die aktuelle Evidenz und gibt Empfehlungen und Anmerkungen zur Umsetzung von Stillberatung, wie bspw. zur Häufigkeit, zum optimalen Zeitpunkt, oder zur Art und zu den Anbietern von Stillberatung, um Stillpraktiken zu verbessern. Der Umfang der Leitlinie ist auf diese Umsetzungs-Details beschränkt.

Background and Objectives Rapid reviews provide an efficient alternative to standard systematic reviews in response to a high priority or urgent need. Although rapid reviews of interventions have been extensively evaluated, little is known about the characteristics of rapid reviews of diagnostic evidence. Study Design and Setting We performed a scoping review for rapid reviews of medical tests published from 2013 to 2018. We extracted information on review characteristics and methods used to assess the evidence. Results We identified 191 rapid reviews. All reviews were developed within a short time (less than 12 months) and were relatively concise (less than 10 pages). The reviews involved multiple index tests (44%), multiple outcomes (88%), and several test applications (29%). Well-known methodological tailoring strategies were infrequently used. Although reporting of several key features was limited, we found that, in general, rapid reviews have similar characteristics to broader knowledge syntheses. Conclusion Our scoping review is the first to describe the characteristics and methods of rapid reviews of diagnostic evidence. Future research should identify the most appropriate methods for performing rapid reviews of medical tests. Standards for reporting of rapid reviews are needed.

Zusammenfassung Ziel Dieser Artikel soll aufzeigen wie Gerechtigkeit im Gesundheitswesen in wichtigen Schritten des Leitlinienentwicklungsprozesses berucksichtigt werden kann. Methode Literaturubersicht gefolgt von Gruppendiskussionen und Konsensfindung. Ergebnisse In den folgenden wichtigen Phasen der Leitlinienentwicklung kann Gerechtigkeit im Gesundheitswesen berucksichtigt werden: Setzen von Prioritaten, Zusammensetzung der Leitliniengruppen, Festlegung der Zielgruppe(n), Formulierung der Leitlinien-Fragen, Auswahl und Gewichtung von Endpunkten und Interventionen, Auswahl der einzuschliesenden Evidenz und nach welcher Evidenz gesucht werden soll, Zusammenfassung der Evidenz und Berucksichtigung zusatzlicher Informationen, Formulierung der Empfehlungen, Nutzung und Evaluation der Leitlinie. Dazu finden sich Beispiele, wie bisherige Leitlinien Gerechtigkeit im Gesundheitswesen in diesen Phasen der Leitlinienentwicklung einbezogen haben. Schlussfolgerung Leitlinienprojekte sollten, wenn es sich um ein Thema handelt, bei dem Gerechtigkeit im Gesundheitswesen eine wichtige Rolle spielt, diese Vorschlage berucksichtigen.

Zusammenfassung Ziel Dieser Artikel beschreibt, warum Gerechtigkeit im Gesundheitswesen bei der Entwicklung von klinischen Leitlinien sowie von Leitlinien im Bereich Public Health oder fur das Gesundheitssystem ausdrucklich berucksichtigt werden soll. Die Methoden werden im Rahmen des GRADE-Ansatzes (GRADE = Grading of Recommendations, Assessment, Development, and Evaluation) vorgestellt. Studiendesign und Setting Es erfolgte eine Suche nach Artikeln zur Methodik der Leitlinienentwicklung, nach konzeptionellen Artikeln zu Gerechtigkeit im Gesundheitswesen und nach Beispielen fur Leitlinien, die diese explizit berucksichtigt hatten. Anschliesend wurde uber die GRADE-Mailing-Liste um Kommentare zu den Ergebnissen gebeten und diese im Rahmen von drei Treffen der GRADE-Workinggroup diskutiert. Ergebnisse Es entstanden drei Artikel, die darlegen, wie man i) Gerechtigkeit im Gesundheitswesen in den gesamten Leitlinien-prozess einbezieht, ii) bei der Bewertung des Vertrauens in die Evidenz berucksichtigt und iii) bei der Erstellung von Evidenzprofilen sowie bei der Ableitung von Empfehlungen und Entscheidungen aus der Evidenz einbindet. Schlussfolgerung Klinische und Public -Health-Leitlinien spielen eine wichtige Rolle in der Forderung von Gerechtigkeit im Gesundheitswesen, indem sie diese explizit in der Entwicklung von Leitlinien berucksichtigen.

Die osterreichische Vorsorgeuntersuchung (VU) wurde 1974 als Kassenleistung eingefuhrt und im Jahr 2005 zum letzten Mal neu gestaltet. Ziel dieser Arbeit war daher, die wissenschaftlichen Grundlagen der VU unter Verwendung des GRADE (Grading of Recommendations Assessment, Development and Evaluation) Ansatzes zu aktualisieren. Die wissenschaftliche Evidenz fur Untersuchungen und Beratungen, die derzeit Teil der VU sind, wurde aktualisiert und um weitere potentiell relevante Untersuchungen erweitert. Vertreter/innen der Bevolkerung diskutierten in drei Fokusgruppen ihre Erwartungen an die VU. In einem strukturierten Prozess wurden von einem Beratungsgremium evidenzbasierte Empfehlungen erarbeitet, welche Untersuchungen/Beratungen Teil der VU sein sollen. Das Beratungsgremium formulierte insgesamt 26 Empfehlungen zu 20 Zielerkrankungen oder Risikofaktoren. Es empfahl erstmals Screening auf abdominales Aortenaneurysma, osteoporotisches Frakturrisiko und chronische Nierenerkrankungen. Screening auf asymptomatische Bakteriurie, Screening auf Eisen‑/Vitamin B12-Mangelanamie und die Identifizierung von Personen mit erhohtem Risiko fur ein Glaukom sollen zukunftig auf Basis der Erkenntnisse nicht mehr in der VU enthalten sein.

Zusammenfassung Hintergrund Risikokommunikation ist ein wesentlicher Bestandteil, um auf Notfälle und Katastrophen, die die Gesundheit der Bevölkerung gefährden, angemessen reagieren zu können. Ziel Die Weltgesundheitsorganisation (WHO) entwickelte diese Leitlinie, um WHO-Mitgliedsstaaten, sowie Stakeholdern aus dem Bereich Notfallschutz und -bekämpfung evidenzbasierte, aktuelle und systemorientierte Handlungsempfehlungen zur Risikokommunikation bereitzustellen. Methode Die Leitlinie wurde gemäß WHO-Standards entwickelt. Ergebnisse Die Leitlinie beinhaltet Empfehlungen zu den Bereichen (1) Vertrauen aufbauen, Unsicherheiten kommunizieren und die betroffene Bevölkerung einbinden, (2) Integration von Risikokommunikation in bestehende Strukturen des Notfallschutz- und der Notfallbekämpfung und (3) Planung, Umsetzung und Evaluierung von Risikokommunikation in der Praxis. Schlussfolgerung Diese Leitlinie gibt Empfehlungen für den Auf- und Ausbau von Risikokommunikation, enthält aber keine Schritt-für-Schritt Anleitungen. Solche detaillierten Anleitungen werden zukünftig in anderer Form von der WHO bereitgestellt.

Background Health promotion programs can only lead to improvements in health outcomes if they are effectively implemented. However, most studies assessing implementation success focus on only one condition, although more conditions influence this process. Therefore, evidence is scarce on what conditions play a role in successful implementation and how they interact. Hence, we aimed to identify which combinations of teacher and implementation process characteristics affected the emotional and social school experience (SCE) of pupils participating in a school-based health promotion program. Methods This study was part of an effectiveness and process evaluation including 24 intervention and 27 control classes. We used fuzzy-set qualitative comparative analysis (fsQCA) to identify combinations of conditions that were associated with either an increase or no increase in the outcome SCE in comparison to the control group at 20 months post intervention. We deductively selected five conditions based on the Consolidated Framework for Implementation Research: teachers’ perceived self-efficacy, teachers’ expectations of the benefits of the intervention, teachers’ previous knowledge about the intervention, dosage of physical activity breaks, and quality of the implementation. Results We identified five different pathways that led to no increase in the pupils’ outcome (parameters of fit: consistency 94%, coverage 66%). The combination of an unsatisfying quality of implementing the intervention and a low previous knowledge about the intervention showed the highest empirical relevance. Similarly, fewer physical activity breaks in combination with other conditions impeded the program’s success. Furthermore, we identified two different pathways characterizing ways to success (consistency: 81%, coverage: 52%). The most relevant combination was good quality implementation of physical activity breaks, implemented by teachers with a high self-efficacy, and a good previous knowledge about the intervention. Conclusions QCA has potential for an in-depth analysis of complex interventions as it can rely on small to medium sample sizes and analyze pathways to success and non-success separately. The investigated program can be improved by considering the following suggestions: The quality of the implementation process should be monitored during the implementation phase, and regular feedback loops and learning opportunities for teachers should accompany a program. Clear recommendations regarding the dosage should be established. Trial registration German register of clinical studies: DRKS00000622. Retrospectively registered: December 3, 2010, (http://www.drks.de/drks_web/setLocale_EN.do). Approved by the Ethics Committee of Lower Austria (GS4-EK-4/107–2010). Electronic supplementary material The online version of this article (10.1186/s12889-018-6284-x) contains supplementary material, which is available to authorized users.

Background Varicoceles are associated with male subfertility; however, the mechanisms by which varicoceles affect fertility have yet to be satisfactorily explained. Several treatment options exist, including surgical or radiological treatment, however the safest and most efficient treatment remains unclear. OBJECTIVES: To evaluate the effectiveness and safety of surgical and radiological treatment of varicoceles on live birth rate, adverse events, pregnancy rate, varicocele recurrence, and quality of life amongst couples where the adult male has a varicocele, and the female partner of childbearing age has no fertility problems. Search methods We searched the following databases on 4 April 2020: the Cochrane Gynaecology and Fertility Group Specialised Register, CENTRAL, MEDLINE, Embase, PsycINFO, and CINAHL. We also searched the trial registries and reference lists of articles. Selection criteria We included randomised controlled trials (RCTs) if they were relevant to the clinical question posed and compared different forms of surgical ligation, different forms of radiological treatments, surgical treatment compared to radiological treatment, or one of these aforementioned treatment forms compared to non-surgical methods, delayed treatment, or no treatment. We extracted data if the studies reported on live birth, adverse events, pregnancy, varicocele recurrence, and quality of life. Data collection and analysis Screening of abstracts and full-text publications, alongside data extraction and 'Risk of bias' assessment, were done dually using the Covidence software. When we had sufficient data, we calculated random-effects (Mantel-Haenszel) meta-analyses; otherwise, we reported results narratively. We used the I2 statistic to analyse statistical heterogeneity. We planned to use funnel plots to assess publication bias in meta-analyses with at least 10 included studies. We dually rated the risk of bias of studies using the Cochrane 'Risk of bias' tool, and the certainty of evidence for each outcome using the GRADE approach. Main results We identified 1897 citations after de-duplicating the search results. We excluded 1773 during title and abstract screening. From the 113 new full texts assessed in addition to the 10 studies (11 references) included in the previous version of this review, we included 38 new studies, resulting in a total of 48 studies (59 references) in the review providing data for 5384 participants. Two studies (three references) are ongoing studies and two studies are awaiting classification. Treatment versus non-surgical, non-radiological, delayed, or no treatment Two studies comparing surgical or radiological treatment versus no treatment reported on live birth with differing directions of effect. As a result, we are uncertain whether surgical or radiological treatment improves live birth rates when compared to no treatment (risk ratio (RR) 2.27, 95% confidence interval (CI) 0.19 to 26.93; 2 RCTs, N = 204; I2 = 74%, very low-certainty evidence). Treatment may improve pregnancy rates compared to delayed or no treatment (RR 1.55, 95% CI 1.06 to 2.26; 13 RCTs, N = 1193; I2 = 65%, low-certainty evidence). This suggests that couples with no or delayed treatment have a 21% chance of pregnancy, whilst the pregnancy rate after surgical or radiological treatment is between 22% and 48%. We identified no evidence on adverse events, varicocele recurrence, or quality of life for this comparison. Surgical versus radiological treatment We are uncertain about the effect of surgical versus radiological treatment on live birth and on the following adverse events: hydrocele formation, pain, epididymitis, haematoma, and suture granuloma. We are uncertain about the effect of surgical versus radiological treatment on pregnancy rate (RR 1.13, 95% CI 0.75 to 1.70; 5 RCTs, N = 456, low-certainty evidence) and varicocele recurrence (RR 1.31, 95% CI 0.82 to 2.08; 3 RCTs, N = 380, low-certainty evidence). We identified no evidence on quality of life for this comparison. Surgery versus other surgical treatment We identified 19 studies comparing microscopic subinguinal surgical treatment to any other surgical treatment. Microscopic subinguinal surgical treatment probably improves pregnancy rates slightly compared to other surgical treatments (RR 1.18, 95% CI 1.02 to 1.36; 12 RCTs, N = 1473, moderate-certainty evidence). This suggests that couples with microscopic subinguinal surgical treatment have a 10% to 14% chance of pregnancy after treatment, whilst the pregnancy rate in couples after other surgical treatments is 10%. This procedure also probably reduces the risk of varicocele recurrence (RR 0.48, 95% CI 0.29, 0.79; 14 RCTs, N = 1565, moderate-certainty evidence). This suggests that 0.4% to 1.1% of men undergoing microscopic subinguinal surgical treatment experience recurrent varicocele, whilst 1.4% of men undergoing other surgical treatments do. Results for the following adverse events were inconclusive: hydrocele formation, haematoma, abdominal distension, testicular atrophy, wound infection, scrotal pain, and oedema. We identified no evidence on live birth or quality of life for this comparison. Nine studies compared open inguinal surgical treatment to retroperitoneal surgical treatment. Due to small sample sizes and methodological limitations, we identified neither treatment type as superior or inferior to the other regarding adverse events, pregnancy rates, or varicocele recurrence. We identified no evidence on live birth or quality of life for this comparison. Radiological versus other radiological treatment One study compared two types of radiological treatment (sclerotherapy versus embolisation) and reported 13% varicocele recurrence in both groups. Due to the broad confidence interval, no valid conclusion could be drawn (RR 1.00, 95% CI 0.16 to 6.20; 1 RCT, N = 30, very low-certainty evidence). We identified no evidence on live birth, adverse events, pregnancy, or quality of life for this comparison. Authors' conclusions Based on the limited evidence, it remains uncertain whether any treatment (surgical or radiological) compared to no treatment in subfertile men may be of benefit on live birth rates; however, treatment may improve the chances for pregnancy. The evidence was also insufficient to determine whether surgical treatment was superior to radiological treatment. However, microscopic subinguinal surgical treatment probably improves pregnancy rates and reduces the risk of varicocele recurrence compared to other surgical treatments. High-quality, head-to-head comparative RCTs focusing on live birth rate and also assessing adverse events and quality of life are warranted.

Background Seasonal affective disorder (SAD) is a seasonal pattern of recurrent depressive episodes that is often treated with second-generation antidepressants (SGAs), light therapy, or psychotherapy. Objectives To assess the efficacy and safety of second-generation antidepressants (SGAs) for the treatment of seasonal affective disorder (SAD) in adults in comparison with placebo, light therapy, other SGAs, or psychotherapy. Search methods This is an update of an earlier review first published in 2011. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2020, Issue 1) in the Cochrane Library (all years), Ovid MEDLINE, Embase, and PsycINFO (2011 to January 2020), together with the Cochrane Common Mental Disorders Controlled Trials Register (CCMDCTR) (all available years), for reports of randomised controlled trials (RCTs). We hand searched the reference lists of all included studies and other systematic reviews. We searched ClinicalTrials.gov for unpublished/ongoing trials. We ran a separate update search for reports of adverse events in the Ovid databases. SELECTION CRITERIA: For efficacy we included RCTs of SGAs compared with other SGAs, placebo, light therapy, or psychotherapy in adult participants with SAD. For adverse events we also included non-randomised studies. Data collection and analysis Two review authors independently screened abstracts and full-text publications against the inclusion criteria. Data extraction and 'Risk of bias' assessment were conducted individually. We pooled data for meta-analysis where the participant groups were similar, and the studies assessed the same treatments with the same comparator and had similar definitions of outcome measures over a similar duration of treatment. Main results In this update we identified no new RCT on the effectiveness of SGAs in SAD patients. We included 2 additional single-arm observational studies that reported on adverse events of SGAs. For efficacy we included three RCTs of between five and eight weeks' duration with a total of 204 participants. For adverse events we included two RCTs and five observational (non-randomised) studies of five to eight weeks' duration with a total of 249 participants. All participants met the DSM (Diagnostic and Statistical Manual of Mental Disorders) criteria for SAD. The average age ranged from 34 to 42 years, and the majority of participants were female (66% to 100%). Results from one trial with 68 participants showed that fluoxetine (20/36) was numerically superior to placebo (11/32) in achieving clinical response; however, the confidence interval (CI) included both a potential benefit as well as no benefit of fluoxetine (risk ratio (RR) 1.62, 95% CI 0.92 to 2.83, very low-certainty evidence). The number of adverse events was similar in both groups (very low-certainty evidence). Two trials involving a total of 136 participants compared fluoxetine versus light therapy. Meta-analysis showed fluoxetine and light therapy to be approximately equal in treating seasonal depression: RR of response 0.98 (95% CI 0.77 to 1.24, low-certainty evidence), RR of remission 0.81 (95% CI 0.39 to 1.71, very low-certainty evidence). The number of adverse events was similar in both groups (low-certainty evidence). We did not identify any eligible study comparing SGA with another SGA or with psychotherapy. Two RCTs and five non-randomised studies reported adverse event data on a total of 249 participants who received bupropion, fluoxetine, escitalopram, duloxetine, nefazodone, reboxetine, light therapy, or placebo. We were only able to obtain crude rates of adverse events, therefore caution is advised regarding interpretation of this information. Between 0% and 100% of participants who received an SGA suffered an adverse event, and between 0% and 25% of participants withdrew from the study due to adverse events. Authors' conclusions Evidence for the effectiveness of SGAs is limited to one small trial of fluoxetine compared with placebo showing a non-significant effect in favour of fluoxetine, and two small trials comparing fluoxetine against light therapy suggesting equivalence between the two interventions. The lack of available evidence precluded us from drawing any overall conclusions on the use of SGAs for SAD. Further, larger RCTs are required to expand and strengthen the evidence base on this topic, and should also include comparisons with psychotherapy and other SGAs. Data on adverse events were sparse, and a comparative analysis was not possible. The data we obtained on adverse events is therefore not robust, and our confidence in the data is limited. Overall, up to 25% of participants treated with SGAs for SAD withdrew from the study early due to adverse events.

Objectives To develop methods guidance to support the conduct of rapid reviews (RRs) produced within Cochrane and beyond, in response to requests for timely evidence syntheses for decision-making purposes including urgent health issues of high priority. Study Design and Setting Interim recommendations were informed by a scoping review of the underlying evidence, primary methods studies conducted, and a survey sent to 119 representatives from 20 Cochrane entities, who were asked to rate and rank RR methods across stages of review conduct. Discussions among those with expertise in RR methods further informed the list of recommendations with accompanying rationales provided. Results Based on survey results from 63 respondents (53% response rate), 26 RR methods recommendations are presented for which there was a high or moderate level of agreement or scored highest in the absence of such agreement. Where possible, how recommendations align with Cochrane methods guidance for systematic reviews is highlighted. Conclusion The Cochrane Rapid Reviews Methods Group offers new, interim guidance to support the conduct of RRs. Because best practice is limited by the lack of currently available evidence for some RR methods shortcuts taken, this guidance will need to be updated as additional abbreviated methods are evaluated.

Objective: We aimed to map the resource use during systematic review (SR) production and reasons why steps of the SR production are resource intensive to discover where the largest gain in improving efficiency might be possible., Study design and setting: We conducted a scoping review. An information specialist searched multiple databases (e.g., Ovid MEDLINE, Scopus) and implemented citation-based and grey literature searching. We employed dual and independent screenings of records at the title/abstract and full-text levels and data extraction., Results: We included 34 studies. Thirty-two reported on the resource use-mostly time; four described reasons why steps of the review process are resource intensive. Study selection, data extraction, and critical appraisal seem to be very resource intensive, while protocol development, literature search, or study retrieval take less time. Project management and administration required a large proportion of SR production time. Lack of experience, domain knowledge, use of collaborative and SR-tailored software, and good communication and management can be reasons why SR steps are resource intensive., Conclusion: Resource use during SR production varies widely. Areas with the largest resource use are administration and project management, study selection, data extraction, and critical appraisal of studies., peer-reviewed

Background and Objective Rapid reviews were first mentioned in the literature in 1997, when Best et al. described the rapid health technology assessment program in the south and west regions of England but did not provide a formal definition. More recently, the only consensus around a rapid review definition is that a formal definition does not exist. The primary aim of this work is to create a repository of existing definitions and to identify key themes, which may help the knowledge synthesis community in defining rapid review products. Methods A systematic scoping review was performed to identify definitions used in journal-published rapid reviews written in English between 2017 and January 2019. We searched Medline, Embase Classic + Embase, PsycINFO, ERIC, Cochrane Library, CINAHL, and Web of Science on December 21, 2018. Two reviewers performed study selection and data extraction using a priori–defined methods published in a protocol. Definitions from rapid review methods articles (published from 1997 onward) identified in another scoping review were added to the results, and all definitions were thematically analyzed using NVivo. A quantitative analysis was also performed around studies cited. Results Definitions from 216 rapid reviews and 90 rapid review methods articles were included in the thematic analysis. Eight key themes were identified: accelerated/rapid process or approach, variation in methods shortcuts, focus/depth/breadth of scope, compare and contrast to a full traditional systematic review, stakeholder rationale, resource efficiency rationale, systematic approach, bias/limitations. Secondary referencing was a common occurrence. Conclusion Thematic analysis performed in this systematic scoping review has allowed for the creation of a suggested definition for rapid reviews that can be used to inform the systematic review community.

Background Rapid reviews (RRs) are useful products to healthcare policy-makers and other stakeholders, who require timely evidence. Therefore, it is important to assess how well RRs convey useful information in a format that is easy to understand so that decision-makers can make best use of evidence to inform policy and practice. Methods We assessed a diverse sample of 103 RRs against the BRIDGE criteria, originally developed for communicating clearly to support healthcare policy-making. We modified the criteria to increase assessability and to align with RRs. We identified RRs from key database searches and through searching organisations known to produce RRs. We assessed each RR on 26 factors (e.g. organisation of information, lay language use). Results were descriptively analysed. Further, we explored differences between RRs published in journals and those published elsewhere. Results Certain criteria were well covered across the RRs (e.g. all aimed to synthesise research evidence and all provided references of included studies). Further, most RRs provided detail on the problem or issue (96%; n = 99) and described methods to conduct the RR (91%; n = 94), while several addressed political or health systems contexts (61%; n = 63). Many RRs targeted policy-makers and key stakeholders as the intended audience (66%; n = 68), yet only 32% (n = 33) involved their tacit knowledge, while fewer (27%; n = 28) directly involved them reviewing the content of the RR. Only six RRs involved patient partners in the process. Only 23% (n = 24) of RRs were prepared in a format considered to make information easy to absorb (i.e. graded entry) and 25% (n = 26) provided specific key messages. Readability assessment indicated that the text of key RR sections would be hard to understand for an average reader (i.e. would require post-secondary education) and would take 42 (± 36) minutes to read. Conclusions Overall, conformity of the RRs with the modified BRIDGE criteria was modest. By assessing RRs against these criteria, we now understand possible ways in which they could be improved to better meet the information needs of healthcare decision-makers and their potential for innovation as an information-packaging mechanism. The utility and validity of these items should be further explored. Protocol availability The protocol, published on the Open Science Framework, is available at: osf.io/68tj7

Background Coronavirus disease 2019 (COVID‐19) is a rapidly emerging disease classified as a pandemic by the World Health Organization (WHO). To support the WHO with their recommendations on quarantine, we conducted a rapid review on the effectiveness of quarantine during severe coronavirus outbreaks. Objectives To assess the effects of quarantine (alone or in combination with other measures) of individuals who had contact with confirmed or suspected cases of COVID‐19, who travelled from countries with a declared outbreak, or who live in regions with high disease transmission. Search methods An information specialist searched the Cochrane COVID‐19 Study Register, and updated the search in PubMed, Ovid MEDLINE, WHO Global Index Medicus, Embase, and CINAHL on 23 June 2020. Selection criteria Cohort studies, case‐control studies, time series, interrupted time series, case series, and mathematical modelling studies that assessed the effect of any type of quarantine to control COVID‐19. We also included studies on SARS (severe acute respiratory syndrome) and MERS (Middle East respiratory syndrome) as indirect evidence for the current coronavirus outbreak. Data collection and analysis Two review authors independently screened abstracts and titles in duplicate. Two review authors then independently screened all potentially relevant full‐text publications. One review author extracted data, assessed the risk of bias and assessed the certainty of evidence with GRADE and a second review author checked the assessment. We used three different tools to assess risk of bias, depending on the study design: ROBINS‐I for non‐randomised studies of interventions, a tool provided by Cochrane Childhood Cancer for non‐randomised, non‐controlled studies, and recommendations from the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) for modelling studies. We rated the certainty of evidence for the four primary outcomes: incidence, onward transmission, mortality, and costs. Main results We included 51 studies; 4 observational studies and 28 modelling studies on COVID‐19, one observational and one modelling study on MERS, three observational and 11 modelling studies on SARS, and three modelling studies on SARS and other infectious diseases. Because of the diverse methods of measurement and analysis across the outcomes of interest, we could not conduct a meta‐analysis and undertook a narrative synthesis. We judged risk of bias to be moderate for 2/3 non‐randomized studies of interventions (NRSIs) and serious for 1/3 NRSI. We rated risk of bias moderate for 4/5 non‐controlled cohort studies, and serious for 1/5. We rated modelling studies as having no concerns for 13 studies, moderate concerns for 17 studies and major concerns for 13 studies. Quarantine for individuals who were in contact with a confirmed/suspected COVID‐19 case in comparison to no quarantine Modelling studies consistently reported a benefit of the simulated quarantine measures, for example, quarantine of people exposed to confirmed or suspected cases may have averted 44% to 96% of incident cases and 31% to 76% of deaths compared to no measures based on different scenarios (incident cases: 6 modelling studies on COVID‐19, 1 on SARS; mortality: 2 modelling studies on COVID‐19, 1 on SARS, low‐certainty evidence). Studies also indicated that there may be a reduction in the basic reproduction number ranging from 37% to 88% due to the implementation of quarantine (5 modelling studies on COVID‐19, low‐certainty evidence). Very low‐certainty evidence suggests that the earlier quarantine measures are implemented, the greater the cost savings may be (2 modelling studies on SARS). Quarantine in combination with other measures to contain COVID‐19 in comparison to other measures without quarantine or no measures When the models combined quarantine with other prevention and control measures, such as school closures, travel restrictions and social distancing, the models demonstrated that there may be a larger effect on the reduction of new cases, transmissions and deaths than measures without quarantine or no interventions (incident cases: 9 modelling studies on COVID‐19; onward transmission: 5 modelling studies on COVID‐19; mortality: 5 modelling studies on COVID‐19, low‐certainty evidence). Studies on SARS and MERS were consistent with findings from the studies on COVID‐19. Quarantine for individuals travelling from a country with a declared COVID‐19 outbreak compared to no quarantine Very low‐certainty evidence indicated that the effect of quarantine of travellers from a country with a declared outbreak on reducing incidence and deaths may be small for SARS, but might be larger for COVID‐19 (2 observational studies on COVID‐19 and 2 observational studies on SARS). Authors' conclusions The current evidence is limited because most studies on COVID‐19 are mathematical modelling studies that make different assumptions on important model parameters. Findings consistently indicate that quarantine is important in reducing incidence and mortality during the COVID‐19 pandemic, although there is uncertainty over the magnitude of the effect. Early implementation of quarantine and combining quarantine with other public health measures is important to ensure effectiveness. In order to maintain the best possible balance of measures, decision makers must constantly monitor the outbreak and the impact of the measures implemented. This review was originally commissioned by the WHO and supported by Danube‐University‐Krems. The update was self‐initiated by the review authors., Plain language summary Does quarantine, alone or in combination with other public health measures, control coronavirus (COVID‐19)? Background Coronavirus disease 2019 (COVID‐19) is caused by a new virus that has spread quickly throughout the world. Most infected people either experience no symptoms or suffer mild, flu‐like symptoms, but some become seriously ill, and may die. There is no vaccine (a medicine that stops people catching a specific disease) for COVID‐19, so other ways of slowing its spread are needed. One way of controlling the disease is quarantine. This means separating healthy people from other healthy people, who may have the virus after being in close contact with an infected person, or because they have returned from an area with high infection rates. Similar recommendations include isolation (like quarantine, but for people who tested positive for COVID‐19) and physical distancing (people without symptoms keep a distance from each other). What did we want to find out? We wanted to find out whether and how effectively quarantine stops COVID‐19 spreading and if it prevents death. We wanted to know if it was more effective when combined with other measures, and how much it costs. Study characteristics COVID‐19 is spreading rapidly, so we needed to answer these questions as quickly as possible. This meant we shortened some steps of the normal Cochrane Review process. Nevertheless, we are confident that these changes do not affect our overall conclusions. We looked for studies that assessed the effect of any type of quarantine, anywhere, on the spread and severity of COVID‐19. We also looked for studies that assessed quarantine alongside other measures, such as isolation, physical distancing or school closures. COVID‐19 is a new disease, so, to find as much evidence as possible, we also looked for studies on similar viruses, such as SARS (severe acute respiratory syndrome) and MERS (Middle East respiratory syndrome). Studies measured the number of COVID‐19, SARS or MERS cases, how many people were infected, how quickly the virus spread, how many people died, and the costs of quarantine. Key results We included 51 studies. Thirty‐two studies focused on COVID‐19, 14 on SARS, three on SARS plus other viruses, and two on MERS. Most studies combined existing data from multiple sources and assumptions to create a model (a simulation) for predicting how events might occur over time, for people in different situations (called modelling studies). Four COVID‐19 studies observed the effects of quarantine (observational studies) on 6064 individuals in China, Greece and Singapore. Twenty‐eight COVID‐19 studies simulated outbreaks in Algeria, China, Canada, Italy, Kazakhstan, Nepal, UK, USA, Singapore, South Korea, on the cruise ship Diamond Princess, and in a general population. Four studies looked back on the effect of quarantine on 178,122 people involved in SARS and MERS outbreaks. The remaining 15 studies modelled SARS and MERS outbreaks. The modelling studies all found that simulated quarantine measures reduce the number of people with COVID‐19 and the number of deaths. With quarantine, estimates showed a minimum reduction in the number of people with COVID‐19 of 44%, and a maximum reduction of 96%. Similarly, with quarantine, estimates of the number of deaths showed a minimum reduction of 31%, and a maximum reduction of 76%. Combining quarantine with other measures, such as closing schools or physical distancing, may be more effective at reducing the spread of COVID‐19 than quarantine alone. The SARS and MERS studies agreed with the studies on COVID‐19. Two SARS modelling studies assessed costs. They found that the costs may be lower when quarantine measures start earlier. Reliability of the evidence We are uncertain about the evidence we found for several reasons. The observational studies on COVID‐19 did not include a comparison group without quarantine. The COVID‐19 studies based their models on limited data and made different assumptions about the virus (e.g. how quickly it would spread). The other studies investigated SARS and MERS so they only provide indirect evidence. Conclusion Despite limited evidence, all the studies found quarantine to be important in reducing the number of people infected and the number of deaths. Results suggest that quarantine was most effective, and cost less, when it started earlier. Combining quarantine with other prevention and control measures may have a greater effect than quarantine alone. This review includes evidence published up to 23 June 2020.

The aim of this systematic review was to assess the performance of anthropometric tools to determine obesity in the general population (CRD42018086888). Our review included 32 studies. To detect obesity with body mass index (BMI), the meta-analyses rendered a sensitivity of 51.4% (95% CI 38.5–64.2%) and a specificity of 95.4% (95% CI 90.7–97.8%) in women, and 49.6% (95% CI 34.8–64.5%) and 97.3% (95% CI 92.1–99.1%), respectively, in men. For waist circumference (WC), the summary estimates for the sensitivity were 62.4% (95% CI 49.2–73.9%) and 88.1% for the specificity (95% CI 77.0–94.2%) in men, and 57.0% (95% CI 32.2–79.0%) and 94.8% (95% CI 85.8–98.2%), respectively, in women. The data were insufficient to pool the results for waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) but were similar to BMI and WC. In conclusion, BMI and WC have serious limitations for use as obesity screening tools in clinical practice despite their widespread use. No evidence supports that WHR and WHtR are more suitable than BMI or WC to assess body fat. However, due to the lack of more accurate and feasible alternatives, BMI and WC might still have a role as initial tools for assessing individuals for excess adiposity until new evidence emerges.

Background Decision-makers increasingly request rapid answers to clinical or public health questions. To save time, personnel, and financial resources, rapid reviews streamline the methodological steps of the systematic review process. We aimed to explore the validity of a rapid review approach that combines a substantially abbreviated literature search with a single-reviewer screening of abstracts and full texts using three case studies. Methods We used a convenience sample of three ongoing Cochrane reviews as reference standards. Two reviews addressed oncological topics and one addressed a public health topic. For each of the three topics, three reviewers screened the literature independently. Our primary outcome was the change in conclusions between the rapid reviews and the respective Cochrane reviews. In case the rapid approach missed studies, we recalculated the meta-analyses for the main outcomes and asked Cochrane review authors if the new body of evidence would change their original conclusion compared with the reference standards. Additionally, we assessed the sensitivity of the rapid review approach compared with the results of the original Cochrane reviews. Results For the two oncological topics (case studies 1 and 2), the three rapid reviews each yielded the same conclusions as the Cochrane reviews. However, the authors would have had less certainty about their conclusion in case study 2. For case study 3, the public health topic, only one of the three rapid reviews led to the same conclusion as the Cochrane review. The other two rapid reviews provided insufficient information for the authors to draw conclusions. Using the rapid review approach, the sensitivity was 100% (3 of 3) for case study 1. For case study 2, the three rapid reviews identified 40% (4 of 10), 50% (5 of 10), and 60% (6 of 10) of the included studies, respectively; for case study 3, the respective numbers were 38% (8 of 21), 43% (9 of 21), and 48% (10 of 21). Conclusions Within the limitations of these case studies, a rapid review approach that combines abbreviated literature searches with single-reviewer screening may be feasible for focused clinical questions. For complex public health topics, sensitivity seems to be insufficient.

Background Rapid reviews (RRs) have emerged as an efficient alternative to time-consuming systematic reviews—they can help meet the demand for accelerated evidence synthesis to inform decision-making in healthcare. The synthesis of diagnostic evidence has important methodological challenges. Here, we performed an international survey to identify the current practice of producing RRs for diagnostic tests. Methods We developed and administered an online survey inviting institutions that perform RRs of diagnostic tests from all over the world. Results All participants (N = 25) reported the implementation of one or more methods to define the scope of the RR; however, only one strategy (defining a structured question) was used by ≥90% of participants. All participants used at least one methodological shortcut including the use of a previous review as a starting point (92%) and the use of limits on the search (96%). Parallelization and automation of review tasks were not extensively used (48 and 20%, respectively). Conclusion Our survey indicates a greater use of shortcuts and limits for conducting diagnostic test RRs versus the results of a recent scoping review analyzing published RRs. Several shortcuts are used without knowing how their implementation affects the results of the evidence synthesis in the setting of diagnostic test reviews. Thus, a structured evaluation of the challenges and implications of the adoption of these RR methods is warranted.

Objectives The objective is to identify studies that have assessed methodological shortcuts for undertaking rapid reviews (RRs) and mapping these to review conduct stages and Methodological Expectations of Cochrane Intervention Reviews (MECIR) guidance. Study Design and Setting We conducted a systematic scoping review. We searched multiple databases (e.g., MEDLINE, Embase), which were supplemented by grey literature searching. Methods were defined a priori in a published protocol. Results Out of 1,873 records, 90 publications were divided into four RR categories: formal evaluation (n = 14), development, which included four subcategories (n = 65), comparison (n = 2), and applying reporting guidelines/critical appraisal tools (n = 3), and a systematic review surrogate category (n = 6). Four formal evaluation studies were composite evaluations, including more than one shortcut simultaneously. The remaining 10 studies evaluated viable (e.g., including English-only publications) and unviable (e.g., single-reviewer screening) shortcuts, covering five key dimensions and five ‘other’ (e.g., involving stakeholders) considerations while conducting a review. Because of complexities around shortcuts evaluated, only a cursory mapping to MECIR criteria was possible. Conclusion Some methods shortcuts may be valid in the context of RRs, but limitations in the studies may limit their applicability. The results will serve to inform discussions within Cochrane regarding possible future implementation of RRs.

Objectives The objective of this study was to assess the agreement of treatment effect estimates from meta-analyses based on abbreviated or comprehensive literature searches. Study Design and Setting This was a meta-epidemiological study. We abbreviated 47 comprehensive Cochrane review searches and searched MEDLINE/Embase/CENTRAL alone, in combination, with/without checking references (658 new searches). We compared one meta-analysis from each review with recalculated ones based on abbreviated searches. Results The 47 original meta-analyses included 444 trials (median 6 per review [interquartile range (IQR) 3–11]) with 360045 participants (median 1,371 per review [IQR 685–8,041]). Depending on the search approach, abbreviated searches led to identical effect estimates in 34–79% of meta-analyses, to different effect estimates with the same direction and level of statistical significance in 15–51%, and to opposite effects (or effects could not be estimated anymore) in 6–13%. The deviation of effect sizes was zero in 50% of the meta-analyses and in 75% not larger than 1.07-fold. Effect estimates of abbreviated searches were not consistently smaller or larger (median ratio of odds ratio 1 [IQR 1–1.01]) but more imprecise (1.02–1.06-fold larger standard errors). Conclusion Abbreviated literature searches often led to identical or very similar effect estimates as comprehensive searches with slightly increased confidence intervals. Relevant deviations may occur.

Zusammenfassung Im Gesundheitswesen bleibt oft unklar, wie Entscheidungsfindungsprozesse ablaufen und welche Kriterien dabei berucksichtigt werden. Entscheidungstrager/innen vernachlassigen manchmal wichtige Kriterien, gewichten Kriterien unangemessen oder berucksichtigen nicht die beste verfugbare Evidenz als Basis fur ihre Entscheidungen. Die GRADE (Grading of Recommendations Assessment, Development and Evaluation) Arbeitsgruppe hat ein System entwickelt, dass die Entscheidungsfindung unterstutzen soll. Der EtD-Ansatz (Evidence to Decision framework) beschreibt einen Prozess zur Ableitung von Empfehlungen und Entscheidungen aus der Evidenz. Der EtD-Ansatz unterstutzt Personen, die vorliegende Evidenz strukturiert und transparent zu nutzen und tragt dazu bei, dass wichtige Kriterien in der Entscheidungsfindung angemessen berucksichtig werden. EtD-Tabellen konnen sowohl fur klinische Entscheidungen als auch fur Entscheidungen im Gesundheitswesen, im Bereich Public Health und fur Kostenubernahmeentscheidungen herangezogen werden. EtD-Tabellen beinhalten die Formulierung einer Frage, die Bewertung der Evidenz und das Ableiten einer Schlussfolgerung. Sie informieren den Nutzer bzw. die Nutzerin uber die Empfehlung, die das Leitlinien-Gremium getroffen hat, sowie uber die zugrundeliegende Evidenz und bieten somit eine transparente Entscheidungsgrundlage. EtD-Tabellen erleichtern zudem die Dissemination von Empfehlungen.

Background Hip fractures are a major public health problem in elderly populations and are accompanied by high-mortality rates. Whether timing of surgery has an impact on morbidity and mortality has been discussed controversially, numerous studies suggest that the delay of surgery can significantly increase the risk of morbidity and mortality; others report that achieving a stable medical condition is more important than early surgery. The goal of our systematic review is to assess the impact of timing of surgery on health outcomes in patients aged 60 years or older with acute hip fracture. In addition, we will investigate differences in beneficial or harmful effects of timing of surgery in subgroups of patients based on demographic characteristics, physical status, and the use of anticoagulant medications. Methods We will systematically search MEDLINE via Ovid, the Cochrane Library, Embase, PubMed, and clinical trial registries (from 1997 to 2017). In addition, we will search reference lists of pertinent reviews, archives of annual meetings of orthopaedic societies, and contact experts. We will include randomized controlled trials and non-randomized studies assessing the impact of timing of surgery after hip fracture in patients 60 years or older, published in English or German. Our outcomes of interest include health outcomes such as mortality, perioperative complications, functional capacity, and quality of life. We plan to perform meta-analyses if we have at least three sufficiently similar studies. If data are sufficient, we will conduct subgroup-analyses testing for differences between age groups, sex, patients’ physical status as assessed with ASA (American Society of Anesthesiologists) scores, and the use of anticoagulation. Discussion Since this is the first systematic review on this topic since 2010, our findings will help to inform clinical practice guidelines concerning timing of surgery in hip fractures. Furthermore, our findings could contribute to define an optimal time period for surgery for different groups of patients with acute hip fracture. Systematic review registration PROSPERO 2017 CRD42017058216 Electronic supplementary material The online version of this article (doi:10.1186/s13643-017-0559-7) contains supplementary material, which is available to authorized users.

Background Periodontal diseases are responsible for a vast burden of disease globally and are associated with other severe illnesses such as cardiovascular diseases or diabetes. Tests for early diagnosis of periodontal diseases and effective treatments are available. The effectiveness of screening for periodontal diseases to detect periodontal diseases at an early stage during periodic health examinations at primary care facilities, however, is unclear. The objective of this systematic review is to assess the benefits and risks of screening for periodontal diseases in adults during the periodic health examinations. Methods We will use two methodological approaches: (1) a systematic review to assess the effectiveness and risk of harms of screening for periodontal diseases during periodic health examinations and (2) an overview of systematic reviews to determine the effectiveness of treatment approaches for early periodontal disease. We will search electronic databases (Ovid MEDLINE, Embase.com, the Cochrane Library, Epistemonikos, Centre for Reviews and Dissemination databases, PubMed (non-MEDLINE content)) for published studies as well as sources for grey literature to detect unpublished studies. Two authors will independently screen abstracts and full texts using pre-defined eligibility criteria, select studies, extract data, and assess the risk of bias of included studies or reviews. In general, we will conduct a systematic narrative synthesis. Criteria for conducting meta-analyses were defined a priori. Our primary outcomes of interest are tooth loss, loosening of teeth, and depletion of bone tissue. Secondary outcomes are gingivitis/gum inflammation, pocket depths, dental hygiene, lifestyle modifications (e.g., smoking, alcohol, nutrition), and toothache. We consulted a panel of experts and patient representatives to prioritize these outcomes. Two investigators will assess independently the certainty of the evidence for each outcome using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Discussion We anticipate that our review will highlight the gaps in the available evidence about the effectiveness of screening for periodontal diseases during periodic health examinations. Implications for screening programs may be based on linked evidence about the validity of available screening tools and the effectiveness of early treatment. Systematic review registration PROSPERO CRD42017081150 Electronic supplementary material The online version of this article (10.1186/s13643-019-0977-9) contains supplementary material, which is available to authorized users.

Objective To assess the effects of abbreviated literature searches on evidence syntheses conclusions. Study design and setting We randomly selected 60 Cochrane reviews of clinical interventions and repeated literature searches using 14 abbreviated approaches (combinations of MEDLINE, Embase, CENTRAL with and without searches of reference lists). If abbreviated searches missed included studies, we recalculated meta-analyses. Cochrane authors determined whether the new evidence base would change conclusions. We assessed the noninferiority of abbreviated searches allowing for a maximum of 10% changed conclusions. Results We conducted 840 abbreviated literature searches. Noninferiority varied based on the definition of “changed conclusion”. When the reduction of the certainty of a conclusion was of concern, all abbreviated searches were inferior. Searching Embase only rendered the greatest proportion of changed conclusions (27%, 95% confidence interval [CI]: 16%–40%); combining MEDLINE, Embase, CENTRAL with searches of references lists the lowest (8%, 95% CI 3%–18%). When falsely reaching an opposite conclusion was of concern, combining one database with another or with searches of reference lists was noninferior to comprehensive searches (2%, 95% CI: 0%–9%). Conclusion If decision-makers are willing to accept less certainty and a small risk for opposite conclusions, some abbreviated searches are viable options for rapid evidence syntheses. Decisions demanding high certainty require comprehensive searches.

Objectives The aim of article was to assess the risk for random errors in outcomes graded as high certainty of evidence (CoE). Study Design and Setting We randomly selected 100 Cochrane reviews with dichotomous outcomes rated as high CoE using Grading of Recommendations Assessment, Development, and Evaluation. To detect increased risks for random errors, two investigators independently conducted trial sequential analysis using conventional thresholds for type I (α = 0.05) and type II (β = 0.10) errors. We dually regraded all outcomes with increased risks for random errors and conducted multivariate logistic regression analyses to determine predictors of increased risks for random errors. Results Overall, 38% (95% confidence interval: 28–47%) of high CoE outcomes had increased risks for random errors. Outcomes assessing harms were more frequently affected than outcomes assessing benefits (47% vs. 12%). Regrading of outcomes with increased random errors showed that 74% should have been downgraded based on current guidance. Regression analyses rendered small absolute risk differences (P = 0.009) and low number of events (P = 0.001) as significant predictors of increased risks for random errors. Conclusion Decisionmakers need to be aware that outcomes rated as high CoE often have increased risks for false-positive or false-negative findings.

Background: Decisionmakers and guideline developers demand rapid syntheses of the evidence when time sensitive evidence-informed decisions are required. A potential trade-off of such rapid reviews is that their results can have less reliability than results of systematic reviews that can lead to an increased risk of making incorrect decisions or recommendations. We sought to determine how much incremental uncertainty about the correctness of an answer guideline developers and health policy decisionmakers are willing to accept in exchange for a rapid evidence-synthesis. Methods: Employing a purposive sample, we conducted an international web-based, anonymous survey of decisionmakers and guideline developers. Based on a clinical treatment, a public health, and a clinical prevention scenario, participants indicated the maximum risk of getting an incorrect answer from a rapid review that they would be willing to accept. We carefully reviewed data and performed descriptive statistical analyses. Results: In total, 325 (58.5%) of 556 participants completed our survey and were eligible for analysis. The median acceptable incremental risk for getting an incorrect answer from a rapid review across all three scenarios was 10.0% (interquartile range [IQR] 5.0-15.0). Acceptable risks were similar for the clinical treatment (n = 313, median 10.0% [IQR 5.0-15.0]) and the public health scenarios (n = 320, median 10.0% [IQR 5.0-15.0]) and lower for the clinical prevention scenario (n = 312, median 6.5% [IQR 5.0-10.5]). Conclusions: Findings suggest that decisionmakers are willing to accept some trade-off in validity in exchange for a rapid review. Nevertheless, they expect the validity of rapid reviews to come close to that of systematic reviews. Fil: Wagner, Gernot. Danube University Krems; Alemania Fil: Nussbaumer Streit, Barbara. Danube University Krems; Alemania Fil: Greimel, Judith. Universidad de Hohenheim; Alemania Fil: Ciapponi, Agustín. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Gartlehner, Gerald. Danube University Krems; Alemania

Background Seasonal affective disorder (SAD) is a seasonally recurrent type of major depression. This predictable aspect makes it promising for preventive treatment. However, evidence for the efficacy and harm of preventive treatment of SAD is scarce, as are recommendations from clinical practice guidelines. The aim of this study was to assess the current use of preventive treatment of SAD in clinical practice in German-speaking countries for the first time. Methods We conducted a postal and web-based survey sent to the heads of all psychiatric institutions listed in the inventory “Deutsches Krankenhaus Adressbuch, 2015” that contains all psychiatric hospitals in Germany, Austria, and Switzerland. Results One hundred institutions (out of 533 institutions, 19%), which treated in total more than 3100 SAD patients in the years 2014/2015, responded. Of those, 81 reported recommending preventive treatment to patients with a history of SAD. There was no consensus on the optimal starting point for preventive treatment. Most of the institutions that implemented prevention of SAD, recommended lifestyle changes (85%), antidepressants (84%), psychotherapy (73%), and light therapy (72%) to their patients. The situation was similar in northern and southern regions. Conclusions Most hospitals recommended the use of preventive treatment to SAD patients, although evidence on efficacy and harm is limited. A wide variety of interventions were recommended, although guidelines only include recommendations for acute treatment. To assist psychiatrists and patients in future decision making, controlled studies on preventive treatment for SAD that compare different interventions with one another are needed.

Background Systematic reviews offer the most reliable and valid support for health policy decision-making, patient information, and guideline development. However, they are labor intensive and frequently take longer than 1 year to complete. Consequently, they often do not meet the needs of those who need to make decisions quickly. Rapid reviews have therefore become a pragmatic alternative to systematic reviews. They are knowledge syntheses that abbreviate certain methodological aspects of systematic reviews to produce information more quickly. Methodological shortcuts often take place in literature identification. A potential drawback is less reliable results. To date, the impact of abbreviated searches on estimates of treatment effects and subsequent conclusions has not been analyzed systematically across multiple bodies of evidence. We aim to answer the research question: Do bodies of evidence that are based on abbreviated literature searches lead to different conclusions about benefits and harms of interventions compared with bodies of evidence that are based on comprehensive, systematic literature searches? Methods We will use a non-inferiority and meta-epidemiologic design. The primary outcome is the proportion of discordant conclusions based on different search approaches. Drawing of a pool of Cochrane reports published between 2012 and 2016, we will randomly select 60 reports. Eligible reports are those that present a summary-of-findings table, draw a clear conclusion, present data for meta-analyses, and document the search strategy clearly. We will conduct several abbreviated searches to detect whether included studies in these Cochrane reviews could be detected. If searches could not detect all studies, we will revise the original summary-of-findings table and ask review authors whether the missed evidence would change conclusions of their report. We will determine the proportion of discordant conclusions for each abbreviated search approach. We will consider an abbreviated search as non-inferior if the lower limit of the 95% confidence interval of the proportion of discordant conclusions is below the non-inferiority margin, which is determined based on results of a survey for clinical and public health scenarios. Discussion This will be the first study to assess whether the reduced sensitivity of abbreviated searches has an impact on conclusions across multiple bodies of evidence, not only on effect estimates.

Background Most European and North American clinical practice guidelines recommend screening for asymptomatic bacteriuria (ASB) as a routine pregnancy test. Antibiotic treatment of ASB in pregnant women is supposed to reduce maternal upper urinary tract infections (upper UTIs) and preterm labour. However, most studies supporting the treatment of ASB were conducted in the 1950s to 1980s. Because of subsequent changes in treatment options for ASB and UTI, the applicability of findings from these studies has come into question. Our systematic review had three objectives: firstly, to assess the patient-relevant benefits and harms of screening for ASB versus no screening; secondly, to compare the benefits and harms of different screening strategies; and thirdly, in case no reliable evidence on the overarching screening question was identified, to determine the benefits and harms of treatment of ASB. Methods We systematically searched several bibliographic databases, trial registries, and other sources (up to 02/2016) for randomised controlled trials (RCTs) and prospective non-randomised trials. Two authors independently reviewed abstracts and full-text articles and assessed the risk of bias of the studies included. As meta-analyses were not possible, we summarised the results qualitatively. Results We did not identify any eligible studies that investigated the benefits and harms of screening for ASB versus no screening or that compared different screening strategies. We identified four RCTs comparing antibiotics with no treatment or placebo in 454 pregnant women with ASB. The results of 2 studies published in the 1960s showed a statistically significant reduction in rates of pyelonephritis (odds ratio [OR] = 0.21, 95 % confidence interval [CI] 0.07–0.59) and lower UTI (OR = 0.10, 95 % CI 0.03–0.35) in women treated with antibiotics. By contrast, event rates reported by a recent study were not statistically significantly different, neither regarding pyelonephritis (0 % vs. 2.2 %; OR = 0.37, CI 0.01–9.25, p = 0.515) nor regarding lower UTI during pregnancy (10 % vs. 18 %; Peto odds ratio [POR] = 0.53, CI 0.16–1.79, p = 0.357). Data were insufficient to determine the risk of harms. As three of the four studies were conducted several decades ago and have serious methodological shortcomings, the applicability of their findings to current health care settings is likely to be low. The recent high-quality RCT was stopped early due to a very low number of primary outcome events, a composite of preterm delivery and pyelonephritis. Therefore, the results did not show a benefit of treating ASB. Conclusions To date, no reliable evidence supports routine screening for ASB in pregnant women. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-1128-0) contains supplementary material, which is available to authorized users.

BACKGROUND: Lead exposure is a serious health hazard, especially for children. It is associated with physical, cognitive and neurobehavioural impairment in children. There are many potential sources of lead in the environment, therefore trials have tested many household interventions to prevent or reduce lead exposure. This is an update of a previously published review. OBJECTIVES: To assess the effects of household interventions intended to prevent or reduce further lead exposure in children on improvements in cognitive and neurobehavioural development, reductions in blood lead levels and reductions in household dust lead levels. SEARCH METHODS: In March 2020, we updated our searches of CENTRAL, MEDLINE, Embase, 10 other databases and ClinicalTrials.gov. We also searched Google Scholar, checked the reference lists of relevant studies and contacted experts to identify unpublished studies. SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi‐RCTs of household educational or environmental interventions, or combinations of interventions to prevent lead exposure in children (from birth to 18 years of age), where investigators reported at least one standardised outcome measure. DATA COLLECTION AND ANALYSIS: Two authors independently reviewed all eligible studies for inclusion, assessed risk of bias and extracted data. We contacted trialists to obtain missing information. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS: We included 17 studies (three new to this update), involving 3282 children: 16 RCTs (involving 3204 children) and one quasi‐RCT (involving 78 children). Children in all studies were under six years of age. Fifteen studies took place in urban areas of North America, one in Australia and one in China. Most studies were in areas with low socioeconomic status. Girls and boys were equally represented in those studies reporting this information. The duration of the intervention ranged from three months to 24 months in 15 studies, while two studies performed interventions on a single occasion. Follow‐up periods ranged from three months to eight years. Three RCTs were at low risk of bias in all assessed domains. The other 14 studies were at unclear or high risk of bias; for example, we considered two RCTs and one quasi‐RCT at high risk of selection bias and six RCTs at high risk of attrition bias. National or international research grants or governments funded 15 studies, while the other two did not report their funding sources. Education interventions versus no intervention None of the included studies in this comparison assessed effects on cognitive or neurobehavioural outcomes, or adverse events. All studies reported data on blood lead level outcomes. Educational interventions showed there was probably no evidence of a difference in reducing blood lead levels (continuous: mean difference (MD) –0.03, 95% confidence interval (CI) –0.13 to 0.07; I² = 0%; 5 studies, 815 participants; moderate‐certainty evidence; log‐transformed data), or in reducing floor dust levels (MD –0.07, 95% CI –0.37 to 0.24; I² = 0%; 2 studies, 318 participants; moderate‐certainty evidence). Environmental interventions versus no intervention Dust control: one study in this comparison reported data on cognitive and neurobehavioural outcomes, and on adverse events in children. The study showed numerically there may be better neurobehavioural outcomes in children of the intervention group. However, differences were small and the CI included both a beneficial and non‐beneficial effect of the environmental intervention (e.g. mental development (Bayley Scales of Infant Development‐II): MD 0.1, 95% CI –2.1 to 2.4; 1 study, 302 participants; low‐certainty evidence). The same study did not observe any adverse events related to the intervention during the eight‐year follow‐up, but observed two children with adverse events in the control group (1 study, 355 participants; very low‐certainty evidence). Meta‐analysis also found no evidence of effectiveness on blood lead levels (continuous: MD –0.02, 95% CI –0.09 to 0.06; I² = 0%; 4 studies, 565 participants; moderate‐certainty evidence; log‐transformed data). We could not pool the data regarding floor dust levels, but studies reported that there may be no evidence of a difference between the groups (very low‐certainty evidence). Soil abatement: the two studies assessing this environmental intervention only reported on the outcome of 'blood lead level'. One study showed a small effect on blood lead level reduction, while the other study showed no effect. Therefore, we deem the current evidence insufficient to draw conclusions about the effectiveness of soil abatement (very low‐certainty evidence). Combination of educational and environmental interventions versus standard education Studies in this comparison only reported on blood lead levels and dust lead levels. We could not pool the studies in a meta‐analysis due to substantial differences between the studies. Since the studies reported inconsistent results, the evidence is currently insufficient to clarify whether a combination of interventions reduces blood lead levels and floor dust levels (very low‐certainty evidence). AUTHORS' CONCLUSIONS: Based on available evidence, household educational interventions and environmental interventions (namely dust control measures) show no evidence of a difference in reducing blood lead levels in children as a population health measure. The evidence of the effects of environmental interventions on cognitive and neurobehavioural outcomes and adverse events is uncertain too. Further trials are required to establish the most effective intervention for reducing or even preventing further lead exposure. Key elements of these trials should include strategies to reduce multiple sources of lead exposure simultaneously using empirical dust clearance levels. It is also necessary for trials to be carried out in low‐ and middle‐income countries and in differing socioeconomic groups in high‐income countries.