Follow-up care after a positive human papillomavirus (HPV) screening result is essential for cervical cancer prevention, yet many individuals do not complete diagnostic evaluation or treatment. We conducted a systematic review to synthesize barriers to follow-up care after a positive HPV screening result across diverse international settings. The protocol was registered in PROSPERO (CRD420251062691). We searched MEDLINE, Embase, Scopus, and Web of Science for English language studies published from 2015 to 2025. Two reviewers independently screened studies, and findings were narratively synthesized. Fifteen studies met inclusion criteria, and were conducted across 12 locations in Africa, Europe, North America, and South America. Five barrier groups emerged: health system barriers (lack of local treatment, long wait times, limited follow-up capacity), knowledge and communication barriers (confusion about HPV results and next steps), psychological and emotional barriers (fear of treatment, stigma surrounding HPV, distrust in medical systems), social and relational barriers (partner influence, gender roles, lack of peer support), and structural and logistical barriers (transportation, costs, work conflicts). Across settings, missed follow-up after positive HPV screening appeared more strongly linked to health-system and structural barriers than lack of motivation. Strengthening referral pathways, patient tracking systems, communication of results, navigation support, and timely treatment access may improve follow-up completion and enhance the effectiveness of HPV-based screening programs.
Abstract Self-swab enhanced surveillance of respiratory pathogens is an emerging public health tool that could expand the reach of existing surveillance, providing real-time monitoring of circulating pathogens in the community. We conducted a literature search using terms covering self-swabbing, respiratory infection, and surveillance. For inclusion, publications had to describe a study on the use of serial unsupervised self-swabbing for the purpose of tracking the frequency of respiratory infections in the general population. We found 42 publications originating from 27 unique studies on self-swab enhanced surveillance for respiratory infection. Twenty-six studies (96%) were conducted in a high-income setting. Eleven studies (41%) included children under the age of 12 years. Most studies involved a central laboratory conducting polymerase chain reaction testing on returned self-swabs which permitted testing for a wide range of pathogens. Among studies reporting the number of invitees, <20% of invited individuals typically agreed to join. In studies requiring regular symptom reporting, adherence was commonly > 75%. Adherence rates for self-swab return were more variable (between 42% and 96%). Eight studies (30%) explored rapid antigen testing which appears to reduce the time taken between symptom onset and test result notification but limits the number of pathogens that can be evaluated compared with polymerase chain reaction testing. Based on our findings, we present a list of suggestions to guide future implementation and investigation. Further work is needed to characterize self-swab enhanced surveillance approaches that optimize community participation and protocol adherence, generate as close to real-time data as possible, and minimize costs.
Abstract With the aim to identify risk factors associated with bloodstream infections (BSI) caused by carbapenem-resistant Enterobacterales (CRE) in patients with hematological malignancies (HM), a systematic review and meta-analysis were conducted in accordance with PRISMA guidelines and registered in PROSPERO (CRD420251176369). MEDLINE, PubMed, and Embase were searched for studies published up to 31 October 2025. Observational studies evaluating risk factors for laboratory-confirmed CRE BSI in adult or paediatric patients with HMs were included. Adjusted and unadjusted effect estimates were analysed separately. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random- or fixed-effects models based on heterogeneity. Six studies were included. In meta-analyses based on adjusted estimates, prior exposure to carbapenems (OR 8.01, 95% CI 2.98–21.54), cephalosporins (OR 4.11, 95% CI 1.53–11.05) and fluoroquinolones (OR 3.94, 95% CI 1.83–8.44) resulted to be associated with CRE BSI. Meta-analyses of crude data showed additional associations with CRE colonization, previous infections, newly diagnosed disease or first relapse, chronic liver disease, diabetes mellitus, and prior exposure to multiple antibiotic classes. Prior exposure to carbapenems, cephalosporins, and fluoroquinolones was consistently associated with CRE BSI in adjusted analyses. However, the small number of included studies and the wide confidence intervals limit the precision and generalizability of these estimates. Previous antibiotic exposure should therefore be considered as part of an integrated risk assessment together with colonization status, previous microbiological findings, clinical severity, and local epidemiology, rather than as a stand-alone criterion for empirical therapy.
Abstract This review aims to assess the condition and primary factors influencing reporting quality and bias in systematic reviews of clinical prediction models. We conducted a critical review through searching three databases (PubMed, Embase, Cochrane Library) from inception to January 7, 2023 in which screening, data extraction, and assessment were conducted independently by pairs, employing TRIPOD-SRMA and ROBIS to evaluate the reporting and methodological quality. Data were summarized through descriptive statistics, visual analysis, and multiple linear regression analysis. Thousand four reviews were included. Reporting quality was poor. The average main text quality score was 16.4 ± 4.1 out of 33 points, and the average abstract quality score was 5.2 ± 1.7 out of 12 points. Year, economic level, purpose of the model, impact factors, and types of systematic reviews were associated with the quality of abstracts or the main text. Merely, 0.2% (2/1004) of the reviews assessed were classified as having low risk of bias. Systematic reviews of clinical prediction models demonstrate inadequate reporting and significant risk of bias. Optimizing research design, enforcing stricter reporting guidelines, promoting protocol pre-registration, and enhancing journal review processes to boost reliability and transparency are warranted.
Rapid changes in urbanization in India have paralleled increased prevalence in noncommunicable diseases (NCDs), including type 2 diabetes (T2D), hypertension (HTN), and obesity. To examine sex-specific temporal trends in the prevalence of T2D, HTN, general obesity (GO), and abdominal obesity (AO) among urban populations in India since 2000, a systematic review and meta-analysis was conducted in accordance with a registered Prospective Register of Systematic Reviews protocol (CRD42024548962). PubMed, Global Health (via EBSCOhost), Embase, Scopus, and Web of Science were searched for studies from 2000-2025 (initial search: October 12, 2024; update: July 4, 2025). Eligible studies were cross-sectional and reported the prevalence of T2D or HTN or obesity in urban Indian populations. Screening, data extraction, and risk-of-bias assessment using the Hoy tool were performed independently by 2 reviewers, with a third resolving conflicts. Pooled prevalence was estimated via random-effects meta-analysis in R (version 4.5.3), with forest and funnel plots generated using ggplot2. Out of 3143 records screened, 57 studies were included. The pooled prevalence demonstrated upward trajectory. T2D rose from 13% in 2000-2005 to 21% in 2021-2025, and HTN from 29% to 31%. For obesity, GO increased from 24% in 2000-2005 to 36% in 2016-2020, while AO rose from 47% to 72% over the same period. Sex-stratified analyses showed greater increases among males for T2D and HTN, whereas AO increased more among females. These findings underscore increasing T2D, HTN, and obesity in urban India, highlighting the need for strengthened primary care and supportive environmental and policy measures address the urban NCD burden.
