Women with a history of gestational diabetes mellitus (GDM) are at a higher risk of developing type 2 diabetes. Several postpartum lifestyle intervention studies have been conducted for this high-risk group; however, the randomized clinical trials have not been evaluated systematically. Thus, the aim of this article is to evaluate the outcomes of clinical trials that focus on diabetes prevention among women with DGM. This systematic review utilized Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Chinese and US databases were searched. Randomized controlled trials of postpartum lifestyle interventions to prevent type 2 diabetes in women with prior GDM were reviewed. Outcomes included in this review are type 2 diabetes incidences, insulin insistence, and weight-related measures. The effect size of these outcomes in each study was computed. Data on intervention components were extracted, including type (in-person vs. technology-based), content (diet or physical activity or both), form (individual session vs. group session), duration, intensity, evaluation time point, and program delivery. A total of 12 studies met the inclusion criteria. The mean annual type 2 diabetes mellitus (T2DM) incidence of the intervention group was lower than that of the comparison group (6.0% vs. 9.3%), although there was no statistical difference between the two groups. About 50% of these studies and two-thirds of studies, respectively, reported a significant decrease in insulin resistance-related measures and weight-related measures in the intervention group compared with the comparison group. The median intervention duration and study length were 6 months. Postpartum lifestyle interventions can be effective in reducing T2DM development and insulin resistance, and decrease weight in women with GDM history, regardless of the intervention types (technology-based or in-person). Effective interventions typically include dietary changes while some physical activity changes can also improve outcomes. However, more interventions with long-term efficacy evaluation are warranted.

Despite clear evidence that colorectal cancer (CRC) screening reduces mortality, screening, including fecal immunochemical tests (FIT), is underutilized. We conducted a systematic review to determine the evidence of efficacy of interventions to improve FIT completion that could be scaled and utilized in population health management. We systematically searched publication databases for studies evaluating provider- or system-level interventions to improve CRC screening by FIT between 1 January 1996 and 13 December 2017 without language restrictions. Twenty articles describing 25 studies were included, 23 were randomized controlled trials with 1 quasi-experimental and 1 observational study. Ten studies discussed mailed FIT outreach, 4 pre-FIT patient reminders, 3 tailored patient messages, 2 post-FIT reminders, 2 paired FIT with influenza vaccinations, 2 provider alerts and 1 study each described the use of high-quality small media and patient financial incentives. Mailed FIT outreach was consistently effective with median improvement in CRC screening of 21.5% (interquartile range (IQR) 13.6%−29.0%). FIT paired with vaccinations led to a median 15.9% (IQR 15.6%−16.3%) improvement, while pre-FIT and post-FIT reminders demonstrated modest efficacy with median 4.1% (IQR 3.6%−6.7%) and 3.1% (IQR 2.9%−3.3%) improvement in CRC screening, respectively. More than half the studies were at high or unclear risk of bias; heterogenous study designs and characteristics precluded meta-analysis. FIT-based CRC screening programs utilizing multilevel interventions (e.g. mailed FIT outreach, FIT paired with other preventative services, and provider alerts) have the potential to significantly increase screening participation. However, such programs must also follow-up patients with abnormal FIT results.

PURPOSE Based on the recognition that food insecurity (FI) is associated with poor health across the life course, many US health systems are actively exploring ways to help patients access food resources. This review synthesizes findings from studies examining the effects of health care-based interventions designed to reduce FI. METHODS We conducted a systematic review of peer-reviewed literature published from January 2000 through September 2018 that described health carebased FI interventions. Standardized mean differences (SMD) were calculated and pooled when appropriate. Study quality was rated using Grading Recommendations Assessment Development and Evaluation criteria. RESULTS Twenty-three studies met the inclusion criteria and examined a range of FI interventions and outcomes. Based on study design and sample size, 74% were rated low or very low quality. Studies of referral-based interventions reported moderate increases in patient food program referrals (SMD = 0.67, 95% CI, 0.36-0.98; SMD = 1.42, 95% CI, 0.76-2.08) and resource use (pooled SMD = 0.54, 95% CI, 0.31-0.78). Studies describing interventions providing food or vouchers reported mixed results for the actual change in fruit/vegetable intake, averaging to no impact when pooled (-0.03, 95% CI,-0.66 to 0.61). Few studies evaluated health or utilization outcomes; these generally reported small but positive effects. CONCLUSIONS Although a growing base of literature explores health care-based FI interventions, the low number and low quality of studies limit inferences about their effectiveness. More rigorous evaluation of FI interventions that includes health and utilization outcomes is needed to better understand roles for the health care sector in addressing FI.

Background-Spontaneous loss of hepatitis B surface antigen (HBsAg), or functional cure, in patients with chronic hepatitis B (CHB) significantly reduces liver-related complications. Differential rates have been suggested by individual studies performed in non-endemic and endemic regions, potentially related to likelihood of spontaneous clearance if CHB was acquired as an adult versus child. We systematically determined a pooled annual rate of HBsAg loss in untreated CHB-infected adults and examined impact of regional endemicity. Methods-Pubmed/EMBASE were searched for observational cohort studies and non-treatment arms of randomized controlled trials (RCTs) reporting proportion of patients with CHB achieving spontaneous HBsAg loss. RCTs were excluded from meta-analyses due to substantial cohort differences. Results were stratified on whether the underlying cohort primarily arose from an endemic, defined as CHB prevalence >2%, or non-endemic region. We explored sources of heterogeneity through univariate meta-regression. Results-Of 4771 screened, 66 studies (11 RCTs, 38 prospective and 17 retrospective cohort studies) met inclusion criteria and 55 were included in meta-analyses with exclusion of RCTs. Spontaneous HBsAg loss occurred in 3489 (7.6%) of 45,975 patients with 341,862 person-years of follow-up. The pooled annual incidence rate of HBsAg loss was 1.13% (0.92-1.36%, I 2 =96%). Rates did not differ by endemicity: 1.13% (0.85-1.45%) in endemic vs 1.29% (0.99-1.62%) in non-endemic cohorts. Meta-regression showed proportion of cohort HBeAg-negative and cohort age were primary contributors to substantial heterogeneity. Conclusion-Globally, spontaneous HBsAg loss occurs infrequently (~1% per year) in treatment-naïve adults with CHB infection. The low and homogeneous rate of HBsAg loss

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