Background: Patients have described symptoms persisting or recurring for weeks after acute COVID-19 illness referred to as post COVID-19 conditions. The objective of this living systematic review is to document the prevalence of post COVID-19 conditions 4-12 weeks (short-term) and >12 weeks (long-term) after COVID-19 diagnosis. Methods: We conducted a systematic review of primary peer-reviewed published literature reporting on the prevalence of the symptoms, sequelae and difficulties conducting usual activities ≥4 weeks after COVID-19 diagnosis. We adapted a previous search strategy used by the U.K. National Institute for Health and Care Excellence and updated it to search for new research published until January 15, 2021 in Embase, Medline, PsychInfo, and Cochrane Central. Two independent reviewers screened references; one reviewer extracted data and assessed risk of bias and certainty in the evidence while another verified them. Prevalence data from laboratory-confirmed individuals were meta-analyzed, where appropriate, using a random effects model and synthesized separately in the short- and long-term periods after COVID-19 diagnosis; data from clinically-diagnosed populations were synthesized narratively. Results: Of the 2807 unique citations, 36 observational studies met our inclusion criteria. Over 100 post COVID-19 conditions were reported in laboratory-confirmed individuals. Eighty-three percent (95%CI: 65-93%; low certainty) and 56% (95%CI: 34-75%; very low certainty) reported persistence or presence of one or more symptoms in the short- and long-term, respectively. The most prevalent symptoms in both periods included: fatigue, general pain or discomfort, sleep disturbances, shortness of breath and anxiety or depression (point estimates ranging from 22-51%; low to very low certainty). Interpretation: Our data indicate that a substantial proportion of individuals reported a variety of symptoms ≥4 weeks after COVID-19 diagnosis. Due to low certainty in the evidence, further research is needed to determine the true burden of post COVID-19 conditions.

Our review highlights that discordance exists between studies examining blinded versus unblinded risk of bias assessments at the systematic review level. The best approach to risk of bias assessment remains unclear, however, given the increased time and resources required to conceal reports effectively, it may not be necessary for risk of bias assessments to be conducted under blinded conditions in a systematic review.

BackgroundIn 2018, the World Health Organization reported that depression is the most common cause of disability worldwide, with over 300 million people currently living with depression. Depression affects an individual’s physical health and well-being, impacts psychosocial functioning, and has specific negative short- and long-term effects on maternal health, child health, developmental trajectories, and family health. The aim of these reviews is to identify evidence on the benefits and harms of screening for depression in the general adult population and in pregnant and postpartum women.MethodsSearch strategies were developed and tested through an iterative process by an experienced medical information specialist in consultation with the review team. We will search MEDLINE, Embase, PsycINFO, CINAHL, and the Cochrane Library, and a randomized controlled trial filter will be used. The general adult review will be an update of a systematic review previously used by the Canadian Task Force on Preventive Health Care for their 2013 guideline recommendation. The search strategy will be updated and will start from the last search date of the previous review (May 2012). The pregnant and postpartum review will be a de novo review with no date restriction. For both reviews, we will search for unpublished documents following the CADTH Grey Matters checklist and relevant websites. Titles and abstracts will be screened using the liberal accelerated method. Two reviewers will independently screen full-text articles for relevance using pre-specified eligibility criteria and assess the risk of bias of included studies using the Cochrane Risk of Bias tool. Outcomes of interest for the general adult population review include symptoms of depression or diagnosis of major depressive disorder, health-related quality of life, day-to-day functionality, lost time at work/school, impact on lifestyle behaviour, suicidality, false-positive result, labelling/stigma, overdiagnosis or overtreatment, and harms of treatment. Outcomes of interest for the pregnant and postpartum review include mental health outcomes (e.g. diagnosis of major depressive disorder), parenting outcomes (e.g. mother-child interactions), and infant outcomes (e.g. infant health and development).DiscussionThese two systematic reviews will offer informative evaluations of depression screening. The findings will be used by the Task Force to help develop guideline recommendations on depression screening in the general adult population and in pregnant and postpartum women in Canada.Systematic review registrationPROSPERO (CRD42018099690)Electronic supplementary materialThe online version of this article (10.1186/s13643-018-0930-3) contains supplementary material, which is available to authorized users.

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his guideline from the Canadian Task Force on Preventive Health Care focuses on screening for thyroid dysfunction among asymptomatic nonpregnant adults in primary care beyond usual care and vigilance for signs and symptoms of thyroid dysfunction. Thyroid dysfunction is diagnosed based on abnormal levels of serum thyroid-stimulating hormone (TSH) and can be characterized as either hypo-or hyperthyroidism. Hypothyroidism results from impaired thyroid hormone production (i.e., thyroxine [T 4 ] or triiodothyronine [T 3 ]), leading to elevated levels of TSH. Hypothyroidism is often caused by autoimmune disorders (e.g., Hashimoto thyroiditis) or occurs as a sequela of hyperthyroidism treatment, which can render the thyroid gland nonfunctional. 1 Hyperthyroidism results from an overproduction of thyroid hormone, leading to the suppression of TSH. 1 Causes of hyperthyroidism include Graves disease, toxic multinodular goitre and toxic adenoma. 2 Signs and symptoms of thyroid dysfunction are variable between patients and often nonspecific. For hypothyroidism, symptoms may include tiredness, sensitivity to cold, dry skin, hair loss, weight gain and slowed movements and thoughts. 1,3-6 For hyperthyroidism, symptoms may include sinus tachycardia, atrial fibrillation, hyperactivity or irritability, intolerance to heat, tremor and weight loss. 1,2,7 Some people with thyroid dysfunction are asymptomatic. 8 If left untreated, hypothyroidism may increase the risk of cardiac dysfunction, hypertension, dyslipidemia, cognitive impairment and, in rare cases, myxedema coma. 3,9 Untreated hyperthyroidism may increase the risk of cardiac conditions (e.g., atrial fibrillation, heart failure) or bone fractures, and could lead to thyroid storm, an uncommon, life-threatening condition associated with tachycardia, extreme fatigue, fever and nausea. 2,10 Minor variations in thyroid function as measured by abnormal levels of TSH are often self-limiting. Observational studies have reported that levels of TSH appear to revert to normal without treatment in 37%-62% of patients with initially elevated levels and 51% with initially low levels, particularly for milder cases of thyroid dysfunction (mean follow-up 32-60 mo). 11,12 Screening is intended to detect thyroid dysfunction in asymptomatic patients in order to prevent adverse consequences of untreated thyroid dysfunction. 13 Screening is done by performing a blood test for TSH. Abnormal levels of TSH are followed up with additional diagnostic testing that often includes blood tests to measure thyroid hormone levels or other tests (e.g., ultrasound) as warranted. An estimated 10% of Canadians aged 45 years or older report that they have been diagnosed with thyroid dysfunction, and prevalence is higher in women (16%) than in men (4%). 14 Prevalence has also been reported to be higher in adults older than 85 years (16%), 14 GUIDELINE HEALTH SERVICES CPD