scispace - formally typeset
Search or ask a question
Author

Nancy D Berkman

Bio: Nancy D Berkman is an academic researcher from University of North Carolina at Chapel Hill. The author has contributed to research in topics: Systematic review & Observational study. The author has an hindex of 14, co-authored 40 publications receiving 3011 citations. Previous affiliations of Nancy D Berkman include United States Department of Health and Human Services & Research Triangle Park.

Papers
More filters
Journal ArticleDOI
TL;DR: Low literacy is associated with several adverse health outcomes and future research, using more rigorous methods, will better define these relationships and guide developers of new interventions.
Abstract: OBJECTIVE: To review the relationship between literacy and health outcomes DATA SOURCES: We searched MEDLINE, Cumulative Index to Nursing and Allied Health (CINAHL), Educational Resources Information Center (ERIC), Public Affairs Information Service (PAIS), Industrial and Labor Relations Review (ILLR), PsychInfo, and Ageline from 1980 to 2003 STUDY SELECTION: We included observational studies that reported original data, measured literacy with any valid instrument, and measured one or more health outcomes Two abstractors reviewed each study for inclusion and resolved disagreements by discussion DATA EXTRACTION: One reviewer abstracted data from each article into an evidence table; the second reviewer checked each entry The whole study team reconciled disagreements about information in evidence tables Both data extractors independently completed an 11-item quality scale for each article; scores were averaged to give a final measure of article quality DATA SYNTHESIS: We reviewed 3,015 titles and abstracts and pulled 684 articles for full review; 73 articles met inclusion criteria and, of those, 44 addressed the questions of this report Patients with low literacy had poorer health outcomes, including knowledge, intermediate disease markers, measures of morbidity, general health status, and use of health resources Patients with low literacy were generally 15 to 3 times more likely to experience a given poor outcome The average quality of the articles was fair to good Most studies were cross-sectional in design; many failed to address adequately confounding and the use of multiple comparisons CONCLUSIONS: Low literacy is associated with several adverse health outcomes Future research, using more rigorous methods, will better define these relationships and guide developers of new interventions

1,863 citations

08 Mar 2012
TL;DR: This Guide presents issues key to the development of Comparative Effectiveness Reviews and describes recommended approaches for addressing difficult, frequently encountered methodological issues.
Abstract: This document updates the existing Agency for Healthcare Research and Quality (AHRQ) Evidence-based Practice Center (EPC) Methods Guide for Effectiveness and Comparative Effectiveness Reviews on assessing the risk of bias of individual studies. As with other AHRQ methodological guidance, our intent is to present standards that can be applied consistently across EPCs and topics, promote transparency in processes, and account for methodological changes in the systematic review process. These standards are based on available empirical evidence, theoretical principles, or workgroup consensus: as greater evidence accumulates in this methodological area, our standards will continue to evolve. When possible, our recommended standards offer flexibility to account for the wide range of AHRQ EPC review topics and included study designs.Some EPC reviews may rely on an assessment of high risk of bias to serve as a threshold between included and excluded studies; in addition, EPC reviews use risk-of-bias assessments in grading the strength of the body of evidence. Assessment of risk of bias as unclear, high, medium, or low may also guide other steps in the review process, such as study inclusion for qualitative and quantitative synthesis, and interpretation of heterogeneous findings.This guidance document begins by defining terms as appropriate for the EPC program, explores the potential overlap in various constructs used in different steps of the systematic review, and offers recommendations on the inclusion and exclusion of constructs that may apply to multiple steps of the systematic review process. We note that this guidance applies to reviews—such as AHRQ-funded reviews—that separately assess the risk of bias of outcomes from individual studies, the strength of the body of evidence, and applicability of the findings. This guidance applies to comparative effectiveness reviews that require interventions with comparators and systematic reviews that may include noncomparative studies. A key construct, however, is that risk-of-bias assessments judge whether the design and conduct of the study compromised the believability of the link between exposure and outcome. This guidance may not be relevant for reviews that combine evaluations of risk of bias or quality of individual studies with applicability.Later sections of this guidance document provide guidance on the stages involved in assessing risk of bias and design-specific minimum criteria to evaluate risk of bias. We discuss and recommend tools and conclude with guidance on summarizing risk of bias.

513 citations

06 Sep 2013
TL;DR: This article developed a framework for the assessment of the risk of bias and confounding against causality from a body of observational evidence, and to refine a tool to aid in identifying risk of biases, confounding, and precision in individual studies.
Abstract: Objectives To develop a framework for the assessment of the risk of bias and confounding against causality from a body of observational evidence, and to refine a tool to aid in identifying risk of bias, confounding, and precision in individual studies. Methods In conjunction with a Working Group, we sought to develop an overarching approach to assess the effect of confounding across the body of observational study evidence and within individual studies. We sought feedback from Working Group members on critical sources of bias most common to each observational study design type. We then refined and reduced the set of “core” questions that would most likely be necessary for evaluating risk of bias and confounding concerns for each design and refined the instructions provided to users to improve clarity and usefulness. Results We developed a framework that identifies additional steps necessary to evaluate the validity of causal claims in observational studies of benefits and harms from interventions. With the help of the Working Group, we narrowed the list of RTI Item Bank questions for evaluating risk of bias and precision from 29 to 16. Working Group members also provided their opinion of the most important questions for assessing risk of bias for four common observational study design types. Conclusions Attributing causality to interventions from such evidence requires prespecification of anticipated sources of confounding prior to the review, followed by appraisal of potential confounders at three levels: outcomes, studies, and the body of evidence. We propose a substantial expansion in the critical appraisal of confounding when systematic reviews include observational studies for evaluation of benefits or harms of interventions. Questions about burden, reliability, and validity remain to be answered. Consensus around specific items necessary for evaluating risk of bias for different types of observational study designs does not yet exist.

205 citations

Journal ArticleDOI
TL;DR: In this paper, the authors present guidelines for risk-of-bias assessment in systematic reviews, focusing on transparency and reproducibility of judgments, separating risk of bias from other constructs such as applicability and precision.

149 citations

Journal ArticleDOI
26 Jun 2018-JAMA
TL;DR: In women, screening to prevent osteoporotic fractures may reduce hip fractures, and treatment reduced the risk of vertebral and nonvertebral fractures; there was not consistent evidence of treatment harms.
Abstract: Importance Osteoporotic fractures cause significant morbidity and mortality. Objective To update the evidence on screening and treatment to prevent osteoporotic fractures for the US Preventive Services Task Force. Data Sources PubMed, the Cochrane Library, EMBASE, and trial registries (November 1, 2009, through October 1, 2016) and surveillance of the literature (through March 23, 2018); bibliographies from articles. Study Selection Adults 40 years and older; screening cohorts without prevalent low-trauma fractures or treatment cohorts with increased fracture risk; studies assessing screening, bone measurement tests or clinical risk assessments, pharmacologic treatment. Data Extraction and Synthesis Dual, independent review of titles/abstracts and full-text articles; study quality rating; random-effects meta-analysis. Main Outcomes and Measures Incident fractures and related morbidity and mortality, diagnostic and predictive accuracy, harms of screening or treatment. Results One hundred sixty-eight fair- or good-quality articles were included. One randomized clinical trial (RCT) (n = 12 483) comparing screening with no screening reported fewer hip fractures (2.6% vs 3.5%; hazard ratio [HR], 0.72 [95% CI, 0.59-0.89]) but no other statistically significant benefits or harms. The accuracy of bone measurement tests to identify osteoporosis varied (area under the curve [AUC], 0.32-0.89). The pooled accuracy of clinical risk assessments for identifying osteoporosis ranged from AUC of 0.65 to 0.76 in women and from 0.76 to 0.80 in men; the accuracy for predicting fractures was similar. For women, bisphosphonates, parathyroid hormone, raloxifene, and denosumab were associated with a lower risk of vertebral fractures (9 trials [n = 23 690]; relative risks [RRs] from 0.32-0.64). Bisphosphonates (8 RCTs [n = 16 438]; pooled RR, 0.84 [95% CI, 0.76-0.92]) and denosumab (1 RCT [n = 7868]; RR, 0.80 [95% CI, 0.67-0.95]) were associated with a lower risk of nonvertebral fractures. Denosumab reduced the risk of hip fracture (1 RCT [n = 7868]; RR, 0.60 [95% CI, 0.37-0.97]), but bisphosphonates did not have a statistically significant association (3 RCTs [n = 8988]; pooled RR, 0.70 [95% CI, 0.44-1.11]). Evidence was limited for men: zoledronic acid reduced the risk of radiographic vertebral fractures (1 RCT [n = 1199]; RR, 0.33 [95% CI, 0.16-0.70]); no studies demonstrated reductions in clinical or hip fractures. Bisphosphonates were not consistently associated with reported harms other than deep vein thrombosis (raloxifene vs placebo; 3 RCTs [n = 5839]; RR, 2.14 [95% CI, 0.99-4.66]). Conclusions and Relevance In women, screening to prevent osteoporotic fractures may reduce hip fractures, and treatment reduced the risk of vertebral and nonvertebral fractures; there was not consistent evidence of treatment harms. The accuracy of bone measurement tests or clinical risk assessments for identifying osteoporosis or predicting fractures varied from very poor to good.

124 citations


Cited by
More filters
Journal ArticleDOI
02 Jan 2015-BMJ
TL;DR: The PRISMA-P checklist as mentioned in this paper provides 17 items considered to be essential and minimum components of a systematic review or meta-analysis protocol, as well as a model example from an existing published protocol.
Abstract: Protocols of systematic reviews and meta-analyses allow for planning and documentation of review methods, act as a guard against arbitrary decision making during review conduct, enable readers to assess for the presence of selective reporting against completed reviews, and, when made publicly available, reduce duplication of efforts and potentially prompt collaboration. Evidence documenting the existence of selective reporting and excessive duplication of reviews on the same or similar topics is accumulating and many calls have been made in support of the documentation and public availability of review protocols. Several efforts have emerged in recent years to rectify these problems, including development of an international register for prospective reviews (PROSPERO) and launch of the first open access journal dedicated to the exclusive publication of systematic review products, including protocols (BioMed Central's Systematic Reviews). Furthering these efforts and building on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, an international group of experts has created a guideline to improve the transparency, accuracy, completeness, and frequency of documented systematic review and meta-analysis protocols--PRISMA-P (for protocols) 2015. The PRISMA-P checklist contains 17 items considered to be essential and minimum components of a systematic review or meta-analysis protocol.This PRISMA-P 2015 Explanation and Elaboration paper provides readers with a full understanding of and evidence about the necessity of each item as well as a model example from an existing published protocol. This paper should be read together with the PRISMA-P 2015 statement. Systematic review authors and assessors are strongly encouraged to make use of PRISMA-P when drafting and appraising review protocols.

9,361 citations

Journal ArticleDOI
TL;DR: Low health literacy was consistently associated with more hospitalizations; greater use of emergency care; lower receipt of mammography screening and influenza vaccine; poorer ability to demonstrate taking medications appropriately; poorer able to interpret labels and health messages; and, among elderly persons, poorer overall health status and higher mortality rates.
Abstract: Health literacy has been associated with health-related knowledge and patient comprehension. This systematic review updates a 2004 review and found 96 eligible studies that suggest that low health ...

3,457 citations

01 Jan 2013
TL;DR: The related problem, loss-of-control (LOC) eating, describes recurrent binge-like eating behavior in individuals who cannot meet full criteria for BED such as post-bariatric surgery patients and children.
Abstract: Binge eating disorder (BED) is characterized by recurrent episodes of binge eating and, subsequently, significant psychological distress (e.g., shame, guilt). Recently recognized by the American Psychiatric Association (APA) as a distinct eating disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), BED is considered a significant public health problem independently and for its impact on obesity and diabetes. The related problem, loss-of-control (LOC) eating, describes recurrent binge-like eating behavior in individuals who cannot meet full criteria for BED such as post-bariatric surgery patients and children. LOC eating has detrimental psychological and physical health effects, including significant distress and symptoms of depression, as well as excess weight gain in children and suboptimal weight loss and weight regain in post-bariatric patients. Table 1 lists the diagnostic criteria for BED (as defined in the current DSM-5 and earlier, in the DSM, Fourth Edition [DSM-IV]) and frequently-used definitions of LOC eating.

2,276 citations

Journal ArticleDOI
Don Nutbeam1
TL;DR: The paper concludes that both conceptualizations are important and are helping to stimulate a more sophisticated understanding of the process of health communication in both clinical and community settings, as well as highlighting factors impacting on its effectiveness.

2,082 citations

Journal ArticleDOI
TL;DR: NVS, the Newest Vital Sign, is suitable for use as a quick screening test for limited literacy in primary health care settings and correlates with the Test of Functional Health Literacy in Adults.
Abstract: PURPOSE Current health literacy screening instruments for health care settings are either too long for routine use or available only in English. Our objective was to develop a quick and accurate screening test for limited literacy available in Eng- lish and Spanish. METHODS We administered candidate items for the new instrument and also the Test of Functional Health Literacy in Adults (TOFHLA) to English-speaking and Spanish-speaking primary care patients. We measured internal consistency with Cronbach's and assessed criterion validity by measuring correlations with TOFHLA scores. Using TOFLHA scores 0.76 in English and 0.69 in Spanish) and correlates with the TOFHLA. Area under the ROC curve is 0.88 for English and 0.72 for Spanish ver- sions. Patients with more than 4 correct responses are unlikely to have low literacy, whereas fewer than 4 correct answers indicate the possibility of limited literacy. CONCLUSION NVS is suitable for use as a quick screening test for limited literacy in primary health care settings.

1,941 citations