Five-year results of cervical disc prostheses in the SWISSspine registry

BACKGROUND: The Swiss Federal Office of Public Health demanded a nationwide HTA-registry for cervical total disc arthroplasty (TDA), to decide about its reimbursement. The goal of the SWISSspine registry is to generate evidence about the safety and efficiency of cervical TDA. MATERIALS AND METHODS: Three hundred thirty-two cases treated between 3.2005 and 6.2006 who were eligible for 5 years follow-ups were included in the study. Follow-up rates for 3-6 months, 1, 2 and 5 years were 84.6, 74.4, 50.6 and 64.8 %, respectively. Outcome measures were neck and arm pain, medication, quality of life, intraoperative and postoperative complication and revision rates. In addition, segmental mobility, ossification, adjacent and distant segment degeneration were analyzed at the 5-year follow-up. RESULTS: There was significant, clinically relevant and lasting reduction of neck (preop/postop 60/21 VAS points) and arm pain (preop/postop VAS 67/17) and a consequently decreased analgesics consumption and quality of life improvement (preop/postop 0.39/0.82 EQ-5D points) until the 5-year follow-up. The rates for intraoperative and early postoperative complications were 0.6 and 7.2 %, respectively. In 0.6 % an early and in 3.9 % a late revision surgery was performed. At the 5-year follow-up, the average range of motion of the mobile segments (88.2 %) was 10.2°. In 40.7 % of the patients osteophytes at least potentially affecting range of motion were seen. CONCLUSIONS: Cervical TDA appeared as safe and efficient in long-term pain alleviation, consequent reduction of pain killer consumption and in improvement of quality of life. The improvement is stable over the 5 years postoperative period. The vast majority of treated segments remained mobile after 5 years, although 40.7 % of patients showed osteophytes.

Comparative effectiveness research across two spine registries

Comparative effectiveness research in spine surgery is still a rarity. In this study, pain alleviation and quality of life (QoL) improvement after lumbar total disc arthroplasty (TDA) and anterior lumbar interbody fusion (ALIF) were anonymously compared by surgeon and implant.

SWISSspine: a nationwide registry for health technology assessment of lumbar disc prostheses

SWISSspine is a so-called pragmatic trial for assessment of safety and efficiency of total disc arthroplasty (TDA). It follows the new health technology assessment (HTA) principle of "coverage with evidence development". It is the first mandatory HTA registry of its kind in the history of Swiss orthopaedic surgery. Its goal is the generation of evidence for a decision by the Swiss federal office of health about reimbursement of the concerned technologies and treatments by the basic health insurance of Switzerland. During the time between March 2005 and 2008, 427 interventions with implantation of 497 lumbar total disc arthroplasties have been documented. Data was collected in a prospective, observational multicenter mode. The preliminary timeframe for the registry was 3 years and has already been extended. Data collection happens pre- and perioperatively, at the 3 months and 1-year follow-up and annually thereafter. Surgery, implant and follow-up case report forms are administered by spinal surgeons. Comorbidity questionnaires, NASS and EQ-5D forms are completed by the patients. Significant and clinically relevant reduction of low back pain VAS (70.3-29.4 points preop to 1-year postop, p < 0.0001) leg pain VAS (55.5-19.1 points preop to 1-year postop, p < 0.001), improvement of quality of life (EQ-5D, 0.32-0.73 points preop to 1-year postop, p < 0.001) and reduction of pain killer consumption was revealed at the 1-year follow-up. There were 14 (3.9%) complications and 7 (2.0%) revisions within the same hospitalization reported for monosegmental TDA; there were 6 (8.6%) complications and 8 (11.4%) revisions for bisegmental surgery. There were 35 patients (9.8%) with complications during followup in monosegmental and 9 (12.9%) in bisegmental surgery and 11 (3.1%) revisions with 1 [corrected] new hospitalization in monosegmental and 1 (1.4%) in bisegmental surgery. Regression analysis suggested a preoperative VAS "threshold value" of about 44 points for increased likelihood of a minimum clinically relevant back pain improvement. In a short-term perspective, lumbar TDA appears as a relatively safe and efficient procedure concerning pain reduction and improvement of quality of life. Nevertheless, no prediction about the long-term goals of TDA can be made yet. The SWISSspine registry proofs to be an excellent tool for collection of observational data in a nationwide framework whereby advantages and deficits of its design must be considered. It can act as a model for similar projects in other health-care domains.

Five-year results of lumbar disc prostheses in the SWISSspine registry

PURPOSE The Swiss Federal Office of Public Health demanded a nationwide HTA registry for lumbar total disc arthroplasty (TDA), to decide about its reimbursement. The goal of the SWISS spine registry is to generate evidence about the safety and efficiency of lumbar TDA. METHODS Two hundred forty-eight cases treated between 3-2005 and 6-2006, who were eligible for the 5-year follow-up were included in the study. Follow-up rates for 3-6 months, 1, 2 and 5 years were 85.9, 77.0, 44.0 and 51.2 %, respectively. Outcome measures were back and leg pain, medication consumption, quality of life, intraoperative and postoperative complication and revision rates. Additionally, segmental mobility, ossification, adjacent and distant segment degeneration were analysed at the 5-year follow-up. RESULTS There was a significant, clinically relevant and lasting reduction of back (preop/postop 73/29 VAS points) and leg pain (preop/postop VAS 55/22) and a consequently decreased analgesics consumption and quality of life improvement (preop/postop 0.30/0.76 EQ-5D score points) until 5 years after surgery. The rates for intraoperative and early postoperative complications were 4.4 and 3.2 %, respectively. The overall complication rate during five postoperative years was 23.4 %, and the adjacent segment degeneration rate was 10.7 %. In 4.4 % of patients, a revision surgery was performed. Cumulative survivorship probability for a revision/re-intervention-free 5-year postoperative course was 90.4 %. At the 5-year follow-up, the average range of motion of the mobile segments (86.8 %) was 9.7°. In 43.9 % of patients, osteophytes at least potentially affecting the range of motion were seen. CONCLUSIONS Lumbar TDA appeared as efficient in long-term pain alleviation, consequent reduction of pain medication consumption and improvement of quality of life. The procedure also appeared sufficiently safe, but surgeons have to be aware of a list of potential adverse events. The outcome is stable over the 5-year postoperative period. The vast majority of treated segments remained mobile after 5 years, although almost half of patients showed osteophytes.

Intravital and whole-organ imaging reveals capture of melanoma-derived antigen by lymph node subcapsular macrophages leading to widespread deposition on follicular dendritic cells.

Aberrant antigens expressed by tumor cells, such as in melanoma, are often associated with humoral immune responses, which may in turn influence tumor progression. Despite recent data showing the central role of adaptive immune responses on cancer spread or control, it remains poorly understood where and how tumor-derived antigen (TDA) induces a humoral immune response in tumor-bearing hosts. Based on our observation of TDA accumulation in B cell areas of lymph nodes (LNs) from melanoma patients, we developed a pre-metastatic B16.F10 melanoma model expressing a fluorescent fusion protein, tandem dimer tomato, as a surrogate TDA. Using intravital two-photon microscopy (2PM) and whole-mount 3D LN imaging of tumor-draining LNs in immunocompetent mice, we report an unexpectedly widespread accumulation of TDA on follicular dendritic cells (FDCs), which were dynamically scanned by circulating B cells. Furthermore, 2PM imaging identified macrophages located in the subcapsular sinus of tumor-draining LNs to capture subcellular TDA-containing particles arriving in afferent lymph. As a consequence, depletion of macrophages or genetic ablation of B cells and FDCs resulted in dramatically reduced TDA capture in tumor-draining LNs. In sum, we identified a major pathway for the induction of humoral responses in a melanoma model, which may be exploitable to manipulate anti-TDA antibody production during cancer immunotherapy.

Total disc arthroplasty versus anterior cervical interbody fusion: use of the Spine Tango registry to supplement the evidence from randomized control trials.

BACKGROUND CONTEXT Several randomized controlled trials (RCTs) have compared patient outcomes of anterior (cervical) interbody fusion (AIF) with those of total disc arthroplasty (TDA). Because RCTs have known limitations with regard to their external validity, the comparative effectiveness of the two therapies in daily practice remains unknown. PURPOSE This study aimed to compare patient-reported outcomes after TDA versus AIF based on data from an international spine registry. STUDY DESIGN AND SETTING A retrospective analysis of registry data was carried out. PATIENT SAMPLE Inclusion criteria were degenerative disc or disc herniation of the cervical spine treated by single-level TDA or AIF, no previous surgery, and a Core Outcome Measures Index (COMI) completed at baseline and at least 3 months' follow-up. Overall, 987 patients were identified. OUTCOME MEASURES Neck and arm pain relief and COMI score improvement were the outcome measures. METHODS Three separate analyses were performed to compare TDA and AIF surgical outcomes: (1) mimicking an RCT setting, with admission criteria typical of those in published RCTs, a 1:1 matched analysis was carried out in 739 patients; (2) an analysis was performed on 248 patients outside the classic RCT spectrum, that is, with one or more typical RCT exclusion criteria; (3) a subgroup analysis of all patients with additional follow-up longer than 2 years (n=149). RESULTS Matching resulted in 190 pairs with an average follow-up of 17 months that had no residual significant differences for any patient characteristics. Small but statistically significant differences in outcome were observed in favor of TDA, which are potentially clinically relevant. Subgroup analyses of atypical patients and of patients with longer-term follow-up showed no significant differences in outcome between the treatments. CONCLUSIONS The results of this observational study were in accordance with those of the published RCTs, suggesting substantial pain reduction both after AIF and TDA, with slightly greater benefit after arthroplasty. The analysis of atypical patients suggested that, in patients outside the spectrum of clinical trials, both surgical interventions appeared to work to a similar extent to that shown for the cohort in the matched study. Also, in the longer-term perspective, both therapies resulted in similar benefits to the patients.

Particle flux measurements from moorings and surface sediment studies of sediment cores in the SE Pacific Ocean

Flux of siliceous plankton and taxonomic composition of diatom and silicoflagellate assemblages were determined from sediment trap samples collected in coastal upwelling-influenced waters off northern Chile (30°S, CH site) under "normal" or non-El Niño (1993-94) and El Niño conditions (1997-98). In addition, concentration of biogenic opal and siliceous plankton, and diatom and silicoflagellate assemblages preserved in surface sediments are provided for a wide area between 27° and 43°S off Chile. Regardless of the year, winter upwelling determines the maximum production pattern of siliceous microorganisms, with diatoms numerically dominating the biogenic opal flux. During the El Niño year the export is markedly lower: on an annual basis, total mass flux diminished by 60%, and diatom and silicoflagellate export by 75%. Major components of the diatom flora maintain much of their regular seasonal cycle of flux maxima and minima during both sampling periods. Neritic resting spores (RS) of Chaetoceros dominate the diatom flux, mirroring the influence of coastal-upwelled waters at the CH trap site. Occurrence of pelagic diatoms species Fragilariopsis doliolus, members of the Rhizosoleniaceae, Azpeitia spp. and Nitzschia interruptestriata, secondary components of the assemblage, reflects the intermingling of warmer waters of the Subtropical Gyre. Dictyocha messanensis dominates the silicoflagellate association almost year-around, but Distephanus pulchra delivers ca. 60% of its annual production in less than three weeks during the winter peak. The siliceous thanatocoenosis is largely dominated by diatoms, whose assemblage shows significant qualitative and quantitative variations from north to south. Between 27° and 35°S, the dominance of RS Chaetoceros, Thalassionema nitzschioides var. nitzschioides and Skeletonema costatum reflects strong export production associated with occurrence of coastal upwelling. Both highest biogenic opal content and diatom concentration at 35° and 41°-43°S coincide with highest pigment concentrations along the Chilean coast. Predominance of the diatom species Thalassiosira pacifica and T. poro-irregulata, and higher relative contribution of the silicoflagellate Distephanus speculum at 41°-43°S suggest the influence of more nutrient-rich waters and low sea surface temperatures, probably associated with the Antarctic Circumpolar Water.

Physico-chemical parameters of sediment core PG1972-1 (09-Tik-03) from a Tundra Lake, Northeastern Siberia

Thermokarst lakes in the Siberian Arctic contain sediment archives that can be used for paleoenvironmental inference. Until now, however, there has been no study from the inner Lena River Delta with a focus on diatoms. The objective of this study was to investigate how the diatom community in a thermokarst lake responded to past limnogeological changes and what specific factors drove variations in the diatom assemblage. We analysed fossil diatom species, organic content, grain-size distribution and elemental composition in a sediment core retrieved in 2009 from a shallow thermokarst lake in the Arga Complex, western Lena River Delta. The core contains a 3,000-year record of sediment accumulation. Shifts in the predominantly benthic and epiphytic diatom species composition parallel changes in sediment characteristics. Paleoenvironmental and limnogeological development, inferred from multiple biological and sedimentological variables, are discussed in the context of four diatom zones, and indicate a strong relation between changes in the diatom assemblage and thermokarst processes. We conclude that limnogeological and thermokarst processes such as lake drainage, rather than direct climate forcing, were the main factors that altered the aquatic ecosystem by influencing, for example, habitat availability, hydrochemistry, and water level.

High resolution study of sediment core GeoB3606-1

Based on a high-resolution analysis of the diatom signal and biogenic bulk components at site GeoB3606-1 (25°S, off Namibia), we describe rapid palaeoceanographic changes in the Benguela Upwelling System (BUS) from early MIS 3 through to the early Holocene (55 000 to 7 000 14C yr BP). Coastal upwelling strongly varied at 25°S from MIS 3 through to MIS 2. The abrupt decrease in the accumulation rate of biogenic silica and diatoms from MIS 3 into MIS 2 records rapid oceanographic changes in the BUS off Namibia. During MIS 3, leakage of excess H4SiO4 acid from the Southern Ocean into low-latitude surface waters, as indicated by the occurrence of Antarctic diatoms, enhanced the production of spores of Chaetoceros at the expense of calcareous phytoplankton. Furthermore, shallower Antarctic Intermediate Water (AAIW) would have enriched the thermocline off Namibia with silicate transported from the Southern Ocean. The strong decrease of the siliceous signal throughout MIS 2 represents a decrease in the nutrient input to the BUS, even though the diatom assemblage is still dominated by spores of the upwelling-associated diatom genus Chaetoceros. Depletion of silicate in the thermocline from the onset of MIS 2 through to the early Holocene reflects the shutdown of AAIW injection from the Southern Ocean into the BUS, causing upwelled waters to become reduced in silicate, hence less favourable for diatom production. The deglaciation and early Holocene are characterised by the replacement of the upwelling-associated flora by a non-upwelling-related diatom community, reflecting weakened upwelling, retraction of the seaward extension of the chlorophyll filament off Lüderitz, and dominance of warmer waters.

Sea ice diatoms from Late Quaternary sediments in the Scotia Sea

Sea-ice growth and decay in Antarctica is one of the biggest seasonal changes on Earth, expanding ice cover from 4x10**6 km**2 to a maximum of 19x10**6 km**2 during the austral winter. Analyses of six marine sediment cores from the Scotia Sea, SW Atlantic, yield records of sea-ice migration across the basin since the Lateglacial. The cores span nearly ten degrees of latitude from the modern seasonal sea-ice zone to the modern Polar Front. Surface sediments in the cores comprise predominantly diatomaceous oozes and muddy diatom oozes that reflect Holocene conditions. The cores exhibit similar down-core stratigraphies with decreasing diatom concentrations and increasing magnetic susceptibility from modern through to the Last Glacial Maximum (LGM). Sediments in all cores contain sea-ice diatoms that preserve a signal of changing sea-ice cover and permit reconstruction of past sea-ice dynamics. The sea-ice records presented here are the first to document the position of both the summer and winter sea-ice cover at the Last Glacial Maximum (LGM) in the Scotia Sea. Comparison of the LGM and Holocene sea-ice conditions shows that the average winter sea-ice extent was at least 5° further north at the LGM. Average summer sea-ice extent was south of the most southerly core site at the LGM, and suggests that sea-ice expanded from approximately 61°S to 52°S each season. Our data also suggest that the average summer sea-ice position at the LGM was not the maximum extent of summer sea-ice during the last glacial. Instead, the sediments contain evidence of a pre-LGM maximum extent of summer sea-ice between ab. 30 ka and 22 ka that extended to ab. 59°S, close to the modern average winter sea-ice limit. Based on our reconstruction we propose that the timing of the maximum extent of summer sea-ice and subsequent retreat by 22 ka, could be insolation controlled and that the strong links between sea-ice and bottom water formation provide a potential mechanism by which Southern Hemisphere regional sea-ice dynamics at the LGM could have a global impact and promote deglaciation.

Mineralogical, sedimentological and paleontological analyses of ODP Hole 127-797B upper Quarternary sediments

Nearly continuous cores of Quaternary fine-grained sediments with distinct dark-light colored cycles were recovered from Sites 794, 795, and 797 in the basinal parts of the Japan Sea during Leg 127. A comparison of gray value (darkness) profiles supplemented by visual inspection of core photographs between sites indicated that most of the dark and light layers were correlatable between sites, and that two of the dark layers lie close to adjacent marker ash layers. These observations indicate that deposition of dark and light layers resulted from basin-wide synchronous events. In order to understand the origin of these dark-light cycles, petrographical, mineralogical, compositional, and paleontological studies were carried out on closely spaced samples from the upper Quaternary sediments recovered from Site 797. Age model was constructed based on comparison between variation in diatom abundance and the standard oxygen isotope curve of Imbrie et al. (1984), the latter was interpolated between the five age controlled levels established at Site 797. The two curves show similar patterns which enabled us to "tune" the sediment ages to the oxygen isotope stages. We have to use variation in diatom abundance as a substitute for oxygen isotope curve since oxygen isotopic data are not available at the studied sites. Bottom water oxygenation conditions were estimated based on two criteria: (1) the degree of lamina preservation and (2) the ratio of Corg to Stot. The surface water productivity was deduced from the Corg and biogenic silica content. Results suggest that the bottom water oxygenation level and the surface water productivity varied significantly in response to the glacial-interglacial cycles. Glacio-eustatic sea-level changes and subsequent changes in water circulation in the Japan Sea appear to have been responsible for these variations and consequent changes in sediment composition throughout the Quaternary.

Water chemistry and diatom occurrences in sediments of Terrasovoje, Radok and Beaver Lake, Amery Oasis, East Antarctica

The diatom flora of three lakes in the ice-free Amery Oasis, East Antarctica, was studied. Two of the lakes are meltwater reservoirs, Terrasovoje Lake (31 m depth) and Radok Lake (362 m depth), while Beaver Lake (>435 m depth) is an epishelf lake. The lakes can be characterized as cold, ultra-oligotrophic and alkaline, displaying moderate (Radok and Terrasovoje lakes) to high (Beaver Lake) conductivities. There was no diatom phytoplankton present in any of the three lakes. While 34 benthic diatom taxa were identified from modern and Holocene sediments of Terrasovoje and Radok lakes, a 30-cm long sediment core recovered in Beaver Lake was barren. Five species (Luticola muticopsis, Muelleria peraustralis, Pinnularia cymatopleura, Psammothidium metakryophilum, P. stauroneioides) are endemic to the Antarctic region. All identified taxa are photographically documented and brief notes on their taxonomy, biogeography and ecology are provided. The most abundant diatom taxa are Amphora veneta, Craticula cf. molesta, Diadesmis spp, M. peraustralis and Stauroneis anceps. This is the first report on the diatom flora in lakes of the Amery Oasis.

Capacitación en metodologías de desarrollo de programas interactivos para Televisión Digital

La TV Digital ha tenido en estos últimos años una gran expansión en todo el mundo (en algunos países ya se está implementando el "apagón analógico", luego del cual toda transmisión televisiva será digital) y con una creciente cobertura en toda Latinoamérica debido a las políticas activas que en los últimos años han llevado a cabo los gobiernos (por ejemplo, el sistema de TDA – Televisión Digital Abierta de Argentina tiene una cobertura actual superior al 80% de la población). Esta expansión se debe a que esta tecnología permite no sólo una mejor calidad de imagen sino también una experiencia de usuario-televidente mucho más rica gracias a que el sistema puede transmitir y procesar datos, además del video y el sonido, y permite interacciones más complejas que la TV tradicional o analógica. Sin embargo, y a pesar de su alcance cada vez más masivo, las grandes ventajas de la TV Digital no están siendo aún explotadas en todo su potencial. Esto se debe, según los estudios realizados, a dos razones principales: (1) no se ha encontrado aún un modelo de negocios superador de la TV tradicional que aproveche la interacción del usuario-televidente (el cual, generalmente por desconocimiento, tampoco exige mayor complejidad y riqueza en su interacción con la TV) y (2) no hay suficientes recursos humanos adecuadamente formados que puedan desarrollar productos que exploten la compleja interacción entre el producto de TV (serie, unitario, película, documental) y el software (que permite el procesamiento de los datos y la interacción con el usuario-televidente) para generar producciones innovadoras en el campo televisivo. El Centro Tecnológico Comunitario de la Municipalidad de Nono (CTC Nono) nos ha solicitado ser recipiente de actividades de extensión que apunten a subsanar específicamente esta segunda causa, la falta de recursos humanos que puedan apropiarse de esta tecnología. A diferencia de muchos otros Centros Tecnológicos Comunitarios, el CTC Nono pudo continuar funcionando durante estos 14 años gracias a la capacidad de sus dirigentes de adaptar permanentemente sus objetivos y su forma de funcionamiento. EL CTC Nono, como tal, comenzó siendo un centro de alfabetización informática y de acceso popular a los servicios TIC básicos, para llegar a ser hoy un activo centro generador de programas de TV regional por un lado y de desarrollos de software por otro. Sin embargo, la característica principal que ha permanecido inmutable a lo largo de estos años es la de ser un centro de atracción, contención y aprendizaje abierto para todos los vecinos con inquietudes productivas y artísticas. Es por ello que, concientes de la enorme potencialidad y alcance de la TV Digital, es que el CTC Nono realiza esta demanda de transferencia que implica proveer conocimiento teórico y práctico para el desarrollo de programas interactivos de TV Digital a grupos multidisciplinarios (de programadores, artistas y productores de TV) de toda la zona de Traslasierra que les permita expandir su producción a esta nueva tecnología de difusión masiva. Es de esperarse que de los cursos, talleres y actividades de seguimiento de proyectos, se podrán obtener productos innovadores que aprovechen todos los beneficios que brinda la TV Digital, llevando el polo de desarrollo de TV generado gracias al CTC Nono a una nueva etapa, de expansión y uso de esta novedosa tecnología.

Synthèse systématique des écrits : les instruments d’évaluation de la comorbidité psychiatrique présentée par les adolescent(e)s

Ce mémoire présente les résultats d’une synthèse systématique (SS) des écrits traitant des instruments d’évaluation multidimensionnelle des troubles concomitants qui peuvent être présentés par les adolescent(e)s. La SS a permis d’identifier 11 instruments en mesure d’évaluer les troubles comorbides de l’Axe I du DSM-IV, incluant chaque fois les troubles liés à l’utilisation de substances psychoactives (TUS). Une fois les instruments répertoriés, une seconde recherche fut effectuée afin identifier les études les ayant mis à l’épreuve du point de vue de leur validité et de leur fidélité diagnostique : 57 études furent identifiées. La robustesse méthodologique de ces études fut analysée à l’aide de la grille du QUADAS-2 et 47 études furent retenues pour l’échantillon final. Les résultats sont présentés par diagnostics (troubles liés à l’utilisation des substances (TUS) (obligatoire), trouble d’anxiété généralisée (TAG), épisode dépressif majeur (ÉDM), troubles des conduites (TC), trouble du déficit de l’attention /hyperactivité (TDA/H), état de stress post-traumatique (ÉSPT) et par instrument retenu. Suite à l’analyse des données recueillies, il s’avère difficile de comparer les instruments les uns aux autres, étant donnée la très grande diversité des échelles qu’ils contiennent, ainsi que les devis fort différents des études qui les ont mis à l’épreuve. Par contre, deux instruments se distinguent par la robustesse méthodologique des études à leur sujet, ainsi que leur excellente performance globale. Il s’agit du ChIPS et du K-SADS.

Synthèse systématique des écrits : les instruments d’évaluation de la comorbidité psychiatrique présentée par les adolescent(e)s.

Ce mémoire présente les résultats d’une synthèse systématique (SS) des écrits traitant des instruments d’évaluation multidimensionnelle des troubles concomitants qui peuvent être présentés par les adolescent(e)s. La SS a permis d’identifier 11 instruments en mesure d’évaluer les troubles comorbides de l’Axe I du DSM-IV, incluant chaque fois les troubles liés à l’utilisation de substances psychoactives (TUS). Une fois les instruments répertoriés, une seconde recherche fut effectuée afin identifier les études les ayant mis à l’épreuve du point de vue de leur validité et de leur fidélité diagnostique : 57 études furent identifiées. La robustesse méthodologique de ces études fut analysée à l’aide de la grille du QUADAS-2 et 47 études furent retenues pour l’échantillon final. Les résultats sont présentés par diagnostics (troubles liés à l’utilisation des substances (TUS) (obligatoire), trouble d’anxiété généralisée (TAG), épisode dépressif majeur (ÉDM), troubles des conduites (TC), trouble du déficit de l’attention /hyperactivité (TDA/H), état de stress post-traumatique (ÉSPT) et par instrument retenu. Suite à l’analyse des données recueillies, il s’avère difficile de comparer les instruments les uns aux autres, étant donnée la très grande diversité des échelles qu’ils contiennent, ainsi que les devis fort différents des études qui les ont mis à l’épreuve. Par contre, deux instruments se distinguent par la robustesse méthodologique des études à leur sujet, ainsi que leur excellente performance globale. Il s’agit du ChIPS et du K-SADS.