Disclosure of researcher allegiance in meta-analyses and randomised controlled trials of psychotherapy: a systematic appraisal

Psychotherapy research may suffer from factors such as a researchers own therapy allegiance. The aim of this study was to evaluate if researcher allegiance (RA) was reported in meta-analyses and randomised controlled trials (RCTs) of psychotherapeutic treatments.Systematic approach using meta-analyses of different types of psychotherapies.Medline, PsycINFO and Cochrane Database of Systematic Reviews.We evaluated meta-analyses of RCTs regarding various types of psychotherapies. Meta-analyses were eligible if they included at least one RCT with RA and they were published in journals in Medline, PsycINFO and Cochrane Database of Systematic Reviews with an impact factor larger than 5.We identified 146 eligible meta-analyses that synthesised data from a total of 1198 unique RCTs. Only 25 of the meta-analyses (17.2%) reported allegiance and only 6 (4.1%) used a proper method to control its effect. Of the 1198 eligible primary RCTs, 793 (66.3%) were allegiant. Authors in 25 of these 793 RCTs (3.2%) reported their allegiance while only one study (0.2%) controlled for its effect.The vast majority among a group of published meta-analyses and RCTs of psychotherapeutic treatments seldom reported and evaluated the allegiance effect. The results of the present study highlight a major lack of this information in meta-analyses and their included studies, though meta-analyses perform slightly better than RCTs. Stringent guidelines should be adopted by journals in order to improve reporting and attenuate possible effects of RA in future research

Predictive association between immigration status and chronic pain in the general population: results from the SwePain cohort.

BACKGROUND: Previous studies suggest that immigration may influence the experience of pain. OBJECTIVE: This population-based study examines whether immigration status is associated with chronic pain (CP), chronic widespread pain (CWSP), and severe CP at a two-year follow-up. We also tested mediation by mood status (i.e., anxiety and depression). METHODS: 15, 563 participants from a representative stratified random sample of 34,000 individuals living in south-eastern Sweden completed a postal survey, during 2013-2015, that included the following data: immigration status; presence of CP (pain lasting at least 3 months) and CWSP (a modified classification of widespread pain for use in epidemiological studies); severity of CP based on a numeric rating scale; and depression, anxiety, economic situation, and sociodemographic information. We applied logistic regressions using the generalized estimating equations (GEE), with Swedish-born as the reference group and path analyses models. RESULTS: Compared to the Swedish-born participants (n = 14,093;90%), the immigrants (n = 1470;10%) had an elevated risk of all pain outcomes (CP: odds ratio [OR] = 1.18; 95% confidence interval [CI = 1.04-1.33, CWSP: OR = 1.39; 95% CI: 1.15-1.69 and severe CP: 1.51; 95% CI: 1.23-1.87) after adjustments. Path analyses showed that baseline age, immigrant status, and financial hardship had a significant influence on chronic pain outcomes at follow-up with baseline mood status as the mediator. Immigration status was also associated with age and financial hardship. CONCLUSION: Immigrants may have increased risk of chronic pain, widespread pain, and severe pain and this risk is mediated by mood status. Targeted interventions better tailored to the socio-economic and psychological status of immigrants with chronic pain are warranted

Risk and protective factors for cannabis, cocaine, and opioid use disorders: An umbrella review of meta-analyses of observational studies

Several meta-analyses of observational studies have addressed the association between risk and protective factors and cannabis/cocaine/opioid use disorders, but results are conflicting. No umbrella review has ever graded the credibility of this evidence (not significant/weak/suggestive/highly suggestive/convincing). We searched Pubmed-MEDLINE/PsycInfo, last search September 21, 2020. We assessed the quality of meta-analyses with the AMSTAR-2 tool. Out of 3,072 initial references, five were included, providing 19 associations between 12 putative risk/protective factors and cannabis/cocaine/opioid use disorders (cases: 4539; N=1,118,872,721). While 84% of the associations were statistically significant, none was convincing. One risk factor (smoking) had highly suggestive evidence for association with nonmedical use of prescription opioid medicines (OR=3.07, 95%CI:2.27 to 4.14). Convincing evidence emerged in sensitivity analyses on antisocial behavior and cannabis use disoder (OR 3.34, 95%CI 2.53-4.41). Remaining associations had weak evidence. The quality of meta-analyses was rated as moderate in two (40%), low in one (20%), and critically low in two (40%). Future research is needed to better profile risk/protective factors for cannabis/cocaine/opioid use disorders disorders informing preventive approaches

Minimalkonsens in Nairobi: Ein Scheitern der Doha-Runde gefährdet die WTO

Nach vierzehn Jahren Verhandlungen im Rahmen der Doha-Runde ist auch auf der 10. Ministerkonferenz in Nairobi bei den grundlegenden Themen keine Einigung in Sicht. Um ihre handelspolitischen Interessen durchzusetzen, haben sich die großen Handelsnationen bereits mehr und mehr mega-regionalen Abkommen wie TTIP und TPP zugewandt. Doch scheitert die Doha-Runde endgültig, ist auch die WTO als Hüterin des Welthandels in Gefahr

Efficacy and acceptability of pharmacological and non-pharmacological interventions for non-specific chronic low back pain:a protocol for a systematic review and network meta-analysis

Background: Despite the enormous financial and humanistic burden of chronic low back pain (CLBP), there is little consensus on what constitutes the best treatment options from a multitude of competing interventions. The objective of this network meta-analysis (NMA) is to determine the relative efficacy and acceptability of primary care treatments for non-specific CLBP, with the overarching aim of providing a comprehensive evidence base for informing treatment decisions. Methods: We will perform a systematic search to identify randomised controlled trials of interventions endorsed in primary care guidelines for the treatment of non-specific CLBP in adults. Information sources searched will include major bibliographic databases (MEDLINE, Embase, CENTRAL, CINAHL, PsycINFO and LILACS) and clinical trial registries. Our primary outcomes will be patient-reported pain ratings and treatment acceptability (all-cause discontinuation), and secondary outcomes will be functional ability, quality of life and patient/physician ratings of overall improvement. A hierarchical Bayesian class-based NMA will be performed to determine the relative effects of different classes of pharmacological (NSAIDs, opioids, paracetamol, anti-depressants, muscle relaxants) and non- pharmacological (exercise, patient education, manual therapies, psychological therapy, multidisciplinary approaches, massage, acupuncture, mindfulness) interventions and individual treatments within a class (e.g. NSAIDs: diclofenac, ibuprofen, naproxen). We will conduct risk of bias assessments and threshold analysis to assess the robustness of the findings to potential bias. We will compute the effect of different interventions relative to placebo/no treatment for both short- and long-term efficacy and acceptability. Discussion: While many factors are important in selecting an appropriate intervention for an individual patient, evidence for the analgesic effects and acceptability of a treatment are key factors in guiding this selection. Thus, this NMA will provide an important source of evidence to inform treatment decisions and future clinical guidelines

A follow-up study to a randomised control trial to investigate the perceived impact of mindfulness on academic performance in university students

1 Objectives Mindfulness research in education has focussed on its potential to support student well-being. There is a paucity of research on the interaction between mindfulness and academic performance. This qualitative study builds on results of the largest randomised control trial of mindfulness in education to date which suggested mindfulness can have mixed effects on academic performance. A more in-depth understanding of the relationship between mindfulness and academic performance is therefore needed to ascertain if, how and for which students, mindfulness facilitates academic performance. The objective of the study was to capture students’ perceptions of the impact of mindfulness on their academic performance. 2 Methods Thematic analysis was applied to data obtained by six in-depth interviews from three higher and three lower performing undergraduate participants in the mindfulness intervention arm of the Mindful Student Study randomised control trial. 3 Results Three themes emerged, whereby five students described mindfulness having a positive impact on their academic performance. One student felt mindfulness had an initial negative impact on academic performance. All students felt mindfulness enhanced self-awareness and self-regulation of their thinking, feelings and behaviours, and our analysis suggests students perceived these processes underpinned the effect of mindfulness on academic performance 4 Conclusion Differences in students’ psychological distress and study habits may determine the differing initial impact of mindfulness on academic performance

Environmental risk factors and biomarkers for autism spectrum disorder:an umbrella review of the evidence

Background Numerous studies have identified potential risk factors and biomarkers for autism spectrum disorder. We aimed to study the strength and validity of the suggested environmental risk factors or biomarkers of autism spectrum disorder. Methods We did an umbrella review and systematically appraised the relevant meta-analyses of observational studies. We searched PubMed, Embase, and the Cochrane Database of Systematic Reviews for papers published between database inception and Oct 17, 2018, and screened the reference list of relevant articles. We obtained the summary effect, 95% CI, heterogeneity, and 95% prediction intervals. We examined small study effects and excess significance. We did analyses under credibility ceilings. This review is registered with PROSPERO, number CRD42018091704. Findings 46 eligible articles yielded data on 67 environmental risk factors (544 212 cases, 81 708 787 individuals) and 52 biomarkers (15 614 cases, 15 433 controls). Evidence of association was convincing for maternal age of 35 years or over (relative risk [RR] 1.31, 95% CI 1.18-1.45), maternal chronic hypertension (odds ratio [OR] 1.48, 1.29-1.70), maternal gestational hypertension (OR 1.37, 1.21-1.54), maternal overweight before or during pregnancy (RR 1.28, 1.19-1.36), pre-eclampsia (RR 1.32, 1.20-1.45), prepregnancy maternal antidepressant use (RR 1.48, 1.29-1.71), and maternal selective serotonin reuptake inhibitor (SSRI) use during pregnancy (OR 1.84, 1.60-2.11). Only two associations, maternal overweight before or during pregnancy and SSRI use during pregnancy, retained their high level of evidence under subset sensitivity analyses. Evidence from biomarkers was scarce, being supported by p values close to the significance threshold and too few cases. Interpretation Convincing evidence suggests that maternal factors, such as age and features of metabolic syndrome, are associated with risk of autism spectrum disorder. Although SSRI use during pregnancy was also associated with such risk when exposed and non-exposed groups were compared, this association could be affected by other confounding factors, considering that prepregnancy maternal antidepressant use was also convincingly associated with higher risk of autism spectrum disorder. Findings from previous studies suggest that one possible confounding factor is underlying maternal psychiatric disorders. Copyright (C) 2019 Elsevier Ltd. All rights reserved.Funding Agencies|Health Education England [ICA-CL-2017-03-001]; National Institute for Health Research (NIHR) [ICA-CL-2017-03-001]; NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust; Maudsley Charity; Kings College London; NIHR South London Collaboration for Leadership in Applied Health Research and Care</p

Incidence of Capillary Leak Syndrome as an Adverse Effect of Drugs in Cancer Patients: A Systematic Review and Meta-Analysis

Capillary leak syndrome (CLS) is a rare disease with profound vascular leakage, which can be associated with a high mortality. There have been several reports on CLS as an adverse effect of anti-cancer agents and therapy, but the incidence of CLS according to the kinds of anti-cancer drugs has not been systemically evaluated. Thus, the aim of our study was to comprehensively meta-analyze the incidence of CLS by different types of cancer treatment or after bone marrow transplantation (BMT). We searched the literatures (inception to July 2018) and among 4612 articles, 62 clinical trials (studies) were eligible. We extracted the number of patients with CLS, total cancer patients, name of therapeutic agent and dose, and type of cancer. We performed a meta-analysis to estimate the summary effects with 95% confidence interval and between-study heterogeneity. The reported incidence of CLS was categorized by causative drugs and BMT. The largest number of studies reported on CLS incidence during interleukin-2 (IL-2) treatment (n = 18), which yielded a pooled incidence of 34.7% by overall estimation and 43.9% by meta-analysis. The second largest number of studies reported on anti-cluster of differentiation (anti-CD) agents (n = 13) (incidence of 33.9% by overall estimation and 35.6% by meta-analysis) or undergoing BMT (n = 7 (21.1% by overall estimation and 21.7% by meta-analysis). Also, anti-cancer agents, including IL-2 + imatinib mesylate (three studies) and anti-CD22 monoclinal antibodies (mAb) (four studies), showed a dose-dependent increase in the incidence of CLS. Our study is the first to provide an informative overview on the incidence rate of reported CLS patients as an adverse event of anti-cancer treatment. This meta-analysis can lead to a better understanding of CLS and assist physicians in identifying the presence of CLS early in the disease course to improve the outcome and optimize management