The efficacy of fish oil supplements in the treatment of depression: food for thought.

A recent meta-analysis and meta-regression of 13 randomized clinical trials by Mocking et al.1 concluded that supplementation with omega-3 fatty acids, found naturally in fatty fish, has a beneficial effect in patients with major depressive disorder (MDD), especially for higher doses of the eicosapentaenoic acid (EPA) and in patients taking antidepressants. Novel treatments for MDD are certainly desired. However, in our view the evidence in this study does not solve the academic debate on the efficacy of omega-3 fatty acids for MDD. Some food for thought

Effects of varenicline and cognitive bias modification on neural response to smoking-related cues:Study protocol for a randomized controlled study

BACKGROUND: Smoking-related cues can trigger drug-seeking behaviors, and computer-based interventions that reduce cognitive biases towards such cues may be efficacious and cost-effective cessation aids. In order to optimize such interventions, there needs to be better understanding of the mechanisms underlying the effects of cognitive bias modification (CBM). Here we present a protocol for an investigation of the neural effects of CBM and varenicline in non-quitting daily smokers. METHODS/DESIGN: We will recruit 72 daily smokers who report smoking at least 10 manufactured cigarettes or 15 roll-ups per day and who smoke within one hour of waking. Participants will attend two sessions approximately one week apart. At the first session participants will be screened for eligibility and randomized to receive either varenicline or a placebo over a seven-day period. On the final drug-taking day (day seven) participants will attend a second session and be further randomized to one of three CBM conditions (training towards smoking cues, training away from smoking cues, or control training). Participants will then undergo a functional magnetic resonance imaging scan during which they will view smoking-related pictorial cues. Primary outcome measures are changes in cognitive bias as measured by the visual dot-probe task, and neural responses to smoking-related cues. Secondary outcome measures will be cognitive bias as measured by a transfer task (modified Stroop test of smoking-related cognitive bias) and subjective mood and cigarette craving. DISCUSSION: This study will add to the relatively small literature examining the effects of CBM in addictions. It will address novel questions regarding the neural effects of CBM. It will also investigate whether varenicline treatment alters neural response to smoking-related cues. These findings will inform future research that can develop behavioral treatments that target relapse prevention. TRIAL REGISTRATION: Registered with Current Controlled Trials: ISRCTN65690030. Registered on 30 January 2014

A Delphi Study to Strengthen Research-Methods Training in Undergraduate Psychology Programs

Psychology programs often emphasize inferential statistical tests over a solid understanding of data and research design. This imbalance may leave graduates underequipped to effectively interpret research and employ data to answer questions. We conducted a two-round modified Delphi to identify the research-methods skills that the UK psychology community deems essential for undergraduates to learn. Participants included 103 research-methods instructors, academics, students, and nonacademic psychologists. Of 78 items included in the consensus process, 34 reached consensus. We coupled these results with a qualitative analysis of 707 open-ended text responses to develop nine recommendations for organizations that accredit undergraduate psychology programs—such as the British Psychological Society. We recommend that accreditation standards emphasize (1) data skills, (2) research design, (3) descriptive statistics, (4) critical analysis, (5) qualitative methods, and (6) both parameter estimation and significance testing; as well as (7) give precedence to foundational skills, (8) promote transferable skills, and (9) create space in curricula to enable these recommendations. Our data and findings can inform modernized accreditation standards to include clearly defined, assessable, and widely encouraged skills that foster a competent graduate body for the contemporary world

Impact of health warning labels and calorie labels on selection and purchasing of alcoholic and non‐alcoholic drinks: a randomized controlled trial

Aims: To estimate the impact on selection and actual purchasing of (a) health warning labels (text‐only and image‐and‐text) on alcoholic drinks and (b) calorie labels on alcoholic and non‐alcoholic drinks. Design: Parallel‐groups randomised controlled trial. Setting: Drinks were selected in a simulated online supermarket, before being purchased in an actual online supermarket. Participants: Adults in England and Wales who regularly consumed and purchased beer or wine online (n = 651). Six hundred and eight participants completed the study and were included in the primary analysis. Interventions: Participants were randomized to one of six groups in a between‐subjects three [health warning labels (HWLs) (i): image‐and‐text HWL; (ii) text‐only HWL; (iii) no HWL] × 2 (calorie labels: present versus absent) factorial design (n per group 103–113). Measurements: The primary outcome measure was the number of alcohol units selected (with intention to purchase); secondary outcomes included alcohol units purchased and calories selected and purchased. There was no time limit for selection. For purchasing, participants were directed to purchase their drinks immediately (although they were allowed up to 2 weeks to do so). Findings: There was no evidence of main effects for either (a) HWLs or (b) calorie labels on the number of alcohol units selected (HWLs: F(2,599) = 0.406, P = 0.666; calorie labels: F(1,599) = 0.002, P = 0.961). There was also no evidence of an interaction between HWLs and calorie labels, and no evidence of an overall difference on any secondary outcomes. In pre‐specified subgroup analyses comparing the ‘calorie label only’ group (n = 101) with the ‘no label’ group (n = 104) there was no evidence that calorie labels reduced the number of calories selected (unadjusted means: 1913 calories versus 2203, P = 0.643). Among the 75% of participants who went on to purchase drinks, those in the ‘calorie label only’ group (n = 74) purchased fewer calories than those in the ‘no label’ group (n = 79) (unadjusted means: 1532 versus 2090, P = 0.028). Conclusions: There was no evidence that health warning labels reduced the number of alcohol units selected or purchased in an online retail context. There was some evidence suggesting that calorie labels on alcoholic and non‐alcoholic drinks may reduce calories purchased from both types of drinks

Smoking cessation medicines and e-cigarettes : a systematic review, network meta-analysis and cost-effectiveness analysis

Background Cigarette smoking is one of the leading causes of early death. Varenicline [Champix (UK), Pfizer Europe MA EEIG, Brussels, Belgium; or Chantix (USA), Pfizer Inc., Mission, KS, USA], bupropion (Zyban; GlaxoSmithKline, Brentford, UK) and nicotine replacement therapy are licensed aids for quitting smoking in the UK. Although not licensed, e-cigarettes may also be used in English smoking cessation services. Concerns have been raised about the safety of these medicines and e-cigarettes. Objectives To determine the clinical effectiveness, safety and cost-effectiveness of smoking cessation medicines and e-cigarettes. Design Systematic reviews, network meta-analyses and cost-effectiveness analysis informed by the network meta-analysis results. Setting Primary care practices, hospitals, clinics, universities, workplaces, nursing or residential homes. Participants Smokers aged ≥ 18 years of all ethnicities using UK-licensed smoking cessation therapies and/or e-cigarettes. Interventions Varenicline, bupropion and nicotine replacement therapy as monotherapies and in combination treatments at standard, low or high dose, combination nicotine replacement therapy and e-cigarette monotherapies. Main outcome measures Effectiveness – continuous or sustained abstinence. Safety – serious adverse events, major adverse cardiovascular events and major adverse neuropsychiatric events. Data sources Ten databases, reference lists of relevant research articles and previous reviews. Searches were performed from inception until 16 March 2017 and updated on 19 February 2019. Review methods Three reviewers screened the search results. Data were extracted and risk of bias was assessed by one reviewer and checked by the other reviewers. Network meta-analyses were conducted for effectiveness and safety outcomes. Cost-effectiveness was evaluated using an amended version of the Benefits of Smoking Cessation on Outcomes model. Results Most monotherapies and combination treatments were more effective than placebo at achieving sustained abstinence. Varenicline standard plus nicotine replacement therapy standard (odds ratio 5.75, 95% credible interval 2.27 to 14.90) was ranked first for sustained abstinence, followed by e-cigarette low (odds ratio 3.22, 95% credible interval 0.97 to 12.60), although these estimates have high uncertainty. We found effect modification for counselling and dependence, with a higher proportion of smokers who received counselling achieving sustained abstinence than those who did not receive counselling, and higher odds of sustained abstinence among participants with higher average dependence scores. We found that bupropion standard increased odds of serious adverse events compared with placebo (odds ratio 1.27, 95% credible interval 1.04 to 1.58). There were no differences between interventions in terms of major adverse cardiovascular events. There was evidence of increased odds of major adverse neuropsychiatric events for smokers randomised to varenicline standard compared with those randomised to bupropion standard (odds ratio 1.43, 95% credible interval 1.02 to 2.09). There was a high level of uncertainty about the most cost-effective intervention, although all were cost-effective compared with nicotine replacement therapy low at the £20,000 per quality-adjusted life-year threshold. E-cigarette low appeared to be most cost-effective in the base case, followed by varenicline standard plus nicotine replacement therapy standard. When the impact of major adverse neuropsychiatric events was excluded, varenicline standard plus nicotine replacement therapy standard was most cost-effective, followed by varenicline low plus nicotine replacement therapy standard. When limited to licensed interventions in the UK, nicotine replacement therapy standard was most cost-effective, followed by varenicline standard. Limitations Comparisons between active interventions were informed almost exclusively by indirect evidence. Findings were imprecise because of the small numbers of adverse events identified. Conclusions Combined therapies of medicines are among the most clinically effective, safe and cost-effective treatment options for smokers. Although the combined therapy of nicotine replacement therapy and varenicline at standard doses was the most effective treatment, this is currently unlicensed for use in the UK. Future work Researchers should examine the use of these treatments alongside counselling and continue investigating the long-term effectiveness and safety of e-cigarettes for smoking cessation compared with active interventions such as nicotine replacement therapy. Study registration This study is registered as PROSPERO CRD42016041302

Comparative clinical effectiveness and safety of tobacco cessation pharmacotherapies and electronic cigarettes : a systematic review and network meta‐analysis of randomized controlled trials

Aim To determine how varenicline, bupropion, nicotine replacement therapy (NRT) and electronic cigarettes compare with respect to their clinical effectiveness and safety. Method Systematic reviews and Bayesian network meta-analyses of randomized controlled trials, in any setting, of varenicline, bupropion, NRT and e-cigarettes (in high, standard and low doses, alone or in combination) in adult smokers and smokeless tobacco users with follow-up duration of 24 weeks or greater (effectiveness) or any duration (safety). Nine databases were searched until 19 February 2019. Primary outcomes were sustained tobacco abstinence and serious adverse events (SAEs). We estimated odds ratios (ORs) and treatment rankings and conducted meta-regression to explore covariates. Results We identified 363 trials for effectiveness and 355 for safety. Most monotherapies and combination therapies were more effective than placebo at helping participants to achieve sustained abstinence; the most effective of these, estimated with some imprecision, were varenicline standard [OR = 2.83, 95% credible interval (CrI) = 2.34–3.39] and varenicline standard + NRT standard (OR = 5.75, 95% CrI = 2.27–14.88). Estimates were higher in smokers receiving counselling than in those without and in studies with higher baseline nicotine dependence scores than in those with lower scores. Varenicline standard + NRT standard showed a high probability of being ranked best or second-best. For safety, only bupropion at standard dose increased the odds of experiencing SAEs compared with placebo (OR = 1.27, 95% CrI = 1.04–1.58), and we found no evidence of effect modification. Conclusions Most tobacco cessation monotherapies and combination therapies are more effective than placebo at helping participants to achieve sustained abstinence, with varenicline appearing to be most effective based on current evidence. There does not appear to be strong evidence of associations between most tobacco cessation pharmacotherapies and adverse events; however, the data are limited and there is a need for improved reporting of safety data

The impact of introducing alcohol‐free beer options in bars and public houses on alcohol sales and revenue: a randomised crossover field trial

Aims: The study aimed to estimate the impact of introducing a draught alcohol‐free beer, thereby increasing the relative availability of these products, on alcohol sales and monetary takings in bars and pubs in England. Design: Randomised crossover field trial. Setting: England. Participants: Fourteen venues that did not previously sell draught alcohol‐free beer. Intervention and comparator: Venues completed two intervention periods and two control periods in a randomised order over 8 weeks. Intervention periods involved replacing one draught alcoholic beer with an alcohol‐free beer. Control periods operated business as usual. Measurements: The primary outcome was mean weekly volume (in litres) of draught alcoholic beer sold. The secondary outcome was mean weekly revenue [in GBP (£)] from all drinks. Analyses adjusted for randomised order, special events, season and busyness. Findings: The adjusted mean difference in weekly sales of draught alcoholic beer was −20 L [95% confidence interval (CI) = −41 to +0.4], equivalent to a 4% reduction (95% CI = 8% reduction to 0.1% increase) in the volume of alcoholic draught beer sold when draught alcohol‐free beer was available. Excluding venues that failed at least one fidelity check resulted in an adjusted mean difference of −29 L per week (95% CI = −53 to −5), equivalent to a 5% reduction (95% CI = 8% reduction to 0.8% reduction). The adjusted mean difference in weekly revenue was +61 GBP per week (95% CI = −328 to +450), equivalent to a 1% increase (95% CI = 5% decrease to 7% increase) when draught alcohol‐free beer was available. Conclusions: Introducing a draught alcohol‐free beer in bars and pubs in England reduced the volume of draught alcoholic beer sold by 4% to 5%, with no evidence of the intervention impacting net revenue