47 research outputs found
Response to: Female Genital Mutilation and Obstetric Outcomes: Flawed Systematic Review and Meta-Analysis Does Not Accurately Reflect the Available Evidence
Ressenyes
Obra ressenyada: MartĂn F. RĂOS SALOMA, La Reconquista. Una construcciĂłn historiogrĂĄfica (siglos XVI-XIX). Madrid: Marcial Pons (Ediciones de Historia), 2011
Solution scenarios and the effect of top down versus bottom up N mitigation measures:Experiences from the Danish Nitrogen Assessment
Videnskabelig udredning af international viden om skifergas relateret til en dansk kontekst:DTU, GEUS, DCE
A Televised, Web-Based Randomised Trial of an Herbal Remedy (Valerian) for Insomnia
BACKGROUND: This trial was conducted as part of a project that aims to enhance public understanding and use of research in decisions about healthcare by enabling viewers to participate in research and to follow the process, through television reports and on the web. Valerian is an herbal over-the-counter drug that is widely used for insomnia. Systematic reviews have found inconsistent and inconclusive results about its effects. METHODS: Participants were recruited through a weekly nationally televised health program in Norway. Enrolment and data collection were over the Internet. 405 participants who were 18 to 75 years old and had insomnia completed a two week diary-keeping run-in period without treatment and were randomised and mailed valerian or placebo tablets for two weeks. All participants and investigators were blind to treatment until after the analysis was completed. FINDINGS: For the primary outcome of a minimally important improvement in self-reported sleep quality (> or = 0.5 units on a 7 point scale), the difference between the valerian group (29%) and the placebo group (21%) was not statistically significant (difference 7.5%; 95% CI-0.9 to 15.9; p = 0.08). On the global self-assessment question at the end of the treatment period 5.5% (95% CI 0.2 to 10.8) more participants in the valerian group perceived their sleep as better or much better (p = 0.04). There were similar trends favouring the valerian group for night awakenings (difference = 6.0%, 95% CI-0.5 to 12.5) and sleep duration (difference = 7.5%, 95% CI-1.0 to 16.1). There were no serious adverse events and no important or statistically significant differences in minor adverse events. INTERPRETATION: Based on this and previous studies, valerian appears to be safe, but with modest beneficial effects at most on insomnia compared to placebo. The combined use of television and the Internet in randomised trials offers opportunities to answer questions about the effects of health care interventions and to improve public understanding and use of randomised trials. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN72748991
Evaluation of a Web Portal for Improving Public Access to Evidence-Based Health Information and Health Literacy Skills: A Pragmatic Trial
Background: Using the conceptual framework of shared decision-making and evidence-based practice, a web portal was
developed to serve as a generic (non disease-specific) tailored intervention to improve the lay publicâs health literacy skills.
Objective: To evaluate the effects of the web portal compared to no intervention in a real-life setting.
Methods: A pragmatic randomised controlled parallel trial using simple randomisation of 96 parents who had children aged
,4 years. Parents were allocated to receive either access to the portal or no intervention, and assigned three tasks to
perform over a three-week period. These included a searching task, a critical appraisal task, and reporting on perceptions
about participation. Data were collected from March through June 2011.
Results: Use of the web portal was found to improve attitudes towards searching for health information. This variable was
identified as the most important predictor of intention to search in both samples. Participants considered the web portal to
have good usability, usefulness, and credibility. The intervention group showed slight increases in the use of evidencebased
information, critical appraisal skills, and participation compared to the group receiving no intervention, but these
differences were not statistically significant.
Conclusion: Despite the fact that the study was underpowered, we found that the web portal may have a positive effect on
attitudes towards searching for health information. Furthermore, participants considered the web portal to be a relevant
tool. It is important to continue experimenting with web-based resources in order to increase user participation in health
care decision-making.
Trial Registration: ClinicalTrials.gov NCT0126679
Comparative effectiveness of antihypertensive medication for primary prevention of cardiovascular disease: systematic review and multiple treatments meta-analysis
Background: We conducted a systematic review of evidence from randomized controlled trials to answer the following research question: What are the relative effects of different classes of antihypertensive drugs in reducing the incidence of cardiovascular disease outcomes for healthy people at risk of cardiovascular disease? Methods: We searched MEDLINE, EMBASE, AMED (up to February 2011) and CENTRAL (up to May 2009), and reference lists in recent systematic reviews. Titles and abstracts were assessed for relevance and those potentially fulfilling our inclusion criteria were then assessed in full text. Two reviewers made independent assessments at each step. We selected the following main outcomes: total mortality, myocardial infarction and stroke. We also report on angina, heart failure and incidence of diabetes. We conducted a multiple treatments meta-analysis using random-effects models. We assessed the quality of the evidence using the GRADE-instrument. Results: We included 25 trials. Overall, the results were mixed, with few significant dif-ferences, and with no drugclass standing out as superior across multiple outcomes. The only significant finding for total mortality based on moderate to high quality evidence was that beta-blockers (atenolol) were inferior to angiotensin receptor blockers (ARB) (relative risk (RR) 1.14; 95% credibility interval (CrI) 1.02 to 1.28). Angiotensin converting enzyme (ACE)- inhibitors came out inferior to calcium-channel blockers (CCB) regarding stroke-risk (RR 1.19; 1.03 to 1.38), but superior regarding risk of heart failure (RR 0.82; 0.69 to 0.94), both based on moderate quality evidence. Diuretics reduced the risk of myocardial infarction compared to beta-blockers (RR 0.82; 0.68 to 0.98), and lowered the risk of heart failure compared to CCB (RR 0.73; 0.62 to 0.84), beta-blockers (RR 0.73; 0.54 to 0.96), and alpha-blockers (RR 0.51; 0.40 to 0.64). The risk of diabetes increased with diuretics compared to ACE-inhibitors (RR 1.43; 1.12 to 1.83) and CCB (RR 1.27; 1.05 to 1.57). Conclusion: Based on the available evidence, there seems to be little or no difference between commonly used blood pressure lowering medications for primary prevention of cardiovascular disease. Beta-blockers (atenolol) and alpha-blockers may not be first-choice drugs as they were the only drug-classes that were not significantly superior to any other, for any outcomes