The credence of statistical generalisations should not categorically license outright rational belief

Background: Vitamin D is an essential nutrient involved in various bodily functions such as bone health, immune system regulation, and cell growth. Despite its importance, vitamin D deficiency is a widespread issue globally, affecting individuals across different age groups and backgrounds. The deficiency's prevalence and impact on health outcomes vary among populations due to factors like sun exposure, dietary habits, skin pigmentation, and geographic location. This study reviews the recent advancements in understanding the prevalence of vitamin D deficiency among different population groups and its impact on health outcomes. Methods and Materials: A comprehensive literature review was conducted using databases such as PubMed, Google Scholar, and others from 2014 to 2024. Keywords like "Vitamin D," "Vitamin D Deficiency," and "evidence-based medicine" guided the search. The inclusion criteria focused on studies written in English and covered a wide range of research articles, clinical trials, and meta-analyses to ensure a thorough understanding of the topic. Results: The review revealed that vitamin D deficiency is prevalent across various demographic groups, with significant variations based on factors like skin pigmentation, age, geographic location, and lifestyle. Darker-skinned individuals, older adults, and those living in high-latitude regions are particularly at risk. The deficiency is linked to several adverse health outcomes, including osteoporosis, cardiovascular diseases, autoimmune disorders, and mood disorders like depression. Conclusion: Addressing vitamin D deficiency is crucial for improving public health. Tailored interventions considering demographic and geographic differences are necessary to mitigate the deficiency's impact. Public health strategies should promote sun exposure, dietary adjustments, and supplementation to enhance vitamin D levels, ultimately improving health outcomes and reducing healthcare disparities.

Objective This article expands the review of psychosocial treatments for adolescents with disruptive behavior (DB), published previously by this journal. That earlier review focused on DB treatment studies published 1966–2014; the current paper updates the evidence base by incorporating DB treatment studies published 2014–2021. Method A literature search and screening process identified 63 new studies for inclusion in this updated review. The 63 new studies were combined with 86 studies from the prior review and evaluated using Journal of Clinical Child and Adolescent Psychology level of support criteria, which classify studies as well established, probably efficacious, possibly efficacious, experimental, or of questionable efficacy based on the evidence. Results In total, 3 well-established, 7 probably efficacious, and 10 possibly efficacious treatments for adolescents with DB were identified. Further, 52 treatments were classified as experimental and 22 treatments were determined to have questionable efficacy. Conclusions There continues to be a large body of literature building the evidence base for treatments of adolescent DB. With a few exceptions, treatments falling into the top three evidence levels utilized more than one theoretical approach, enhancing each treatment’s ability to target DB from multiple angles. Key advances include broad representation of various demographic groups, countries of origin, treatment settings, and provider types in this body of research. Despite these advances, more research is needed to address key gaps in the field, including the need for more studies on treatments tailored to adolescents with DB who are not yet involved with the juvenile justice system.

In the pages of Evidence-Based Mental Health and elsewhere, authors have argued that it is ethically obligatory to practice evidence-based medicine (EBM).1–,3 The argument in favour of this position begins...

Background: STEM disciplines run a deficit of majors needed for national workforce needs, and students of color, first-generation college students, and women are systemically underrepresented. This deficit is often attributed to entrenched instructor-centered teaching approaches and noninclusive classroom environments, suggesting the need to explore the impact of alternative STEM pedagogies, including varieties of experiential learning, on these outcomes. Community-based learning, in which students help communities solve real-world problems, may be particularly valuable for these populations’ cultural and personal values. Purpose : We apply Astin's Input-Environment-Output model to a systematic review of the literature to investigate the impact of CBL in STEM interventions on historically underrepresented populations’ STEM major, minor, or career intent and their STEM-affiliated self-beliefs. Method : Following PRISMA reporting guidelines and JBI methodologies, we identified nine studies published between 1999 and 2024 and analyzed them for themes and strength of evidence. Findings : Only two compared the effect of CBL to that of other pedagogies, two compared outcomes across racial or ethnic groups, two compared outcomes for first versus continuing generation college students, and four compared outcomes across genders. Implications : Future studies should compare student outputs across demographic groups that are well-represented versus underrepresented in STEM ( inputs ) for CBL interventions compared to other STEM pedagogies ( environments ).

This review will focus on the evaluation of biomarkers and surrogate endpoints in chronic disease risk with a focus on cardiovascular disease. It provides an example of how identification of relevant biomarkers might be useful in sleep research and clinical care. Much of this review is derived from work performed by the Institute of Medicine (IOM) Committee on Qualification of Biomarkers and Surrogate Endpoints in Chronic Disease (see footnote in the Acknowledgments). This discussion will review the committee charge, definitions of biomarkers and other endpoints, biomarker evaluation framework, case studies of representative biomarkers, recommendations, and conclusions.

Evidence-based medicine has become both the mantra of clinical practice and the dominant contemporary approach to patient care. Gordon Guyatt et al. first proposed applying the concept to medical education in the early 1990s, arguing for training that "de-emphasizes intuition, unsystematic clinical experience, and pathophysiologic rationale" in favor of "examination of evidence from clinical research"; over the following twenty-five years, nearly every medical school and residency program in the United States incorporated these methods into its training. During this same period, admissions requirements and protocols have continued to rely on subjective, non-evidence-based ideals largely developed a century earlier. In light of the continued underrepresentation of certain demographic groups among matriculants, as well as the national controversy surrounding admissions standards at undergraduate institutions-most notably embodied in the lawsuit by Students for Fair Admissions against Harvard University-the moment may be ripe for a radical reexamination of those requirements.

Many veterans who begin evidence-based therapies for posttraumatic stress disorder (PTSD) discontinue care prior to treatment completion. Examination of individual-level factors as predictors of dropout has been inconclusive, and it may be important to examine organizational factors as predictors. The present study investigates the role of both individual variables (i.e., gender identity, age, racial background, ethnicity, perceived barriers to treatment) and organizational variables (i.e., time from evaluation to individual treatment, number of preparatory sessions, and inclusion of family in an informational session) in predicting treatment discontinuation. Participants consisted of 557 veterans who presented to a Veterans Affairs PTSD specialty clinic and began trauma-focused treatment (86.89% male, 50.99% White, 47.94% Operation Iraqi Freedom/Operation Enduring Freedom). Most veterans reported at least one barrier to treatment (85.10%). A total of 53.32% of veterans completed a course of evidence-based trauma-focused therapy, while 46.68% discontinued. In a series of logistic regression models, older age significantly predicted treatment completion (OR = 1.017, p = .007), and longer time from evaluation to treatment initiation significantly predicted treatment discontinuation (OR = 0.992, p = .045). Findings highlight older age as a reliable predictor of treatment completion among veterans. Findings add to the existing literature by demonstrating that improving organizational-level variables (i.e., reducing wait time from evaluation to treatment initiation) may be particularly helpful in facilitating treatment completion across demographic groups, even in the presence of barriers to treatment. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

BackgroundManagement for multi-drug-resistant tuberculosis (MDR-TB) is challenging and has poor patient outcomes. Peru has a high burden of MDR-TB. The Loreto region in the Peruvian Amazon is worst affected for reasons including high rates of poverty and poor healthcare access. Current evidence identifies factors that influence MDR-TB medication adherence, but there is limited understanding of the patient and healthcare professional (HCP) perspective, the HCP-patient relationship and other factors that influence outcomes. A qualitative investigation was conducted to explore and compare the experiences and perceptions of MDR-TB patients and their dedicated HCPs to inform future management strategies.MethodTwenty-six, semi-structured in-depth interviews were conducted with 15 MDR-TB patients and 11 HCPs who were purposively recruited from 4 of the worst affected districts of Iquitos (capital of the Loreto region). Field notes and transcripts of the two groups were analysed separately using thematic content analysis. Ethics approval was received from the Institutional Research Ethics Committee, Department of Health, Loreto, and the University of Birmingham Internal Research Ethics Committee.ResultsFour key themes influencing patient outcomes emerged in each participant group: personal patient factors, external factors, clinical factors, and the HCP-patient relationship. Personal factors included high standard patient and population knowledge and education, which can facilitate engagement with treatment by encouraging belief in evidence-based medicine, dispelling belief in natural medicines, health myths and stigma. External factors included the adverse effect of the financial impact of MDR-TB on patients and their families. An open, trusting and strong HCP-patient relationship emerged as a vitally important clinical factor influencing of patient outcomes. The results also provide valuable insight into the dynamic of the relationship and ways in which a good relationship can be fostered.ConclusionsThis study highlights the importance of financial support for patients, effective MDR-TB education and the role of the HCP-patient relationship. These findings add to the existing evidence base and provide insight into care improvements and policy changes that could improve outcomes if prioritised by local and national government.

In his memoirs, the legendary head of the Department of Oncology (Radiumhemmet), Karolinska Hospital, Professor Jerzy Einhorn, described a chain of events during the late 1980s that led to discussions within the Swedish parliament about the state of Swedish cancer care [1]. In particular, the parliamentary discussions concerned the intolerable waiting times for patients scheduled to receive radiotherapy at Radiumhemmet. The whole affair started with Jerzy being alarmed by the increasing waiting times. He felt he had to take measures to remedy the situation by introducing stricter indications for radiotherapy. These measures gained wide media attention, were reviewed by various health care authorities, and, finally, as mentioned, were discussed by the Swedish parliament. One important outcome of these events was that Radiumhemmet was given the possibility to expand its radiotherapy resources. The alarmingly long waiting times that were felt to be intolerable, the very reason that set off this chain of events was . . . 2 /3 weeks. In this issue of Acta Oncologica the Danish head & neck cancer collaborative group (DAHANCA) reports the results of a survey of changes between 1992 and 2002 in the pretreatment delay for patients with squamous cell cancer of the head & neck seen at five oncology centers in Denmark [2]. They found that the median total time from first contact with the health care system to start of definitive treatment (typically radiotherapy) was longer in 2002 than in 1992 (70 versus 50 days, pB/0.001). The main reason was an increase in time from referral to radiotherapy to start of treatment (40 versus 21 days, pB/0.001). The study was inspired by a Swedish report from the Stockholm area, which also analysed pre-treatment delays for head & neck cancer patients [3]. The main impetus for that study was a major reorganisation and centralisation of the local ENT service in Stockholm during the 1990s. The median time to initiation of treatment was found to have increased over time. In contrast to the Danish study, the main reason in Stockholm was increased time used for initial diagnosis / caused by logistical problems at the university center to which all ENT cancer surgery had been centralised. There is reason to believe that these reports of longer waiting times for cancer patients are not specific to head and neck cancer. Recent media attention in Sweden suggests that it is a growing problem also in many other, large cancer patient groups, such as breast, prostate and gastrointestinal cancer. A recent survey among the members of the Swedish breast cancer patients’ organisation, for instance, showed that about 40% of them had waited for 3 weeks or longer for their breast cancer surgery. In my experience, delays in excess of 2 /3 months to initiate postoperative radiotherapy are today not uncommon in Sweden. When these issues are discussed in the media, administrators and even physicians typically state that waiting is, of course, deplorable from a psychosocial point of view, but it is not an issue of patient safety. What is implied is that waiting, from a purely medical point of view, has no effect on outcome. It is enigmatic how such statements can be made by individuals who in other circumstances profess a belief in evidence-based medicine. In fact, the notion that waiting for definitive treatment has no effect on outcome in terms of recurrence or death due to the disease lacks scientific support. Admittedly, there are no large randomized trials that have compared longer versus shorter waiting times. Such trials would be impossible for ethical reasons. But there

Barriers to treatment for depression and anxiety are prevalent among older adults and caregivers living in the community. We designed and implemented an evidence-based psychotherapy program to reduce obstacles to care. A practice improvement initiative providing no-fee evidence-based mental health care at home in clients' primary languages. Independence at Home, a community service of SCAN Health Plan in Southern California. Diverse older adults and adult caregivers of older people with age-related disability (mainly dementia). Redesign of an existing supportive counseling program to improve access to validated models of psychotherapy for depression and anxiety. We describe program content, phases of development, equity in participation from referral to program completion, clinical outcomes, and estimated direct program delivery costs. Insights successfully served demographically diverse clients experiencing a broad range of barriers to mental health care. A total of 211 clients completed therapy using one of three evidence-based approaches in the first 33 months of operation (2015-2018). Clinical efficacy was high and equivalent across demographic groups and therapy models. Depression, anxiety, quality of life, self-rated disability, and patient activation all improved significantly. We supported therapists' transition to the new model, modified workflows, and used clinical outcome data and therapist focus groups to improve referral, selection, and enrollment processes and simplify treatment assignment. With program maturation, treatment duration and direct costs both declined. The Insights model could add value to healthcare organizations seeking to provide effective, equitable mental health services for older adults and caregivers who have difficulty accessing care for depression, anxiety, or difficult life challenges. J Am Geriatr Soc 67:2174-2179, 2019.

Background: Hypertension remains a critical global health burden and a primary modifiable risk factor for cardiovascular disease. Despite a multitude of available interventions, optimal strategies for management and prevention across diverse demographic and risk groups are not fully elucidated, necessitating a synthesized evaluation of contemporary evidence. Objective: This systematic review aimed to evaluate the effectiveness of lifestyle, dietary, and pharmacological interventions in controlling and preventing hypertension among diverse population groups. Methods: A systematic search of PubMed, Scopus, Web of Science, and the Cochrane Library was conducted for studies published between 2019 and 2024. The review included randomized controlled trials and prospective cohort studies that assessed the impact of these interventions on systolic and/or diastolic blood pressure in adult populations. Study selection, data extraction, and risk of bias assessment were performed by two independent reviewers following PRISMA guidelines. Results: Eight studies (n=11,542 participants) were included. The evidence demonstrated that intensive, multi-component lifestyle interventions produced substantial blood pressure reductions (e.g., -10.2/-5.6 mmHg). Culturally-tailored dietary approaches and technology-enabled strategies (e.g., mHealth for salt reduction) showed significant efficacy. Pharmacologically, spironolactone was highly effective in resistant hypertension, and low-dose triple therapy provided superior control in elderly patients compared to monotherapy. The overall strength of evidence was moderate, though significant clinical and methodological heterogeneity precluded a meta-analysis. Conclusion: Structured and personalized interventions are effective for hypertension control across diverse populations. The findings support a paradigm shift towards tailored lifestyle and pharmacological strategies rather than a uniform approach. Future research should focus on long-term outcomes and identifying predictive factors for personalized intervention selection to optimize public health impact.

This study was intended to evaluate the mental health literacy vis-à-vis depression among inhabitants of Penang state in North Malaysia. Using a clustered random sampling method, 1,855 respondents were approached to participate in the survey. A total of 1,149 respondents actually participated, for a 61.9% response rate. Face to face interviews were then conducted using a pre-validated 21-item questionnaire. The mean age of the respondents was 30 years (SD +/-11.5). The majority (n = 884; 76.9%) could recognize three or more symptoms of depression. Chinese and/or female respondents performed the best in this domain. Respondents with a personal experience of depression displayed a significantly better knowledge of symptoms of and therapies for depression than those who did not (t = -35.745, P = <0.001). Overall, a moderate knowledge level of the symptoms of depression and a cursory knowledge towards therapy were observed among the general population in Penang. Notably, respondents were generally inclined towards the use of alternative medicine. The study suggests that strong beliefs in alternative and traditional medicines could undermine the respondents' willingness and ability to seek evidence-based mental health care.

19 - Stable Coronary Artery Disease

Since its beginning in the 1990s, enthusiasm for evidence-based medicine (EBM) has flourished. As its methodology becomes more sophisticated and its breadth expands, EBM increasingly is referred to in patient care, insurance coverage decisions, technology assessments, medical education, and health care policymaking. Despite this growth, the intersection of EBM and bioethics often is not explored. This article discusses the deontologic and utilitarian aspects of EBM and assesses EBM according to 4 bioethical principles: Respect for autonomy, beneficence, nonmaleficence, and justice. Strong ethical arguments support EBM as the best approach to patient care. However, practitioners and health care organizations must be aware that each principle involves complex issues that challenge EBM’s ethical values.

The Ethical Debate on Evidence-based Medicine — Introduction to the Volume