Type Of Scientific Evidence Research Articles

Uber use after alcohol consumption among car/motorcycle drivers in ten Brazilian capitals.

This study aimed to measure the proportion of Uber use instead of drinking and driving in ten Brazilian capitals, in 2019. A cross-sectional survey was developed in ten Brazilian capitals. Data were collected in agglomeration points (AP) and sobriety checkpoints (SC). Based on responses to a standardized questionnaire, the proportion of drivers who used Uber instead of drinking and driving was measured for total sample of each methodology and stratified by municipality, age group, gender, education level, and type of vehicle. Fisher's exact test was used to make comparisons between the strata. A total of 8,864 drivers were interviewed. The most used means of transport to replace driving after drinking alcohol was the Uber system (AP: 54.6%; 95%CI: 51.2-58.0. SC: 58.6%; 95%CI: 55.2-61.9). Most of these users were aged from 18 to 29 years, women, with at least one higher education degree. According to the AP methodology, the highest magnitude of this indicator was found in Vitória (ES) (71.0%; 95%CI: 63.5-77.5), whereas the lowest was observed in Teresina (PI) (33.1%; 95%CI: 22.7-45.5). According to the SC methodology, the highest magnitude of the indicator was also found in Vitória (ES) (78.3%; 95%CI: 68.8-85.5), whereas the lowest was observed in Boa Vista (RR) (36.6%; 95%CI: 26.8-47.7). In Brazilian capitals, the study showed higher proportions of Uber use instead of drinking and driving. This type of scientific evidence on factors associated with road traffic injuries presents the potential to guide public health interventions.

Mobile Applications in Mood Disorders and Mental Health: Systematic Search in Apple App Store and Google Play Store and Review of the Literature.

Objectives: The main objective of this work was to explore and characterize the current landscape of mobile applications available to treat mood disorders such as depression, bipolar disorder, and dysthymia. Methods: We developed a tool that makes both the Apple App Store and the Google Play Store searchable using keywords and that facilitates the extraction of basic app information of the search results. All app results were filtered using various inclusion and exclusion criteria. We characterized all resultant applications according to their technical details. Furthermore, we searched for scientific publications on each app’s website and PubMed, to understand whether any of the apps were supported by any type of scientific evidence on their acceptability, validation, use, effectiveness, etc. Results: Thirty apps were identified that fit the inclusion and exclusion criteria. The literature search yielded 27 publications related to the apps. However, these did not exclusively concern mood disorders. 6 were randomized studies and the rest included a protocol, pilot-, feasibility, case-, or qualitative studies, among others. The majority of studies were conducted on relatively small scales and 9 of the 27 studies did not explicitly study the effects of mobile application use on mental wellbeing. Conclusion: While there exists a wealth of mobile applications aimed at the treatment of mental health disorders, including mood disorders, this study showed that only a handful of these are backed by robust scientific evidence. This result uncovers a need for further clinically oriented and systematic validation and testing of such apps.

Considerações sobre o uso de evidências científicas em tempos de pandemia: o caso da COVID-19

Making better use of available evidence on drugs and non-pharmacological therapies in the context of the COVID-19 pandemic is critical to minimizing suffering and saving lives. This debate aimed to present considerations about the concept of evidence, the hierarchy of evidence and the types of scientific evidence, seeking application in the context of the COVID-19 pandemic, with regard to the use of therapies for prevention and treatment of the disease. Initially, we made a brief introduction on the topic, highlighting the existence of doubts regarding the use of various drugs, as well as whether those available to combat other diseases can be safe and effective in the treatment of COVID-19. Then, we present some definitions about evidence, reinforcing that an exact definition depends on the context in which it will be used, and may even have a broad or restrictive connotation. Next, we mention that the evidence is classified in a hierarchical order, illustrated by means of a pyramid, according to the design of the study employed, one of the important markers to define the quality of the evidence. Emphasis is given to the evidence from the expert opinion, which is based on beliefs built on the basis of theory and non-systematic learning. Soon after, we resorted to basic concepts about three types of scientific evidence (direct, indirect and preliminary evidence) to explain the divergences between expert opinions. We conclude with comments and reflections on the need to define reasonably acceptable criteria for the use of evidence, for now available, in times of a pandemic, such as COVID-19.

Transcreation: an implementation science framework for community-engaged behavioral interventions to reduce health disparities

BackgroundMethods for translating evidence-based behavioral interventions into real-world settings seldom account for the special issues in reaching health disparity populations.Main textThe objective of this article is to describe an innovative “transcreational” framework for designing and delivering interventions in communities to reduce health disparities. We define transcreation as the process of planning, delivering, and evaluating interventions so that they resonate with the community experiencing health disparities, while achieving intended health outcomes. The Transcreation Framework for Community-engaged Behavioral Interventions to Reduce Health Disparities comprises seven steps: 1) identify community infrastructure and engage partners; 2) specify theory; 3) identify multiple inputs for new program; 4) design intervention prototype; 5) design study, methods, and measures for community setting; 6) build community capacity for delivery; and 7) deliver transcreated intervention and evaluate implementation processes. Communities are engaged from the start and interventions are delivered by community-based interventionists and tested in community settings. The framework applies rigorous scientific methods for evaluating program effectiveness and implementation processes. It incorporates training and ongoing technical assistance to assure treatment fidelity and build community capacity.ConclusionsThis framework expands the types of scientific evidence used and balances fidelity to evidence and fit to the community setting. It can guide researchers and communities in developing and testing behavioral interventions to reduce health disparities that are likely to be sustained because infrastructure development is embedded in the research.

Challenges to decision-making processes in the national HTA agency in Brazil: operational procedures, evidence use and recommendations

BackgroundThe quality of the evidence used in health technology assessment (HTA) agency reports has been considered essential for decision-making processes and their legitimacy. In Brazil, CONITEC is the agency responsible for defining data mandatory for the submission of proposals for the incorporation of new technologies. The objective of this study was to analyse CONITEC recommendation reports, the type of scientific evidence used in them and their compliance with operational procedures.MethodsThis is a descriptive study based on CONITEC official reports from July 2012 through December 2016. Data were collected with a specific extraction form and analysed using descriptive statistics.ResultsWe evaluated 199 CONITEC recommendation reports. The annual number of reports increased during the study period. The absolute annual number of new technologies incorporated in 2013 (n = 24) was similar to that observed for 2014 (n = 24) and 2015 (n = 22), decreasing in 2016 (n = 13). The type of technology most frequently evaluated was ‘drugs’ (68.3%), followed by ‘procedures’ (20.1%). Overall, 117 (58.8%) reports were internal demands, 75 (37.7%) were external demands and 7 (3.5%) were mixed demands. There were differences between internal and external demands in terms of the evidence used in the reports and the decision regarding the recommendation to incorporate the technologies. Among the internal demands, the recommendation to incorporate the new technology was made for 70.9% of the reports, only 9.6% of which included full HTAs. Among the external demands, the incorporation of the new technology was recommended for 17.3% of the reports, 76.9% of which included full HTAs. Of the 101 reports in which incorporation of the new technology was recommended, 88 (87.1%) did not include a full health economic evaluation and ICER calculation. There are compliance difficulties with the recommendations in the CONITEC internal regulations regarding the type and quality of evidence considered in the analysis of recommendation reports.ConclusionsThe characteristics of the evidence used in recommendation reports and those considered to be mandatory were very different, indicating problems in decision-making processes. There is a need to study, with a broader perspective, the factors that influence the type of evidence used in decision-making processes in order to contribute to the development of better practices and policies.

Potential and limitations of the attribution of climate change impacts for informing loss and damage discussions and policies

The issue of climate related loss and damage (L&D) has re-emerged and gained significant traction in international climate policy in recent years. However, many aspects remain unclear, including how aspects of liability and compensation in relation with L&D will be treated under the UNFCCC, human rights and environmental law. Furthermore, the type of scientific evidence required to link climate change impacts for each of these L&D mechanisms needs to be clarified. Here we analyze to which degree different types of scientific evidence can inform L&D discussions and policies. We distinguish between (i) L&D observation, (ii) understanding causation, and (iii) linking L&D to anthropogenic emissions through attribution studies. We draw on three case studies from Australia, Colombia and Alaska to demonstrate the relevance of the different types of evidence. We then discuss the potential and limitations of these types of scientific evidence, in particular attribution, for informing current L&D discussions and policies. Attribution (iii) sets the highest bar, but also provides the most complete set of information to support adaptation, risk reduction and L&D policies. However, rather than suggesting that attribution is a necessary requirement for L&D policies we want to highlight its potential for facilitating a more thematically structured, and thus hopefully a more constructive, policy and justice discussion.

Assessment of potential drug–drug interactions and its associated factors in the hospitalized cardiac patients

Drug–drug interactions (DDIs) may result in the alteration of therapeutic response. Sometimes they may increase the untoward effects of many drugs. Hospitalized cardiac patients need more attention regarding drug–drug interactions due to complexity of their disease and therapeutic regimen. This research was performed to find out types, prevalence and association between various predictors of potential drug–drug interactions (pDDIs) in the Department of Cardiology and to report common interactions. This study was performed in the hospitalized cardiac patients at Ayub Teaching Hospital, Abbottabad, Pakistan. Patient charts of 2342 patients were assessed for pDDIs using Micromedex® Drug Information. Logistic regression was applied to find predictors of pDDIs. The main outcome measure in the study was the association of the potential drug–drug interactions with various factors such as age, gender, polypharmacy, and hospital stay of the patients. We identified 53 interacting-combinations that were present in total 5109 pDDIs with median number of 02 pDDIs per patient. Overall, 91.6% patients had at least one pDDI; 86.3% were having at least one major pDDI, and 84.5% patients had at least one moderate pDDI. Among 5109 identified pDDIs, most were of moderate (55%) or major severity (45%); established (24.2%), theoretical (18.8%) or probable (57%) type of scientific evidence. Top 10 common pDDIs included 3 major and 7 moderate interactions. Results obtained by multivariate logistic regression revealed a significant association of the occurrence of pDDIs in patient with age of 60years or more (p<0.001), hospital stay of 7days or longer (p<0.001) and taking 7 or more drugs (p<0.001). We found a high prevalence for pDDIs in the Department of Cardiology, most of which were of moderate severity. Older patients, patients with longer hospital stay and with elevated number of prescribed drugs were at higher risk of pDDIs.

The Effect on Mock-Juror Decision-Making of Power-of-Speech Within Eyewitness Testimony and Types of Scientific Evidence

This study examined whether manipulating power-of-speech within eyewitness testimony (EWT) and the type of scientific evidence (deoxyribonucleic acid [DNA] or fingerprint) had an effect on mock-juror decision-making. A between-participants design was utilised with jury-eligible participants randomly assigned to one of eight online experimental conditions. Participants were presented with a scenario followed by one type of scientific evidence and EWT. After each piece of evidence, participants made judgements of the probability of defendant guilt, judgement confidence and evidence strength. Lastly, participants chose a verdict and, if applicable, a sentence length. It was found that although powerful EWT was rated as more indicative of guilt (and indeed stronger than powerless EWT), only scientific evidence type affected the final verdicts with DNA evidence being associated with a greater number of guilty verdicts. Results suggest a biasing effect of DNA that outweighs the effect of other types of evidence including EWT.

The Selective Allure of Neuroscientific Explanations

Some claim that recent advances in neuroscience will revolutionize the way we think about human nature and legal culpability. Empirical support for this proposition is mixed. Two highly-cited empirical studies found that irrelevant neuroscientific explanations and neuroimages were highly persuasive to laypersons. However, attempts to replicate these effects have largely been unsuccessful. Two separate experiments tested the hypothesis that neuroscience is susceptible to motivated reasoning, which refers to the tendency to selectively credit or discredit information in a manner that reinforces preexisting beliefs. Participants read a newspaper article about a cutting-edge neuroscience study. Consistent with the hypothesis, participants deemed the hypothetical study sound and the neuroscience persuasive when the outcome of the study was congruent with their prior beliefs, but gave the identical study and neuroscience negative evaluations when it frustrated their beliefs. Neuroscience, it appears, is subject to the same sort of cognitive dynamics as other types of scientific evidence. These findings qualify claims that neuroscience will play a qualitatively different role in the way in which it shapes people’s beliefs and informs issues of social policy.

Frequency, Levels and Predictors of Potential Drug-Drug Interactions in a Pediatrics Ward of a Teaching Hospital in Pakistan

Purpose : To identify the frequency, levels and predictors of potential drug-drug interactions (pDDIs) in a pediatrics ward of a teaching hospital in Pakistan. Methods : Medication profiles of 400 pediatric patients were evaluated for pDDIs using Micromedex Drug-Reax® software. Logistic regression was used to identify association of pDDIs with hospital-stay, patient’s gender, and number of medications. Results : In total, 86 interacting drug-combinations resulting in 260 pDDIs were identified. Overall, 25.8 % patients were exposed to at least one pDDI regardless of severity-type, 10.7 % to at least one majorpDDI, 15.2 % to at least one moderate-pDDI, and 12.5 % to at least one minor-pDDI. Of 260 pDDIs, most were of moderate severity (41.5 %) followed by minor (35.4 %) and major severity (21.9 %); good (76.9 %) or fair (16.5 %) type of scientific evidence; and delayed onset (46.5 %). Some widespread major or moderate interactions included rifampin + pyrazinamide (14 cases), phenobarbital + diazepam (14), dexamethasone + rifampin (8), amikacin + furosemide (7), furosemide + captopril (7), dexamethasone + phenobarbital (6), phenobarbital + divalproex sodium (6), isoniazid + rifampin (5) amikacin + ibuprofen (5), digoxin + furosemide (4), and acetaminophen + phenytoin sodium (4). There was significant association of the occurrence of pDDIs with five or more prescribed medications (p < 0.001). Conclusion : PDDIs are less prevalent in the pediatrics ward of the hospital studied. Most of the interactions were of moderate severity. Patients with increased number of prescribed medications were more exposed to these interactions. Keywords : Drug-drug interactions, Prescription screening, Drug related problems

Potential drug–drug interactions in internal medicine wards in hospital setting in Pakistan

Multiple drugs therapies may be the potential source of drug-drug interactions that can result in alteration of therapeutic response and/or increase untoward effects of many drugs. To identify the frequency and levels of potential drug-drug interactions (pDDIs) in internal medicine wards and their association with patients' age, gender, length of hospital stay and number of prescribed medications; and to describe management of frequently identified major or moderate pDDIs. Internal medicine wards of two major tertiary care hospitals of Khyber Pakhtunkhwa, Pakistan. Micromedex Drug-Reax system was used to screen patient's profiles for pDDIs. Logistic regression was applied to determine the odds ratio for specific risk factors of pDDIs i.e., age, gender, hospital-stay and number of medications. Overall prevalence and prevalence of contraindicated, major, moderate and minor pDDIs; levels of pDDIs; frequently identified major or moderate interactions; and odds ratios for risk factors. Total, 188 interacting drug-combinations were identified that contributed to 675 pDDIs. Of 400 patients, 52.8% patients were presented with at least one pDDI (overall prevalence), 21.3% with at least one major-pDDI, and 44.3% with at least one moderate-pDDI. Of 675 pDDIs, most were of moderate (63.6%) or major severity (23%); good (61.2%) or fair (25.5%) type of scientific evidence; and delayed onset (50.2%). Most frequently identified major or moderate interactions resulted in 45.3% of all pDDIs. Their potential adverse outcomes included hepatotoxicity, bleeding, ototoxicity, nephrotoxicity, hypoglycemia, hyperglycemia, risk of thrombosis, hypotension, cardiac arrhythmias and reduction in therapeutic-effectiveness. There was significant association of the occurrence of pDDIs with patients' age of 60 years or more (OR = 2.1; 95% CI = 1.3-3.3; p = 0.003), hospital stay of 6 days or longer (OR = 2.6; 95% CI = 1.5-4.5; p = 0.001), and seven or more number of prescribed medications (OR = 5.9; 95% CI = 3.6-9.6; p < 0.001). The present study has recorded a high prevalence of pDDIs in internal medicine wards. Patients with old age, longer hospital stay and increased number of prescribed medications were at higher risk.

Effectiveness of GH isoform differential immunoassay for detecting rhGH doping on application of various growth factors

The analytical method for detecting growth hormone (GH) doping, the so-called GH isoform differential immunoassay, is currently approved by the World Anti-Doping Agency (WADA). Anti-doping laboratories often face challenges by athletes' lawyers and need to have various types of scientific evidence against the claim that the adverse analytical finding (AAF) result was caused by excess ectopic or abnormal excretion. In this work, a population study of Japanese athletes (255 male and 256 female) and administration studies of recombinant human GH (rhGH) in Japanese females were conducted to confirm the applicability of GH isoform differential immunoassay. The present paper describes the effectiveness of the GH isoform differential immunoassay under abnormal excretion of endogenous GH as determined by administration studies of GH releasing hormone (GHRH(1-44)) and insulin-like growth factor-1 (IGF-1). No false positive findings were found in Japanese athletes. The GH isoform differential immunoassays could detect application of rhGH for approximately 12-24 h. The administration of GHRH(1-44) and IGF-1 as well as ghrelin receptor agonists did not affect the isoform ratio (no false positives). We conclude that the GH isoform differential immunoassay is a highly specific method for detecting rhGH doping. Subject-based profiling (i.e. athlete biological passport) very likely will represent a highly sensitive approach for detecting rhGH doping.

Potential Drug-Drug Interactions in Psychiatric Ward of a Tertiary Care Hospital: Prevalence, Levels and Association with Risk Factors

Purpose: To identify the prevalence of potential drug-drug interactions (pDDIs) in a psychiatric ward, their levels and association with risk factors. Methods: This study was conducted in the psychiatric ward of Ayub Teaching Hospital, Abbottabad, Pakistan. Medical records of 415 patients were retrospectively reviewed for pDDIs using Micromedex Drug-Reax software. Logistic regression was applied to determine association of pDDIs with age, gender, hospital stay and number of drugs. Results: In our study, we identified total number of 825 pDDIs of 126 types, with median number of 1 pDDIs per patient. Overall 64.8 % of the patients had at least one pDDI; 27.2 % at least one major pDDI; and 58.5 % patients at least one moderate pDDI. Among 825 identified pDDIs, most were of moderate (75.6 %) or major (20.8 %) severity, good (66.4 %) or fair (29 %) type of scientific evidence; and delayed onset (71 %). The most frequent major and moderate pDDIs included haloperidol + procyclidine (127 cases), haloperidol + olanzapine (49), haloperidol + promethazine (47), haloperidol + fluphenazine (41), diazepam + divalproex sodium (40), haloperidol + trihexyphenidyl (37), lorazepam + divalproex sodium (34), fluphenazine + procyclidine (33) and olanzapine + divalproex sodium (32). There was significant association of occurrence of pDDIs with hospital stay of 7 days or longer (p = 0.005) and taking 7 or more drugs (p < 0.001). Conclusion: A high prevalence of pDDIs in the psychiatric ward was recorded, a majority of which were of moderate severity. Patients with long hospital stay and increased number of drugs were more exposed to pDDIs. Keywords : Drug-drug interactions, Potential drug-drug interaction, Prescriptions screening, Drug-related problems, Clinical pharmacy.

Using Theory to Identify Beliefs Associated With Support for Policies to Raise the Price of High-Fat and High-Sugar Foods

Public policies designed to dramatically raise the price of high-fat and high-sugar foods have received substantial attention from researchers and the media. Although econometric studies suggest that these policies could reduce obesity rates, they are likely to face substantial public opposition. This study used the theory of perceived responsibility and social motivation as a framework to analyze data from a politically diverse convenience sample of 500 adults in upstate New York. The authors examined associations between attribution beliefs and policy support to identify what types of scientific evidence and accompanying messages appear most likely to generate public support for price-raising policies. Results suggest that public health advocates and health communicators could benefit from an increased emphasis on advertising for unhealthy foods as a cause of obesity and the food industry's (manufacturers, advertisers, markets, and restaurants) responsibility for addressing the problem.

English

The objective of the study was to identify prevalence, types and predictors of potential drug-drug interactions (pDDIs) in pulmonology ward and to report common interactions. Medical records of 400 randomly-selected patients were reviewed for pDDIs using Micromedex Drug-Reax software. Logistic-regression was applied to determine predictors of pDDIs. We identified 126 interacting-combinations that encountered in total 558 pDDIs with median number of 01 pDDI per patient. Overall 45% patients had at least one pDDI; 24.25% were having at least one major pDDI, and 36% patients had at least one moderate pDDI. Among 558 identified pDDIs, most were of moderate (53.6%) or major severity (34%); good (74.2%) or fair (16.3%) type of scientific-evidence; and delayed onset (70%). Top 15 common pDDIs included 6 major, 7 moderate and 2 minor interactions. There was significant association of the occurrence of pDDIs with patient with age of 60 years or more (p <0.001), hospital stay of 7 days or longer (p = 0.01) and taking 7 or more drugs (p <0.001). We have recorded a high prevalence of pDDIs in pulmonology ward, most of which were of moderate severity. Patients with old age, long hospital stay and increased number of drugs were more exposed to pDDIs. Key words: Drug-drug interactions, potential drug-drug interaction, prescriptions screening, drug related problems, clinical pharmacy.

Translating Evidence-Based Decision Making into Practice: Appraising and Applying the Evidence

This is the second of 2 articles that focus on strategies to integrate an evidence-based decision-making (EBDM) approach into your practice. The previous article provided an overview of EBDM concepts and identified strategies for finding evidence to answer clinical questions, the first 2 steps in the evidence-based process. The next steps are to determine the credibility and usefulness of the evidence and to apply the evidence to patient care. The purpose of this article is to discuss those steps by reviewing the critical appraisal criteria used to assess the methodological quality of a study. A case scenario will be used to demonstrate how appraising the evidence helps to answer questions and how to translate the evidence into everyday practice. Characteristics of an evidence-based practice and educational tips are provided along with a glossary of terms related to appraising the literature. Together, the two articles can serve as a primer for integrating EDBM into your practice. Generally, the most frequently asked clinical questions are related to the effectiveness of a certain technique, medication, diagnostic test, treatment, material, or product. The type of scientific evidence may include systematic reviews and critically appraised topics; clinical practice guidelines and protocols; article reviews; pharmaceutical and drug interaction information; and individual studies addressing questions about therapy, prevention, diagnosis, prognosis, and harm/etiology. Once the most current evidence has been found, the next step in the EBDM process is to understand what you have and its relevance to your patient.

HEALTH FUNCTIONALITY OF SMALL FRUIT

Various types of scientific evidence are accumulating which suggests that fruits and vegetables may provide benefits against such significant disease states as cancer, cardiovascular disease, immune system decline, and certain neurological disorders. These and other diseases have been associated with unrepaired oxidative damage to nucleic acids, proteins, and lipids. Thus the antioxidant properties of certain plant phytochemicals are purported to provide protective effects. The phenolics are the major group of antioxidant phytochemicals found in berry crops such as blueberries, bilberries, and cranberries. Evidence from either in vitro, in vivo, or both types of studies suggest that fruit extracts and/or isolated phenolic compounds are associated with antioxidant, as well as anti-cancer, anti-inflammatory, cardioprotective, and neurprotective properties. Increased awareness of the reported health functionality of small fruit has stimulated consumer interest in the possibility of positively affecting personal health and disease risk through the consumption of fruit and vegetable phytochemicals.

Psychosocial influences on coronary heart disease

A variety of types of scientific evidence supports the hypothesis that stress and related psychosocial processes contribute to the development and course of coronary hean disease (CHD). In animal models, stress can accelerate the development of coronary artery disease and precipitate acute cardiac events. In human epidemiological studies, social isolation and low social support, Type A behaviour, and hostility predict the development of CHD. In clinical studies of patients with CHD, psychological stress is associated with transient myocardial ischemia, suggesting that psychosocial factors can increase vulnerability to acute coronary events. Finally, intervention research suggests that modification of these psychosocial risk factors may prevent recurrence of cardiac events in patients with CHD. This paper reviews each of these topics and discusses the implications for prevention and management of CHD.

HYPOCHROMIC ANEMIA IN PATIENTS WITH DEFICIENCY OF THE VITAMIN B COMPLEX

Many clinicians have the impression that the response to iron therapy of patients with hypochromic anemia is enhanced if the vitamin B complex is administered concomitantly. Relatively expensive combinations of these two therapeutic agents have been prepared by pharmaceutical houses and are being extensively used. The reasoning behind this dual therapy accepts the recent impression that subclinical or subcritical deficiencies of the B complex are relatively common in the United States 1 and postulates that the circumstances which bring about iron deficiency may lead also to suboptimal intake of vitamins. It is assumed, furthermore, that vitamin deficiency may result either in poor absorption of iron from the intestinal tract or in its defective utilization for hemoglobin synthesis. These ideas about the interrelationship of iron metabolism and the vitamin B complex germinate from three separate types of scientific evidence. In the first place, many investigators have frequently observed hypochromic anemias in