Multiplicity of data in trial reports and the reliability of meta-analyses: empirical study

Multiplicity of data in trial reports and the reliability of meta-analyses: empirical study — Tendal et al. 343 — bmj.com.

This article is available freely via Open Access. Please click on the above link to view it fully.

Abstract

Objectives To examine the extent of multiplicity of data in trial reports and to assess the impact of multiplicity on meta-analysis results.

Design Empirical study on a cohort of Cochrane systematic reviews.

Data sources All Cochrane systematic reviews published from issue 3 in 2006 to issue 2 in 2007 that presented a result as a standardised mean difference (SMD). We retrieved trial reports contributing to the first SMD result in each review, and downloaded review protocols. We used these SMDs to identify a specific outcome for each meta-analysis from its protocol.

Review methods Reviews were eligible if SMD results were based on two to ten randomised trials and if protocols described the outcome. We excluded reviews if they only presented results of subgroup analyses. Based on review protocols and index outcomes, two observers independently extracted the data necessary to calculate SMDs from the original trial reports for any intervention group, time point, or outcome measure compatible with the protocol. From the extracted data, we used Monte Carlo simulations to calculate all possible SMDs for every meta-analysis.

Results We identified 19 eligible meta-analyses (including 83 trials). Published review protocols often lacked information about which data to choose. Twenty-four (29%) trials reported data for multiple intervention groups, 30 (36%) reported data for multiple time points, and 29 (35%) reported the index outcome measured on multiple scales. In 18 meta-analyses, we found multiplicity of data in at least one trial report; the median difference between the smallest and largest SMD results within a meta-analysis was 0.40 standard deviation units (range 0.04 to 0.91).

Conclusions Multiplicity of data can affect the findings of systematic reviews and meta-analyses. To reduce the risk of bias, reviews and meta-analyses should comply with prespecified protocols that clearly identify time points, intervention groups, and scales of interest

Can chocolate really protect the heart?

Can chocolate really protect the heart? – Health News – NHS Choices.

NHS Choices examines the science behind the newspaper headlines.

Links to the headlines

Chocolate may protect the brain and heart. BBC News, August 30 2011

Chocolate is good for you, declares study (well, sort of). The Guardian, August 30 2011

Chocolate ‘cuts heart risk by a third’. The Daily Telegraph, August 30 2011

Links to the science

Buitrago-Lopez A, Sanderson J, Johnson L et al. Chocolate consumption and cardiometabolic disorders: systematic review and meta-analysis. BMJ 2011; 343:d4488

Chair appointed for Bury’s shadow clinical commissioning group

via Chair appointed for Bury’s shadow clinical commissioning group | HSJ Local | Health Service Journal.

This article is solely the work of the HSJ. For a full copy of the article please contact the library.

Dr Kiran Patel, a local GP, has been appointed to the role of chair and clinical lead of Bury’s shadow Clinical Commissioning Group (CCG).

 

Positive waiting time data called into question

via Positive waiting time data called into question | News | Health Service Journal.

This article is solely the work of the HSJ. For a full copy of the article please contact the library.

New figures showing that the NHS in Scotland is close to reaching its target for reducing hospital waiting times has been played down by statisticians

 

Obesity plan could cost shoppers dear

Obesity plan could cost shoppers dear | Society | The Guardian.

Labour attacks NHS bill amendments

Labour attacks NHS bill amendments | Society | guardian.co.uk.

Opticians ‘should offer blood sugar checks’

via BBC News – Opticians ‘should offer blood sugar checks’.

Opticians should offer blood sugar checks alongside eye tests to help spot patients with undiagnosed diabetes, experts propose.

 

Japan’s life expectancy ‘down to equality and public health measures’

Japan’s life expectancy ‘down to equality and public health measures’ | World news | The Guardian.

 

The maths of coalition has opened the door to lobbyists

The maths of coalition has opened the door to lobbyists | Simon Jenkins | Comment is free | The Guardian.

Physical activity, cardiorespiratory fitness, and metabolic syndrome in adolescents: a cross-sectional study.

Abstract | Physical activity, cardiorespiratory fitness, and metabolic syndrome in adolescents: a cross-sectional study..

This article is available freely via Open Access. Please click on the above link to view it fully.

Abstract (provisional)

 

Background

In adults, there is a substantial body of evidence that physical inactivity or low cardiorespiratory fitness levels are strongly associated with the development of metabolic syndrome. Although this association has been studied extensively in adults, little is known regarding this association in adolescents. The aim of this study was to analyze the association between physical activity and cardiorespiratory fitness levels with metabolic syndrome in Brazilian adolescents.

Methods

A random sample of 223 girls (mean age, 14.4 [1.6] years) and 233 boys (mean age, 14.6 [1.6] years) was selected for the study. The physical activity level was determined by the Bouchard three-day physical activity record. Cardiorespiratory fitness was estimated by the Leger 20-meter shuttle run test. The metabolic syndrome components assessed included waist circumference, blood pressure, HDL-cholesterol, triglycerides, and fasting plasma glucose levels. Independent Student t-tests were used to assess gender differences. The associations between physical activity and cardiorespiratory fitness with the presence of metabolic syndrome were calculated using logistic regression models adjusted for age and gender.

Results

A higher prevalence of metabolic syndrome was observed in inactive adolescents (males, 11.4%; females, 7.2%) and adolescents with low cardiorespiratory fitness levels (males, 13.9%; females, 8.6%). A significant relationship existed between metabolic syndrome and low cardiorespiratory fitness (OR, 3.0 [1.13-7.94]).

Conclusion

The prevalence of metabolic syndrome is high among adolescents who are inactive and those with low cardiorespiratory fitness. Prevention strategies for metabolic syndrome should concentrate on enhancing fitness levels early in life.

Cancer drug access unequal across UK

via Cancer drug access unequal across UK | News | Health Service Journal.

This article is solely the work of the HSJ. For a full copy of the article please contact the library.

A clear divide in the number of patients approved to access cancer drugs has appeared between England, Scotland and Wales, campaigners say.

 

Medtronic submits full data on spinal protein to independent scrutiny

via Medtronic submits full data on spinal protein to independent scrutiny — Cohen 343 — bmj.com.

An NHS Athens account may be required to view this in full.

The company at the centre of an investigation by a US Senate committee into an alleged failure to mention the side effects of a spinal treatment it makes has agreed to fund an independent review into the safety and effectiveness of the product. It is the first time that a medical technology company has agreed to this type of detailed scrutiny

 

Online patient-doctor consultations encouraged by Keogh

via Online patient-doctor consultations encouraged by Keogh | News | Health Service Journal.

This article is solely the work of the HSJ. For a full copy of the article please contact the library.

Doctors will be able to hold patient consultations using online technologies as part of plans to revolutionise the delivery of health services, the medical director of the NHS has said

 

NHS Bolton Library Presents… Primary Care News, Opinions and Research week ending 28th August 2011

Please find below a selection of the most relevant and interesting news stories of the past week. Including:

• The future of the primary medical workforce
• The Frankfurt Patient Safety Climate Questionnaire for General Practices (FraSiK): analysis of psychometric properties
• Learning our way into the future public health: a proposition
• Reported cancer spending in relation to population characteristics, disease burden and service activity for primary care trusts in South East England
• Uptake of the NHS Health Checks programme in a deprived, culturally diverse setting: cross-sectional study
• Bowel cancer awareness ‘stubbornly low’
• The Big Drink Debate: perceptions of the impact of price on alcohol consumption from a large scale cross-sectional convenience survey in north west England

Bolton GP commissioners forecast to overspend delegated budgets by £1.4m

Source: Bolton GP commissioners forecast to overspend delegated budgets by £1.4m | HSJ Local | Health Service Journal.

The area’s clinical commissioners are forecast to overspend their delegated budgets by £1.4m this year, the primary care trust’s latest finance report shows

The area’s clinical commissioners are forecast to overspend their delegated budgets by £1.4m this year, the primary care trust’s latest finance report shows

Causes of Death: UK National Statistics Publication Hub

via Causes of Death: UK National Statistics Publication Hub.

Latest statistics on causes of death in the United Kingdom and constituent countries, including alcohol-related deaths, suicides, drug-related deaths, deaths involving MRSA and Clostridium difficile, and estimates of excess winter mortality.

Less than a third of patients asked about diet

via Less than a third of patients asked about diet | News | Health Service Journal.

This article is solely the work of the HSJ. For a full copy of the article please contact the library.

Summary: Less than a third of patients have been asked about their diet and weight during a stay in hospital and less than a quarter have been given a choice of what they would like to eat, according to new research

Achieving public health legal preparedness: how dissonant views on public health law threaten emergency preparedness and response

Achieving public health legal preparedness: how dissonant views on public health law threaten emergency preparedness and response.

An NHS Athens account may be required to view this in full.

 

 

Abstract

 

Background Effective management of modern public health emergencies requires the coordinated efforts of multiple agencies representing various disciplines. Organizational culture differences between public health (PH) and emergency management (EM) entities may hinder inter-agency collaboration. We examine how PH and EM differ in their approach to PH law and how such differences affect their collaboration towards PH preparedness.

 

Methods We conducted 144 semi-structured interviews with local and state PH and EM officials between April 2008 and November 2009. Thematic qualitative analysis in ATLAS.ti was used to extract characteristics of each agency’s approach to PH legal preparedness.

 

Results Two conflicting approaches to the law emerge. The PH approach is characterized by perceived uncertainty regarding legal authority over preparedness planning tasks; expectation for guidance on interpretation of existing laws; and concern about individual and organizational liability. The EM approach reveals perception of broad legal authority; flexible interpretation of existing laws; and ethical concerns over infringement of individual freedoms and privacy.

 

Conclusions Distinct interpretations of preparedness law impede effective collaboration for PH preparedness. Clarification of legal authority mandates, designation within laws of scope of preparedness activities and guidance on interpretation of current federal and state laws are needed

 

‘Crude’ spending estimates risk CCGs’ funding

via ‘Crude’ spending estimates risk CCGs’ funding | News | Health Service Journal.

This article is solely the work of the HSJ. For a full copy of the article please contact the library.

Future commissioners could face “catastrophic consequences” if a rushed attempt to map current spending on GP practice populations leads to inaccurate funding allocations, experts have warned

 

The association between socio-demographic characteristics and adherence to breast and colorectal cancer screening: Analysis of large sub populations

Abstract | The association between socio-demographic characteristics and adherence to breast and colorectal cancer screening: Analysis of large sub populations.

This article is available freely via Open Access. Please click on the above link to view it fully.

Abstract (provisional)

 

Background

Populations having lower socioeconomic status, as well as ethnic minorities, have demonstrated lower utilization of preventive screening, including tests for early detection of breast and colorectal cancer. The objective: To explore socio-demographic disparities in adherence to screening recommendations for early detection of cancer.

Methods

The study was conducted by Maccabi Healthcare Services, an Israeli HMO (health plan) providing healthcare services to 1.9 million members. Utilization of breast cancer (BC) and colorectal cancer (CC) screening were analyzed by socio-economic ranks (SERs), ethnicity (Arab vs non-Arab), immigration status and ownership of voluntarily supplemental health insurance (VSHI).

Results

Data on 157,928 and 303,330 adults, eligible for BC and CC screening, respectively, were analyzed. Those having lower SER, Arabs, immigrants from Former Soviet Union countries and non-owners of VSHI performed fewer cancer screening examinations compared with those having higher SER, non-Arabs, veterans and owners of VSHI (p<0.001). Logistic regression model for BC Screening revealed a positive association with age and ownership of VSHI and a negative association with being an Arab and having a lower SER. The model for CC screening revealed a positive association with age and ownership of VSHI and a negative association with being an Arab, having a lower SER and being an immigrant. The model estimated for BC and CC screening among females revealed a positive association with age and ownership of VSHI and a negative association with being an Arab, having a lower SER and being an immigrant.

Conclusion

Patients from low socio-economic backgrounds, Arabs, immigrants and those who do not own supplemental insurance do fewer tests for early detection of cancer. These sub-populations should be considered priority populations for targeted intervention programs and improved resource allocation. Key Words: Breast Cancer, Colon Cancer, Early Detection of Cancer, Health Disparities, Demographic Characteristics

Trust access to PFI funding could be constrained by Treasury rule change

via Trust access to PFI funding could be constrained by Treasury rule change | News | Health Service Journal.

This article is solely the work of the HSJ. For a full copy of the article please contact the library.

NHS trusts could find it harder to secure badly needed private finance initiative funding after chief secretary to the Treasury Danny Alexander ordered the Department of Health to review how it authorises potential schemes, HSJ has learned

 

Hospitals seeing 900 more alcohol related cases a day

via Hospitals seeing 900 more alcohol related cases a day | News | Health Service Journal.

This article is solely the work of the HSJ. For a full copy of the article please contact the library.

Nearly 900 more people a day are being admitted to hospitals in England with drink related problems compared to five years ago, figures show

 

NHS unions meeting to discuss joint walk out

via NHS unions meeting to discuss joint walk out | News | Health Service Journal.

This article is solely the work of the HSJ. For a full copy of the article please contact the library.

Unions representing health service workers at all levels are meeting this afternoon to discuss potential industrial action over changes to the NHS pension scheme

 

Lung disease costs to rise in retirement hotspots

via Lung disease costs to rise in retirement hotspots | News | Health Service Journal.

This article is solely the work of the HSJ. For a full copy of the article please contact the library.

Health commissioners for seaside retirement communities are being urged to adopt the latest guidance on the treatment of lung disease to buttress themselves against a predicted surge in the cost of the illness in these areas

 

Diabetes medication costing NHS £725m a year

via Diabetes medication costing NHS £725m a year | News | Health Service Journal.

This article is solely the work of the HSJ. For a full copy of the article please contact the library.

Drugs to treat people with diabetes now take up almost a tenth of the entire NHS budget for medicine, new data released by the service’s information division shows

 

Cholera pandemic has a single global source

Source: BBC News – Cholera pandemic has a single global source.

A major cholera pandemic has spread in at least three waves from a single global source: the Bay of Bengal.

 

Determinants of self-rated health in old age: A population-based, cross-sectional study using the International Classification of Functioning

Abstract | Determinants of self-rated health in old age: A population-based, cross-sectional study using the International Classification of Functioning.

This article is available freely via Open Access. Please click on the above link to view it fully.

 

Abstract (provisional)

 

Background

Self-rated health (SRH) is a widely used indicator of general health and multiple studies have supported the predictive validity of SRH in older populations concerning future health, functional decline, disability, and mortality. The aim of this study was to use the theoretical framework of the International Classification of Functioning, Disability and Health (ICF) to create a better understanding of factors associated with SRH among community-dwelling older people in urban and rural areas.

Methods

The study design was population-based and cross-sectional. Participants were 185 Icelanders, randomly selected from a national registry, community-dwelling, 65-88 years old, 63% urban residents, and 52% men. Participants were asked: “In general, would you say your health is excellent, very good, good, fair, or poor?” Associations with SRH were analyzed with ordinal logistic regression. Explanatory variables represented aspects of body functions, activities, participation, environmental factors, and personal factors components of the ICF.

Results

Univariate analysis revealed that SRH was significantly associated with all analyzed ICF components through 16 out of 18 explanatory variables. Multivariate analysis, however, demonstrated that SRH had an independent association with five variables representing ICF body functions, activities, and personal factors components: The likelihood of a better SRH increased with advanced lower extremity capacity (adjusted odds ratio [adjOR] = 1.05, p < 0.001), upper extremity capacity (adjOR = 1.13, p = 0.040), household physical activity (adjOR = 1.01, p = 0.016), and older age (adjOR = 1.09, p = 0.006); but decreased with more depressive symptoms (adjOR = 0.79, p < 0.001).

Conclusions

The results highlight a collection of ICF body functions, activities, and personal factors associated with higher SRH among community-dwelling older people. Some of these, such as physical capacity, depressive symptoms, and habitual physical activity are of particular interest due to their potential for change through public health interventions. The use of ICF conceptual framework and widely accepted standardized assessments should make these results comparable and relevant in an international context.

 

 

Future heart health ‘shaped by diet’

Source: BBC News – Future heart health ‘shaped by diet’

Growing up starved of calories may give you a higher risk of heart disease 50 years on, research suggests.

.

Socio-demographic, psychosocial and home-environmental attributes associated with adults’ domestic screen time

Abstract | Socio-demographic, psychosocial and home-environmental attributes associated with adults’ domestic screen time.

This article is available freely via Open Access. Please click on the above link to view it fully.

Abstract (provisional)

 

Background

Sedentary behaviors (involving prolonged sitting time) are associated with deleterious health consequences, independent of (lack of) physical activity. To inform interventions, correlates of prevalent sedentary behaviors need to be identified. We examined associations of socio-demographic, home-environmental and psychosocial factors with adults’ TV viewing time and leisure-time Internet use; and whether psychosocial and environmental correlates differed according to gender, age and educational attainment.

Methods

This cross-sectional study was conducted in Ghent, Belgium, between March and May 2010. Respondents to a mail-out survey (n=419; 20-65 years; mean age 48.5 [12.1] years; 47.3% men) completed a questionnaire on sedentary behaviors and their potential socio-demographic, psychosocial and home environmental correlates. Statistical analyses were performed using multiple linear regression models.

Results

The independent variables explained 31% of the variance in TV viewing time and 38% of the variance in leisure-time Internet use. Higher education, greater perceived pros of and confidence about reducing TV time were negatively associated with TV viewing time; older age, higher body mass index, larger TV set size and greater perceived cons of reducing TV time showed positive associations. Perceived pros of and confidence about reducing Internet use were negatively associated with leisure-time Internet use; higher education, number of computers in the home, positive family social norms about Internet use and perceived cons of reducing Internet use showed positive associations. None of the socio-demographic factors moderated these associations.

Conclusions

Educational level, age, self-efficacy and pros/cons were the most important correlates identified in this study. If further cross-sectional and longitudinal research can confirm these findings, tailored interventions focusing on both psychosocial and environmental factors in specific population subgroups might be most effective to reduce domestic screen time.

Rise in FTs not reporting complaints

via Rise in FTs not reporting complaints | News | Health Service Journal.

This article is solely the work of the HSJ. For a full copy of the article please contact the library.

Rules will be tightened to force foundation trusts to pass on patients’ complaints to the government, the Department of Health has revealed to HSJ.