Novos artigos de livre acesso publicados na revista online Plos One, 18/03/2009
O sítio PLoS ONE é uma publicação online, de livre acesso, com destacadas pesquisas científicas, coordenado pela Public Library of Science. Nesta semana merecem destaque várias pesquisas, tais como:
Media Reporting of Health Interventions: Signs of Improvement, but Major Problems Persist
Abaixo estão os Abstract’s:
Placebo Response of Non-Pharmacological and Pharmacological Trials in Major Depression: A Systematic Review and Meta-Analysis
André Russowsky Brunoni1,2, Mariana Lopes1, Ted J. Kaptchuk3, Felipe Fregni1*
1 Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America, 2 Department and Institute of Psychiatry, University of Sao Paulo, Sao Paulo, Brazil, 3 Osher Research Center, Harvard Medical School, Boston, Massachusetts, United States of America
Abstract
Background
Although meta-analyses have shown that placebo responses are large in Major Depressive Disorder (MDD) trials; the placebo response of devices such as repetitive transcranial magnetic stimulation (rTMS) has not been systematically assessed. We proposed to assess placebo responses in two categories of MDD trials: pharmacological (antidepressant drugs) and non-pharmacological (device- rTMS) trials.
Methodology/Principal Findings
We performed a systematic review and meta-analysis of the literature from April 2002 to April 2008, searching MEDLINE, Cochrane, Scielo and CRISP electronic databases and reference lists from retrieved studies and conference abstracts. We used the keywords placebo and depression and escitalopram for pharmacological studies; and transcranial magnetic stimulation and depression and sham for non-pharmacological studies. All randomized, double-blinded, placebo-controlled, parallel articles on major depressive disorder were included. Forty-one studies met our inclusion criteria – 29 in the rTMS arm and 12 in the escitalopram arm. We extracted the mean and standard values of depression scores in the placebo group of each study. Then, we calculated the pooled effect size for escitalopram and rTMS arm separately, using Cohen’s d as the measure of effect size. We found that placebo response are large for both escitalopram (Cohen’s d – random-effects model – 1.48; 95%C.I. 1.26 to 1.6) and rTMS studies (0.82; 95%C.I. 0.63 to 1). Exploratory analyses show that sham response is associated with refractoriness and with the use of rTMS as an add-on therapy, but not with age, gender and sham method utilized.
Conclusions/Significance
We confirmed that placebo response in MDD is large regardless of the intervention and is associated with depression refractoriness and treatment combination (add-on rTMS studies). The magnitude of the placebo response seems to be related with study population and study design rather than the intervention itself.
Citation: Brunoni AR, Lopes M, Kaptchuk TJ, Fregni F (2009) Placebo Response of Non-Pharmacological and Pharmacological Trials in Major Depression: A Systematic Review and Meta-Analysis. PLoS ONE 4(3): e4824. doi:10.1371/journal.pone.0004824
Editor: Kenji Hashimoto, Chiba University Center for Forensic Mental Health, Japan
Received: December 5, 2008; Accepted: February 3, 2009; Published: March 18, 2009
Copyright: © 2009 Brunoni et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: The authors have no support or funding to report.
Competing interests: The authors have declared that no competing interests exist.
* E-mail: ffregni{at{bidmc.harvard.edu
Media Reporting of Health Interventions: Signs of Improvement, but Major Problems Persist
Amanda Wilson1*, Billie Bonevski2, Alison Jones1, David Henry3
1 Discipline of Clinical Pharmacology, School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia, 2 Centre for Health Education and Psycho-oncology (CHeRP), School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia, 3 Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, Canada
Abstract
Background
Studies have persistently shown deficiencies in medical reporting by the mainstream media. We have been monitoring the accuracy and comprehensiveness of medical news reporting in Australia since mid 2004. This analysis of more than 1200 stories in the Australian media compares different types of media outlets and examines reporting trends over time.
Methods and Findings
Between March 2004 and June 2008 1230 news stories were rated on a national medical news monitoring web site, Media Doctor Australia. These covered a variety of health interventions ranging from drugs, diagnostic tests and surgery to dietary and complementary therapies. Each story was independently assessed by two reviewers using ten criteria. Scores were expressed as percentages of total assessable items deemed satisfactory according to a coding guide. Analysis of variance was used to compare mean scores and Fishers exact test to compare proportions. Trends over time were analysed using un-weighted linear regression analysis. Broadsheet newspapers had the highest average satisfactory scores: 58% (95% CI 56–60%), compared with tabloid newspapers and online news outlets, 48% (95% CI 44–52) and 48% (95% CI 46–50) respectively. The lowest scores were assigned to stories broadcast by human interest/current affairs television programmes (average score 33% (95% CI 28–38)). While there was a non- significant increase in average scores for all outlets, a significant improvement was seen in the online news media: a rise of 5.1% (95%CI 1.32, 8.97; P 0.009). Statistically significant improvements were seen in coverage of the potential harms of interventions, the availability of treatment or diagnostic options, and accurate quantification of benefits.
Conclusion
Although the overall quality of medical reporting in the general media remains poor, this study showed modest improvements in some areas. However, the most striking finding was the continuing very poor coverage of health news by commercial current affairs television programs.
Citation: Wilson A, Bonevski B, Jones A, Henry D (2009) Media Reporting of Health Interventions: Signs of Improvement, but Major Problems Persist. PLoS ONE 4(3): e4831. doi:10.1371/journal.pone.0004831
Editor: Lise Lotte Gluud, Copenhagen University Hospital, Denmark
Received: September 18, 2008; Accepted: February 2, 2009; Published: March 18, 2009
Copyright: © 2009 Wilson et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: Media Doctor Australia has received funding over the past two years from the Hunter Medical Research Institute and the University of Newcastle. The funders has no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
* E-mail: amanda.j.wilson{at}studentmail.newcastle.edu.au
[EcoDebate, 20/03/2009]
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