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Pedro M Teixeira

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Category Archives: Research

Não basta recomendar o uso de máscaras na comunidade

19 Thu Nov 2020

Posted by Pedro M Teixeira in COVID-19, Research

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Máscaras

A publicação dos resultados do único ensaio clínico aleatorizado, até ao momento, sobre o uso de máscaras na comunidade para prevenir o contágio por SARS-CoV-2 revela que não se encontrou um efeito estatisticamente significativo. É, portanto, inconclusivo. 

É sempre importante recordar que ausência de evidência de efeito não corresponde a evidência de ausência de efeito.

Uma explanação sobre as evidências que favorecem a recomendação do uso de máscaras na comunidade demonstra que o seu uso pode ser eficaz, como em contexto hospitalar, na redução do número de contágios por SARS-CoV-2. A investigação sobre infeções respiratórias sugere que o uso combinado de medidas preventivas será mais eficaz.

Contudo, os resultados do ensaio clínico aleatorizado dinamarques não podem deixar de nos fazer pensar que o efeito pode ser pequeno ou até na direção oposta ao desejado. Não basta recomendar o uso de máscaras na comunidade. É preciso que as pessoas as usem de forma adequada e não ignorem as outras medidas, como lavar as mãos regularmente e obrigatoriamente antes de comer.

Como recorda a Organização Mundial de Saúde na orientação sobre o uso de máscaras no contexto da COVID-19 de 5 de Junho de 2020:

“Quando as máscaras são recomendadas para o público em geral, o decisor deve:
• comunicar com clareza a finalidade do uso da máscara, onde, quando, como e que tipo de máscara deve ser utilizada. Explicar a vantagem e a desvantagem de usar uma máscara e comunicar claramente que isso faz parte de um pacote de medidas, conjuntamente com a higiene das mãos, distanciamento físico e outras medidas que são necessárias, todas elas, e que todas se reforçam umas às outras;
• informar/ensinar as pessoas quando e como devem usar as máscaras em segurança (ver as secções de gestão e manutenção das máscaras), i.e., colocá-las, usá-las, retirá-las, limpá-las e descartá-las;
• considerar a viabilidade da utilização, questões de abastecimento/acesso, aceitação social e psicológica (de usar e não usar diferentes tipos de máscaras em diferentes contextos);
• continuar a recolher dados e evidências científicas sobre a eficácia do uso de máscaras (incluindo diferentes tipos e marcas, assim como outras protecções da cara, como lenços) em contextos externos às unidades de saúde;
• avaliar o impacto (positivo, neutro ou negativo) do uso de máscaras pela população em geral (incluindo as ciências comportamentais e sociais).”

OMS. Orientação sobre o uso de máscaras no contexto da COVID-19, 5 de Junho de 2020

Medidas como a lavagem das mãos, o uso de máscaras e o distanciamento físico, para serem eficazes, requerem um conhecimento, compreensão e aplicação adequada por parte da população. Não basta criar manuais. Sem programas de educação e de orientação comportamental dirigidos a diferentes segmentos da população, enquadrados numa estratégia de comunicação de risco em saúde, dificilmente teremos os resultados de que precisamos. Restará apenas o confinamento compulsório.

Discrepâncias entre resultados pré-especificados e reportados

15 Fri Feb 2019

Posted by Pedro M Teixeira in Class Content, Escrita científica, Must read, Research

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CONSORT, Trials

A mais recente publicação de Ben Goldacre é um estudo de coorte prospectivo que dá conta da real dimensão do problema das discrepâncias entre os outcomes pré-especifícados (antes do estudo) e os outcomes reportados (após o estudo) em 67 ensaios clínicos publicados num de cinco principais jornais científicos em saúde – New England Journal of Medicine, The Lancet, Journal of the American Medical Association, British Medical Journal, and Annals of Internal Medicine.[1] O estudo considera ainda as tentativas de corrigir essas discrepâncias.[2] Todos estes jornais estão publicamente comprometidos com o CONSORT (Consolidated Standards of Reporting Trials). Para ler, com preocupação, em duas partes:

1. COMPare: a prospective cohort study correcting and monitoring 58 misreported trials in real time

2. COMPare: Qualitative analysis of researchers’ responses to critical correspondence on a cohort of 58 misreported trials

 

The Global Gender Gap Report

19 Wed Dec 2018

Posted by Pedro M Teixeira in Must read, Research

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Gender Gap, Reports

The World Economic Forum just issued The Global Gender Gap Report and the best-ranked countries are:

GenderGap_2018_2018_top10_global-1.png

The best-ranked countries in western Europe are:

GenderGap_2018_2018_globaltop10_westerneurope-1.png

Progress has been done and there is an improvement to close the gap. However, at this rate, it will take 108 years for the world to close the Gap. In western Europe, it may be about 61 years.

2018_Regions_to_Close_Gap.png

Portugal dropped to the 37th position compared to the 33rd position in 2006. The economic and educational indicators also dropped from the 33rd to the 44th and from the 57th to the 82nd positions respectively. Only the health and survival indicators have improved from the 71st to the 54th position. Regarding gender inequality, we still have a long road ahead of us. You can further explore the data here.

gender gap portugal.jpg

 

They finally did it | Parachute use to prevent death and major trauma when jumping from aircraft

17 Mon Dec 2018

Posted by Pedro M Teixeira in Class Content, Must read, Research

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Christmas Pearls, Fun Stuff

A randomized controlled trial about parachute use to prevent death and major trauma when jumping from aircraft was finally published by Robert W Yeh in BMJ.

Since 2003 Smiths’ Systematic Review that was unable to identify any randomised controlled trials of parachute intervention and thus concluded that the effectiveness of parachutes had not been subjected to rigorous evaluation by using randomised controlled trials, the world was expecting such a trial.

aviao.jpgThe conclusions: ‘Parachute use did not reduce death or major traumatic injury when jumping from aircraft in the first randomized evaluation of this intervention. However, the trial was only able to enroll participants on small stationary aircraft on the ground, suggesting cautious extrapolation to high altitude jumps. When beliefs regarding the effectiveness of an intervention exist in the community, randomized trials might selectively enroll individuals with a lower perceived likelihood of benefit, thus diminishing the applicability of the results to clinical practice’.

Scientific Publications | Christmas Pearls

13 Thu Dec 2018

Posted by Pedro M Teixeira in Class Content, Escrita científica, Must read, Research

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Christmas Pearls, Fun Stuff

Several journals have developed a tradition of publishing slightly different papers in their December issues. These papers are intended to either make a provocative statement, making us reflect upon unusual topics, or provide unusual examples of scientific topics. I like to call them Christmas Pearls. This year my favorite Christmas Pearls:

  • by Reidar P. Lystad and Benjamin T. Brown in Injury Epidemiology 2018 5:44 – https://doi.org/10.1186/s40621-018-0174-7

“Death is certain, the time is not”: mortality and survival in Game of Thrones

Kaplan-Meier survival analysis with Cox proportional hazard regression modeling was used to quantify survival times and probabilities to identify independent predictors of mortality among ‘important characters’ (n = 330) appearing in Seasons 1 to 7 of Game of Thrones.

Although the statistics are quite sound and the data extensive some remarks are mandatory.

First, resuscitation bias was not considered (e.g. John snow). Neither were white walkers. Not clear what justifies the exclusion of these non-less important characters. From a mixed-methods perspective, white walkers could have participated in a focus group discussion of the results, for example.

Secondly, the effectiveness of wall policies for security purposes is clearly understated.

Finally, the authors conclude:

“There is great potential for preventing violent deaths in the world of Game of Thrones. Stable democratic governments, resilient institutions that deliver public goods, and implementation of evidence-based violence prevention policies can decrease the risk of violent deaths considerably“.

Given that winter is coming this is clearly an unrealistic and utopic worldview of Game of Thrones.

 

  • by Vikas N O’Reilly-Shah, Grant C Lynde and Craig S Jabaley in BMJ 2018; 363 – doi: https://doi.org/10.1136/bmj.k5033

Is it time to start using the emoji in biomedical literature?

 

The lack of standardisation in emoji artwork that may cause ambiguity in interpretation is quite disturbing. Also, the emoji based alternatives to the denotation of statistical significance can’t really apprehend the need to consider the enunciation of the null hypothesis for adequate interpretation of P-values. The smiling-face-with-sunglasses_1f60e.png in a Kolmogorov-Smirnov to check distribution assumptions for parametric testing may be actually hiding

crying_emoji_small_classic_round_sticker-r4c998b077b254fe69908fa4ca57ce521_v9waf_8byvr_540.jpg.

table 01

F8.large.jpg

Research on self-treatment of “writer’s block” – a timeline critical appraisal

05 Fri Oct 2018

Posted by Pedro M Teixeira in Escrita científica, Must read, Opinião, Research

≈ 3 Comments

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Fun Stuff, methods

Research on the self-treatment of ‘Writer’s Block’ is vast and diversified. You might enjoy reading these articles, they are a fun and fast read. Please, do pay attention to the notes on them. My critical appraisal on the research about ‘Writter’s Block’ may be found at the end of this post.

1974 – the classical CASE REPORT by Dennis Upper:

  • Upper, Dennis (Fall 1974), “The unsuccessful self-treatment of a case of “writer’s block””, Journal of Applied Behavior Analysis, 7 (3): 497, doi:10.1901/jaba.1974.7-497a PDF Here

1983 – a REPLICATION study is performed by Molloy:

  • Molloy, G. N. (1983). The unsuccessful self-treatment of a case of “writer’s block”: A replication. Perceptual and Motor Skills, 57(2), 566-566. PDF Here

1984 – a new REPLICATION, however it partially failed, by Hermann:

  • Hermann, B. P. (1984). Unsuccessful self-treatment of a case of “writer’s block”: a partial failure to replicate. Perceptual and Motor Skills, 58(2), 350-350. PDF Here

1984 – a first REVIEW OF THE LITERATURE on the topic. Still, it was a narrative literature review, we have to wait until 2014 for the first systematic review and meta-analysis

  • Olson, K. R. (1984). Unsuccessful Self-Treatment of “Writer’s Block”: A Review of the Literature. Perceptual and Motor Skills, 59(1), 158–158. doi:10.2466/pms.1984.59.1.158 PDF Here

1985 – a CLINICAL TRIAL by Skinner:

  • Skinner, N. F., Perlini, A. H., Fric, L., Werstine, E. P., & Calla, J. (1985). The Unsuccessful Group-Treatment of “Writer’s Block”. Perceptual and Motor Skills, 61(1), 298-298. PDF Here

1996 – a COHORT study by Skinner:

  • Skinner, N. F., & Perlini, A. H. (1996). The unsuccessful group treatment of “writer’s block”: a ten-year follow-up. Perceptual and motor skills, 82(1), 138-138. PDF Here

2007 – a MULTICENTER REPLICATION study, an attempt to address statistical power issues by Didden:

  • Didden, R., Sigafoos, J., O’Reilly, M. F., Lancioni, G. E., & Sturmey, P. (2007). A multisite cross‐cultural replication of upper’s (1974) unsuccessful self‐treatment of writer’s block. Journal of applied behavior analysis, 40(4), 773-773. PDF Here

2014 – an evidence synthesis in a META-ANALYSIS by McLean:

  • McLean, D. C., & Thomas, B. R. (2014). Unsuccessful treatments of “Writer’s Block”: a meta-analysis. Psychological reports, 115(1), 276-278. PDF Here

Captura de ecrã 2018-10-05, às 16.11.03

McLean, D. C., & Thomas, B. R. (2014). Unsuccessful treatments of “Writer’s Block”: a meta-analysis. Psychological reports, 115(1), 276-278

 

After systematic and iterative readings on the ‘Writer’s Block’ scientific literature my critical appraisal is

 

 


If you have updates on this topic, please let me know

Acknowlegements: to Professor Pedro Lopes dos Santos and Professor Isabel Menezes for sharing with me several ideas on “Writer’s Block” and useful literature about it. I would like to say to them tha

 

 

 

p-Hacking – A call for ethics

04 Thu Oct 2018

Posted by Pedro M Teixeira in Research, Statistics

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Statistics

p-hacking consists of the exhaustive exploitation of data through the use of different analytical models and/or the manipulation of the application criteria of these models until statistically significant results are obtained.

p-hacking can be described in a simpler manner has the art of torturing data until they confess something.

While publication bias removes from the scientific literature true or false negatives the p-hacking brings to the scientific literature true or false positives.

Conditioned scientific literature (i.e. the absence of false negatives and the presence of false positives) will bias the results of secondary studies aiming to synthesise scientific evidence, such as meta-analyses, that inform clinical guidelines and evidence-based decision making.

Here, I present a call for health ethics committees to assess the manifestation of researchers’ analytical intent in research protocols (i.e. pre-specified or exploratory) as a way to help prevent and further study the p-hacking bias.


p-Hacking – A call for ethics | PDF. Available from: https://www.researchgate.net/publication/324231282_p-Hacking_-_A_call_for_ethics
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