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This commentary highlights three common difficulties faced by the literature that aims to specify models of speech production based on the performance of aphasic speakers, taking as a springboard a recent study by Mailend et al. These include: (1) difficulties with theoretical assumptions which linki psycholinguistic effects unequivocally to one processing level; (2) difficulties using clinical classifications to localize experimental effects; (3) difficulties making theoretical inferences given the controversial nature of the representations that characterize different processing levels. We argue that these three types of difficulties could be ameliorated by studies in which: (1) the level of psycholinguistic effects is demonstrated with converging analyses; (2) clinical classification is not taken as a starting point in studies investigating the nature of an impairment, but, instead, associations between clusters of symptoms are carefully analysed; (3) The nature of processing levels associated with deficits is made clear and results are not over-interpreted as supporting models whose characteristics go beyond an explanation of the results.
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Afasia , Apraxias , Humanos , Psicolinguística , Fala , Distúrbios da FalaRESUMO
Investigations into the sensitivity of heart rate-(HR) derived indices for tracking parasympathetic nervous system (PNS) changes in functionally overreached (F-OR) endurance-trained athletes have produced equivocal findings. Lack of clarity may be a result of methodological inconsistencies. Therefore, the aims of this systematic review and meta-analysis were (a) to determine the sensitivity of resting and post-exercise vagal-related HR variability (HRV) and HR recovery (HRR) indices to detect PNS modulation in F-OR and non-overreached (non-OR) athletes, and (b) to investigate the influence of methodological factors on the sensitivity of HR-based indices to detect PNS hyperactivity in F-OR athletes. We searched CENTRAL, Scopus, PubMed, Embase, and Web of Science up to May 2020 for the following terms: male and female endurance-trained athletes, controlled and uncontrolled studies that carried out an overload training period, and PNS modulation measured in resting and post-exercise, pre- and post-overload training period. A random-effects model of standardized mean difference (SMD) was estimated for each outcome measure based on the training-induced fatigue status (F-OR vs non-OR athletes), and the influence of methodological issues to detect PNS hyperactivity in F-OR was assessed by subgroup analyses. Pooled analysis showed that resting vagal-related HRV indices did not detect PNS hyperactivity in F-OR athletes (SMD+ = -0.01; 95% confidence interval [CI] = -0.51, 0.50), and no statistical difference (P = .600) was found with non-OR athletes (SMD+ = 0.15; 95% CI = -0.14, 0.45). However, subgroup analysis based on HRV parameter showed a moderate statistical increase in weekly averaged HRV in F-OR athletes (SMD+ = 0.81; 95% CI = 0.35, 1.26), while isolated HRV values did not reach statistical significance (SMD+ = -0.45; 95% CI = -0.96, 0.06). We observed a moderate and statistically significant increase in HRR indices among F-OR athletes (SMD+ = 0.65; 95% CI = 0.44, 0.87), no changes for non-OR athletes (SMD+ = 0.10; 95% CI = -0.15, 0.34), and statistically significant differences between F-OR and non-OR athletes (P < .001). Insufficient data prevented meta-analysis for post-exercise vagal-related HRV indices. Our findings show that when methodological factors are considered, HR-based indices are sensitive to increased PNS modulation in F-OR.
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Atletas , Frequência Cardíaca/fisiologia , Sistema Nervoso Parassimpático/fisiologia , Resistência Física/fisiologia , Descanso/fisiologia , Adulto , Desempenho Atlético/fisiologia , Intervalos de Confiança , Fadiga/fisiopatologia , Feminino , Humanos , Masculino , Condicionamento Físico Humano/fisiologia , Fatores de Tempo , Nervo Vago/fisiologiaRESUMO
This article aims to provide an overview of the most recent research on child sexual abuse by members of the Catholic Church that occurred in Italy and France. The studies reported here have been selected as representative of major trends in the field. In particular, they illustrate the paths taken by current scholarship addressing child sexual abuse that has occurred in mono-confessional Catholic culture areas not yet affected by large-scale scandals. The assessment of the last two decades of literature shows that existing research attests the presence of regional patterns regarding the incidence of confirmed cases of abuse, the cover-up procedures, and the reactions of both ecclesiastical and civil institutions and society. However, this review also indicates that scholars have thus far neglected to problematize the local peculiarities of the phenomenon, and to relate them to the broader debate on regional variability in the articulation of modernization processes and religious vitality and power.
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Catolicismo , Abuso Sexual na Infância , Criança , Clero , França , Humanos , ItáliaRESUMO
BACKGROUND: Around 50% of PD patients experience motor fluctuations, which are often accompanied by mood fluctuations. The nature of the relationship between motor and mood fluctuations remains unknown. It is suggested that the experience sampling method can reveal such associations on both a group and individual level. Revealing group patterns may enhance our understanding of symptom interactions and lead to more general treatment recommendations, whereas analyses in individual patients can be used to establish a personalized treatment plan. OBJECTIVES: To explore the usability of routinely collected experience sampling method data over a brief period of time to detect associations between motor fluctuations, affective state, and contextual factors in PD patients with motor fluctuations on a group level and on an individual level. METHODS: Eleven patients with motor fluctuations collected data at 10 semirandom moments over the day for 5 consecutive days. RESULTS: On a group level, multilevel analyses showed significant associations between all motor symptoms and positive affect. Being at home was associated with increased balance problems and rigidity. Analyses on an individual level revealed much less significant associations that mostly, but not always, were in line with the results on a group level. CONCLUSION: This exploratory study showed significant associations between affective state, motor symptoms, and contextual factors in a group of PD patients with motor fluctuations, but less so in individual patients. Given that the ultimate aim is to use the experience sampling method as an aid to personalize treatments, the sensitivity of the approach needs to be increased. © 2020 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
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Doença de Parkinson , Avaliação Momentânea Ecológica , Emoções , Humanos , Projetos de PesquisaRESUMO
This review synthesises theoretical approaches and methodological considerations in mental health service quality assessment from consumers-perspective. We searched published articles from databases: EMBASE, MEDLINE, CIHNAL, Scopus, Web of Science, and PsycINFO. Of the 30 included papers, 16 contained instruments used to mental health quality assessment and 14 focused on theoretical constructs. The review finds that mental health quality assessment is explained and measured using constructs that focus on structure, process and outcome. The methodological issues that need critical consideration are the context and cultural norms of services, outcome perspectives, evaluator, sources of information as well as the selection of consumers and instruments. The review recommends that researchers and clinicians should consider the theoretical constructs and methodological issues in mental health quality assessment.
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Satisfação do Paciente , Garantia da Qualidade dos Cuidados de Saúde , Humanos , Serviços de Saúde MentalRESUMO
The sixth section of our Special Task Force (STF) report reviews and comments on recent US-oriented value assessment frameworks, specifically those published by the American College of Cardiology/American Heart Association, the Institute for Clinical and Economic Research, the American Society of Clinical Oncology, the National Comprehensive Cancer Network, and the Memorial Sloan Kettering Cancer Center. We review published commentaries that address the validity, reliability, and conceptual underpinnings of these frameworks. We find common themes of critique regarding the strengths and limitations across frameworks. Particular shortcomings of some frameworks pose greater threats to their face validity and utility compared with others. The most significant limitations include lack of clear perspective (e.g., patient vs. health plan) and poor transparency in accounting for costs and benefits. We then review how each framework adheres to core STF recommendations, with particular emphasis on whether the framework can be used to support coverage decisions by health insurers, and whether it adheres to core principles of cost-effectiveness analysis. The Institute for Clinical and Economic Research framework most closely adheres to core STF recommendations. Others have significant limitations that vary widely from framework to framework. We also review how the frameworks follow STF recommendations for addressing potentially relevant issues beyond cost-effectiveness analysis - for example, equity in resource allocation and patient heterogeneity. Finally, we review whether and how each framework uses value thresholds and addresses affordability concerns. We conclude with suggestions for further research, particularly in the areas of testing the measurement and use of novel elements of value and deliberative processes.
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Análise Custo-Benefício/métodos , Tomada de Decisões , Atenção à Saúde/economia , Gastos em Saúde , Seguro Saúde/economia , Avaliação de Resultados em Cuidados de Saúde/métodos , Avaliação da Tecnologia Biomédica/economia , Comitês Consultivos , Farmacoeconomia , Política de Saúde , Humanos , Sociedades Médicas , Estados UnidosRESUMO
Due to reliability problems, use of retrospective measurement to assess child sexual abuse has long concerned researchers. Possible psychosocial causes of these reliability issues-including problem avoidance-have not been thoroughly studied. We tested the reliability of retrospective child sexual abuse measurement in a nationally representative sample of 12,438 adults over two periods (2001-2002, 2007-2008), assessed sex differences in reliability, and examined whether reliability depends on problem avoidance tendencies. Nearly three-fourths of child sexual abuse cases in the former wave were not again reported, and two-thirds of child sexual abuse cases in the latter wave were not previously reported. Females were more likely to report CSA later if reported previously (OR = 5.11). Participants who reported child sexual abuse in the former wave but not the latter were more avoidant than consistent reporters (3.13 versus 2.77). Our findings suggest that females may report child sexual abuse more consistently. Furthermore, inconsistent reporting may indicate problem avoidance. Suggestions for researchers and practitioners are discussed.
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Sobreviventes Adultos de Maus-Tratos Infantis/estatística & dados numéricos , Abuso Sexual na Infância/estatística & dados numéricos , Autorrelato/normas , Adolescente , Adulto , Criança , Feminino , Humanos , Estudos Longitudinais , Masculino , Reprodutibilidade dos Testes , Fatores de Tempo , Adulto JovemRESUMO
Reliability (precision, repeatability, agreement) and validity (accuracy) are two completely different issues which should be assessed using appropriate tests. It is crucial to know that, reporting concordance rate; the selection error rate and the classification error rate are not the most appropriate estimates to assess reliability. Regarding reliability, for qualitative variables, weighted kappa should be used with caution. However, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), likelihood ratio positive and negative as well as diagnostic accuracy are estimates that are usually used to evaluate the validity of a test compared to a gold standard.
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Transtornos Cerebrovasculares , Humanos , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeAssuntos
Epilepsia , Adolescente , Estudos de Casos e Controles , Criança , Epilepsia/epidemiologia , Humanos , Fatores de Risco , Síria/epidemiologiaAssuntos
Diabetes Gestacional , Macrossomia Fetal , Feminino , Feto , Idade Gestacional , Teste de Tolerância a Glucose , Humanos , GravidezRESUMO
AIM: To reflect on the experiences of nurses performing ethnographic fieldwork in three studies. BACKGROUND: The application of ethnography to nursing research requires discussion about nurses' experiences of ethnographic fieldwork. This article examines some of the dilemmas that arise during the research process. DATA SOURCES: Three ethnographic studies conducted by the authors in the south and southeast of Brazil. Excerpts from field diaries created during each research are presented at the end of each topic discussed. REVIEW METHODS: This is a reflexive paper that explores the nurses' experience in ethnographic fieldwork. DISCUSSION: This article discusses the main tasks involved in ethnographic research, including defining the study aim, reading and understanding anthropological theoretical bases, and setting a timeframe for the study. The article also discusses the idiosyncrasies of the cultural contexts studied, the bureaucracy that may be confronted when gaining access to the field, the difficulty of transforming the familiar into the strange, why ethnocentric perspectives should be avoided, and the anthropological doubt that places the ethnographer in the position of apprentice. It also discusses the importance of listening to others, reflexivity and strategies to stay in the field. CONCLUSIONS: For researchers, ethnographic fieldwork can be a rite of passage, but one that provides invaluable experiences that emphasise the value of relationships based on dialogue, reflexivity and negotiation. IMPLICATIONS FOR PRACTICE/RESEARCH: The main tasks undertaken in ethnographic research discussed in this article could contribute to the nurse' experience of conducting ethnographic fieldwork.
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Antropologia Cultural , Recursos Humanos de Enfermagem/psicologia , Criança , Cuidado da Criança , Diabetes Mellitus Tipo 2/enfermagem , HumanosRESUMO
Learning disabilities (LD) may affect a range of academic skills but are most often observed in reading. Researchers and policymakers increasingly recommend addressing reading difficulties encountered by students with LD using evidence-based practices, or interventions validated through multiple, high-quality research studies. A valuable tool in identifying evidence-based practices is the meta-analysis, which entails statistically aggregating the results obtained through primary studies. Specific methods used in meta-analyses have the potential to influence their findings, with ramifications for research and practice. This review assessed the methodological features of the systematic reviews and analytic procedures featured in meta-analyses of reading intervention studies that included students with LD written between 2000 and 2020. Identified articles (N = 23) suggest that meta-analyses have become more prevalent and transparent over time, notwithstanding issues related to publication bias and the opacity of coding procedures. A discussion of implications follows a description of results.
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Deficiências da Aprendizagem , Leitura , Humanos , Deficiências da Aprendizagem/terapia , Estudantes , Projetos de Pesquisa , RedaçãoRESUMO
Yoga therapy has been widely accepted as part of the evidence-based modern healthcare system. Although research publications are growing in leaps and bounds, many methodological issues pose stumbling blocks. In this narrative review, various issues like standalone or add-on treatment, blinding, randomization, nature of dependent and intervening variables, duration of intervention, sustainability of effects, attrition bias, adherence and accuracy, all or none performance, diverse schools, heterogeneity and multidimensionality, assortment, permutations, and combinations of different components, neglect of essential ingredients, mindfulness, catch-22 situation, credentials of the instructors, cultural factors, naivety, multicentric studies, duration of collection of data, primary or standard treatment, interdisciplinary research, statistical lapses, qualitative research, biomedical research are discussed. There is a need to frame guidelines for conducting yoga therapy research and publication.
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Robust evidence from health policy research has the potential to inform policy-making, but studies have suggested that methodological shortcomings are abundant. We aimed to identify common methodological weaknesses in pharmaceutical pricing policy analyses. A systematic review (SR) of studies examining pharmaceutical pricing policies served as basis for the present analysis. We selected all studies that were included in the SR (n = 56), and those that were excluded from the SR due to ineligible study designs only (n = 101). Risk of bias was assessed and specific study design issues were recorded to identify recurrent methodological issues. Sixty-one percent of studies with a study design eligible for the SR presented with a high risk of bias in at least one domain. Potential interference of co-interventions was a source of possible bias in 53% of interrupted time series studies. Failing to consider potential confounders was the primary cause for potential bias in difference-in-differences, regression, and panel data analyses. In 101 studies with a study design not eligible for the SR, 32% were uncontrolled before-after studies and 23% were studies without pre-intervention data. Some of the methodological issues encountered may be resolved during the design of a study. Awareness among researchers on methodological issues will help improve the rigor of health policy research in general.
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Política de Saúde , Formulação de Políticas , Humanos , Custos e Análise de Custo , Preparações Farmacêuticas , Análise de Séries Temporais InterrompidaRESUMO
Yoga and meditation-based interventions have been extensively utilized in the field of contemporary complementary and alternative medicine for various physical and mental health conditions. Ongoing COVID-19 pandemic has rekindled the interest of researchers in yoga and meditation for its preventive and therapeutic utilities. However, the available literature in this area has several methodological concerns, limiting formers' clinical utility. A comprehensive literature on this topic would stimulate researchers and guide them to conduct research on this topic with robust methodologies. The current review highlights the methodological issues with the yoga and meditation-based Research (henceforth, MBR), discusses some of the contentious issues, and provides future directions. The PubMed, Medline, and google scholar databases were searched to screen records dealing with the methodological issues on MBR. The search yielded 299 records, upon screening, only 24 articles were found suitable for the current study. Common methodological issues with MBR: lack of the consensus definitions of the yoga and meditations, interventions lacking theoretical framework of meditation; inadequate description of the study design; difficulty with participants recruitment, setting up the control groups, and blinding; difficulty in assessing the baseline characteristics of the participants, and validity issues with the outcome measures. A few research, however, have also highlighted the potential measures to overcome these methodological challenges. Yoga and meditation-based interventions are promising for several health conditions. However, literature suffers from considerable methodological issues, thus, limiting its utility in modern clinical practice. The study findings can stimulate and guide future research on this topic.
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Psilocybin has been suggested as a promising transdiagnostic treatment strategy for a wide range of psychiatric disorders. Recent findings showed that psychedelic-assisted/"psycholitic" psychotherapy should provide significant and sustained alleviation of depressive symptoms. However, to date, there have been several study limitations (e.g., small sample sizes, blinding, limited follow-up, highly screened treatment populations) and some health/political issues, including practitioners' experience, lack of standardized protocols, psychedelics' legal status, ethical concerns, and potential psychological/psychopathological/medical untoward effects. The focus here is on a range of clinical and methodological issues, also aiming at outlining some possible suggestions. We are confident that newer evidence, more precise protocols, and eventual reclassification policies may allow a better understanding of the real potential of psilocybin as a transdiagnostic therapeutic molecule.