How often do scientists cite previous research in their studies?

You’ve heard us tout the benefits of systematic reviews over and over again here at Evidence-based Living.  The truth is they are the best way to evaluate the real evidence available on any topic because they use sophisticated methods to evaluate the dozens of research-based articles. 

They’re also essential for scientists conducting their own research because one of the main premises of scientific study is that new discoveries build on previous conclusions.

So we were disappointed to see an article in the New York Times last week discussing how few research studies cite preceding studies on the same topic. 

The article discussed a study published in the Annals of Internal Medicine that reviewed 227 systematic reviews of medical topics.  In total, the reviews included 1523 trials published from 1963 to 2004. For each clinical trial, the investigators asked how many of the other trials, published before it on the same topic and included with it in the meta-analysis, were cited. They found that fewer than 25 percent of preceding trials were cited.

The results shocked study co- author Dr. Steven N. Goodman of Johns Hopkins University School of Medicine.

“No matter how many randomized clinical trials have been done on a particular topic, about half the clinical trials cite none or only one of them,” he told the New York Times. “As cynical as I am about such things, I didn’t realize the situation was this bad.”

The lack of previous citations could lead to all sorts of problems – from wasted resources to incorrect conclusions, the study concluded.

Here at Evidence-based Living, we’d like to see citations for systematic reviews and previous trials in most scientific articles.

New evidence on calcium and Vitamin D

Television news programs, newspapers and the Internet are all full of recommendations of how to lead a healthier life. They recommend specific foods, vitamins and all sorts of dietary supplements. But it’s important to look toward research-based facts to understand what your body really needs.

It turns out the federal Institute of Medicine (IOM) is recommending that you up the dose of two nutrients in particular – calcium and Vitamin D.

Cornell nutritionist Patsy Brannon recently served on an IOM panel that issued new recommendations for calcium and vitamin D consumption.  The report triples the recommended vitamin D intake for most healthy people from 200 to 600 international units (IUs) per day. It also caps the suggested vitamin D intake at 4,000 IUs per day, citing links between elevated vitamin D blood levels and adverse effects, including kidney and tissue damage.

The panel making the recommendation was composed of 14 physicians and nutritionists from the United States and Canada, who reviewed more than 1,000 studies and reports and consulted many scientists and stakeholders.

The updated recommendations will influence food policy on many levels, including U.S. Department of Agriculture standards for school meals, nutrition information on food packages and the content of rations eaten by soldiers in the field.

Even with the sharp increase in daily intake levels, the panel found that few people in the United States or Canada lack adequate vitamin D, in part because sunlight provides enough of the nutrient to overcome dietary deficiencies.

“Contrary to the highly publicized epidemic of vitamin D deficiency in America and Canada, the average American and Canadian is meeting his or her needs for vitamin D,” Brannon told the Cornell Chronicle for a story.

The findings also counter recent studies suggesting that insufficient vitamin D levels may be linked to a host of chronic conditions, including cancer, diabetes, autoimmune disorders, and heart and cardiovascular disease.

“The evidence available is inconsistent, with some studies demonstrating this association while others show no association, and still others show evidence of adverse effects with high blood levels of vitamin D,” Brannon said. “Thus, it is not possible to conclude whether there is an association of low vitamin D with chronic disease or not.”

For a complete listing of recommended intakes by age group and gender, click here.

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As an aside, the Cochrane Collaboration has conducted several systematic reviews on Vitamin D supplements for specific medical conditions.  They’ve found that:

Video games: Helpful or harmful to the brain?

It’s January, the month when children across the country spend hours in front of the television playing with the millions of video game counsels sold over the holidays.  In fact, you probably personally know a “gamer” yourself. According to the Entertainment Software Association, more than 68 percent of American households play computer or video games.

We hear often about studies demonstrating that too much screen-time – whether television, video games or computers – is associated with attention problems in children.  But it turns out there are some benefits to playing video games, too.

A cadre of researchers in cognitive sciences, psychology and neuroscience are building a body of evidence that shows video gaming (in moderation, of course) helps improve attention, vision, multitasking and other cognitive skills.

A systematic review by researchers at the University of Rochester’s Department of Brain and Cognitive Sciences found that playing action video games significantly reduces reaction times without sacrificing accuracy across a variety of real-world tasks, including looking for a letter in a field of other letters and indicating the direction of an arrow while ignoring arrows pointing in the other direction.

Another study found that video games help improve contrast sensitivity, or the ability to see subtle shades of gray.

“And this is a skill that comes in very handy if you’re driving in fog,” explained Daphene Bavelier, a cognitive researcher at the University of Rochester, who spoke to reporters from National Public Radio for a recent story. “Seeing the car ahead of you is determined by your contrast sensitivity. We looked at the effect of playing action games on this visual skill of contrast sensitivity, and we’ve seen effects that last up to two years.”

Lauren Sergio from York University in Toronto used functional brain scans to find that skilled gamers mainly an area of the brain specialized for planning, attention and multitasking, meaning that they don’t activate as much of their brain to do complex tasks with their hands. Non-gamers, in contrast, predominately use an area called the parietal cortex, the part of the brain specializing in visual spatial functions.

“The non-gamers had to think a lot more and use a lot more of the workhorse parts of their brains for eye-hand coordination,” she says. “Whereas the gamers really didn’t have to use that much brain at all, and they just used these higher cognitive centers to do it.”

In fact, employers including hospitals, the U.S. armed services and many police departments are using video games to help doctors, soldiers and police officers work on skills they use in their jobs everyday.

The bottom line: video games, played in moderation, actually help kids develop some important life skills. Just make sure to set a timer, or find another way to limit screen-time.

Science in the courtroom: A Cornell professor uncovers the facts behind child testimony

I received a postcard in the mail last week notifying me I was called for jury duty.  The prospect seemed an inconvenience. (Where would I find care for my two-year-old son while serving?). But it was also exciting!

I’ve always been interested in the law, and the idea of serving on a jury conjured up a feeling of civic responsibility that felt good.  It was a job I wanted to take seriously, and I immediately began wondering if there was any research I should consider before embarking on this important task.

Unfortunately, there were no trials in my town this week, so I didn’t even have to report to the court. But the notice did bring to mind the work of Cornell Professor Stephen Ceci, an expert in developmental psychology who has conducted ground-breaking research on the testimony of children.

Ceci’s work bridges the gap between research and real-life in a very tangible way: findings from his studies have influenced the way thousands of law enforcement officers, social workers, lawyers, and judges deal with the testimony of children. This is research that makes a tangible difference in the lives of people who often find themselves in difficult situations.

 (An interesting side note: Ceci refuses to be an expert witness for either prosecutors or defenders – a decision that has lent him credibility among judges throughout North America, who often cite his work in their decisions.)

A main topic of Ceci’s work is how children respond when they are questions about sexual abuse. The conventional wisdom says that children delay reporting abuse for years and will initially deny any abuse occurred when asked directly. But after repeated questioning, they gradually begin to tell little bits and pieces about how they were abused. Next, they recant altogether. Only later, when they are in what is perceived to be a psychologically safe situation, do they give a full and elaborate disclosure.

In analyses of dozens of published studies, Ceci and his colleagues separated out the methodologically-sound studies on children’s disclosure from poorly conducted ones. They found in high-quality studies, children did report abuse in full detail when explicitly asked. They also found that when a child is questioned repeatedly, he is likely to relent and say what he thinks the interviewer wants to hear to get out of an uncomfortable situation.

“It’s important for judges to know what science shows, because this set of invalid beliefs animates the whole investigatory process,” Ceci explained. “It motivates investigators and interviewers to pursue reluctant children, who may be reluctant because nothing actually happened.”

In the case U.S. v. Desmond Rouse, the United States Court of Appeals for the Eighth Circuit (the court directly beneath the U.S. Supreme Court) established new law on vetting child testimony based almost exclusively on the work of Ceci and his colleagues.

For anyone who works with children involved in the court system, Ceci’s work provides a whole new way to think about their testimony.

Your flu vaccine will help…a little

It’s the time of year when everyone is lining up for the annual flu vaccine.  Doctor’s offices and employers are holding special clinics, and even many drug stores are offering a poke in the arm to prevent influenza this winter.  But do these vaccines actually work?

A systematic review of the literature says they do, a little bit.

The Cochrane Collaboration (one of our favorite resources here at EBL) reviewed 50 reports of the benefits of the influenza vaccine, including 40 randomized-controlled trials involving more than 70,000 people.

Before I explain the results, here’s a little background on the flu:  There are more than 200 different viruses that cause influenza with similar symptoms including fever, headache, cough and body aches.  It is difficult for vaccine-manufacturers to know which of these viruses will be active in any given year.  The World Health Organization does its best to predict what type of flu will be prevalent in a given season, and then recommends which viral strains should be included in vaccinations each year.

Under ideal conditions – meaning that the vaccine completely matches the active flu viruses – 33 healthy adults need to be vaccinated to avoid one person coming down with the flu. But the vaccine rarely matches the active flu viruses entirely. In more realistic conditions where the vaccine partially matches the active flu viruses, 100 people need to be vaccinated to avoid one set of influenza symptoms.

None of the studies showed that vaccines reduced the number of people hospitalized for the flu.  Also, studies show the vaccine caused one case of Guillian-Barré syndrome, a neurological condition leading to paralysis, for every one million vaccinations.

The bottom line:  The flu vaccine will reduce your chances of getting sick this winter, but provides no guarantees of completely avoiding the flu.

Evidence-Based Elections: If the House changes over, is it the President’s fault?

In all of the hubbub about the upcoming elections, Evidence-Based Living had to ask: Is there any research evidence that might help us interpret what’s going on? (And, of course, we always scratch our heads about why there isn’t more discussion of research evidence on something so important.)

One of the few enlightening discussions I’ve seen comes in article by Jonathan Chait. Chait notes the endless debate over “Did Obama Lose the 2010 Elections?” that is roiling in media discussions this week.

Folks on the left say Obama’s responsible because he: 1) didn’t stick more to progressive principles, and 2) didn’t more aggressively tout the Democrats accomplishments. People on the right argue that Obama’s responsible because he 1) is out of step with what the country wants, and 2) has moved too far to the left.

But the blaming in either direction hinges on one question: What if the predicted election results are simply, well, normal? That is, what if the ruling party losing seats in the mid-term election is a predictable, scientific phenomenon, rather than someone’s (Obama’s, the Democrat’s, the media’s, etc.) fault? Of course, if this were the case, major news organizations would have nothing to discuss and pundits would be out of a job. Still, it’s worth considering.

This points us to an analysis by Douglas Hibbs, professor of political economy, in a just-published report from the Center for Public Sector Research. Hibbs, like a good scientist, makes clear that his model isn’t designed to specifically predict the elections, but rather to explain midterm House election outcomes in terms of systematic predetermined and exogenous factors.

Based on prior research, Hibbs tells us there are three fundamental factors that predict midterm elections:

1) the number of House seats won by the party in power in the previous election

2) the margin of votes by which the party in power’s candidates won in the prior presidential election

3) the average growth rate of per capita real disposable personal income during the congressional term (a measure of economic prosperity).

From the available data plugged into this model, Hibbs predicts the Democrats will lose about 45 seats. In other words, based on the model alone, we would expect the Democrats to lose control of the house even if the President made no difference at all. And most predictions show the Democrats losing about this many seats (or 5-10 more, depending on which electoral prediction web sites you look at).

Hibbs provides the necessary caveats about his work not being definitive. But it is certainly strong enough to make us ask: Where’s the science behind a lot of the political debate and punditry? The evidence-based perspective encourages us to be careful in attributing cause and effect where none may exist.

Exciting news for pregnant woman: One cup of Joe is safe

There’s new and exciting new in our family: we’re expecting another child to arrive sometime around mid-March.  My husband and I are thrilled!  The development also brings along a multitude of research topics to make sure I’m keeping up the latest evidence on having a healthy pregnancy.

One of the first things that caught my eye was a note from my doctor’s office about caffeine intake: basically one (normal-sized) cup of coffee a day is safe for the baby.

That was news to me!  I do enjoy wrapping my hands around a steamy cup of dark roast every day. Last time I was pregnant, only two years ago, I cut out caffeine altogether because studies have linked caffeine with low-birth weight. But – as often – the available evidence has changed.

Earlier this year, the American College of Obstetricians and Gynecologists issued guidelines that recommend less than 200 mg of caffeine a day for pregnant women. (An 8-ounce cup of brewed, drip coffee averages 137 mg of caffeine.)

“Finally, we have good evidence to show that having a cup of coffee a day is fine and it poses no risk to the fetus,” Dr. William H. Barth Jr., chairman of the committee on obstetric practice and chief of the division of maternal-fetal medicine at Massachusetts General Hospital in Boston, told U.S. News and World Report.

As for more than that, the jury is still out. The Cochrane Collaboration says that more work needs to be done to determine exactly how much caffeine is safe for a fetus. Their researchonly found one piece of evidence that met the collaboration’s inclusion criteria and provided relevant data: A study in Denmark where women less than 20 weeks pregnant were randomly assigned to drinking caffeinated instant coffee or dedecaffeinated instant coffee. The study found drinking three cups of coffee a day in early pregnancy had no effect on birthweight, preterm births or growth restriction.

For now, I’ll take my one cup a day.  It’s just enough to help me keep up with our two-year-old during those late afternoon periods of low-energy.

Mothers in poverty need help with depression

New research from the Urban Institute finds that more than half of mothers in poverty show symptoms of depression, posing a serious risk to their children’s well-being and development.

The study is the first took look at depression among mothers in poverty across the nation and also assess parenting approaches for infants living in poverty whose mothers are depressed. The research was based on data from a federal education survey of 14,000 children born in 2001. It was funded by The Doris Duke Charitable Foundation.

Among the surprising results are:

  • Eleven percent of infants living in poverty have a mother suffering from severe depression.
  • Compared with non-depressed mothers, severely depressed mothers are more likely to struggle with domestic violence and substance abuse.
  • Infants of depressed mothers are breastfed for shorter periods of time than those with mothers who are not depressed.
  • Even though depression is treatable, many severely depressed mothers do not receive care.

The evidence suggests that depression interferes with mothers’ parenting abilities.

“A mom who is too sad to get up in the morning won’t be able to take care of all of her child’s practical needs,’’ researcher Olivia Golden, who coauthored the paper, told the Washington Post. “If she is not able to take joy in her child, talk baby talk, play with the child — those are features of parenting that brain development research has told us contribute to babies’ and toddlers’ successful development.’’

But many of these mothers are already connected with programs that could provide help with depression or referrals for mental health services. Ninety-six percent of severely depressed mothers live with some who qualifies for the Special Supplemental Nutrition Program for Women, Infants, and Children. Seventy percent participated in the Supplemental Nutrition Assistance Program, formerly known as Food Stamps. And 90 percent of infants receive Medicaid benefits, giving their mothers’ access to health care providers.

Now researchers need to find an evidence-based approach to reaching these mothers and providing them with mental health services.

Using the evidence: TV-time in our family

We have written about the topic of screen-time for children several times on this blog.  It’s a sign of our society today. As kids have more multimedia options than ever before, researchers are continually trying to assess the long-term effects of technology on children. And many parents, myself included, are trying to assess what all of that means for their own household rules.

In our family, my nearly-two-year-old son loves Sesame Street. He’s happy to watch it quietly for up to an hour at a time, which is a very tempting when I need to accomplish something without any toddler “help.” 

But I worry about what that means for his development. Am I ruining his ability to focus, or creating problems that will surface later in school?

When Rachel Dunifon, associate professor of human development at Cornell, posted a comment in our previous post about TV-watching, I was anxious to read her opinion.

Dunifon shared a study published earlier this year in the journal Child Development, which reexamined more than 1,000 mothers’ reports of television-viewing for 1- to 3-year-olds, and the assessed those children’s attention problems at age 7.

The study found, among other things, that watching TV is only associated with a higher risk of attention problems in children who watch seven or more hours a day.  It also suggested the effect of television may depend on the “quality” of viewing. Children who watch educational television have actually shown higher school readiness and language skills compared with children who viewed general programming.

Those results made me feel a lot better about the TV rules in our house. For now, our son is allowed to watch a half-hour a day of a recorded, educational show. That gives me a little extra time to jump in the shower or get dinner on the table, and it gives him a little down time to relax as well.

–        Sheri Hall

The evidence on living a good life

For centuries, medical and social research has focused on human illness and dysfunction. But over the last decade, there is a growing cadre of researchers who are looking into specific factors that lead to social and emotional well-being.

A center at the University of California-Berkley called the Greater Good Science Center is focused on just that – the scientific research into social and emotional well-being, and how to help people apply this research to their personal and professional lives.

The center sponsors its own research, and also publishes on on-line magazine to disseminate the latest information to parents, educators, community leaders, and policy makers.

So, what really does make people happy?  A recent article on the Greater Good site summed up the evidence about specific actions that everyone can take to improve their own happiness.

  • Make time for quality, social interactions. The dominant finding in happiness research is that that social connections are key to bliss. Some research also shows that it’s the quality of our social interactions that really matter, not the quantity.
  • Learn forgiveness. New research show that when we forgive those who have wronged us, we feel better about ourselves, experience more positive emotions, and feel closer to others.
  • Be grateful. Studies show that simply counting listing things you are thankful for on a regular basis leads to more optimism and greater satisfaction.
  • Foster generosity. A 2008 study published in the journal Science found that people reported greater happiness when they spent money on others than when they spent it on themselves, even though they initially thought the opposite would be true.
  • Exercise.  Studies show that regular physical activity increases happiness and self-esteem, reduces anxiety and stress, and can even lift symptoms of depression.
  • Sleep enough. Research has consistently reduced amounts of sleep to reduced amounts of happiness.
  • Be mindful. Studies show that being aware of our thoughts, feelings and circumstances reduces hostility and anxiousness, and leads to greater life satisfaction.

The science behind barefoot running

Humans have been running long distances for millions of years, well before the advent of the modern running shoe. In fact, it’s only in the past three decades that athletic companies have developed cushioned, supportive shoes for runners.

Recently, a movement of runners have gone back to their roots – forgoing shoes for running barefoot or with minimal footwear. Why the heck would they do that? Thanks to sports historian Michael Civille for posing this question, and we’ll take a look at the evidence here.

There is some evidence that barefoot running reduces the amount of force on the foot and knee joints. Daniel Lieberman, a professor of human evolutionary biology at Harvard University, studies the biomechanics of barefoot running and how early humans survived by evolving the ability to travel long distances to hunt.

His work – which has been published twice in the journal Nature – has shown that experienced, barefoot runners tend to land in the front or middle of their feet, compared to runners with shoes, who tend to land on their heels. These forefoot and midfoot strikes do not generate the sudden, large impacts that occur with heel strikes. Therefore, barefoot people can run more easily on hard surfaces without discomfort from landing.

Lieberman, who runs barefoot once a week himself, is the first to admit there is no evidence on whether running barefoot causes fewer or more injuries than running with shoes.  (There is also no evidence that running shoes reduce injuries either.)

How about speed?

There is some evidence that barefoot running uses about five percent less energy because runners use the natural springs in their feet and calf muscles to store and release energy.  

But runners with forefoot or midfoot strikes don’t seem to be any faster than runners with heel strikes, according to a Japanese study.  In it, researchers took photographs of elite runners foot strike positions midway through a half-marathon. Seventy-five percent of the runners were landing on their heels, 24 percent landed at about near the arch of their shoe, and only four landed on their forefoot. And they weren’t the four fastest.

The take-home message?  The jury is still out on barefoot running. One thing is clear:  If you want to try barefoot running, start slowly. One thing all of the experts agree on is that the body does take some time to adjust.

Texting while driving: Clearly dangerous

Multitasking has become a way of life in this digital age, where most people can access their e-mail, their calendars and make phone calls from a mobile device they keep in their pockets or purse. While communication-on-the-go certainly can make us more efficient, it can have dire consequences as well.

Some 200,000 car accidents each year are caused by texting while driving, according to a report from the National Safety Council, a nonprofit group recognized by congressional charter as a leader on safety.

The scientific literature backs up the report.  A 2009 study of long-haul truckers by the Virginia Tech Transportation Institute found drivers were more than 23 times more likely to experience a safety-critical event when texting. The study also found that drivers typically take their eyes off the road for an average of four out of six seconds when texting, during which time he travels the distance of a football field without their eyes on the road.

Another study by psychologists and the University of Utah found that texting while driving is riskier than talking on a cell phone or with another passenger. In the study, people texting in a driving simulator had more crashes, responded more slowly to brake lights on cars in front of them, and showed more impairment in forward and lateral control than did drivers who talked on a cell phone or drove without texting.

The Utah study found that drivers who talked on the phone attempted to divide their attention between the conversation and driving, adjusting the priority of each activity based on what was happening on the road.  But texting required drivers to switch their attention from one task to the other, causing a substantial reduction in reaction times compared to those talking on the phone.

State governments are responding to the evidence. Text messaging is banned for all drivers in 30 states and the District of Columbia. In addition, novice drivers are banned from texting in 8 states.  And President Barack Obama issued a texting-ban while driving for on all federal employees while using a government vehicle or government-issued cell phone.

The take home message: Save your text for non-driving times.

–        Sheri Hall

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