Friday, October 30, 2009

UM BOM FERIADÃO A TODOS.

QUERO AGRADECER A TODOS QUE VOTARAM EM MIM.
QUEM AINDA NÃO VOTOU AMANHÃ É O ÚLTIMO DIA.
CONTO CONTIGO LÁ NA MINHA ALDEIA.
VEJA O LINK ACIMA NA BARRA DA LATERAL.
MUITO OBRIGADO MEUS QUERIDOS AMIGOS SEGUIDORES E VISITANTES.

VOU VIAJAR A NOITE.
ESTOU INDO PARA PRAIA, CURTIR ESTE LINDO SOL.
NA VOLTA VOU VISITAR, QUEM EU AINDA NÃO VI.
JÁ PROCUREI RETRIBUIR TODOS QUE ME VISITARAM, HOJE.

CONTINUE COM A FESTA DO HALLOWEEN.
VISITE OS OUTROS BLOGS.
UM BOM FINAL DE SEMANA A TODOS.
COM MUITO CARINHO
SANDRA

Poetas-Um Vôo Livre

Sinal de Liberdade-uma expressão de sentimento

Blog Coletivo-Uma Interação de Amigos

HALLOWEEN!!!!

HOJE TEM HALLOWEEN NA CURIOSA E NO BLOG UMA INTERAÇÃO DE AMIGOS. PASSE LÁ E CONFIRA A HISTORIA DO JACK.

VENHA BRINCAR COMIGO!!!













(Estas lindas imagens me foram cedidas pelo blog da M@ http://changessimply.blogspot.com/)

Muito obrigada Amiga.

E DAI, VOCÊ ACREDITA EM BRUXAS???
CONTE UMA FAÇANHA PARA MIM!!!!




Mensagens de Amor





EU ME LEMBRO QUE QUANDO PEQUENA, TINHA MUITO MEDO DE MARIPOSA, AQUELAS BORBOLETAS BEM GRANDES...( GRANDONAS).

MINHA MÃE, E DEMAIS PESSOAS, ME DIZIAM, QUE ERAM BRUXAS.
TINHA UM VERDADEIRO PAVOR QUANDO VIA UMA DESSAS BORBOLETAS, GRANDONAS, PRETAS, MARRONS, TUDO PARA MIM ERAM BRUXAS.


OLHA SÓ A INOCÊNCIA: - MATAVA TODAS, POR CAUSA DO MEDO, ACHANDO QUE IREM VIRAR, REALMENTE BRUXAS, E VOAR..

QUE MALDADE COM AS PEQUENAS MARIPOSAS!

ATÉ HOJE, QUANDO AS VEJO, TENHO UM CERTO PAVOR... CLARO QUE NÃO MATO MAIS...RRSRRSRSR.
MAS, FORAM HISTÓRIAS, COLOCADAS NA ÉPOCA DE CRIANÇA QUE FICARAM REGISTRADAS NO CEREBRO DA GENTE.

E AINDA MAIS, DIZIAM QUE NA FAMÍLIA QUE HOUVESSE SETE MULHERES, A SETIMA ERA BRUXA, E SAIA VOANDO POR AI...

NOSSA QUE LOUCURA!!!! NÃO ERA PARA MENOS O MEU MEDO.

AINDA BEM QUE CRESCEMOS E PERCEBEMOS QUE NADA DISSO EXISTE.

VENHA CONDEFEIR A HISTORIA DO JACK NO Blog Coletivo-Uma Interação de Amigos

GANHEI ESTA LINDA BRUXINHA DA ANNA DO LE!
OBRIGADA AMIGA.






COMPARTILHO COM VOCÊ, MEU SEGUIDOR/VISITANTE.


Thursday, October 29, 2009

More Antidepressant Debates

Six months ago, I asked What's The Best Antidepressant?, and I discussed a paper by Andrea Cipriani et al. The paper claimed that of the modern antidepressants, escitalopram (Lexapro) and sertraline (Zoloft) offer the best combination of effectiveness and mild side effects, and that sertraline has the advantage of being much cheaper.

The Cipriani paper was a meta-analysis of trials comparing one drug against another. With a total of over 25,000 patients, it boasted an impressively large dataset, but I advised caution. Their method of crunching the numbers (indirect comparisons) was complex, and rested on a lot of assumptions.

I wasn't the only skeptic. Cipriani et al has attracted plenty of comments in the medical literature, and they make for some fascinating reading. Indeed, they amount to crash-course in the controversies surrounding antidepressants today - a whole debate in microcosm. So here's the microcosm, in a nutshell:

*

In The Lancet, the original paper was accompanied by glowing praise by one Sagar Parikh:
Free of any potential funding bias... Now, the clinician can identify the four best treatments... A new gold standard of reliable information has been compiled for patients to review.
But critical comments swiftly appeared in the Lancet's letters pages. While not accusing Cipriani and colleagues themselves of bias or conflicts-of-interest, Tom Jefferson noted that way back in 2003, David Healy drew attention to:
documents that a communications agency acting on behalf of the makers of sertraline were forced to make available by a US court. Among them was a register of completed sertraline studies awaiting to be assigned to authors. This practice (rent-a-key-opinion-leader) is of unknown prevalence but it undermines any attempt at reviewing the evidence in a meaningful way.
This is what's known as medical ghostwriting, and it is indeed a scandal. However, by itself, ghostwriting doesn't distort evidence as such. It's what's published - or not published - that counts. Almost all antidepressant trials are run and funded by drug companies. All too often, they just don't publish data showing their products in an unfavourable light. The fearsome John Ioannidis - known for writing papers with titles like Why most published research findings are false - pulled no punches in reminding readers of this, in his letter:
Among placebo controlled antidepressant trials registered with the US FDA, most negative results are unpublished or published as positive. Take sertraline, which Cipriani and colleagues recommend as the best ... of five FDA-registered trials, the only positive trial was published, one negative trial was published as positive, and three negative trials were unpublished. Head-to-head comparisons can suffer worse bias, since regulatory registration is uncommon. Meta-analysis of published plus industry-furnished data could spuriously suggest that the best drugs are those with the most shamelessly biased data ...
Ioannidis also noted that Cipriani did not include placebo-controlled trials in their analysis. He helpfully provided a table showing that if you do include these trials, the ranking of antidepressants is very different:

Of course, Ioannidis was not saying that the drug-vs-placebo data is better than the drug-vs-drug trials. After all, he had just declared it to be biased. But neither is it necessarily worse, and there's no good reason not to consider it.

Cipriani et al's response to their critics was a little light on detail. In response to concerns of industrial publication bias, they said that:
we contacted the original authors and pharmaceutical companies to obtain further data or to confirm reported figures.
But of course the pharmaceutical companies were under no obligation to play ball. They could just have chosen not to reveal embarrassing data. Rather more reassuring is the fact that the original paper did look for correlations between the drug company running each trial, and the results of the trial; they didn't find any. Rather cheekily, Cipriani et al then went on to suggest that they were the ones who were sticking it to Big Pharma:
The standard thinking has become that most antidepressants are of similar average efficacy and tolerability ... In some ways, this is a comfortable position for industry and its hired academic opinion leaders—it sets a low threshold for the introduction of new agents which can initially be marketed on the basis of small differences in specific adverse effects rather than on clear advantages in terms of overall average efficacy and acceptability.
They certainly have a point here. If aspiring antidepressants had to be proven better than existing ones in order to be sold, instead of just as good, there would probably have been no new antidepressants since Prozac in 1990. (And Prozac is only "better" than the drugs available in 1960 in that it's safer and has fewer side effects; it's no more effective.)

But this is not really relevant to whether the Cipriani analysis is valid. And in The Lancet letters, the authors did not address some of the criticisms, such as Ioannidis's point about including placebo-controlled trials, at all. They do point out that their raw data is available online for anyone to play around with.

The debate continued in the pages of Evidence Based Mental Health. In 2008, Gerald Gartlehner and Bradley Gaynes conducted a rather similar meta-analysis, but they reached very different conclusions. They declared that all post-1990 antidepressants are equally effective (or ineffective).

In their comments on the Cipriani paper, Gartlehner and Gaynes say that they were just more cautious in interpreting the results of a complex and problematic statistical process:
Ranking sertraline and escitalopram higher than other drugs conveys a precision
and existence of clinically important differences that is not reflected in the body of evidence. ...for sertraline and escitalopram the range of probabilities actually extends from the first to the eighth rank for both efficacy and acceptability... the validity of results of indirect comparisons depends on various assumptions, some of which are unverifiable ... We simply took underlying uncertainties into greater consideration and interpreted findings more cautiously than Cipriani and colleagues.
They also accuse Cipriani et al of various technical shortcomings - and in a meta-analysis, such 'technicalities' can often greatly the skew the results:
they included studies with very different populations such as frail elderly, patients with accompanying anxiety and inpatients as well as outpatients ... the effect measure of choice was odds ratios rather than relative risks. Odds ratios have mathematical advantages that statisticians value. Practitioners, however, frequently overestimate their clinical importance...
Cipriani et al respond to some of these technical criticisms, while admitting that their analysis has limitations. But, they say, even an imperfect ranking of antidepressants is better than none at all:
We have a choice. We may either make the best use of the available randomised evidence or we essentially ignore it. We believe that it is better to have a set of criteria based on the available evidence than to have no criteria at all... We believe that, despite the likely biases of the included trials, and the limitations of our approach, our analysis makes the best use of the randomised evidence, providing clinicians with evidence based criteria that can be used to guide treatment choices.
*
What are we to make of all this? Here's my two cents. It's implausible that all antidepressants are truly equally effective. They affect the brain in different ways. The pharmacological differences between SSRIs such as Prozac, Zoloft and Lexapro are minimal at best but mirtazapine and reboxetine, say, target entirely different systems. They work differently, so it would be odd if they all worked equally well.

The search phrase that most often leads people to this blog is "best antidepressant". People really want to know which antidepressant is most likely to help them. In truth, everyone responds differently to every drug, so there is no one best treatment. But Cipriani et al are quite right that even a roughly correct ranking could help improve the treatment of people with depression, even if the differences are tiny. If Drug X helps 1% more people than Drug Y on average, that's a lot of people when 30 million Americans take antidepressants every year.

So, what is the best antidepressant, on average? I don't know. But maybe it's escitalopram or sertraline. Stranger things have happened.

ResearchBlogging.orgIoannidis JP (2009). Ranking antidepressants. Lancet, 373 (9677) PMID: 19465221

Gartlehner, G., & Gaynes, B. (2009). Are all antidepressants equal? Evidence-Based Mental Health, 12 (4), 98-100 DOI: 10.1136/ebmh.12.4.98

More Antidepressant Debates

Six months ago, I asked What's The Best Antidepressant?, and I discussed a paper by Andrea Cipriani et al. The paper claimed that of the modern antidepressants, escitalopram (Lexapro) and sertraline (Zoloft) offer the best combination of effectiveness and mild side effects, and that sertraline has the advantage of being much cheaper.

The Cipriani paper was a meta-analysis of trials comparing one drug against another. With a total of over 25,000 patients, it boasted an impressively large dataset, but I advised caution. Their method of crunching the numbers (indirect comparisons) was complex, and rested on a lot of assumptions.

I wasn't the only skeptic. Cipriani et al has attracted plenty of comments in the medical literature, and they make for some fascinating reading. Indeed, they amount to crash-course in the controversies surrounding antidepressants today - a whole debate in microcosm. So here's the microcosm, in a nutshell:

*

In The Lancet, the original paper was accompanied by glowing praise by one Sagar Parikh:
Free of any potential funding bias... Now, the clinician can identify the four best treatments... A new gold standard of reliable information has been compiled for patients to review.
But critical comments swiftly appeared in the Lancet's letters pages. While not accusing Cipriani and colleagues themselves of bias or conflicts-of-interest, Tom Jefferson noted that way back in 2003, David Healy drew attention to:
documents that a communications agency acting on behalf of the makers of sertraline were forced to make available by a US court. Among them was a register of completed sertraline studies awaiting to be assigned to authors. This practice (rent-a-key-opinion-leader) is of unknown prevalence but it undermines any attempt at reviewing the evidence in a meaningful way.
This is what's known as medical ghostwriting, and it is indeed a scandal. However, by itself, ghostwriting doesn't distort evidence as such. It's what's published - or not published - that counts. Almost all antidepressant trials are run and funded by drug companies. All too often, they just don't publish data showing their products in an unfavourable light. The fearsome John Ioannidis - known for writing papers with titles like Why most published research findings are false - pulled no punches in reminding readers of this, in his letter:
Among placebo controlled antidepressant trials registered with the US FDA, most negative results are unpublished or published as positive. Take sertraline, which Cipriani and colleagues recommend as the best ... of five FDA-registered trials, the only positive trial was published, one negative trial was published as positive, and three negative trials were unpublished. Head-to-head comparisons can suffer worse bias, since regulatory registration is uncommon. Meta-analysis of published plus industry-furnished data could spuriously suggest that the best drugs are those with the most shamelessly biased data ...
Ioannidis also noted that Cipriani did not include placebo-controlled trials in their analysis. He helpfully provided a table showing that if you do include these trials, the ranking of antidepressants is very different:

Of course, Ioannidis was not saying that the drug-vs-placebo data is better than the drug-vs-drug trials. After all, he had just declared it to be biased. But neither is it necessarily worse, and there's no good reason not to consider it.

Cipriani et al's response to their critics was a little light on detail. In response to concerns of industrial publication bias, they said that:
we contacted the original authors and pharmaceutical companies to obtain further data or to confirm reported figures.
But of course the pharmaceutical companies were under no obligation to play ball. They could just have chosen not to reveal embarrassing data. Rather more reassuring is the fact that the original paper did look for correlations between the drug company running each trial, and the results of the trial; they didn't find any. Rather cheekily, Cipriani et al then went on to suggest that they were the ones who were sticking it to Big Pharma:
The standard thinking has become that most antidepressants are of similar average efficacy and tolerability ... In some ways, this is a comfortable position for industry and its hired academic opinion leaders—it sets a low threshold for the introduction of new agents which can initially be marketed on the basis of small differences in specific adverse effects rather than on clear advantages in terms of overall average efficacy and acceptability.
They certainly have a point here. If aspiring antidepressants had to be proven better than existing ones in order to be sold, instead of just as good, there would probably have been no new antidepressants since Prozac in 1990. (And Prozac is only "better" than the drugs available in 1960 in that it's safer and has fewer side effects; it's no more effective.)

But this is not really relevant to whether the Cipriani analysis is valid. And in The Lancet letters, the authors did not address some of the criticisms, such as Ioannidis's point about including placebo-controlled trials, at all. They do point out that their raw data is available online for anyone to play around with.

The debate continued in the pages of Evidence Based Mental Health. In 2008, Gerald Gartlehner and Bradley Gaynes conducted a rather similar meta-analysis, but they reached very different conclusions. They declared that all post-1990 antidepressants are equally effective (or ineffective).

In their comments on the Cipriani paper, Gartlehner and Gaynes say that they were just more cautious in interpreting the results of a complex and problematic statistical process:
Ranking sertraline and escitalopram higher than other drugs conveys a precision
and existence of clinically important differences that is not reflected in the body of evidence. ...for sertraline and escitalopram the range of probabilities actually extends from the first to the eighth rank for both efficacy and acceptability... the validity of results of indirect comparisons depends on various assumptions, some of which are unverifiable ... We simply took underlying uncertainties into greater consideration and interpreted findings more cautiously than Cipriani and colleagues.
They also accuse Cipriani et al of various technical shortcomings - and in a meta-analysis, such 'technicalities' can often greatly the skew the results:
they included studies with very different populations such as frail elderly, patients with accompanying anxiety and inpatients as well as outpatients ... the effect measure of choice was odds ratios rather than relative risks. Odds ratios have mathematical advantages that statisticians value. Practitioners, however, frequently overestimate their clinical importance...
Cipriani et al respond to some of these technical criticisms, while admitting that their analysis has limitations. But, they say, even an imperfect ranking of antidepressants is better than none at all:
We have a choice. We may either make the best use of the available randomised evidence or we essentially ignore it. We believe that it is better to have a set of criteria based on the available evidence than to have no criteria at all... We believe that, despite the likely biases of the included trials, and the limitations of our approach, our analysis makes the best use of the randomised evidence, providing clinicians with evidence based criteria that can be used to guide treatment choices.
*
What are we to make of all this? Here's my two cents. It's implausible that all antidepressants are truly equally effective. They affect the brain in different ways. The pharmacological differences between SSRIs such as Prozac, Zoloft and Lexapro are minimal at best but mirtazapine and reboxetine, say, target entirely different systems. They work differently, so it would be odd if they all worked equally well.

The search phrase that most often leads people to this blog is "best antidepressant". People really want to know which antidepressant is most likely to help them. In truth, everyone responds differently to every drug, so there is no one best treatment. But Cipriani et al are quite right that even a roughly correct ranking could help improve the treatment of people with depression, even if the differences are tiny. If Drug X helps 1% more people than Drug Y on average, that's a lot of people when 30 million Americans take antidepressants every year.

So, what is the best antidepressant, on average? I don't know. But maybe it's escitalopram or sertraline. Stranger things have happened.

ResearchBlogging.orgIoannidis JP (2009). Ranking antidepressants. Lancet, 373 (9677) PMID: 19465221

Gartlehner, G., & Gaynes, B. (2009). Are all antidepressants equal? Evidence-Based Mental Health, 12 (4), 98-100 DOI: 10.1136/ebmh.12.4.98

Wednesday, October 28, 2009

HOJE É DIA DE VOTAR!!!

Outubro:Na minha terra come-se bem!


CONTO COM VOCÊ DE HOJE, DIA 28 ATÉ DIA 31 DE OUTUBRO PARA VOTAR NO MELHOR TEXTO, QUE ESTÁ NA MINHA ALDEIA,
NESTE SEGUINTE ENDEREÇO:
http://aldeiadaminhavida.blogspot.com/2009/10/o-maravilhoso-parque-de-jaragua-do-sul.html#comment-form.

CONTO CONTIGO.
SEU VOTO É MUITO IMPORTANTE. SE VOCÊ GOSTOU DA CULINÁRIA, DO ALMOÇO DA MINHA TERRA, PASSE LÁ E VOTE.

NÃO ESQUEÇA.
ESTÁ NA LATERAL/BARRA DE ROLAGEM TEM A ÁREA PARA VOTAR.

Outubro:Na minha terra come-se bem!
TE ESPERO.SEU VOTO É IMPORTANTE PARA MIM.....
/2009/10/o-maravilhoso-parque-de-jaragua-do-sul.html#comment-form.
TEM UMA CAIXINHA NA BARRA DE ROLAGEM COM ESSES DIZRES:

Vote no Melhor Texto Aqui ! click no nome Sandra Andrade e vote.


MAIS INFORMAÇÕES AQUI :Blog Coletivo-Uma Interação de Amigos

QUER LEMBRAR DO LINDO ALMOÇO!! PASSE NA INTERAÇÃO DE AMIGOS OU DIRETO NA MINHA ALDEIA, CONFORME O LINK ACIMA.

CONTO CONTIGO MEU QUERIDO AMIGO.
SANDRA

Monday, October 26, 2009

Barack Obama Boosts Testosterone

But only if you voted for him, and only if you're a man. That's according to a PLoS One paper called Dominance, Politics, and Physiology.

It's already known that in males, winning competitions - achieving "dominance" - causes a rapid rise in testosterone release, whilst losing does the opposite. That's true in humans, as well as in other mammals. The authors wondered whether the same thing happens when men "win" vicariously - i.e. when someone we identify with triumphs.

What better way of testing this than the U.S. Presidential Election? The authors took 163 American voters, and got them to provide saliva samples before, during and after the results came in on the night of the 4th November. Here's what happened -

In Obama supporters (the blue line, natch), salivary testosterone levels stayed flat throughout the crucial hours. But supporters of John McCain or Libertarian candidate Bob Barr, suffered a testosterone crash after Obama's victory became apparent. That was only true in men, though; in women, there was no change.

Heh. Of course, we hardly needed biology to tell us that people often identify strongly with their preferred political parties, and the fact that social events cause hormonal changes shouldn't surprise anyone - the brain controls the secretion of most hormones.

The gender difference is interesting, though. Does this mean that men identify closer with politicians? Or maybe only with male ones - what would have happened if Hilary had won... or Palin? It could be that the testosterone surge accompanying success is strictly a man thing, although it's been shown to occur in women in some studies, but not consistently.

Finally, I should mention that this paper contains some excellent quotes, such as "...Robert Barr, who arguably did not have a chance of winning...", "In retrospective reports of their affective state upon the announcement of Obama as the president-elect, McCain and Barr voters felt significantly more unhappy" and my favourite, "men who voted for John McCain or Bob Barr (losers)". That last one may be taken slightly out of context.

ResearchBlogging.orgStanton, S., Beehner, J., Saini, E., Kuhn, C., & LaBar, K. (2009). Dominance, Politics, and Physiology: Voters' Testosterone Changes on the Night of the 2008 United States Presidential Election PLoS ONE, 4 (10) DOI: 10.1371/journal.pone.0007543

Barack Obama Boosts Testosterone

But only if you voted for him, and only if you're a man. That's according to a PLoS One paper called Dominance, Politics, and Physiology.

It's already known that in males, winning competitions - achieving "dominance" - causes a rapid rise in testosterone release, whilst losing does the opposite. That's true in humans, as well as in other mammals. The authors wondered whether the same thing happens when men "win" vicariously - i.e. when someone we identify with triumphs.

What better way of testing this than the U.S. Presidential Election? The authors took 163 American voters, and got them to provide saliva samples before, during and after the results came in on the night of the 4th November. Here's what happened -

In Obama supporters (the blue line, natch), salivary testosterone levels stayed flat throughout the crucial hours. But supporters of John McCain or Libertarian candidate Bob Barr, suffered a testosterone crash after Obama's victory became apparent. That was only true in men, though; in women, there was no change.

Heh. Of course, we hardly needed biology to tell us that people often identify strongly with their preferred political parties, and the fact that social events cause hormonal changes shouldn't surprise anyone - the brain controls the secretion of most hormones.

The gender difference is interesting, though. Does this mean that men identify closer with politicians? Or maybe only with male ones - what would have happened if Hilary had won... or Palin? It could be that the testosterone surge accompanying success is strictly a man thing, although it's been shown to occur in women in some studies, but not consistently.

Finally, I should mention that this paper contains some excellent quotes, such as "...Robert Barr, who arguably did not have a chance of winning...", "In retrospective reports of their affective state upon the announcement of Obama as the president-elect, McCain and Barr voters felt significantly more unhappy" and my favourite, "men who voted for John McCain or Bob Barr (losers)". That last one may be taken slightly out of context.

ResearchBlogging.orgStanton, S., Beehner, J., Saini, E., Kuhn, C., & LaBar, K. (2009). Dominance, Politics, and Physiology: Voters' Testosterone Changes on the Night of the 2008 United States Presidential Election PLoS ONE, 4 (10) DOI: 10.1371/journal.pone.0007543

COMEMORANDO 25.00MIL VISITAS.

HOJE, O BLOG CURIOSA ESTÁ MUITO FELIZ.
COMEMORA A SUAS 25.000MIL VISITAS.
AGRADEÇO O CARINHO DA SONIA EM FAZER O SELO PARA MIM.
VALE A PENA CONFERI
http://cantinhodeaconchego.blogspot.com/

ESTE PRESENTE É PARA VOCÊ MEU QUERIDO SEGUIDOR(A).




AGRADEÇO A TODOS PELO GRANDE CARINHO EM COMENTAR LÁ NA MINHA ALDEIA, SOBRE O TEMA, NA MINHA TERRA COME-SE BEM...

NOS DIAS 28 A 31 TEM A VOTAÇÃO. CONTO COM SEU VOTO.
PASSAREI MAIORES INFORMAÇÕES ATÉ LÁ.
POIS A VOTAÇÃO, TAMBÉM VAI ACONTECER NO BLOG DA MINHA ALDEIA.



MUITO OBRIGADA A TODOS.


SOU DESTAQUE NESTE LINDO CANTINHO.
MUITO OBRIGADA AMIGA.

http://cantinhodeaconchego.blogspot.com/


VENHA BUSCAR SEU SELINHO AQUI TAMBÉM....
Blog Coletivo-Uma Interação de Amigos


EM MEUS MIMOS TEM SELO ESPERANDO SER LEVADO..PASSE LÁ E CONFIRA:
http://sandraandrade7.blogspot.com/2009/10/selo-violeta.html#comments.

VENHA VOCÊ TAMBÉM FAZER PARTE DESSE CANTINHO.
Meus Mimos!

Saturday, October 24, 2009

HOJE TEM COLETIVA.

CONFORME JÁ COMBINADO, HOJE TEM COLETIVA, LA NA ALDEIA DE MINHA VIDA.
É UMA PROMOÇÃO DA SUSANA E DA LENA.
CONTO COM VOCÊ NO MELHOR COMENTARIO FEITO LÁ NA ALDEIA.
EMBORA TODO O TEXTO E RECEITA ESTEJAM NO BLOG UMA INERAÇÃO DE AMIGOS, E LÁ QUE SEU COMENTÁRIO VAI VALER UM PRÊMIO.
TE ESPERO LÁ MEU QUERIDO AMIGO.
É SÓ CLICAR NA IMAGEM ABAIXO E VOCÊ ARÁ UM LINDO PASSEIO.
NA VOLTA VENHA ALMOÇAR E PASSEAR PELO PARQUE DE MINHA CIDADE.

TENHA UM LINDO PASSEIO E BOM ALMOÇO.
MARRECO RECHEADO É NO BLOG.Blog Coletivo-Uma Interação de Amigos
......

MELHOR COMENTÁRIO É AQUI NESTA IMAGEM.

Para Outubro:Na minha terra come-se bem!

CLICK AQUI PARA CONHECER MELHOR E POSTAR O SEU COMENTÁRIO.

DIA 24/10/09, CONTO COM SEU COMENTÁRIO LÁ.


MAS O PRINCIPAL É LÁ NA ALDEIA GERAL.


TE ESPERO. CONCORRA COM ESTA IDEIA.


Na minha terra come-se bem!

Para Outubro:Na minha terra come-se bem!
Clique na imagem para saber mais


Espero por vocês.
Abraço grande, da SANDRA.

OBRIGADO!

SANDRA

Friday, October 23, 2009

VOLTEI DE NOVO!!!

BOA NOITE A TODOS!!!

ESTAMOS AQUI NOVAMENTE.
AINDA BEM!!!
O PC JÁ ESTÁ TRABALHANDO DE NOVO.
ESTOU COM MUITO FELIZ E , RECEBO VOCÊ NESTA CASA,
QUE É FEITA COM MUITO AMOR E ALEGRIA.
.
ABRO ESTA PÁGINA COM O CARINHO RECEBIDO DA ANA, MINHA QUERIDA IRMÃ/AMIGA VIRTUAL.

VALEU MINHA QUERIDA AMIGA, PELO POEMINHA.



Sorriso nos lábios, sempre podemos ter,mas para nossa alma sorrir, precisamos estar felizes...
Aquela felicidade que cria raízes, que nos faz desejar o que está por vir...que nos dá alegria de viver...
Temos alegria interior...
Vontade de correr e gritar.
A felicidade não podemos esconder.
É um real reviver...
Só pensamos em beijar...amar
É algo que desejamos, seja como for...
Assim é a felicidade ...
Que nos deixa com os lábios e a alma a sorrir.

TEM UM LINDO SELINHO TE ESPERANDO EM:
Meus Mimos!

PASSE LÁ.

Deep Brain Stimulation for Depressed Rats

Deep-brain stimulation (DBS) is probably the most exciting emerging treatment in psychiatry. DBS is the use of high-frequency electrical current to alter the function of specific areas of the brain. Originally developed for Parkinson's disease, over the past five years DBS has been used experimentally in severe clinical depression, OCD, Tourette's syndrome, alcoholism, and more.

Reports of the effects have frequently been remarkable, but there have been few scientifically rigorous studies, and the number of psychiatric patients treated to date is just dozens. So the true usefulness of the technique is unclear. How DBS works is also a mystery. Even the most basic questions - such as whether high-frequency stimulation switches the brain "on" or "off" - are still being debated.

Recent data from rodents sheds some important light on the issue: Antidepressant-Like Effects of Medial Prefrontal Cortex Deep Brain Stimulation in Rats. The authors took rats, and implanted DBS electrodes in the infralimbic cortex. This area is part of the vmPFC. It's believed to be the rat equivalent of the human region BA25, the subgenual cingulate cortex, which is the most common target for DBS in depression. The current settings (100 microA, 130 Hz, 90 microsec) were chosen to be similar to the ones used in humans.

In a standard rat model of depression, the forced-swim test, infralimbic DBS exerted antidepressant-like effects. DBS was equally as effective as imipramine, a potent antidepressant, in terms of reducing "depression-like" behaviours, namely immobility.

This is not all that surprising. Almost everything which treats depression in humans also reduces immobility in this test (along with few things which don't treat it). Much more interesting is what did and did not block the effects of DBS in these rats.

First off, DBS worked even when the rat's infralimbic cortex had been destroyed by the toxin ibotenic acid. This strongly suggests that DBS does not work simply by activating the infralimbic cortex, even though this is where the electrodes were implanted.

Crucially, infralimbic lesions did not have an antidepressant effect per se, which also rules out the theory that DBS works by inactivating this region. (Infralimbic lesions produced by other methods did have a mild antidepressant effect, but it was smaller than the effect of DBS. This may still be important, however.)

What did block the effects of DBS was the depletion of serotonin (5HT). Serotonin is known to its friends as the brain's "happy chemical", although it's a bit more complicated than that. Most antidepressants target serotonin. And rats whose serotonin systems had been lesioned got no benefit from DBS in this study.

So this suggests that DBS might work by affecting serotonin, and indeed, DBS turned out to greatly increase serotonin release, even in a distant part of the brain (the hippocampus). Interestingly this lasted for nearly two hours after the electrodes were switched off.

Depletion of another neurotransmitter, noradrenaline, did not alter the effects of DBS.

Overall, it seems that infralimbic DBS works by increasing serotonin release, but that this is not because it activates or inactivates the infralimbic cortex itself. Rather, nearby structures must be involved. The most likely explanation is that DBS affects nearby white-matter tracts carrying signals between other areas of the brain; the infralimbic cortex might just happen to be "by the roadside". Many researchers believe that this is how DBS works in humans, but this is the first hard evidence for this.

Of course, evidence from rats is never all that hard when it comes to human mental illness. We need to know whether the same thing is true in people. As luck would have it, you can temporarily reduce human serotonin levels with a technique called acute tryptophan depletion This reverses the effects of antidepressants in many people. If this rat data is right, it should also temporarily reverse the benefits of DBS. Someone should do this experiment as soon as possible - I'd like to do it myself, but I'm British, and all the DBS research happens in America. Bah, humbug, old bean.

There's a couple of others things to note here. In other behavioural tests, infralimbic DBS also had antidepressant-like effects: it seemed to reduce anxiety, and it made rats more resistant to the stress of having electrical shocks (although only slightly.) Finally, DBS in another region, the striatum, had no antidepressant effect at all. That's a bit odd because DBS of the striatum does seem to treat depression in humans - but the part of the striatum targeted here, the caudate-putamen, is quite separate to the one targeted in human depression, the nucleus accumbens.

ResearchBlogging.orgHamani, C., Diwan, M., Macedo, C., Brandão, M., Shumake, J., Gonzalez-Lima, F., Raymond, R., Lozano, A., Fletcher, P., & Nobrega, J. (2009). Antidepressant-Like Effects of Medial Prefrontal Cortex Deep Brain Stimulation in Rats Biological Psychiatry DOI: 10.1016/j.biopsych.2009.08.025

Deep Brain Stimulation for Depressed Rats

Deep-brain stimulation (DBS) is probably the most exciting emerging treatment in psychiatry. DBS is the use of high-frequency electrical current to alter the function of specific areas of the brain. Originally developed for Parkinson's disease, over the past five years DBS has been used experimentally in severe clinical depression, OCD, Tourette's syndrome, alcoholism, and more.

Reports of the effects have frequently been remarkable, but there have been few scientifically rigorous studies, and the number of psychiatric patients treated to date is just dozens. So the true usefulness of the technique is unclear. How DBS works is also a mystery. Even the most basic questions - such as whether high-frequency stimulation switches the brain "on" or "off" - are still being debated.

Recent data from rodents sheds some important light on the issue: Antidepressant-Like Effects of Medial Prefrontal Cortex Deep Brain Stimulation in Rats. The authors took rats, and implanted DBS electrodes in the infralimbic cortex. This area is part of the vmPFC. It's believed to be the rat equivalent of the human region BA25, the subgenual cingulate cortex, which is the most common target for DBS in depression. The current settings (100 microA, 130 Hz, 90 microsec) were chosen to be similar to the ones used in humans.

In a standard rat model of depression, the forced-swim test, infralimbic DBS exerted antidepressant-like effects. DBS was equally as effective as imipramine, a potent antidepressant, in terms of reducing "depression-like" behaviours, namely immobility.

This is not all that surprising. Almost everything which treats depression in humans also reduces immobility in this test (along with few things which don't treat it). Much more interesting is what did and did not block the effects of DBS in these rats.

First off, DBS worked even when the rat's infralimbic cortex had been destroyed by the toxin ibotenic acid. This strongly suggests that DBS does not work simply by activating the infralimbic cortex, even though this is where the electrodes were implanted.

Crucially, infralimbic lesions did not have an antidepressant effect per se, which also rules out the theory that DBS works by inactivating this region. (Infralimbic lesions produced by other methods did have a mild antidepressant effect, but it was smaller than the effect of DBS. This may still be important, however.)

What did block the effects of DBS was the depletion of serotonin (5HT). Serotonin is known to its friends as the brain's "happy chemical", although it's a bit more complicated than that. Most antidepressants target serotonin. And rats whose serotonin systems had been lesioned got no benefit from DBS in this study.

So this suggests that DBS might work by affecting serotonin, and indeed, DBS turned out to greatly increase serotonin release, even in a distant part of the brain (the hippocampus). Interestingly this lasted for nearly two hours after the electrodes were switched off.

Depletion of another neurotransmitter, noradrenaline, did not alter the effects of DBS.

Overall, it seems that infralimbic DBS works by increasing serotonin release, but that this is not because it activates or inactivates the infralimbic cortex itself. Rather, nearby structures must be involved. The most likely explanation is that DBS affects nearby white-matter tracts carrying signals between other areas of the brain; the infralimbic cortex might just happen to be "by the roadside". Many researchers believe that this is how DBS works in humans, but this is the first hard evidence for this.

Of course, evidence from rats is never all that hard when it comes to human mental illness. We need to know whether the same thing is true in people. As luck would have it, you can temporarily reduce human serotonin levels with a technique called acute tryptophan depletion This reverses the effects of antidepressants in many people. If this rat data is right, it should also temporarily reverse the benefits of DBS. Someone should do this experiment as soon as possible - I'd like to do it myself, but I'm British, and all the DBS research happens in America. Bah, humbug, old bean.

There's a couple of others things to note here. In other behavioural tests, infralimbic DBS also had antidepressant-like effects: it seemed to reduce anxiety, and it made rats more resistant to the stress of having electrical shocks (although only slightly.) Finally, DBS in another region, the striatum, had no antidepressant effect at all. That's a bit odd because DBS of the striatum does seem to treat depression in humans - but the part of the striatum targeted here, the caudate-putamen, is quite separate to the one targeted in human depression, the nucleus accumbens.

ResearchBlogging.orgHamani, C., Diwan, M., Macedo, C., Brandão, M., Shumake, J., Gonzalez-Lima, F., Raymond, R., Lozano, A., Fletcher, P., & Nobrega, J. (2009). Antidepressant-Like Effects of Medial Prefrontal Cortex Deep Brain Stimulation in Rats Biological Psychiatry DOI: 10.1016/j.biopsych.2009.08.025

Thursday, October 22, 2009

BOM DIA MEUS AMIGOS

OLA!
HOJE SÓ VOU DEIXAR UM AVISO PARA TODOS.
INFELIZMENTE MEU PC, QUEIMOU A PLACA DE ALIMENTAÇÃO.
NÃO TENHO COM POSTAR POR ALGUNS DIAS. MAS VOLTAREI ASSIM QUE TUDO FICAR BEM.




AS TECNOLOGIAS TAMBÉM NOS DEIXAM NA MÃO, MUITAS VEZES.
NESTE ANO, NÃO TIVE MUITA SORTE COM ESTE PC. E OLHA QUE ELE É NOVO!
BRINCADEIRA O QUE VEM ACONTECENDO....

CASO NÃO VOLTAR A SÁBADO DIA 24.10.09, PARA FAZER POSTAGEM, ESPERO VOCÊ. LÁ NO BLOG UMA INTERAÇÃO DE AMIGOS.

NESTE DIA VAI ACONTECER A POSTAGEM REFERENTE: EM MINHA TERRA SE COMO BEM.
É UMA PROMOÇÃO DA ALDEIA DE MINHA VIDA.
JÁ POSTEI LÁ.
MAS PARA DEIXAR OS COMENTÁRIOS, REFERENTE A POSTAGEM, VOCÊ DEVERÁ IR ATÉ AQUELE BLOG, PARA REALIZAR O COMENTÁRIO.

O MELHOR COMENTÁRIO GANHARÁ UM PRÉMIO SURPRESA, DAQUELE BLOG, QUE ESTÁ PROMOVENDO A COLETIVA.
CONTO COM VOCÊ NESTE DIA.
BASTA CLICAR NO LINK, UMA INTERAÇÃO DE AMIGOS, LOGO ACIMA E VOCÊ TERÁ ACESSO AO BLOG.

NO MEU BLOG UMA INTERAÇÃO DE AMIGOS TEM COMO FAZER.
BASTA CLICAR NA IMAGEM, E VOCÊ TERÁ ACESSO AO BLOG ALDEIA DE MINHA VIDA.

NÃO TENHO COMO DEIXAR O LINK AQUI HOJE.
ESTOU FORA DO MEU PC.

CONTO COM VOCÊ MEU AMIGO(A) SEGUIDOR(A) E VISITANTES PARA ESTE MOMENTO.

NÃO ESQUEÇA: DIA 24.10.09
LOCAL: BLOG UMA INTERAÇÃO DE AMIGOS.
TEMA: NA MINHA TERRA COME-SE BEM.

O CONVITE ESTÁ FEITO.
TE ESPERO LÁ.

Wednesday, October 21, 2009

On Sexed-Up Statistics

In yesterday's Guardian, Nick Davies, author of seemingly every British blogger's favourite book, Flat Earth News, delivered a pair of remarkable articles that confirmed him as one of the country's most important journalists.

In the first, Davies reported that a recent nationwide police initiative, Operation Pentameter, did not convict anyone of the crime of forcing women into prostitution after illegally trafficking them into the country.

This is rather surprising because, as he explains in a companion comment piece, forced sex trafficking has been widely reported as rife in Britain. The government has been telling Parliament and the nation that there are no less than 25,000 victims across the country. Anti-prostitution groups and charities agreed. Davies goes on to describe how this startling statistic was constructed through a process of exaggeration, misunderstanding, and plain invention.

In 1998, two academics identified a total of 71 trafficked women in the UK, and this did not refer specifically to forced or coerced trafficking. They suggested that the true figure could be anywhere between 142 and 1,420, but admitted that this was speculation, based on the assumption that for every confirmed case, there might be 2 to 20 in reality. A Christian charity quoted this as "an estimated 1,420 women", and others quoted them. The snowball had begun.

A second study estimated 4,000 victims of trafficking, but the researchers noted that this figure was "subject to a very large margin of error", "should be treated with great caution" and "should be regarded as an upper bound", as it was based on many assumptions. Heedless, another major charity quoted this as "4,000 trafficked women ... this figure is believed to be a massive underestimation of the problem". The government started repeating 4,000 as a fact.

Not to be outdone, a tabloid headline then reported no less than 25,000 sex slaves on the streets of Britain! Politicians started quoting this as a fact, although the newspaper provided no evidence for this figure at all. Asked why they believed it, a government minister said he used to work for the tabloid in question, and he trusted them to be accurate.

*

I have no idea how common forced sex trafficking is. I'd imagine it's not an easy thing to detect, let alone prove in court, so it could be going on behind closed doors and never make it into the statistics. It does happen, and obviously, every case is one too many.

But what certainly is true is that statistics have been greatly exaggerated, and then repeated, by the government and by various campaigning organizations. For more informed commentary on the issue by workers in the field, see Dr Petra Boynton's remarks here and the ongoing discussion here featuring Boynton and Belinda Brooks-Gordon.

Politician Dennis McShane MP "responded" to the criticisms of the 25,000 figure in an almost unwatchable TV interview and unconvincing article in which, amongst other things, he claims that 25,000 came from Amnesty International statistics. This is an outright lie. In fact, the tabloid did quote someone from Amnesty who commented on trafficking in general, but they didn't mention about numbers at all.
*

Attentive Neuroskeptic readers may well be experiencing a sense of déjà vu at this point. I have often written about the statistic - ubiquitous in Britain and elsewhere - that "1 in 4 people suffer mental illness". That number is made up, rather like the inflated statistics on forced sex trafficking.

Why are such statistics made up, and why are the made-up numbers usually shockingly high ones? It's no coincidence. This is what happens when the only people with an interest in talking about a statistic also have an interest in making it seem as high as possible. This is not to say that anyone deliberately fiddles the numbers, but rather, people naturally focus on the ones that suit them best.

In the case of mental illness, those who research mental illness know that their funding depends on the idea that it's a widespread problem. The more common people think it is, the more important studying it seems. Meanwhile, charities representing the interests of the mentally ill like high statistics because they make mental illness seem more "normal", thus destigmatizing it. It can't hurt their donation rates either.

With sex slavery, the inflated statistics were produced and repeated by organisations opposed to prostitution on moral grounds (including Christian charities and feminist groups), and by the government. The government's interest in the matter seems to be that they are currently trying to pass a law further restricting prostitution and the sex industry. The 25,000 supposed sex slaves must have helped convince Parliament about the importance of this move...

There must be many other examples of inflated statistics out there. It's inevitable, because in order to be taken seriously and to attract money, media attention and political support, campaigning organisations need to make their cause sound important. We can hardly blame charities for doing this, and as for politicians, we know not to trust them about anything. To expect an activist group or a political party to deal with evidence in a neutral and objective way is just naive.

What we'll always need, therefore, is people to scrutinize claims about social problems to keep the campaigners and the politicians honest. This is, or should be, the job of the media, but as Davies points out, the British media completely failed to do this for years. There will always be sexed-up statistics. What we need is more journalists like Davies to sex them back down again.

[BPSDB]

On Sexed-Up Statistics

In yesterday's Guardian, Nick Davies, author of seemingly every British blogger's favourite book, Flat Earth News, delivered a pair of remarkable articles that confirmed him as one of the country's most important journalists.

In the first, Davies reported that a recent nationwide police initiative, Operation Pentameter, did not convict anyone of the crime of forcing women into prostitution after illegally trafficking them into the country.

This is rather surprising because, as he explains in a companion comment piece, forced sex trafficking has been widely reported as rife in Britain. The government has been telling Parliament and the nation that there are no less than 25,000 victims across the country. Anti-prostitution groups and charities agreed. Davies goes on to describe how this startling statistic was constructed through a process of exaggeration, misunderstanding, and plain invention.

In 1998, two academics identified a total of 71 trafficked women in the UK, and this did not refer specifically to forced or coerced trafficking. They suggested that the true figure could be anywhere between 142 and 1,420, but admitted that this was speculation, based on the assumption that for every confirmed case, there might be 2 to 20 in reality. A Christian charity quoted this as "an estimated 1,420 women", and others quoted them. The snowball had begun.

A second study estimated 4,000 victims of trafficking, but the researchers noted that this figure was "subject to a very large margin of error", "should be treated with great caution" and "should be regarded as an upper bound", as it was based on many assumptions. Heedless, another major charity quoted this as "4,000 trafficked women ... this figure is believed to be a massive underestimation of the problem". The government started repeating 4,000 as a fact.

Not to be outdone, a tabloid headline then reported no less than 25,000 sex slaves on the streets of Britain! Politicians started quoting this as a fact, although the newspaper provided no evidence for this figure at all. Asked why they believed it, a government minister said he used to work for the tabloid in question, and he trusted them to be accurate.

*

I have no idea how common forced sex trafficking is. I'd imagine it's not an easy thing to detect, let alone prove in court, so it could be going on behind closed doors and never make it into the statistics. It does happen, and obviously, every case is one too many.

But what certainly is true is that statistics have been greatly exaggerated, and then repeated, by the government and by various campaigning organizations. For more informed commentary on the issue by workers in the field, see Dr Petra Boynton's remarks here and the ongoing discussion here featuring Boynton and Belinda Brooks-Gordon.

Politician Dennis McShane MP "responded" to the criticisms of the 25,000 figure in an almost unwatchable TV interview and unconvincing article in which, amongst other things, he claims that 25,000 came from Amnesty International statistics. This is an outright lie. In fact, the tabloid did quote someone from Amnesty who commented on trafficking in general, but they didn't mention about numbers at all.
*

Attentive Neuroskeptic readers may well be experiencing a sense of déjà vu at this point. I have often written about the statistic - ubiquitous in Britain and elsewhere - that "1 in 4 people suffer mental illness". That number is made up, rather like the inflated statistics on forced sex trafficking.

Why are such statistics made up, and why are the made-up numbers usually shockingly high ones? It's no coincidence. This is what happens when the only people with an interest in talking about a statistic also have an interest in making it seem as high as possible. This is not to say that anyone deliberately fiddles the numbers, but rather, people naturally focus on the ones that suit them best.

In the case of mental illness, those who research mental illness know that their funding depends on the idea that it's a widespread problem. The more common people think it is, the more important studying it seems. Meanwhile, charities representing the interests of the mentally ill like high statistics because they make mental illness seem more "normal", thus destigmatizing it. It can't hurt their donation rates either.

With sex slavery, the inflated statistics were produced and repeated by organisations opposed to prostitution on moral grounds (including Christian charities and feminist groups), and by the government. The government's interest in the matter seems to be that they are currently trying to pass a law further restricting prostitution and the sex industry. The 25,000 supposed sex slaves must have helped convince Parliament about the importance of this move...

There must be many other examples of inflated statistics out there. It's inevitable, because in order to be taken seriously and to attract money, media attention and political support, campaigning organisations need to make their cause sound important. We can hardly blame charities for doing this, and as for politicians, we know not to trust them about anything. To expect an activist group or a political party to deal with evidence in a neutral and objective way is just naive.

What we'll always need, therefore, is people to scrutinize claims about social problems to keep the campaigners and the politicians honest. This is, or should be, the job of the media, but as Davies points out, the British media completely failed to do this for years. There will always be sexed-up statistics. What we need is more journalists like Davies to sex them back down again.

[BPSDB]