Review of “Oestrogen Matters” Avram Bluming and Carol Tavris, TLS 29th January 2019

In the current TLS I have a brief review of Bluming and Tavris’ book on HRT. The full text is available to subscribers; here is the first paragraph:

Few medical treatments have seen as stark a rise and fall as hormone replacement therapy (HRT). In the early 1940s, methods were developed to extract oestrogen from pregnant mares’ urine, and the resulting medication was named Premarin. Marketed from the 1950s for menopausal symptoms, HRT was catapulted into the public consciousness by the New York gynaecologist Robert Wilson’s bestseller Feminine Forever (1966), and made Ayerst Laboratories, who had developed Premarin and paid Wilson’s expenses for writing the book, extremely rich. HRT was hyped as a wonder drug adding years to life and life to years


Are we winning the War on Sleeplessness?

Or, as the authors of this paper put it, are we seeing the “first signs of success in the fight against sleep deficiency?”



The high prevalence of chronic insufficient sleep in the population has been a concern due to the associated health and safety risks. We evaluated secular trends in sleep duration over the most recent 14-year period.


The American Time Use Survey, representative of US residents ≥15 years, was used to investigate trends in self-reported sleep duration and waking activities for the period 2003-2016 (N = 181335 respondents).


Sleep duration increased across survey years both on weekdays (+1.40 min/year) and weekends (+0.83 min/year, both p < .0001, adjusted models). This trend was observed in students, employed respondents, and retirees, but not in those unemployed or not in the labor force. On workdays, the prevalence of short (≤7 hr), average (>7-9 hr), and long (>9 hr) sleep changed by -0.44% per year (p < .0001), -0.03% per year (p = .5515), and +0.48% per year (p < .0001), respectively. The change in sleep duration was predominantly explained by respondents retiring earlier in the evening. The percentage of respondents who watched TV or read before bed-two prominent waking activities competing with sleep-decreased over the same time period, suggesting that portions of the population are increasingly willing to trade time in leisure activities for more sleep. The results also suggest that increasing online opportunities to work, learn, bank, shop, and perform administrative tasks from home freed up time that likely contributed to increased sleep duration.


The findings indicate first successes in the fight against sleep deficiency. Public health consequences of the observed increase in the prevalence of long sleep remain unclear and warrant further investigation

Here is the American Time Use Survey which the authors used for their study.

Efficacy of PRIME, a Mobile App Intervention Designed to Improve Motivation in Young People With Schizophrenia

From Schizophrenia Bulletin:

The onset of schizophrenia occurs during a period critical for development of social relationships and functional independence. As such, interventions that target the early course of illness have the potential to stave off functional decline and restore functioning to pre-illness levels. In this entirely remote study, people with recent-onset schizophrenia spectrum disorders (SSDs) participated in a 12-week randomized controlled trial to determine the efficacy of PRIME (personalized real-time intervention for motivational enhancement), a mobile-based digital health intervention designed to improve motivation and quality of life. Participants were randomized into the PRIME (n = 22) or treatment-as-usual/waitlist (TAU/WL) condition (n = 21) and completed assessments at baseline, post-trial (12 wk), and for people in the PRIME condition, 3 months after the end of the trial. After 12-weeks, WL participants received PRIME, resulting in a total sample of 38 participants completing PRIME. In PRIME, participants worked towards self-identified goals with the support of a virtual community of age-matched peers with schizophrenia-spectrum disorders as well as motivation coaches. Compared to the WL condition, people in the PRIME condition had significantly greater improvements in self-reported depression, defeatist beliefs, self-efficacy, and a trend towards motivation/pleasure negative symptoms post-trial, and these improvements were maintained 3 months after the end of trial. We also found that people in the PRIME condition had significantly greater improvements in components of social motivation post-trial (anticipated pleasure and effort expenditure). Our results suggest that PRIME has the potential to be an effective mobile-based intervention for improving aspects of mood and motivation in young people with SSDs.

Dept. of Unfortunate Acronyms

Via #revScreen comes the following:

J Hum Hypertens. 1996 Feb;10 Suppl 1:S69-72.
Interactive electronic teaching (ISIS): has the future started?
Consoli SM1, Ben Said M, Jean J, Menard J, Plouin PF, Chatelier G.
Author information
Medical education of hypertensives as well as of other asymptomatic cardiovascular risk patients requires individualized, interactive and attractive strategies. Electronic teaching set up in hospital or clinic settings opens the way of the future, saving time and allowing more advantageous use of caretakers. ISIS (Initiation Sanitaire Informatisee et Scenarisee), a French computer assisted program for cardiovascular risk patients, combines a scientific information, divided in 12 sequential but independent modules, with a recreative imaginary trip in the world of ancient Egypt. To test the impact of this tool on patient health information retention, 158 hypertensives hospitalized in a day-hospital clinic were randomized into an intervention or ISIS group (IG, n = 79) and a control group (CG, n = 79). Both groups received cardiovascular education through standard means. In addition, IG patients underwent a 30 to 60 min session on the computer. Cardiovascular knowledge was tested by a nurse administering a standardized 28-item questionnaire before and two months after education. Retesting was done by telephone interview. A total of 138 completed questionnaires (69 from each group) were analyzed. Overall mean cardiovascular knowledge score before education (14.3 +/- 4.2, range 4-25) improved significantly after education (3.7 +/- 3.5, p = 0.0001). This improvement was more important in the IG than the CG (3.8 +/- 3.6 vs 2.4 +/- 3.2 respectively, p = 0.02), especially in hypertensives having a known disease for more than six months. Isis is now available in two languages: French and English. Patients’ satisfaction and the conclusion of this comparative trial encourage confirmation of these first results in other French or English speaking populations, in order to test the long term effects of structured electronic teaching sessions on health behaviour, and to promote a wide use of computers and multimedia communication in hypertension control programs.

#revScreen – Cochrane Crowd Challenges on home visiting and medical education

Previously I blogged about the addictive nature of EMBASE Screening. This is now rebranded as Cochrane Crowd, but the overall approach is unchanged – the user assesses abtracts to see if they are RCTs/CCTs or not. It it surprisingly addictive.

cochrane crowd logo


Anyhow, there are two new Cochrane tasks – screening for RCTs for two specific reviews Home visiting for socially disadvantaged mothers, and  Interventions for improving medical students’ interpersonal communication in medical consultation. 

If any readers are interested in these areas, the Cochrane Crowd process exposes one to a wide range of (at times rather tenuously related) studies and papers on the topic… I tend to get sidetracked easily.

Anyhow, here is the email:

Dear all,


We need your help!


When you next log into Cochrane Crowd you will be able to see two new ‘tasks’ in your dashboard area. One is for an update of a review entitled: Home visiting for socially disadvantaged mothers, and the other is for a new review, called: Interventions for improving medical students’ interpersonal communication in medical consultations.


The searches for each of these reviews has identified between 3000-5000 records. The core author team for each review has come toCochrane Crowd asking if this community can help. I think we can.


Before you dive in, here are some questions you might have:


What do I need to do that is different from the usual RCT screening task?

Absolutely nothing. The task is exactly the same making you very well qualified to help! We want all the randomized or quasi-randomized trials to be identified even if the trial has nothing to do with the topic of the review.


What’s in it for me?

For those who screen 250 or more records, your contribution will be acknowledged in the review for which you contributed. In addition, on one of the reviews, the home visiting review, the review team will reward authorship to the top screener. This will be based not just on the amount you screen but the accuracy of your screening.


How long will these tasks be posted for?

We’ve set the deadline for 31st March. It would be fantastic to have both sets of records screened by that date.


Who can I contact if I have any questions or queries?

You can either contact me, Anna, ( or my brilliant colleague, Emily ( and we’ll try and get back to you as quickly as possible.


Do I need to let anyone know if I plan to contribute or not?

No, you don’t need to let us know either way. If you want to contribute to either or both reviews, just log into Crowd and get cracking! We’ll know who has taken part. Likewise, if this just isn’t for you or you don’t think you’ll have the time, that’s absolutely fine; you don’t need to let us know.


When can I start?

Right now! Go and make a nice cup of tea and hop over to Cochrane Crowd ( Log in as usual and you should see the two new tasks. I think I’ll head there now myself.

If you’re a twitterer, we’ll be using #RevScreen for these two exciting pilots!


With best wishes to all and happy citation screening,



Anna and Emily


Cochrane Crowd