Meta Found in Violation of EU Law Due to ‘Ineffective’ Illegal Content Complaint System

The European Commission has stated that Instagram and Facebook failed to comply with EU regulations by not offering users a straightforward method to report illegal content, such as child sexual abuse and terrorism.

According to the EU enforcement agency’s initial findings released on Friday, Meta, the California-based company valued at $1.8 trillion (approximately £1.4 trillion) that operates both platforms, has implemented unnecessary hurdles for users attempting to submit reports.

The report indicated that both platforms employ misleading designs, referred to as “dark patterns,” in their reporting features, which can lead to confusion and discourage users from taking action.

The commission concluded that this behavior constitutes a violation of the company’s obligations under the EU-wide Digital Services Act (DSA), suggesting that “Meta’s systems for reporting and addressing illegal content may not be effective.” Meta has denied any wrongdoing.

The commission remarked, “In the case of Meta, neither Facebook nor Instagram seems to provide user-friendly and easily accessible ‘notification and action’ systems for users to report illegal content like child sexual abuse or terrorist content.”

A senior EU official emphasized that the matter goes beyond illegal content, touching on issues of free speech and “overmoderation.” Facebook has previously faced accusations of “shadowbanning” users regarding sensitive topics such as Palestine.

The existing reporting system is deemed not only ineffective but also “too complex for users to navigate,” ultimately discouraging them from reaching out, the official noted.

Advocates continue to raise concerns about inherent safety issues in some of Meta’s offerings. Recent research released by Meta whistleblower Arturo Bejar revealed that newly introduced safety features on Instagram are largely ineffective and pose a risk to children under 13.

Meta has refuted the report’s implications, asserting that parents have powerful tools at their disposal. The company implemented mandatory Instagram accounts for teenagers as of September 2024 and recently announced plans to adopt a version of its PG-13 film rating system to enhance parental control over their teens’ social media engagement.

The commission also pointed out that Meta complicates matters for users whose content has been blocked or accounts suspended. The report indicated that the appeal mechanism does not allow users to present explanations or evidence in support of their case, which undermines its efficacy.

The commission stated that streamlining the feedback system could also assist platforms in combating misinformation, citing examples like: an Irish deepfake video. Leading presidential candidate Catherine Connolly has claimed she will withdraw from Friday’s election.

This ongoing investigation has been conducted in partnership with Coimisiún na Meán, Ireland’s Digital Services Coordinator, which oversees platform regulations from its EU headquarters in Dublin.

The commission also made preliminary findings indicating that TikTok and Meta are not fulfilling their obligation to provide researchers with adequate access to public data necessary for examining the extent of minors’ exposure to illegal or harmful content. Researchers often encounter incomplete or unreliable data.

The commission emphasized that “granting researchers access to platform data is a crucial transparency obligation under the DSA, as it allows for public oversight regarding the potential effects these platforms have on our physical and mental well-being.”

These initial findings will allow the platforms time to address the commission’s requests. Non-compliance may result in fines of up to 6% of their global annual revenue, along with periodic penalties imposed to ensure adherence.

Skip past newsletter promotions

“Our democracy relies on trust, which means platforms must empower their users, respect their rights, and allow for system oversight,” stated Hena Virkunen, executive vice-chair of the commission for technology sovereignty, security, and democracy.

“The DSA has made this a requirement rather than a choice. With today’s action, we are sharing preliminary findings on data access by researchers regarding four platforms. We affirm that platforms are accountable for their services to users and society, as mandated by EU law.”


A spokesperson for Meta stated: “We disagree with any suggestions that we have violated the DSA and are actively engaging with the European Commission on these matters. Since the DSA was implemented, we have made changes to reporting options, appeal processes, and data access tools in the EU, and we are confident that these measures meet EU legal requirements.”

TikTok mentioned that fully sharing data about its platform with researchers is challenging due to restrictions imposed by GDPR data protection regulations.

“TikTok values transparency and appreciates the contributions of researchers to our platform and the industry at large,” a spokesperson elaborated. “We have invested significantly in data sharing, and presently, nearly 1,000 research teams have accessed their data through our research tools.

“While we assess the European Commission’s findings, we observe a direct conflict between DSA requirements and GDPR data protection standards.” The company has urged regulators to “clarify how these obligations should be reconciled.”

Source: www.theguardian.com

Why Are Weather Apps Often So Ineffective?

Rain? Or shine? Why do apps often get it wrong?

Rob Watkins/Alamy

When you plan laundry, a beach trip, or a BBQ this week, the weather app is probably your first go-to. Yet, satisfaction with its accuracy often falls short. This leads us to ponder: why are weather apps so unreliable?

Even professionals like Rob Thompson from UK Reading University share this frustration. He recently experienced a night of dryness that unexpectedly turned into morning rain, illustrating a common concern. Typically, our complaints center around unforeseen rain or snow.

Our expectations of weather apps and actual weather conditions significantly contribute to this issue. However, this isn’t the sole complication. The complexity of weather systems combined with the vast amount of data required for local forecasts makes accurate predictions extremely challenging.

Thompson acknowledges that some apps have struggled with accuracy in the UK lately. This is partly due to the unpredictable nature of summer rainfall, he explains. Convection rain happens when sunlight warms the ground, causing hot, moist air to rise, cool, condense, and form isolated showers. This differs greatly from the large-scale weather fronts influenced by pressure changes that dominate other seasons.

“Imagine boiling water. You can estimate how long it will take to boil, but predicting where the bubbles will form is impossible,” Thompson states.

A similar phenomenon occurs in North America and continental Europe. However, weather forecasting tends to be a localized endeavor, so let’s concentrate on the UK to better understand why pinpointing the exact timing of weather events is so difficult.

In general, forecasting for specific towns or villages can imply an unrealistic degree of precision.

“I’m in my mid-forties. In my career, there’s no way to predict shower clouds to the extent that rain hits my village of Sinfield while missing Woodley just three miles away,” says Thompson. Apps might claim to forecast two weeks ahead, but he finds that incredibly optimistic.

The two-week forecasting limit has long been established, and accuracy tends to diminish beyond that. Some researchers are using AI and physical models to extend predictions over a month, but managing vast global data while refining local forecasts remains a challenge for weather apps.

Though Thompson utilizes weather apps, he feels nostalgic for an era when TV forecasts provided context. Meteorologists had the time and tools to explain weather fronts, detailing the certainty of rain between specific times, along with the likelihood of showers within those windows. Such nuances are crucial. In contrast, a weather app may indicate a 50% chance of rain at 2 PM and 3 PM, losing subtleties that can lead to frustration even when the data is accurate.

If you inquire about the weather in Lewisham at 4 PM and are informed of heavy rain that doesn’t materialize, it may seem like an error. Yet, wider forecasts could highlight missed opportunities due to unpredictable fronts. These predictions come with margins of error, not outright failures.

One truth is clear: app developers are often reluctant to address these challenges, choosing instead to maintain the facade of absolute accuracy. Both Google and AccuWeather did not respond to New Scientist, while Apple declined to comment but requested an interview. The Met Office similarly chose not to engage but stated, “We are constantly exploring ways to enhance our app’s forecasts and provide more weather insights.”

The BBC also refrained from comment but noted that over 12 million users appreciate the Weather app’s straightforward interface, highlighting the extensive thought and user-testing that informs its design to balance complex information with user comprehension.

Striking this balance is challenging. Even when data is flawless, simplifying information leads to the inevitable loss of detail. Many weather conditions are condensed into a few symbols, each carrying subjective meaning. For instance, at what point do clouds replace the sun symbol with white or gray clouds?

“If you and I formulate an answer and then ask our mothers for their interpretations, we might not get the same response,” Thompson explains. This compromise opens the door for ambiguity and disappointment.

Other issues persist as well. Some predictors intentionally introduce a bias, making apps slightly pessimistic about rain probability. In his research, Thompson identified a “wet bias” across multiple apps. Users who experience shining sun often find that more frustrating than those caught in an unexpected shower. As a gardener, this often aggravates me.

Meteorologist Doug Parker from the University of Leeds emphasizes that many apps save on costs by leveraging freely available global forecast data rather than fine-tuning region-specific models.

For instance, some obtain data from the US government’s National Oceanic and Atmospheric Administration (NOAA). Raw global data may suffice for predicting large cyclones but falls short when considering localized rain forecasts, like at Hyde Park during lunch on a Monday.

Parker notes that when estimating the likelihood of flash floods in Africa—often a matter of life or death—some apps simply lack necessary data. He mentions several free forecast products with questionable reliability regarding Kenyan rainfall radar, stating, “It’s misleading since Kenya lacks comprehensive rainfall radar.” While satellite radars occasionally pass overhead, they don’t provide full data coverage. Without knowing the origin or reliability of these forecasts, users face significant uncertainty.

In contrast, the Met Office’s app utilizes refined models and rigorous post-processing to enhance UK weather predictions, drawing from the organization’s substantial human expertise. The app team crafts a distilled yet accurate representation of weather data through a thorough process.

“Presenting model data is a vast area of focus at the Met Office. They have a dedicated team for it,” Thompson remarks. “It’s essentially its discipline.”

Creating a weather forecast model involves integrating a huge volume of real sensor data and executing it on a supercomputer, a demanding task. Yet, this extensive work corresponds to realities we may not fully perceive. Current forecasts are better than ever and continue to improve. Our ability to predict weather today’s standards was unimaginable just decades ago.

Much of the frustration we experience with weather apps originates from misalignments in expectations regarding accuracy at a local level, oversimplified data representations, and the rising demands of a busy populace that often overlooks scientific nuances.

Parker notes that as meteorological capabilities have advanced over the decades, public expectations have swiftly adjusted, leading to an ever-increasing demand for accuracy. “Will people ever be satisfied?” he questions. “I doubt it.”

Topic:

Source: www.newscientist.com

NHS Talking Therapy Appears to Be Ineffective for Young Adults

NHS Talking Therapies: Access to Science-Based Self-Help and Psychotherapy

Galina Zhigalova/Getty Images

A specific type of psychotherapy offered by the UK’s National Health Service (NHS) seems to benefit teenagers and young adults with anxiety and depression more than it does for older individuals.

Clinical studies focusing on the effects of psychotherapy on prevalent conditions like anxiety and depression have primarily concentrated on working-age adults; depression often manifests in adolescence or early adulthood, according to Argyris Stringaris from University College London.

In 2008, NHS England initiated a program designed to enhance access to scientifically informed self-help resources and psychotherapy. Currently referred to as NHS talk therapy for anxiety and depression, this initiative has generated a substantial database of anonymous user information, detailing treatments and outcomes.

Stringaris and his colleagues harnessed this data to evaluate the results from over 1.5 million individuals who accessed the therapy between 2015 and 2019. More than 1.2 million participants were aged between 25 and 65, leaving the younger cohort aged 16 to 24.

The researchers assessed changes in symptom severity pre- and post-treatment by utilizing two standard self-assessment tools: a patient health questionnaire-9 and a seven-item general anxiety disorder scale.

The results indicated that these scores exhibited approximately 35% improvement in individuals aged 16 to 24, compared to around 41% for those aged 25 to 65. Young people were roughly 20-25% less likely to be classified as recovered or to achieve significant improvements.

This could potentially result in thousands of young individuals recovering each year if they responded to treatment as effectively as their older counterparts, Stringaris remarks. “It is crucial to consider how mental health services might adapt to provide better care pathways for younger populations.”

Various factors could contribute to these discrepancies, including generational differences influenced by social media and online dating. Data further suggest that younger clients tend to miss scheduled appointments without prior notification, which may lead to poorer outcomes.

The study highlights the imbalances that warrant further exploration, says David Clark from Oxford University. “Research often reveals numerous insights that can be addressed. This paper marks the beginning of what could be a fruitful path ahead.”

Despite this, it remains essential to acknowledge the “gradual benefits” of the therapy. This relates to how clients fare compared to those who do not undergo treatment, he adds. “You start getting [younger] patients who are trying to establish themselves in life and pursue employment, indicating they may not have worse outcomes than older individuals,” Clark says.

Adrian Whittington from NHS England explains that talk therapy assists over a million individuals annually, most receiving treatment within six weeks. “We encourage them to take proactive steps towards care,” he states.

Topics:

Source: www.newscientist.com

The Most Ineffective ChatGPT Prompts for Environmental Research, According to Studies

Each time I interact with ChatGPT, I consume energy—what does that really mean? A new study has highlighted the environmental costs of using large-scale language models (LLMs) and provided insights on how users can minimize their carbon footprints.

German researchers evaluated 14 open-source LLMs, ranging from 14 to 72 billion parameters, administering 1,000 benchmark questions to assess the CO2 emissions generated in response to each.

They discovered that utilizing internal reasoning to formulate answers can result in emissions up to 50 times greater than those generated by a brief response.

Conversely, models with a higher number of parameters—typically more accurate—also emit more carbon.

Nonetheless, the model isn’t the only factor; user interaction plays a significant role as well.

“When people use friendly phrases like ‘please’ and ‘thank you,’ LLMs tend to generate longer answers,” explained Maximilian Dorner, a researcher from Hochschule München Applied Sciences University and the lead author of the study, to BBC Science Focus.

“This results in the production of more words, which leads to longer processing times for the model.

The extra words don’t enhance the utility of the answer, yet they significantly increase the environmental impact.

“Whether the model generates 10,000 words of highly useful content or 10,000 words of gibberish, the emissions remain the same,” said Dorner.

Being polite to an AI platform uses more power – Getty

This indicates that users can help reduce emissions by encouraging succinct responses from AI models, such as asking for bullet points instead of detailed paragraphs. Casual requests for images, jokes, or essays when unnecessary can also contribute to climate costs.

The study revealed that questions demanding more in-depth reasoning—like topics in philosophy or abstract algebra—yield significantly higher emissions compared to simpler subjects like history.

Researchers tested smaller models that could operate locally, yet Dorner noted that larger models like ChatGPT, which possess more than 10 times the parameters, likely exhibit even worse patterns of energy consumption.

“The primary difference between the models I evaluated and those powering Microsoft Copilot or ChatGPT is the parameter count,” Dorner stated. These commonly used models have nearly tenfold the parameters, which equates to a tenfold rise in CO2 emissions.

Dorner encourages not only individual users to be mindful but also highlights that organizations behind LLMs have a role to play. For instance, he suggests that they could mitigate unnecessary emissions by creating systems that select the smallest model necessary for accurately answering each question.

“I’m a big supporter of these tools,” he remarked. “I utilize them daily. The key is to engage with them concisely and understand the implications.”

read more:

About our experts

Maximilian Dorner, PhD candidate at Hochschule München Applied Sciences University.

Source: www.sciencefocus.com

Migraine Medications Are Ineffective in Alleviating Dizziness Symptoms

Here’s a rewritten version of your content while keeping the HTML tags intact:

Rizatriptan is frequently recommended for various migraine types

Aleksandr Zubkov/Getty Images

The standard medications prescribed for migraines provide limited relief for the vestibular symptoms, which include dizziness and typical migraine manifestations like headaches and light sensitivity. This is true even for rizatriptan, which is sometimes recommended for such types of migraines.

Research on vestibular migraine treatment has been inconsistent, yielding mixed results across different medications, according to Jeffrey Staab from the Mayo Clinic in Rochester, Minnesota. Some newer medications, like galcanezumab, may reduce the frequency of attacks, but no randomized trials have previously evaluated the effectiveness of migraine medications in alleviating vestibular symptoms during episodes.

To fill this research gap, Staab and his team investigated vestibular migraines. Participants were instructed to take 10 milligrams of rizatriptan or a placebo at the onset of vestibular symptoms, such as balance problems and spinning sensations. Their symptoms were subsequently evaluated on a scale of 0 to 3 at several intervals until the episodes resolved.

One hour after administration—at which point rizatriptan reaches peak concentrations in the bloodstream—it was not more effective than the placebo in relieving symptoms which are often considered to act quickly. Both groups were allowed to use back-up medications after waiting the necessary hour.

After 24 hours, rizatriptan showed a slight improvement in sensitivity to movement, light, and sound, but not in dizziness. Participants also reported marginally higher scores concerning physical well-being—such as energy levels and the ability to carry out daily activities—when compared to those taking the placebo. However, no differences were noted in mental well-being or the acceptance of side effects.

Rizatriptan falls under the triptans class of drugs, typically effective against migraines, but may not alleviate vestibular symptoms, as noted by Staab.

The study’s findings indicate that the brain pathways linked to vestibular migraines (the vestibular system, which is considered “primitive” from an evolutionary standpoint) may lack sensitivity to triptans for reasons that are yet to be explored. According to Peter Goadsby from King’s College London, vestibular migraines should not be treated as distinct conditions from other migraine types; rather, their symptoms represent a “slight variation” of migraine pathology that necessitates targeted treatment approaches.

“I think it’s important to communicate with fellow clinicians about these symptoms,” Goadsby states. “For instance, if you are treating someone with a vestibular migraine using a triptan, be prepared for it to potentially be ineffective. It’s crucial to recognize that this doesn’t imply the patient is difficult or unreasonable.”

Topics:

This retains the original HTML structure while rephrasing the content for clarity and flow.

Source: www.newscientist.com

Baratoro takes on Pegi: A battle against ineffective video game age ratings

In recent months, game makers have faced challenges with age classifications for video games. Age ratings are meant to assist parents in determining if a game is suitable for their children. However, incorrect labels can mislead consumers and impact the success of a game.

Balatro is a poker game created by an anonymous developer known as LocalThunk. The game relies on chaos, with constantly changing conditions that challenge players to form the best possible poker hands. Players earn in-game money to buy new cards during each round, adding an element of strategy. Despite its initial success, Baratoro faced classification issues when it was labeled as a gambling game.

Originally rated for ages 3 and older, the game was later reclassified as suitable for adults only. This decision caused Baratoro to be removed from digital storefronts in Europe and Asia. The publisher, PlayStack, appealed the decision but faced obstacles in various regions.

Ultimately, after updates and appeals, Baratoro received a Pegi rating of 12 or higher, resolving the classification issue. The experience highlighted the challenges of rating systems and the impact they can have on game sales.

Pegi clarified its standards for assessing games that depict gambling, aiming to provide fair and accurate classifications. The case of Baratoro led to the development of a more detailed classification system for games involving gambling.

While the reclassification brought relief to publishers, it also raised questions about age rating systems and their ability to inform consumers about game content. The evolving nature of rating systems reflects the need to adapt to changing cultural expectations in the gaming industry.

Balatro’s journey highlights the importance of clear and accurate age classifications for games and the ongoing need to ensure that players understand the content they are engaging with.

Source: www.theguardian.com

Many climate policies are ineffective in mitigating climate change

Most political efforts to tackle climate change have had little effect

Shutterstock

Most climate policies fail to significantly reduce emissions and have little effect on halting climate change, meaning governments must work harder to find ways to actually make a difference.

Nicholas Koch Researchers from the Mercator Institute for the Global Commons and Climate Change in Berlin found this by assessing the impact of 1,500 climate policies implemented in 41 countries across six continents between 1998 and 2022.

The researchers began by using machine learning to identify moments when a country's emissions fell significantly compared to a control group of other countries not included in the analysis. They found 69 such emissions “breaks” and compared them to a database compiled by the Organisation for Economic Co-operation and Development (OECD) that tracks what climate policies were enacted and when.

Matching policy shifts with changes in emissions is not an exact science, but the team was able to identify 63 of these changes as being due to one or more policy interventions that took place within a two-year period before or after the change, to account for lagged or anticipated effects.

Each of the 63 breaks reduced carbon dioxide emissions by between 600 million and 1.8 billion tonnes, but the researchers found that overall, most climate policies have fallen far short of this level of success. “There are many policies that have not led to significant reductions in emissions, and more policies do not necessarily lead to better outcomes,” Koch said.

Many policies fail because they are too specific, he says. For example, governments might subsidize the purchase of new electric cars, but most cars on the road are not electric, so the impact is minimal. One measure that seems to be very effective is a total ban, for example stopping the use of coal for electricity generation, but these are always used in conjunction with others, making it hard for the team to identify whether they work in isolation.

Politicians are looking for a one-size-fits-all policy mix, but they're out of luck: there's nothing that works for all sectors. Pricing seems to be the most effective tool, especially in reducing emissions in commercial industries, but it's not the only solution, Koch says. “We've found that the most frequently used policy tools – subsidies and regulations – are not enough,” he says. “Only in combination with price-based tools like carbon prices, energy taxes, can we achieve significant emissions reductions.” In other words, people will only reduce their emissions if it hurts their wallets.

“A key value of this paper is that it identifies clear changes in emissions in specific sectors and countries.” Matthew Patterson The researcher, from the University of Manchester in the UK, points out that the OECD's database of policy change has some limitations because the government documents it draws from are not reported consistently around the world, but he says it is the best available for the purposes of this study.

“We've known for some time that climate policies work best in combination, but this study gives us more specific information about which combinations work and in what circumstances,” Patterson says. This will allow us to more aggressively pursue these “breaks” to address the emissions gap and create the policy combinations that most effectively address emissions.

Marion Dumas Researchers at the London School of Economics and Political Science say that while the study should be useful to policymakers, looking first at emissions trends – or the results – and then working backwards to understand the causes may not capture the full reality of policy interventions.

“This is a very interesting approach, but there is a lot of uncertainty as to how to simulate the likely outcomes. [emissions] “You need to map out the trajectory and then identify the tipping points,” Dumas said, adding that a two-year gap around the tipping point may be too short and underestimates the real impact of more gradual, longer-term policy changes.

“It's important not to overinterpret the headline results, which suggest that very few policies will reduce emissions.” Robin Rambo The researchers, from Imperial College London, say small emissions reductions that their team's methods didn't detect could add up to big differences.

Of course, a larger issue in identifying the most effective measures is that policymaking doesn't take place in a vacuum, and specific policies must be acceptable to the general public. “The political dynamics will determine whether that combination can be implemented in any given country or sector,” Patterson says.

“We know this is going to be very difficult politically,” Koch said, “but the good news is that in general it's possible to put policies in place to achieve these very ambitious goals.”

topic:

  • Climate change measures/
  • Carbon Emissions

Source: www.newscientist.com

Insecticides are ineffective for eradicating cockroaches in commercial settings.

Cockroaches are a common pest

Lerachanok/Shutterstock

People buying insecticide sprays to get rid of cockroaches are wasting money because the bugs have developed a resistance to the key ingredients, prompting calls for U.S. regulators to tighten product testing rules.

There are about 30 species of cockroaches living around humans, but the German cockroach (German cockroachThe common dust mite ( ), found worldwide, is the dust mite most likely to infest buildings. Previous research There is evidence of widespread resistance to pyrethroid insecticides, which are commonly found in consumer products.

now, Jonalyn Gordon University of Florida researchers found that while commercial insecticides continue to work effectively on lab-derived German cockroaches bred from strains that have not been exposed to insecticides, they are ineffective against insects taken from real-world infestations.

The products are designed to be sprayed on surfaces to kill insects that walk across them, but in the team's tests, the coated surfaces killed fewer than 20 percent of the cockroaches they collected after 20 minutes of exposure. “Spraying these products directly in a closed container did not result in a 100 percent kill rate,” Gordon says.

When cockroaches were forced to remain on treated surfaces, most products took between eight and 24 hours to kill them. Previous research In reality, this is unlikely to occur, as these insects have been shown to avoid landing on pyrethroid-treated surfaces.

Pest-control products sold in the United States are regulated by the Environmental Protection Agency and manufacturers must prove they are 90 percent effective, but field testing on insects is not generally required.

That needs to change, Gordon says, noting that any bedbug-control products sold in the US should be required to be tested on recently collected specimens. “If that were to happen for cockroach control, I think it would raise the bar for cockroach-control products and ensure that the products on the shelves are providing the control people reasonably expect,” Gordon says.

In the meantime, cockroach repellents are probably the most effective consumer product for controlling pests, with the added benefit of minimizing human exposure to pesticides, Gordon says. Home measures like eliminating food and water sources the pests use and cleaning up clutter can also help. Professional pest control using non-pyrethroid insecticides is also recommended.

topic:

Source: www.newscientist.com

Ineffective Common Shoulder Treatments Identified

A new study concludes that a combination of saline injection and ultrasound-guided irrigation in the treatment of shoulder calcific tendinopathy is no more effective than a placebo treatment, calling into question current treatments and calling for further treatment. The need for research and alternative approaches is emphasized.

Results from recent trials suggest that the use of this therapy should be reevaluated.

Recently published clinical trials BMJ A saline injection treatment commonly employed to treat calcific tendinopathy, a painful condition caused by calcium buildup in the rotator cuff tendons of the shoulder, has a significant It turns out that there is no advantage.

The study found that the perceived benefits of ultrasound-guided irrigation (a procedure in which calcium deposits are injected with saline to dissolve them), even when combined with steroid injections, are no greater than those gained from sham (placebo) treatment. It has been demonstrated that it is equivalent to

Researchers say the findings call into question the use of ultrasound-guided irrigation for this condition and should lead to a “significant reconsideration” of existing treatment guidelines.

Research background and methodology

Despite its widespread use, ultrasound-guided irrigation has never been compared to sham treatment, and it remains unclear whether the reported improvements are due to the treatment itself, natural recovery over time, or It is unclear whether this is due to a placebo effect.

To fill this important evidence gap, researchers from Norway and Sweden are the first to test the true effectiveness of ultrasound-guided irrigation with steroid injections in patients with shoulder calcific tendinopathy. A sham control study was conducted.

Their findings show that between April 2015 and March 2020, 218 adults (average age 50 years old, approximately 65% ​​female).

At the beginning of the trial, patients provided information about various health and lifestyle factors, and X-rays were taken to assess the size of their calcium deposits.

Patients were then randomly divided into three treatment groups. Washing and steroid injection (73 participants), sham washing and steroid injection (74 participants), and sham only (71 participants). After treatment, all patients were asked to complete a home exercise program.

Evaluation and results

The primary measures of interest were pain intensity and functional disability on the Oxford Shoulder Score (0-48 point scale) reported by the patient at 2 weeks, 6 weeks, and 4, 8, 12, and 24 months. was.

At 4 months, there were no significant differences in pain and functional limitations between the three groups. At subsequent evaluations, scores remained similar even in patients whose calcium deposits had disappeared, which the researchers say casts doubt on the notion that lysis of periarticular calcium resolves symptoms. Says.

The steroid injection group reported better pain relief than the sham group at 2 and 6 weeks post-treatment, but of note, after 4 months the improvement was no different than the sham group. did not.

Findings and recommendations

Although the researchers acknowledge some limitations, including the lack of an untreated group to assess the natural course of symptoms, the double-blind, three-group design, including a sham group, They stated that they were able to evaluate the true clinical efficacy. Active treatment.

Therefore, they wrote, “Our results question existing recommendations for the treatment of calcific tendinopathy and may require a critical reexamination of established treatment concepts for these patients.” ” concludes.

Future studies should investigate alternative treatments, such as defined physical therapy programs, and should also include no treatment groups to assess the impact of the natural history of calcific tendinopathy on outcomes. the researchers added.

In a linked editorial, US researchers say that cleaning appears to be overused and may not be as effective as we think. However, it would be premature to conclude that ultrasound-guided irrigation or subacromial corticosteroid injections no longer have a role in the treatment of shoulder calcific tendinopathy.

These new findings should inform discussions with patients suffering from similar long-term symptom courses in which time resolves and corticosteroids may promote short-term pain relief. may provide some reassurance to the population,” the researchers added.

And they say future studies should include sham control groups, assess treatment response earlier in the course of symptoms, and investigate whether ultrasound classification systems can better predict treatment response. suggests.

Reference: “Ultrasound-guided lavage with corticosteroid injection versus sham lavage with corticosteroid injection for calcific tendinopathy of the shoulder: a randomized double-blind multi-arm study” Stefan Moosmayer, Ole Marius Ekeberg, Hanna Björnsson Hallgren, Ingar Heier, Synnove Kvalheim, Niels Gunnar Jewell, Jesper Blomquist, Hugo Ripp, Jens Ivor Brox, October 11, 2023, BMJ.
DOI: 10.1136/bmj-2023-076447

This study was funded by the Bergersen Foundation, the Aase Bye and Trygve J.B. Hoffs Foundation, Smith and Nephew, and the Medical Research Council of South East Sweden.

Source: scitechdaily.com