To observe the observations on observational research: how do Italian online media report about a contemporary mainstream observational study?

BACKGROUND: The media's key role in conveying health information to the public is not always supported by the quality of the reporting. Despite findings from observational studies (OSs) represent a substantial proportion of media health news, limitations of OSs are often overlooked in medical journals' abstracts, in press releases, and in associated news stories. The objective of this analysis is to investigate how Italian online news media report on a contemporary OS published in a major medical journal and dealing with a topic of widespread interest. METHODS: The OS was published in Nature Medicine (Nat Med) in February 2022. It is a large retrospective cohort study aimed at characterizing the post-acute cardiovascular manifestations of covid-19. We collected Italian online news articles covering the Nat Med study that were released in the first two weeks after study publication. Based on resources focused on evaluation and proper reporting of OSs, we identified five thematic categories to be employed as a minimal reference standard to address the quality of reporting of the Nat Med study. Namely: 1) causality, 2) fear mongering, 3) spin, 4) actionability and 5) critical evaluation. Then, we defined a 13-item checklist aimed at exploring the existence of issues within each of the online news article with regard to the five thematic categories above. Outcome was the percentage of news articles covering the NM study showing issues with each of the five thematic categories. RESULTS: After checking for inclusion and exclusion criteria, we collected 30 news articles. Global inter-rater agreement related to the checklist completion by 4 raters was substantial. An issue with causality was identified in 30 articles out of 30 (100%). An issue with fear mongering was identified in 25 (83.3%) of the 30 articles, and an issue with spin in 21 (75%) of the 28 articles. Furthermore, an issue with actionability and critical evaluation was identified in 16 (53.3%) and 26 (86.7%) of the 30 articles, respectively. CONCLUSIONS: Our analysis of Italian online news media reporting about a contemporary OS published in a major medical journal and dealing with a topic of high public interest has shown that most news articles fail to properly report on the study's findings.

[About the communication of health research: generating trust through information and education.] / La comunicazione della ricerca scientifica: informare (e formare) generando fiducia.

Public communication strategies of scientific findings can be placed at various levels on a scale that originates from purely informative methods and, through increasingly persuasive methods, goes up to coercion. Institutional communication of science during the covid-19 pandemic is affected by the tension between the pursuit of the ethics of transparency and the need to achieve public health goals: a communication focused on information, that neutrally highlights both the risks and the advantages of an intervention, could reduce the acceptance of this intervention in the short term, but consolidate people's trust in institutions in the long term. On the other hand, a more persuasive communication could lead to a greater adherence to the proposed intervention in the short term, but weaken the trust of the communication's recipients towards the institutions. Whenever there is robust evidence in favor of the net benefit of an intervention, informative and persuasive communication tend to overlap, while interventions with an uncertain relation between pros and cons should orient communication towards more informative strategies: even when this is not possible, as in the case of health emergencies, transparency in communication remains decisive. In this regard, transparency is configured as the common denominator of a type of science communication that can generate trust in its recipients. But transparency alone is not enough. In fact, its effectiveness is lost if the communicated contents are not useful and if the recipients of the messages are not able to receive them adequately. Based on Italo Calvino's Six Memos, we define six requirements for transparent communication of scientific research and emphasize the importance of interventions aimed at promoting health literacy since primary school, such as the international Informed Health Choices project.

[Covid-19, myocarditis and return to play: it's time to be conservative.] / Covid-19, miocarditi e ripresa dell'attività sportiva: quando è il momento di essere conservativi.

Observational studies of cardiac magnetic resonance imaging in people with recent covid-19, including young asymptomatic athletes, have documented variable amounts of myocardial findings deemed suggestive of myocarditis. Despite a critical appraisal of the current literature points toward an insufficient evidence base about the existence of a peculiar association between covid-19 and myocarditis, the concern for unrecognized myocarditis and its potential consequences has led several sports medicine organizations to recommend a variety of cardiac tests to enable return to play in athletes with previous covid-19. We argue that some of these recommendations may lead to unnecessary tests or treatments, especially for asymptomatic SARS-CoV-2 positive people and for those with previous mild disease, and that sports participation may even be discouraged. As a response to current uncertainty, we advocate both for randomized studies that analyse the outcomes of different diagnostic strategies and for a prolonged follow-up of these people.

Il re nudo nella pandemia: sulla produzione e comunicazione del sapere scientifico ai tempi di SARS-CoV-2

The SARS-CoV-2 pandemic has lifted the veil about how medical knowledge is produced and disseminated. Action Bias, together with economic, academic and media-related interests, has concurred to generate and spread low-value and even unreliable information about some hypothetical therapeutic interventions for CoViD-19. Not only this "infodemic"has weakened people's ability to make informed health choices, but it also has influenced the process of new evidence generation through the violation of the equipoise principle. The CoViD-19 infodemic has further highlighted the need for reliable health information and for people to enter the process of understanding and promoting valuable research. Through a randomized controlled trial, the Informed Health Choices project has shown that it is not impossible neither quixotic to better orient people about health choices since primary school. Similar competencies should be disseminated to everyone through sources that are selected and validated for their capability of reporting evidence based health information about the effects of treatments.

[The naked king in the pandemic: about the production and communication of scientific knowledge at the time of SARS-CoV-2.] / Il re nudo nella pandemia: sulla produzione e comunicazione del sapere scientifico ai tempi di SARS-CoV-2.

The SARS-CoV-2 pandemic has lifted the veil about how medical knowledge is produced and disseminated. Action Bias, together with economic, academic and media-related interests, has concurred to generate and spread low-value and even unreliable information about some hypothetical therapeutic interventions for CoViD-19. Not only this "infodemic" has weakened people's ability to make informed health choices, but it also has influenced the process of new evidence generation through the violation of the equipoise principle. The CoViD-19 infodemic has further highlighted the need for reliable health information and for people to enter the process of understanding and promoting valuable research. Through a randomized controlled trial, the Informed Health Choices project has shown that it is not impossible neither quixotic to better orient people about health choices since primary school. Similar competencies should be disseminated to everyone through sources that are selected and validated for their capability of reporting evidence based health information about the effects of treatments.

[New insights into the seriousness of acute myocardial injury during COVID-19]. / Nuove acquisizioni sulla gravità del danno cardiaco acuto in corso di COVID-19.

Retrospective data from Chinese cohorts published in the last few days have placed a strong emphasis on the possibility that acute myocardial injury represents a critical component in the development of serious complications in patients hospitalized with COVID-19. These analyses showed that 19-27% of hospitalized patients with moderate/severe COVID-19 developed acute myocardial injury, defined as an increase in troponin levels. Fifty-sixty percent of these patients died. The highest mortality rate was detected among patients with both progressively incremental troponin levels and a history of cardiovascular disease. Some pathophysiological reasons have been hypothesized regarding the frequently observed increase in troponin levels in patients hospitalized with COVID-19, but, at the moment, these data could already suggest some clinical management implications, also with the aim of prospectively collecting research data: a troponin dosage should be considered, as a prognostic indicator, in all patients with moderate/severe COVID-19 at hospital admission, periodically during hospitalization, and in the case of clinical deterioration. In those patients with increased troponin levels, serial determinations should be carried out to define the enzymatic trajectory and therefore also the degree of clinical attention that must necessarily be closer in those who turn out to have persistently high or increasing troponin levels. In order to reduce the overdiagnosis risk of acute myocardial injury in critically ill patients, detection of increased troponin levels should always be contextualized into a multi-parametric evaluation.