Guiding principles for the use of knowledge bases and real-world data in clinical decision support systems: report by an international expert workshop at Karolinska Institutet.

INTRODUCTION: Technical and logical breakthroughs have provided new opportunities in medicine to use knowledge bases and large-scale clinical data (real-world) at point-of-care as part of a learning healthcare system to diminish the knowledge-practice gap. AREAS COVERED: The article is based on presentations, discussions and recommendations from an international scientific workshop. Value, research needs and funding avenues of knowledge bases and access to real-world data as well as transparency and incorporation of patient perspectives are discussed. EXPERT OPINION: Evidence-based, publicly funded, well-structured and curated knowledge bases are of global importance. They ought to be considered as a public responsibility requiring transparency and handling of conflicts of interest. Information has to be made accessible for clinical decision support systems (CDSS) for healthcare staff and patients. Access to rich and real-world data is essential for a learning health care ecosystem and can be augmented by data on patient-reported outcomes and preferences. This field can progress by the establishment of an international policy group for developing a best practice guideline on the development, maintenance, governance, evaluation principles and financing of open-source knowledge bases and handling of real-world data.

Retrospective reports of parental physical affection and parenting style: a study of Finnish twins.

Individual differences in parenting behaviors are due, in part, to genetic factors. In the present study, the authors sought to determine whether the degree of genetic influence varied according to the type of parental behavior under consideration. A population-based sample of 2,334 pairs of Finnish twins provided ratings on the physical affection, control, abusiveness, and indifference shown by their father and mother during childhood. Genetic influences, shared environmental influences, and nonshared environmental influences accounted for a small-to-medium proportion (17%-30%), a small-to-large proportion (22%-44%), and a medium-to-large proportion (37%-55%) of the variance in each parenting measure, respectively. There were no significant differences in effect sizes for mothers and fathers or across the 4 types of parental behavior. The genetic results may reflect characteristic styles with which parents respond to genetically influenced behaviors of individuals (gene-environment correlations) or individual perceptions of this relationship (gene-person correlation processes). The findings have implications for intervention and prevention work with families and for interpretation of evidence for interactions between genes and parenting behaviors.

The effects of farm size and organic farming on diversity of birds, pollinators, and plants in a Swedish landscape.

This study compares diversity and abundance of birds plus abundance of butterflies, bumblebees and herbaceous plants between six small farms (<52 ha arable land) and six large farms (>135 ha arable land) in Roslagen in southeastern Sweden. Two of the large and four of the small farms were organic. Large-scale landscape mosaic and underlying bedrock were similar for all farms. Statistical analysis was performed using box-plots on medians and analysis of variance on mean values. More than twice as many bird species and territories, butterflies, and herbaceous plant species, and five times more bumblebees were found on the small compared to the large farms. The largest differences were found between small organic and large conventional farms. Differences were also noted between small and large organic farms: 56% more bird species were found on small organic than on large organic farms, although none of the farms used any pesticides. We therefore argue that the consideration of organic agriculture's effect on biodiversity should include factors affected by farm size.