Developing a tool to assess the skills to perform a health technology assessment.

BACKGROUND: Health technology assessment (HTA) brings together evidence from various disciplines while using explicit methods to assess the value of health technologies. In resource-constrained settings, there is a growing demand to measure and develop specialist skills, including those for HTA, to aid the implementation of Universal Healthcare Coverage. The purpose of this study was twofold: a) to find validated tools for the assessment of the technical capacity to conduct a HTA, and if none were found, to develop a tool, and b) to describe experiences of its pilot. METHODS: First, a mapping review identified tools to assess the skills to conduct a HTA. A medical librarian conducted a comprehensive search in four databases (MEDLINE, Embase, Web of Science, ERIC). Then, incorporating results from the mapping and following an iterative process involving stakeholders and experts, we developed a HTA skills assessment tool. Finally, using an online platform to gather and analyse responses, in collaboration with our institutional partner, we piloted the tool in Ghana, and sought feedback on their experiences. RESULTS: The database search yielded 3871 records; fifteen those were selected based on a priori criteria. These records were published between 2003 and 2018, but none covered all technical skills to conduct a HTA. In the absence of an instrument meeting our needs, we developed a HTA skill assessment tool containing four sections (general information, core and soft skills, and future needs). The tool was designed to be administered to a broad range of individuals who would potentially contribute to the planning, delivery and evaluation of HTA. The tool was piloted with twenty-three individuals who completed the skills assessment and shared their initial impressions of the tool. CONCLUSIONS: To our knowledge, this is the first comprehensive tool enabling the assessment of technical skills to conduct a HTA. This tool allows teams to understand where their individual strengths and weakness lie. The tool is in the early validation phases and further testing is needed. TRIAL REGISTRATION: Not applicable.

Users' experiences with an interactive Evidence to Decision (iEtD) framework: a qualitative analysis.

BACKGROUND: Evidence to Decision (EtD) frameworks bring clarity, structure and transparency to health care decision making. The interactive Evidence to Decision (iEtD) tool, developed in the context of the DECIDE project and published by Epistemonikos, is a stand-alone online solution for producing and using EtD frameworks. Since its development, little is known about how organizations have been using the iEtD tool and what characterizes users' experiences with it. This missing information is necessary for any teams planning future developments of the iEtD tool. METHODS: This study aimed to describe users' experiences with the iEtD and identify main barriers and facilitators related to use. We contacted all users registered in the iEtD via email and invited people who identified themselves as having used the solution to a semi-structured interview. Audio recordings were transcribed, and one researcher conducted a directed content analysis of the interviews guided by a user experience framework. Two researchers checked the content independently for accuracy. RESULTS: Out of 860 people contacted, 81 people replied to our introductory email (response rate 9.4%). Twenty of these had used the tool in a real scenario and were invited to an interview. We interviewed all eight users that accepted this invitation (from six countries, four continents). 'Guideline development' was the iEtD use scenario they most commonly identified. Most participants reported an overall positive experience, without major difficulties navigating or using the different sections. They reported having used most of the EtD framework criteria. Participants reported tailoring their frameworks, for instance by adding or deleting criteria, translating to another language, or rewording headings. Several people preferred to produce a Word version rather than working online, due to the burden of completing the framework, or lack of experience with the tool. Some reported difficulties working with the exportable formats, as they needed considerable editing. CONCLUSION: A very limited number of guideline developers have used the iEtD tool published by Epistemonikos since its development. Although users' general experiences are positive, our work has identified some aspects of the tool that need improvement. Our findings could be also applied to development or improvement of other solutions for producing or using EtD frameworks.

Analysis of reporting completeness in exercise cancer trials: a systematic review.

BACKGROUND: Exercise is an effective therapeutic intervention for cancer survivors. Concerns about the completeness of reporting of exercise interventions have been raised in the literature, but without any formal analysis. This study aimed to evaluate the completeness of reporting of exercise interventions for cancer survivors in a large sample of randomized clinical trials (RCTs). METHODS: We developed a pre-defined protocol. We searched MEDLINE, EMBASE, and CENTRAL for exercise trials in oncology between 2010 and 2017. Pairs of independent researchers screened the records, extracted study characteristics, and assessed 16 items on the TIDieR checklist (i.e., the 12 items, with item 5 divided into two and item 8 divided into four). For each of these items, the percentage of interventions in the included studies that reported the item was calculated. RESULTS: We included 131 RCTs reporting 138 interventions in the analysis. Breast cancer was the most common type of cancer (69, 50%), and aerobic exercise was the most studied exercise modality (43, 30%) followed by combined aerobic and resistance training (40, 28%). Completeness of reporting ranged from 42 to 96% among the TIDieR items; none of the items was fully reported. 'Intervention length' was the most reported item across interventions (133, 96%), followed by 'rationale' (131, 95%), whereas 'provider' (58, 42%) and 'how well (planned)' (63, 46%) were the two least reported items. Half of the TIDieR items were completely reported in 50 to 70% of the interventions, and only four items were reported in more than 80% of the interventions (Items 2 and 8a to c). The seven items deemed to be core for replication (Items 3 to 9) exhibited a mean reporting of 71%, ranging from 42 to 96%. CONCLUSION: Exercise training interventions for cancer survivors are incompletely reported across RCTs published between 2010 and 2017. The reporting of information about the provider, materials, and modifications require urgent improvements. Stronger reporting will enhance usability of trial reports by both healthcare providers and survivors, and will help to reduce research waste.

The insulin-like growth factor system is modulated by exercise in breast cancer survivors: a systematic review and meta-analysis.

BACKGROUND: Insulin-like growth factors (IGF´s) play a crucial role in controlling cancer cell proliferation, differentiation and apoptosis. Exercise has been postulated as an effective intervention in improving cancer-related outcomes and survival, although its effects on IGF´s are not well understood. This meta-analysis aimed to determine the effects of exercise in modulating IGF´s system in breast cancer survivors. METHODS: Databases of PuMed, EMBASE, Cochrane Central Register of Controlled Trials, EMBASE, ClinicalTrials.gov, SPORTDiscus, LILACS and Scopus were systematically searched up to November 2014. Effect estimates were calculated through a random-effects model of meta-analysis according to the DerSimonian and Laird method. Heterogeneity was evaluated with the I (2) test. Risk of bias and methodological quality were evaluated using the PEDro score. RESULTS: Five randomized controlled trials (n = 235) were included. Most women were post-menopausal. High-quality and low risk of bias were found (mean PEDro score = 6.2 ± 1). Exercise resulted in significant improvements on IGF-I, IGF-II, IGFBP-I, IGFBP-3, Insulin and Insulin resistance (P < 0.05). Non-significant differences were found for Glucose. Aerobic exercise improved IGF-I, IGFBP-3 and Insulin. No evidence of publication bias was detected by Egger´s test (p = 0.12). CONCLUSIONS: Exercise improved IGF´s in breast cancer survivors. These findings provide novel insight regarding the molecular effects of exercise on tumoral microenvironment, apoptosis and survival in breast cancer survivors.

Vitamin B12 concentrations in pregnant Colombian women: analysis of nationwide data 2010.

BACKGROUND: Vitamin B12 deficiency is associated with many adverse health outcomes and is highly prevalent worldwide. The present study assesses the prevalence and socio-demographic factors associated with vitamin B12 deficiency in a representative sample of pregnant women in Colombia. METHOD: We used data from the cross-sectional, nationally representative survey (ENSIN, 2010). A total of 1.781, (13-49 years old) pregnant women were enrolled. Serum Vitamin B12 a concentration was determined by chemiluminescence and sociodemographic date was assessed by computer-assisted personal interview technology. Multivariate analyses using unordered multinomial logistic regression models were conducted in the main analysis. RESULTS: Vitamin B12 concentrations ranged from 45 to 1000 pg/mL (mean 299.2 pg/mL, 95% CI 290.6 to 303.7 pg/mL). A total of 18.6% of pregnant women had vitamin B12 concentrations below 200 pg/mL and 41.3% had concentrations between 200 and 300 pg/mL. Being of indigenous ethnicity, living in the east and living in a rural area showed the lowest mean values (273.2 pg/mL, 270.8 pg/mL and 290.1 pg/mL, respectively). The multivariate logistic regression shows that pregnant women belonging to the indigenous ethnic group OR 2.2, (95% CI 1.1 to 4.3), living in the pacific region (west) OR 4.4, (95% CI 2.8 to 6.9), or national territories (south) OR 2.3, (95% CI 1.4 to 3.7) were associated with a higher probability of serum vitamin B12 deficiency. CONCLUSION: The prevalence of vitamin B12 deficiency in Colombian pregnant women is substantial. Factors associated with depletion among pregnant women should be considered for future interventions in countries experiencing nutritional transition.

Effects of supervised exercise on cancer-related fatigue in breast cancer survivors: a systematic review and meta-analysis.

BACKGROUND: Cancer-related fatigue (CRF) is the most common and distressing symptom in breast cancer survivors. Approximately 40% to 80% of cancer patients undergoing active treatment suffer from CRF. Exercise improves overall quality of life and CRF; however, the specific effects of the training modalities are not well understood. METHODS: This study aimed to determine the pooled effects of supervised exercise interventions on CRF in breast cancer survivors. We searched PubMed/MEDLINE, EMBASE, Scopus, CENTRAL and CINAHL databases between December 2013 and January 2014 without language restrictions. Risk of bias and methodological quality were evaluated using the PEDro score. Pooled effects were calculated with a random-effects model according to the DerSimonian and Laird method. Heterogeneity was evaluated with the I (2) test. RESULTS: Nine high-quality studies (n = 1156) were finally included. Supervised aerobic exercise was statistically more effective than conventional care in improving CRF among breast cancer survivors (SMD = -0.51, 95%CI -0.81 to -0.21), with high statistical heterogeneity (P = 0.001; I (2) = 75%). Similar effects were found for resistance training on CRF (SMD = -0.41, 95%CI -0.76 to -0.05; P = 0.02; I(2) = 64%). Meta-regression analysis revealed that exercise volume parameters are closely related with the effect estimates on CRF. Egger's test suggested moderate evidence of publication bias (P = 0.04). CONCLUSIONS: Supervised exercise reduces CRF and must be implemented in breast cancer rehabilitation settings. High-volume exercises are safe and effective in improving CRF and overall quality of life in women with breast cancer. Further research is encouraged. TRIAL REGISTRATION: CRD42014007223.

Methods proposed for monitoring the implementation of evidence-based research: a cross-sectional study.

OBJECTIVES: Evidence-based research (EBR) is the systematic and transparent use of prior research to inform a new study so that it answers questions that matter in a valid, efficient, and accessible manner. This study surveyed experts about existing (e.g., citation analysis) and new methods for monitoring EBR and collected ideas about implementing these methods. STUDY DESIGN AND SETTING: We conducted a cross-sectional study via an online survey between November 2022 and March 2023. Participants were experts from the fields of evidence synthesis and research methodology in health research. Open-ended questions were coded by recurring themes; descriptive statistics were used for quantitative questions. RESULTS: Twenty-eight expert participants suggested that citation analysis should be supplemented with content evaluation (not just what is cited but also in which context), content expert involvement, and assessment of the quality of cited systematic reviews. They also suggested that citation analysis could be facilitated with automation tools. They emphasized that EBR monitoring should be conducted by ethics committees and funding bodies before the research starts. Challenges identified for EBR implementation monitoring were resource constraints and clarity on responsibility for EBR monitoring. CONCLUSION: Ideas proposed in this study for monitoring the implementation of EBR can be used to refine methods and define responsibility but should be further explored in terms of feasibility and acceptability. Different methods may be needed to determine if the use of EBR is improving over time.

The effect of machine learning tools for evidence synthesis on resource use and time-to-completion: protocol for a retrospective pilot study.

BACKGROUND: Machine learning (ML) tools exist that can reduce or replace human activities in repetitive or complex tasks. Yet, ML is underutilized within evidence synthesis, despite the steadily growing rate of primary study publication and the need to periodically update reviews to reflect new evidence. Underutilization may be partially explained by a paucity of evidence on how ML tools can reduce resource use and time-to-completion of reviews. METHODS: This protocol describes how we will answer two research questions using a retrospective study design: Is there a difference in resources used to produce reviews using recommended ML versus not using ML, and is there a difference in time-to-completion? We will also compare recommended ML use to non-recommended ML use that merely adds ML use to existing procedures. We will retrospectively include all reviews conducted at our institute from 1 August 2020, corresponding to the commission of the first review in our institute that used ML. CONCLUSION: The results of this study will allow us to quantitatively estimate the effect of ML adoption on resource use and time-to-completion, providing our organization and others with better information to make high-level organizational decisions about ML.

Vitamin B12 concentration and its association with sociodemographic factors in Colombian children: Findings from the 2010 National Nutrition Survey.

OBJECTIVE: Rapid changes in dietary patterns, economic development, and urbanization in low- to middle-income countries are fueling complex malnutrition states that need better characterization using population-level data. The aim of this study was to describe the key findings related to vitamin B12 status to identify the prevalence and associated sociodemographic factors in a representative sample of children in Colombia, based on the 2010 National Nutrition Survey. METHODS: We analyzed cross-sectional data from 6910 Colombian children between the ages of 5 and 12. Serum vitamin B12 concentrations were determined by chemiluminescence. Sociodemographic data was assessed by computer-assisted personal interview technology. RESULTS: Of the children assessed, 2.8% had vitamin B12 deficiency, defined as levels <200 pg/mL, and 18.1% had marginal vitamin B12 deficiency, defined as levels between 200 and 300 pg/mL. A multivariate logistic regression analysis revealed increased risks for vitamin B12 deficiency among children ages ≥9 y and for those living in the eastern, western, and southern regions of the country. No significant associations were found for ethnic groups, socioeconomic status, or urbanity levels. Being 11 y of age (odds ratio [OR], 2.16; 95% confidence interval [CI], 1.56-3.00; P = 0.0001), living in the west (Pacific) region of the country (OR, 3.92; 95% CI, 3.14-4.90; P = 0.0001), and being male (OR, 1.41; 95% CI, 1.20-1.65; P = 0.0001) were the factors most strongly associated with an increased risk for vitamin B12 deficiency. CONCLUSIONS: Compared with data from other Latin American countries, Colombian children have a lower prevalence of vitamin B12 deficiency; however the prevalence of marginal deficiency is substantial. Continued surveillance and implementation of interventions to improve dietary patterns among the high-risk groups identified should be considered.

[Not Available]. / Nivel y estado nutricional en niños y adolescentes de Bogotá, Colombia. Estudio FUPRECOL.

Objetivos: los objetivos de este estudio fueron analizar el nivel nutricional en una población de niños y adolescentes colombianos y determinar la posible relación entre el nivel nutricional y el estado nutricional según el índice de masa corporal (IMC) y la circunferencia de cintura (CC).Material y métodos: estudio transversal en 6.383 niños y adolescentes de entre 9 y 17,9 años de edad, de Bogotá, Colombia. Se aplicó de manera autodiligenciada el cuestionario Krece Plus validado en el estudio enKid como indicador del nivel nutricional con las categorías alto (test ≥ 9), medio (test 6-8) y bajo (test ≤ 5). Se tomaron medidas de peso, talla, CC, y se calculó el IMC como marcadores del estado nutricional.Resultados: de la población general, el 57,9% eran chicas (promedio de edad 12,7 ± 2,3 años). En todas las categorías del IMC, más del 50% de chicos y chicas siguen una dieta de muy baja calidad, que empeora progresivamente con el avance en edad. En ambos sexos, se observaron tendencias entre un nivel nutricional muy bajo con el desarrollo de sobrepeso. Asimismo, la obesidad abdominal por CC se relacionó con una puntuación baja en el Krece Plus en ambos sexos.Conclusiones: en escolares de Bogotá, una dieta de muy baja calidad se relacionó con alteraciones del estado nutricional (IMC y CC), especialmente entre chicas y adolescentes. Estos resultados deben alentar el desarrollo de intervenciones orientadas a mejorar los hábitos nutricionales entre los escolares colombianos.

Effects of Supervised Multimodal Exercise Interventions on Cancer-Related Fatigue: Systematic Review and Meta-Analysis of Randomized Controlled Trials.

OBJECTIVE: Cancer-related fatigue (CRF) is the most common and devastating problem in cancer patients even after successful treatment. This study aimed to determine the effects of supervised multimodal exercise interventions on cancer-related fatigue through a systematic review and meta-analysis. DESIGN: A systematic review was conducted to determine the effectiveness of multimodal exercise interventions on CRF. Databases of PubMed, CENTRAL, EMBASE, and OVID were searched between January and March 2014 to retrieve randomized controlled trials. Risk of bias was evaluated using the PEDro scale. RESULTS: Nine studies (n = 772) were included in both systematic review and meta-analysis. Multimodal interventions including aerobic exercise, resistance training, and stretching improved CRF symptoms (SMD = -0.23; 95% CI: -0.37 to -0.09; P = 0.001). These effects were also significant in patients undergoing chemotherapy (P < 0.0001). Nonsignificant differences were found for resistance training interventions (P = 0.30). Slight evidence of publication bias was observed (P = 0.04). The studies had a low risk of bias (PEDro scale mean score of 6.4 (standard deviation (SD) ± 1.0)). CONCLUSION: Supervised multimodal exercise interventions including aerobic, resistance, and stretching exercises are effective in controlling CRF. These findings suggest that these exercise protocols should be included as a crucial part of the rehabilitation programs for cancer survivors and patients during anticancer treatments.

[SOFT DRINKS CONSUMPTION AMONG PREGNANT WOMEN IN COLOMBIA: FACTORS ASSOCIATED]. / CONSUMO DE BEBIDAS CARBONATADAS ENTRE GESTANTES COLOMBIANAS: FACTORES ASOCIADOS.

OBJECTIVE: to examine the factors associated with regular consumption of soft drinks in Colombian pregnant. MATERIAL AND METHODS: a cross-sectional study was conducted of data from the 2010 National Nutrition Survey of Colombia (ENSIN 2010), in 1.865 pregnant women aged between 13 and 49 years. Soft drink consumption and associated factors (pregnancy trimester, age, ethnicity, urbanicity, academic level, SISBEN score, and geographic region) were collected by structured questionnaire. Associations were established through a multivariable regression model. RESULTS: we found the 17% of pregnant women consume at least a daily soft drink. To be between 13 to 17 years old, belonging to an ethnic groups (afro-Colombian), being in the first pregnancy trimester and to belong to Sisbén level II showed the highest daily consumption pattern (23.8%, 22.8%, 21.4% and 20.9%). Regression models show that being between 13 to 17 years old OR 1.92 (IC95% 1.04-3.55); to reside in the eastern area OR 1.85 (IC95% 1.05-3.27), or central OR 1.73 (IC95% 1.01- 2.96), and being in the first pregnancy trimester OR 1.59 (IC95% 1.01-2.52); were associated with soft drinks daily consumption. CONCLUSIONS: the women studied show a high prevalence of daily consumption of soft drinks. Comprehensive interventions involving both nutritional and educational components are required.

Objetivo: examinar los factores asociados al consumo regular de bebidas carbonatadas (BCS) en gestantes colombianas. Métodos: estudio descriptivo transversal, secundario de la información obtenida en la Encuesta Nacional de la Situación Nutricional 2010 (ENSIN 2010), en 1.865 mujeres embarazas de entre 13 y 49 años de edad. El consumo de BCS y los factores asociados (edad materna, trimestre de embarazo, nivel de Sisbén, región y área geográfica, etnia y escolaridad), se recogieron mediante una encuesta estructurada. Se establecieron asociaciones mediante la construcción de modelos de regresión y factores asociados. Resultados: el 17% de las mujeres embarazadas consumen al menos una bebida BCS diaria. Tener entre 13 y 17 años de edad, pertenecer a la etnia afrocolombiana, cursar el primer trimestre de embarazo y agruparse en el Sisbén nivel II mostraron el mayor patrón de consumo diario (23,8%, 22,8%, 21,4% y 20,9%), respectivamente. Los modelos de regresión muestran que pertenecer al grupo de 13 a 17 años OR 1,92 (IC95% 1,04-3,55), residir en la zona oriental OR 1,85 (IC95% 1,05-3,27) o central OR 1,73 (IC95% 1,01-2,96) y cursar el primer trimestre de gestación OR 1,59 (IC95% 1,01-2,52) se asociaron como factores predisponentes al consumo diario de BCS. Conclusiones: las embarazadas de Colombia presentan una alta prevalencia de consumo diario de BCS, por lo que se recomiendan intervenciones integrales en las que estén involucrados el componente nutricional y educativo.

[SOCIODEMOGRAPHIC FACTORS AND ADEQUACY OF PRENATAL CARE ASSOCIATED PERINATAL MORTALITY IN COLOMBIAN PREGNANT WOMEN]. / FACTORES SOCIODEMOGRÁFICOS Y SEGUIMIENTO PRENATAL ASOCIADOS A LA MORTALIDAD PERINATAL EN GESTANTES DE COLOMBIA.

BACKGROUND: an adequate monitoring and the compliance of the nutritional requirements are essential for fetal development and successful control of pregnancy outcomes. This study aimed to determine the association between sociodemographic factors and the pre-birth monitoring associated with perinatal mortality in pregnant women from Colombia. METHODS: this was a cross-sectional analysis from the 2010 Colombian Demographic and Health Survey and the National Nutritional Survey that included 14 754 pregnant women between 13 and 44 years old. Sociodemographic factors included: new born sex, geographic region, socioeconomic status (SISBEN), pre-birth monitoring (weight control, uterus height, blood pressure, fetal cardiac activity, biochemistry essays, urine analysis) and the supplementation of iron, calcium and folic acid, were collected by structured questionnaire. Associations were established through multivariable and binary regression models. RESULTS: sociodemographic factors such as living in high-density cities, pacific and western regions and low socioeconomic status (SISBEN I) showed a highest perinatal mortality with rates of 1.7%, 1.5%, 1.4% and 1.4%, respectively. After adjustment by new born sex, geographic region and SISBEN score, an adequate monitoring of weight control (OR = 5.12), blood pressure (OR = 5.18), biochemistry essays (OR = 2.19), supplementation of iron (OR = 2.09), calcium (OR=1.73) and folic acid (OR = 2.73) were associated as facilitators of perinatal mortality. CONCLUSIONS: perinatal mortality is determined by the sociodemographic factors and pre-birth follow-up included in this study. Government and decision makers can take these results to garbage actions aiming to improve pregnancy monitoring.

Introducción: el adecuado seguimiento clínico y el cumplimiento de los requerimientos nutricionales, son aspectos esenciales para el adecuado desarrollo fetal y la culminación exitosa del embarazo. El objetivo de este estudio fue determinar la asociación entre los factores sociodemográficos y el seguimiento prenatal asociados a la mortalidad perinatal en gestantes de Colombia. Material y métodos: estudio descriptivo y transversal secundario a la información obtenida en la Encuesta Nacional de la Situación Nutricional 2010 (ENSIN 2010) y la Encuesta Nacional de Demografía y Salud (ENDS 2010), en 14.754 mujeres gestantes de entre 13 y 44 años de edad. Los factores sociodemográficos: sexo del recién nacido, región geográfica (atlántica, oriental, central, pacífica, Bogotá, territorios nacionales), nivel socioeconómico- Sisbén (I al VI) y área geográfica (cabecera municipal, centro poblado, población dispersa), el seguimiento prenatal (control de peso, altura uterina, presión arterial, fetocardia, bioquímica sanguínea, análisis de orina) y la suplementación con hierro, calcio y ácido fólico se recogieron a través de una encuesta estructurada. Se establecieron asociaciones mediante la construcción de modelos de regresión logística binaria simple y multivariable. Resultados: de las variables sociodemográficas, residir en centros poblados, región oriental o pacífica, y pertenecer al nivel Sisbén I, son las que mostraron mayor frecuencia de muerte perinatal, con valores de 1,7%, 1,5%, 1,4% y 1,4%, respectivamente. Tras ajustar por sexo del recién nacido, área, región geográfica y puntaje de Sisbén, se encontró que un inadecuado seguimiento en el control del peso (OR 5,12), la presión arterial (OR 5,18), la bioquímica sanguínea (OR 2,19) y la suplementación con hierro (OR 2,09), calcio (OR 1,73) y ácido fólico (OR 2,73) se asociaron como factores predisponentes a la mortalidad perinatal. Conclusiones: la mortalidad perinatal cambia según los factores sociodemográficos y el seguimiento prenatal estudiados. El Estado podría usar los resultados de este estudio para fomentar intervenciones que mejoren el seguimiento prenatal durante la gestación.

[Effectiveness of physical exercise on fatigue in cancer patients during active treatment: a systematic review and meta-analysis]. / Efectividad del ejercicio físico en la fatiga de pacientes con cáncer durante el tratamiento activo: revisión sistemática y metaanálisis.

This study aimed to determine the effectiveness of physical exercise in decreasing fatigue in cancer patients during active treatment. The PubMed Central, EMBASE, and OVID databases were consulted up to April 2014 to identify randomized clinical trials that evaluated the effect of exercise on fatigue in cancer patients undergoing active treatment. Eleven studies (n = 1,407) were included. Chemotherapy was the most common form of treatment (n = 1,028). The studies showed a low risk of bias and high methodological quality. Effect estimates showed that physical exercise significantly improved fatigue (SMD = -3.0; 95%CI: -5.21; -0.80), p < 0.0001. Similar effects were found for resistance training (SMD = -4.5; 95%CI: -7.24; -1.82), p = 0.001. Significant improvements were found in breast and prostate cancer patients (p < 0.05). Exercise is a safe and effective intervention in the management fatigue in cancer patients undergoing active treatment.

[Demographic and socioeconomic differences in consumption of sugar-sweetened beverages among Colombian children and adolescents]. / DIFERENCIAS DEMOGRÁFICAS Y SOCIOECONÓMICAS ASOCIADAS AL CONSUMO DE BEBIDAS AZUCARADAS EN NIÑOS Y ADOLESCENTES COLOMBIANOS.

INTRODUCTION: Sugar-sweetened beverages (SSB) are becoming a common component in the diets among children and adolescents, and its consumption is associated with an increased risk factors for cardiovascular disease. The aim of the present study was to describe the consumption of sugar-sweetened beverages among Colombian children and adolescents and to examine whether differences by demographic and socioeconomic according to gender. METHODS: We used data from the 2010 National Nutrition Survey of Colombia (ENSIN 2010) for 10,373 children and adolescents between 5 and 17 years old. SSB intake was based on intake from regular soda and/ or concentrated drinks. Demographic factors (sex, age, ethnicity, urbanicity, area and geographic region) and socioeconomic level (social class) were collected by structured questionnaire. Associations were established through a multivariate logistic regression. All analyzes were calculated by complex samples. RESULTS: Nationwide, 23% of girls and 22.4% of boys drank SSB at least once a week. Differences by demographic factors were observed for SSB consumption. In girls, factors associated with a greater odds for SSB intake (≥ 1 time/week) were aged 14 to 17 years old [OR = 1.65 (95%CI = 1.32, 2.06)], living in the central region [OR = 2.42 (95%CI = 1.81, 3.25)] and urban area [OR = 1.77 (95%CI = 1.42, 2.20)]. In boys, the multivariate logistic regression shows that adolescents aged 14 to 17 years old [OR = 1.96 (95%CI = 1.58, 2.24)], living in the national territories (South) [OR = 2.42 (95%CI = 1.77, 3.32)] and urban area [OR = 1.79 (95%CI = 1.45, 2.20)] were associated with a higher probability of SSB consumption. Social class was not associated with SSB intake. CONCLUSIONS: SSB intake varies by certain demographic factors. Government can use findings from this study to tailor efforts to decrease SSB intake and to encourage consumption of more healthful beverages (e.g, water) among Colombian children and adolescents.

Introducción: las bebidas azucaradas (BA) se estan convirtiendo en un componente comun en las dietas de ninos y adolescentes y su consumo se relaciona con factores de riesgo de enfermedad cardiovascular. El objetivo de este estudio fue describir el consumo de BA entre ninos y adolescentes colombianos y examinar las diferencias demograficas y socioeconomicas de acuerdo al sexo. Métodos: estudio descriptivo y transversal secundario de la informacion obtenida en la Encuesta Nacional de la Situacion Nutricional 2010 (ENSIN 2010), en 10.373 ninos y adolescentes, entre 5 y 17 anos. El consumo de BA (bebidas carbonatadas y/o concentrados azucarados), los factores demograficos (sexo, edad, etnia, urbanidad, region y area geografica) y el nivel sociodemografico (puntaje de Sisben) se recogieron por encuesta estructurada. Se establecieron asociaciones mediante la construccion de modelos de regresion logistica binaria simple y multivariable. Resultados: a nivel nacional, el 23% de las ninas y el 22,4% de los ninos acusaron un consumo de al menos una vez a la semana de BA y se observan diferencias significativas por factores demograficos. En las ninas, los factores asociados a la ingesta de BA (≥ 1 vez/sem) eran las pertenecientes al grupo entre 14 y 17 anos de edad [OR = 1,65 (IC95% 1,32-2,06)], las residentes de la region central [OR = 2,42 (IC95% 1,81-3,25)] y las procedentes de las areas urbanas [OR 1,77 (IC95% 1,42-2,20)]. En los ninos, la regresion logistica multivariante muestra que los adolescentes entre 14 y 17 anos de edad [OR= 1,96 (IC 95% 1,58-2,24)], procedentes de los territorios nacionales [OR = 2,42 (IC95% 1,77-3,32)] y los residentes del area urbana [OR 1,79(IC95% 1,45-2.20)] se asociaron con una mayor probabilidad de consumo de BA. La clase social no se asocio con la ingesta de BA. Conclusiones: el consumo de BA cambia segun los factores sociodemograficos estudiados. El Estado podria usar los resultados de este estudio para fomentar la disminucion del consumo regular de BA e incentivar el consumo de bebidas saludables (como el agua) entre los ninos y adolescentes de Colombia.

[Prevalence and demographic factors associated with ferritin deficiency in Colombian children, 2010]. / Prevalencia y factores sociodemográficos asociados a la deficiencia de ferritina en niños de Colombia, 2010.

OBJECTIVES: To determine prevalence and socio-demographic factors associated with ferritin deficiency in a representative sample of children in Colombia. MATERIALS AND METHODS: Cross sectional secondary data analysis of the National Survey on the Nutritional Situation (ENSIN) conducted in 2010 in Colombia in 3542 children between 12 and 59 months. Plasma ferritin levels were determined by chemiluminescence and values <12 ug/L were considered as deficit ferritin. Sociodemographic factors (sex, age, ethnicity, socioeconomic status, and geographical region) were collected using a structured questionnaire. All analyses were performed taking into account the complex nature of the sample. RESULTS: It was found that the average value of ferritin was 32.1 g/L, (CI 95%: 30.7-35.6).10.6% (CI 95%: 9.3-12.0) of the children had ferritin levels less than 12.0 ug/L. The multivariate logistic regression shows that children aged 12 to 23 (OR 5.1, CI 95%: 3.3-8.0) and 24 to 35 months (OR 2.4, CI 95%: 1.5-3.7), belonging to the indigenous ethnic group (OR 1.8, CI 95%: 1.1-2.8), living in the Atlantic region (OR 2.0, CI 95%: 1.1 -3.6), or Pacific area (OR 2.0, CI 95%: 1.1-3.6) were associated with a higher probability of ferritin deficiencies. CONCLUSIONS: A significant prevalence of anemia caused by ferritin deficiency was found as well as various sociodemographic factors that contributed to the likelihood of increasing this problem. Comprehensive interventions are recommended in which nutritional and educational components are involved.

[Effectiveness of educational interventions conducted in latin america for the prevention of overweight and obesity in scholar children from 6-17 years old; a systematic review]. / Efectividad de las intervenciones educativas realizadas en América Latina para la prevención del sobrepeso y obesidad infantil en niños escolares de 6 a 17 años: una revisión sistemática.

INTRODUCTION: Overweight and obesity are serious public health problem, which is specially among children populations. OBJECTIVE: To determine the effectiveness of educational interventions conducted in Latino America for the prevention of overweight and obesity in scholar children from 6 to 17 years old. Metodology: MEDLINE, LILACS and EMBASE were searched between february and may 2014 to retrieve randomized controlled trials and longitudinal studies that evaluated the effects of educational interventions intended to retrieve randomized controlled trials and longitudinal studies aiming to prevent overweight and obesity among Latinoamerican children. Risk of bias was evaluated using the PEDro scale and the CASPe tool. RESULTS: Twenty one studies were included (n=12,092). Different types of educational interventions were identified, such as nutritional campaigns, physical activity practice and environmental changes. Mixed approaches combining nutritional campaigns, physical activity promotion and enviromental changes were the most effective interventions, since their results produced the largest improvements in the overweight and obesity of children. None evidence of reporting bias was observed. CONCLUSION: Educational interventions performed in the educational environment that combined an adequate nutrition and the promotion of physical activity practice, are more effective for preventing overweight and obesity in Latino American children, although familiar interventions are also encouraged approach, associated with better responses on the behavioral change in scholar children.

Introducción: El sobrepeso y la obesidad representan un serio problema de salud pública, de orden creciente en la población infantil. Objetivo: Determinar la efectividad de las intervenciones educativas realizadas en América Latina para la prevención del sobrepeso y la obesidad en niños escolares de 6 a 17 años. Metodología: Las bases de datos MEDLINE, LILACS y EMBASE fueron consultadas entre febrero y mayo de 2014 para identificar estudios controlados aleatorizados y estudios longitudinales que evaluaran los efectos de intervenciones educativas dirigidas a la prevención del sobrepeso y la obesidad en niños latinoamericanos. El riesgo de sesgo y la calidad metodológica se evaluó con la escala de PEDro y el instrumento CASPe. Resultados: Veintiún estudios fueron incluidos (n=12,092). Se identificaron diferentes tipos de intervenciones, tales como estrategias nutricionales, promoción de la práctica de actividad física y cambios en el entorno. Las intervenciones mixtas, que combinaron cambios nutricionales con la promoción de actividad física, fueron las más efectivas, pues sus resultados evidenciaron cambios positivos en las variables asociadas al sobrepeso y obesidad infantil. No se observaron evidencias de sesgo de publicación. Conclusión: Las intervenciones realizadas en el ámbito escolar que combinan la nutrición adecuada y la promoción de la práctica de actividad física son efectivas en la prevención del sobrepeso y la obesidad infantil en escolares latinoamericanos, aunque se deben incorporar intervenciones en el ambiente familiar para permitir un abordaje integral, asociado con mayores respuestas sobre el cambio comportamental de los escolares.

Anthropometric characteristics and physical performance of colombian elite male wrestlers.

BACKGROUND: Wrestling was an important part of the ancient Olympic Games and is still one of the most popular events of the modern Olympic Games. Studies indicate that general physiologic profile of successful wrestlers is high anaerobic power and capacity, muscular strength, above average aerobic power, exceptional flexibility, fat free mass, and a mesomorphic somatotype. OBJECTIVES: The objective of the present study was to evaluate anthropometric characteristics and physical performance of elite male wrestlers. PATIENTS AND METHODS: The Colombian Wrestling Team was evaluated while in preparation for the Olympic Games (n = 21; age, 27.9 ± 6.7 years). Athletes were tested on anthropometric and fitness parameters: body composition, somatotype distribution according to Heath-Carter, aerobic capacity, vertical jump, and anaerobic power. RESULTS: The evaluations showed a mean body fat percentage of 13.6% ± 3.0% (95% CI, 12.2%-15%), muscle mass of 46.4% ± 2.2% (95% CI, 45.4%-47.4%), Ponderal index of 41.0 ± 1.8 (95% CI, 40.2-41.8), body adiposity index (BAI) 25.1 ± 3.6 (95% CI, 23.5-26.8), and somatotype distribution mesomorphic-ectomorph (5.3-1.6-3.8). Mean aerobic capacity was 45.9 ± 6.6 mL/kg/min (95% CI, 42.8-48.9), vertical jump was 36.4 ± 6.6 cm (95% CI, 11.8-16.6), and anaerobic power was 92.6 ± 19.5 kg/s (95% CI, 83.7-101.5). CONCLUSIONS: These results provided a profile of elite wrestlers that could be used as training targets for developing athletes. The results may also provide information for training and tactical planning.

The impact of the FIFA 11+ training program on injury prevention in football players: a systematic review.

The FIFA 11+ is a simple, and easy to implement, sports injury prevention program comprising a warm up of 10 conditioning exercises. The aim of this systematic review was to evaluate the impact of the FIFA 11+ on injury incidence, compliance and cost effectiveness when implemented among football players. MEDLINE, EMBASE and Scopus databases were searched using the search terms "FIFA 11+", "football", "soccer", "injury prevention", and "The 11". The titles and abstracts were screened by two independent reviewers and the data were filtered by one reviewer using a standardized extraction form and thereafter checked by another one. The risk of bias and the methodological quality of the studies were evaluated through the PEDro score and Critical Appraisal Skills Programme (CASP). A total of 911 studies were identified, of which 12 met the inclusion criteria of the review. The FIFA 11+ has demonstrated how a simple exercise program completed as part of warm-up can decrease the incidence of injuries in amateur football players. In general, considerable reductions in the number of injured players, ranging between 30% and 70%, have been observed among the teams that implemented the FIFA 11+. In addition, players with high compliance to the FIFA 11+ program had an estimated risk reduction of all injuries by 35% and show significant improvements in components of neuromuscular and motor performance when participating in structured warm-up sessions at least 1.5 times/week. Most studies had high methodological quality and a low risk of bias. Given the large number of people who play football at amateur level and the detrimental impact of sports injuries on a personal and societal level, the FIFA 11+ can be considered as a fundamental tool to minimize the risks of participation in a sport with substantial health benefits.