The Effectiveness and Sero-Immunity of Hepatitis B Vaccination in People Who Use Drugs: A Systematic Review and Meta-Analysis.

Hepatitis B virus (HBV) vaccination has been available for over four decades. However, a synthesis of the evidence regarding the effectiveness of this strategy on preventing hepatitis B infection in people who use drugs (PWUD) is lacking. A systematic search of the MEDLINE (via PubMed), SCOPUS, Web of Science, and Cochrane Library databases was conducted up to June 2024. Eight studies reported on the effectiveness of HBV vaccination, defined as a positive result for HBsAg or anti-Hbc in vaccinated versus non-vaccinated PWUD, with a pooled effect size of 52% (95% CI: 28.2-67.9) for HBsAg and 31.89% (95% CI: 14.8-45.5) for anti-Hbc. For sero-immunity, defined as the proportion of vaccinated PWUD with levels of anti-HBs ≥ 10 mIU/mL, we found that 66.2% (95% CI: 0.61-0.71; I2 = 94%) had protective levels of anti-HBs. The results of this meta-analysis indicate that the incidence of HBV infection is lower in vaccinated PWUD than in those who did not receive the vaccine. However, the effectiveness is lower than that observed in the general population. This highlights the need for a thorough review of the factors influencing the prevention of HBV infection in PWUD.

Comparative effect of different types of physical exercise and intensity levels on low birth weight: A systematic review and network meta-analysis.

BACKGROUND: Low birth weight (LBW) has been established as a major determinant of neonatal mortality and morbidity. However, there is no evidence of the effectiveness of different types of physical exercise (PE) at different intensities during pregnancy to prevent LBW. OBJECTIVES: To compare the effectiveness of different types of PE at different levels of intensity in pregnant women to prevent LBW. DESIGN: A systematic review and network meta-analysis was performed according to the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols for Network Meta-Analysis extension statement. DATA SOURCES AND METHODS: We searched the PubMed, Cochrane Central Register of Controlled Trials, Scopus, and Web of Science databases from inception to November 2023. We included randomized controlled trials (RCTs). A random effects method was used to calculate the pooled mean difference (MD). The effect of each intervention was calculated using a network meta-analysis with a frequentist perspective. RESULTS: Forty-three RCTs were included in the systematic review, and 38 RCTs were included in the network meta-analysis. In the general population, although no significant results, the MDs for light-moderate strength, moderate-vigorous strength, and moderate-vigorous Pilates exercises were favorable for preventing LBW. Furthermore, moderate-vigorous strength exercise was effective to prevent LBW, reporting significant MD compared to control groups in the healthy population (310.00, 95% confidence interval: 78.40, 541.60; I2 = 81.3%). CONCLUSION: Strength exercises at a moderate-vigorous intensity could be a potential strategy for the prevention of LBW in the healthy population. However, our findings should be interpreted with caution because the overall risk of bias was between "some concerns" and "high," and the overall certainty of the evidence was low. REGISTRATION: PROSPERO CRD42023401770.

Efficacy and Safety of Vamorolone in Duchenne Muscular Dystrophy: A Systematic Review.

BACKGROUND: Vamorolone has recently been approved for the management of Duchenne muscular dystrophy to replace glucocorticosteroids, which theoretically have more side effects. However, its efficacy and safety profile is unclear. OBJECTIVE: We aimed to assess the efficacy of vamorolone in Duchenne muscular dystrophy through the 6-minute walk test (6MWT), the North Star Ambulatory Assessment (NSAA), time to stand velocity (TTSTAND), time to run 10 m (TTRW), time to climb four stairs (TTCLIMB) and a safety profile. METHODS: A systematic search was conducted in MEDLINE, Scopus, Web of Science and the Cochrane Library from inception to June 2024 (PROSPERO: CRD42024558413) for studies evaluating the effect or safety profile of vamorolone in a population with Duchenne muscular dystrophy on 6MWT, NSAA and TTSTAND. TTRW, TTCLIMB and a safety profile were included. The risk of bias was assessed using the Cochrane Collaboration's risk of bias tool (RoB2) and the Quality Assessment Tool for Before-After (Pre-Post) Studies with No Control Group from the US National Institutes of Health National Heart, Lung, and Blood Institute, depending on the type of design. Results were expressed as mean differences or proportions with 95% confidence intervals (CIs), depending on the outcome. RESULTS: Six studies with a total of 145 individuals with Duchenne muscular dystrophy and a baseline age between 4.7 and 5.5 years were included in the systematic review. Overall, the most effective dose was 6 mg/kg/day. At 24 weeks, this dose showed a statistically significant effect compared with the untreated cohorts of 41.60 m (95% CI 14.30, 68.90) on the 6MWT, 3.57 points (95% CI 1.89, 5.25) on the NSAA, 0.06 events/s (95% CI 0.02, 0.10) on the TTSTAND, approximately 0.25 m/s on the TTRW and 0.04 (95% CI -0.00, 0.08) to 0.07 events/s (95% CI 0.03, 0.11) on the TTCLIMB. There was some discrepancy in the statistical significance of some studies, although the direction of the effect was usually similar. In general, the effect was maintained in the extension studies. Adverse events were less frequent than in historical cohorts treated with glucocorticoids. Finally, the risk of bias in the included studies was low. CONCLUSIONS: According to our results, vamorolone offers a statistically and clinically significant benefit in the management of Duchenne muscular dystrophy, with fewer side effects than glucocorticoids. However, the number of studies limits the interpretability and generalisability of these data, requiring more studies with more participants to perform a meta-analysis.

Interpregnancy weight change and neonatal and infant outcomes: A systematic review and meta-analysis.

PURPOSE: To synthesize evidence regarding the association between interpregnancy weight change (IPWC) in consecutive pregnancies and neonatal or infant outcomes in the subsequent pregnancy. METHODS: Search strategy was implemented in MEDLINE, EMBASE, Web of Science, Scopus and Cochrane Library from their inception to 13 November 2023. The most adjusted odds ratio (OR) or risk ratio estimates provided by original studies were used to calculate pooled risk ratios and their corresponding 95 % confidence intervals (CI) with the DerSimonian and Laird random effects method. Publication bias was assessed by funnel plots and Egger's method, and risk of bias was assessed with The NewcastleOttawa Quality Assessment Scale. RESULTS: Thirty-seven observational studies were included. Interpregnancy weight loss or gain were associated with large for gestational age (OR: 0.89; 95 % CI: 0.84-0.94; I2 = 83.6 % and OR: 1.33; 95 % CI:1.26-1.40; I2 = 98.9 %), and stillbirth risk (OR: 1.10; 95 % CI: 1.01-1.18; I2 = 0.0 % and OR: 1.21; 95 % CI: 1.09-1.33; I2 = 60.2 %,). CONCLUSIONS: Findings highlight the importance of managing weight between interpregnancy periods, although these findings should be interpreted cautiously because of the possible influence of social determinants of health and other factors.

Prevalence of Musculoskeletal and Metabolic Disorders in Kidney Transplant Recipients: A Systematic Review and Meta-Analysis.

Introduction: Musculoskeletal disorders could be associated with metabolic disorders that are common after kidney transplantation, which could reduce the quality of life of patients. The aim of this study was to assess the prevalence of both musculoskeletal and metabolic disorders in kidney transplant patients. Methods: MEDLINE, CINAHL, Cochrane Library, EMBASE and Web of Science were searched from their inception up to June 2023. DerSimonian and Laird random-effects method was used to calculate pooled prevalence estimates and their 95% confidence intervals (CIs). Results: 21,879 kidney transplant recipients from 38 studies were analysed. The overall proportion of kidney transplant patients with musculoskeletal disorders was 27.2% (95% CI: 18.4-36.0), with low muscle strength (64.5%; 95% CI: 43.1-81.3) being the most common disorder. Otherwise, the overall proportion of kidney transplant patients with metabolic disorders was 37.6% (95% CI: 21.9-53.2), with hypovitaminosis D (81.8%; 95% CI: 67.2-90.8) being the most prevalent disorder. Conclusion: The most common musculoskeletal disorders were low muscle strength, femoral osteopenia, and low muscle mass. Hypovitaminosis D, hyperparathyroidism, and hyperuricemia were also the most common metabolic disorders. These disorders could be associated with poorer quality of life in kidney transplant recipients. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier [CRD42023449171].

Effectiveness of eHealth Interventions Promoting Physical Activity in Children and Adolescents: Systematic Review and Meta-Analysis.

BACKGROUND: eHealth interventions have been postulated as a feasible, acceptable, and possibly effective tool to promote physical activity (PA) among children and adolescents; however, a comprehensive quantitative analysis of the effects of eHealth interventions promoting PA is lacking. OBJECTIVE: This study aims to conduct a systematic review and meta-analysis on experimental studies reporting the effects of eHealth interventions aimed at promoting PA on PA parameters and sedentary behavior parameters in children and adolescents. METHODS: The CENTRAL, MEDLINE, Embase, and Web of Science databases were searched from inception to February 2022 for randomized controlled trials that analyzed the effects of eHealth interventions aimed at promoting PA on PA and sedentary parameters in children and adolescents. The Hartung-Knapp-Sidik-Jonkman random effects method was used to determine the mean differences (MDs) with their respective 95% CIs. The risk of bias was assessed using the Risk of Bias 2 (RoB2; Cochrane) tool and its extension for cluster randomized controlled trials. The certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool. RESULTS: A total of 20 trials reporting the effects of different eHealth interventions aimed at promoting PA were included. Results for each parameter were as follows: counts per minute (MD -16.11 counts, 95% CI -122.76 to 90.53; k=3; n=402; I2=69%; favoring control), steps per day (MD 593.46 steps, 95% CI -2102.27 to 3289.19; k=2; n=152; I2=0%; favoring intervention [FI]), moderate to vigorous PA (MD -1.99 min/d, 95% CI -8.95 to 4.96; k=14; n=2336; I2=86%; favoring control), light PA (MD 3.28 min/d, 95% CI -15.48 to 22.04; k=5; n=355; I2=67%; FI), screen time (MD -31.48 min/d, 95% CI -68.62 to 5.65; k=5; n=904; I2=0%; FI), and sedentary time (MD -33.12 min/d, 95% CI -57.27 to -8.97; k=8; n=819; I2=75%; FI). Our results should be interpreted cautiously because of important limitations such as the scarcity of evidence, overall risk of bias, and low to very low certainty of evidence. CONCLUSIONS: We did not find conclusive evidence regarding the impact of PA-targeted eHealth interventions on PA parameters, but the very low certainty of evidence suggests that eHealth interventions may reduce sedentary time in children and adolescents. Our results may have important scientific implications as they highlight that the rapid development of eHealth interventions to promote PA lacks robust supporting evidence. TRIAL REGISTRATION: PROSPERO CRD42020211020; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=211020.

Association of daily steps on lipid and glycaemic profiles in children: The mediator role of cardiorespiratory fitness.

AIM: To analyse, in schoolchildren, the relationship between daily steps with metabolic parameters; and to examine whether this association is mediated by cardiorespiratory-fitness (CRF). METHODS: A cross-sectional analysis of baseline data from a feasibility trial was performed in children from two primary schools in Cuenca, Spain. Daily steps were measured using the Xiaomi MI Band 3. Lipid and glycaemic profiles were analysed from blood samples. CRF was assessed using the 20-m shuttle run test. ANCOVA models were used to test the mean differences by daily steps quartiles. Mediation analyses were conducted to examine whether CRF mediates the association between daily steps and lipid and glycaemic parameters. RESULTS: A total of 159 schoolchildren (aged 9-12 years, 53% female) were included in the analysis. Schoolchildren in the highest daily steps quartiles (>10 000 steps) showed significantly lower triglycerides and insulin levels (p = 0.004 and 0.002, respectively). This association did not remain after controlling for CRF. In mediation analyses, a significant indirect effect was observed through CRF in the relationship between daily steps with triglycerides and insulin. CONCLUSION: Children who daily accumulate more than 10 000 steps have better lipid and metabolic profile, and CRF mediated their relationship in schoolchildren.

Steps per day and health-related quality of life in schoolchildren: the mediator role of cardiorespiratory fitness.

To analyse the relationship between steps per day and health-related quality of life (HRQoL) and cardiorespiratory fitness (CRF) and to examine whether the relationship between steps per day and HRQoL is mediated by CRF in schoolchildren. This was a cross-sectional study including 501 schoolchildren (aged 9-12 years, 47% girls), from Cuenca, Spain. Steps per day were measured using the Xiaomi Mi Band 3 Smart Bracelet, HRQoL was estimated by the KIDSCREEN-27 questionnaire, and CRF was assessed using the 20-m shuttle run test. Analysis of covariance and multivariate analysis of covariance models showed that children with a higher mean number of steps per day (> 9000 steps/day) had better HRQoL (global score, and physical and psychological well-being) and higher CRF levels than their peers with a lower number of steps per day (p < 0.05); however, these differences were no longer significant when controlling for sex, age, mother's education level, and CRF (p > 0.05). Linear regression models estimated that each 1000-step increment was associated with better CRF (ß = 0.350; 95% CI, 0.192 to 0.508). In addition, the relationship between steps per day and HRQoL was mediated by CRF (p < 0.05).    Conclusion: Steps per day are a good metric to estimate daily physical activity because of its positive relationship with CRF. Moreover, those children taking more than 9000 steps per day are associated with higher levels of physical and psychological well-being. Finally, a substantial part of the improvement in HRQoL achieved through the increase in physical activity (steps per day) is mediated by CRF. What is Known: • Physical activity is known to have a positive impact on health-related quality of life in children. Steps per day are commonly used as a measure of physical activity. • Cardiorespiratory fitness is a recognized indicator of overall health in youth. What is New: • Increments of steps per day were associated with better CRF, with a nonlinear association after approximately 9000 steps/day. • Schoolchildren with > 9000 steps/ day showed better HRQoL.

Parents' Perceptions of Children's and Adolescents' Use of Electronic Devices to Promote Physical Activity: Systematic Review of Qualitative Evidence.

BACKGROUND: The use of physical activity (PA) electronic devices offers a unique opportunity to engage children and adolescents in PA. For this age group (2-17 years), parents play a key role in promoting healthy lifestyles and regulating the use of electronic devices. Therefore, parents' perceptions of the use of electronic devices for PA in children and adolescents are critical for efficient intervention. OBJECTIVE: The aim of this qualitative systematic review was to improve the understanding of parents' perceptions of the use of electronic devices for PA in children and adolescents. METHODS: A systematic search of electronic databases (Medline/PubMed, SPORTDiscus, Web of Science, Scopus, OpenGrey, and Deep Blue) was conducted. Studies from inception (2010) to May 2022 were identified. Qualitative studies on the perceptions of healthy children's and adolescents' (aged 2-17 years) parents regarding PA interventions performed on electronic devices were included according to the Cochrane Qualitative and Implementation Methods Group Guidance Series and the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) statement. The Joanna Briggs Institute Qualitative Assessment and Review Instrument was used for methodological validity. RESULTS: In total, 18 studies with 410 parents, mostly mothers, were included. Parents' perceptions were grouped into 4 categories: usefulness, advantages, general perceptions (electronic devices for health promotion, preferences for real-life PA, and concerns), and acceptability (barriers and facilitators) of electronic devices for PA. Parents perceived electronic devices as useful for increasing PA, learning new skills, and increasing motivation for PA and valued those devices that promoted socialization and family and peer bonding. In terms of general perceptions, parents had positive attitudes toward PA electronic devices; however, they preferred outdoor and real-life PA, especially for preschoolers and children. Concerns, such as physical and psychological harm, addiction, conflicts, and compliance difficulties, were found. Facilitators were identified as ease of use, appropriate feedback, promotion of socialization, and motivational strategies, such as rewards, challenges, and attractiveness. Barriers, such as discomfort, price, and difficulties in using or understanding electronic devices, were also identified. For older children and adolescents, parents were more concerned about high levels of screen time and setting limits on electronic devices and therefore preferred PA electronic devices rather than traditional ones. CONCLUSIONS: Overall, the participants had positive attitudes toward electronic devices for PA and perceived them as an effective way to promote PA in children and adolescents. They also perceived several benefits of using electronic devices, such as health promotion, increased awareness and motivation, and socialization, as well as barriers, facilitators, and age differences. The results of this study could provide researchers with insights into designing more effective, age-appropriate PA electronic devices for children and adolescents and improving adherence to their use. TRIAL REGISTRATION: PROSPERO CRD42021292340; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=292340.

Intelligence quotient-genotype association in dystrophinopathies: A systematic review and meta-analysis.

AIMS: Becker muscular dystrophy (BMD) and Duchenne muscular dystrophy (DMD) are associated with intelligence quotients (IQs) lower than the normative values, and it is suggested that IQ is negatively correlated with the number of affected isoforms (i.e., Dp427, Dp140 and Dp71). Therefore, the objective of this meta-analysis was to estimate the IQ, and the IQ-genotype association according to the altered dystrophin isoforms, in the population with BMD or DMD. METHODS: A systematic search in Medline, Web of Science, Scopus and the Cochrane Library was conducted from inception to March 2023. Observational studies that determined the IQ and/or the IQ by genotype in the population with BMD or DMD were included. Meta-analyses of IQ, IQ by genotype and IQ-genotype association by comparing IQ according to the genotype were conducted. The results are shown as the mean/mean differences and 95% confidence intervals. RESULTS: Fifty-one studies were included. The IQ in BMD was 89.92 (85.84, 94.01) and in DMD was 84.61 (82.97, 86.26). Moreover, the IQ for Dp427-/Dp140+/Dp71+ and Dp427-/Dp140-/Dp71+ was 90.62 (86.72, 94.53) and 80.73 (67.49, 93.98) in BMD, while the IQ for Dp427-/Dp140+/Dp71+, Dp427-/Dp140-/Dp71+ and Dp427-/Dp140-/Dp71- was 93.05 (89.42, 96.67), 81.78 (77.23, 86.32) and 49.19 (40.47, 57.90) in DMD. Finally, in DMD, Dp427-/Dp140-/Dp71+ vs Dp427-/Dp140+/Dp71+ and Dp427-/Dp140-/Dp71- vs Dp427-/Dp140-/Dp71+ were associated with -10.73 (-14.66, -6.81) and -36.14 (-48.87, -23.41) points, respectively. CONCLUSIONS: The IQ in BMD and DMD was lower than the normative values. Moreover, in DMD, there is a synergistic association between the number of affected isoforms and IQ.

Effect of coenzyme Q10 on cardiac function and survival in heart failure: an overview of systematic reviews and meta-analyses.

Heart failure (HF) is associated with a deficiency in blood levels of coenzyme Q10 (CoQ10), and its supplementation has been proposed. The aim of this systematic review was to synthesise the available evidence on the effects of CoQ10 on cardiac function and quality of life in HF. A systematic search of Medline, Scopus, Web of Science and the Cochrane Library was conducted from inception until March 2023. Meta-analyses measuring the effect of CoQ10 on cardiac function [i.e., ejection fraction (EF), cardiac output (CO), cardiac index (CI), stroke volume (SV)], quality of life [i.e., mortality, exercise capacity, and New York Heart Association (NYHA) classification], and CoQ10 levels in HF were included. Ten meta-analyses met the inclusion criteria. CoQ10 had an effect on EF in 6 of the 9 studies, with an increase of 1.77% (0.10, 3.44) to 3.81% (1.22, 6.40), while it had an effect on CO, CI and SV in one of the two studies. Moreover, CoQ10 did not improve exercise capacity and only one study showed an effect on NYHA classification, while there was a risk ratio (RR) of 0.69 (0.50, 0.95) to 0.58 (0.35, 0.95) in favour of CoQ10 for mortality and a RR of 0.62 (0.49, 0.78) for hospitalisations. Finally, CoQ10 levels were found to increase by 1.40 µg mL-1 in all studies. CoQ10 showed a possible beneficial effect on heart function, which was associated with a reduction in mortality and hospitalisations. However, more research is needed into the conditions that may optimise CoQ10 therapy.

Comparative effectiveness of different types of exercise in reducing arterial stiffness in children and adolescents: a systematic review and network meta-analysis.

OBJECTIVE: Arterial stiffness is an early and detectable marker of vascular changes leading to atherosclerotic cardiovascular disease (ACVD). Our objective was to compare the effectiveness of different types of exercise in reducing arterial stiffness in children and adolescents. DESIGN: A systematic review and network meta-analysis (NMA) was conducted including experimental studies reporting the effects of exercise interventions on pulse wave velocity (PWV) in children and adolescents. DATA SOURCES: Cochrane Central Register of Controlled Trials, EMBASE (via Scopus), PubMed (via Medline) and Web of Science from database inception to 25 March 2022. ELIGIBILITY CRITERIA: Experimental studies reporting the effects of exercise interventions on PWV in children and adolescents. RESULTS: Fourteen studies were included in the NMA, all of them were randomised controlled trials except one quasi-experimental study, with an overall risk of bias of some concern. Regarding PWV reduction, all exercise modalities were more effective than control, with standardised mean difference ranging from -1.93 (95% CI: -2.84 to -1.02) and -1.11 (95% CI: -2.01 to -0.21) for aerobic exercise and high intensity interval training (HIIT), respectively, to -0.59 (95% CI: -1.39 to 0.22) for combined exercise. Only sensorimotor training was not superior to the control group 0.11 (95% CI: -1.10 to 1.32). CONCLUSION: Our results support that exercise interventions, especially aerobic exercise or HIIT, can improve arterial stiffness at early ages. The potential to address ACVD early and mitigate long-term consequences via exercise interventions in children and adolescents with higher arterial stiffness requires further investigation. PROSPERO REGISTRATION NUMBER: CRD42022322536.

Association between severe hypoglycaemia and risk of dementia in patients with type 2 diabetes mellitus: A systematic review and meta-analysis.

The aim of this systematic review was to analyse whether there is an association between severe hypoglycaemia and the incidence of dementia in patients with type 2 diabetes mellitus. We systematically searched the MEDLINE, Scopus, and Cochrane databases from their inception until September 2022 for observational studies on the association between hypoglycaemia and the risk of dementia. The DerSimonian and Laird method was used to compute a pooled estimate of the risk for such association. Risk ratio (RR) and its respective 95% confidence interval (95% CI). Two analyses were performed to estimate the risk of dementia: (i) any hypoglycaemia versus no hypoglycaemia and (ii) a dose-response analysis for one, two, or more than three hypoglycemic events versus no hypoglycaemia. PROSPERO registration number CRD42020219200. Seven studies were included. The pooled RR for the association of severe hypoglycaemia and risk of dementia was 1.47 (95% CI: 1.24-1.74). When the dose-response trend was analysed, the pooled RR for the risk of dementia was increased according to the hypoglycaemia events as follows: 1.29 (95% CI: 1.15-1.44) for one hypoglycemic event; 1.68 (95% CI: 1.38-2.04) for two hypoglycemic events; and 1.99 (95% CI: 1.48-2.68) for three or more hypoglycemic events. Our study demonstrates a 54% higher risk of dementia among people who suffer a hypoglycaemia event compared to nonhypoglycaemia. Considering our results and the prevalence of people suffering from diabetes mellitus, health education for both newly diagnosed and already diagnosed people could be a useful tool for glycaemic control, thus avoiding hypoglycaemic events.

Dystrophin Genotype and Risk of Neuropsychiatric Disorders in Dystrophinopathies: A Systematic Review and Meta-Analysis.

BACKGROUND: Dystrophinopathies are associated with neuropsychiatric disorders due to alterations in dystrophin/DMD expression. OBJECTIVE: The objective was to estimate the association of developmental disorders, autism spectrum disorders (ASD), attention deficit hyperactivity disorder (ADHD), depression, anxiety disorders, and obsessive-compulsive disorder with the dystrophin/DMD genotype in population with dystrophinopathies. METHODS: Systematic searches of Medline, Scopus, Web of Science, and Cochrane Library were performed from inception to September 2022. We included observational studies in the population with Becker or Duchenne muscular dystrophies (BMD, DMD) that estimated the prevalence of these disorders according to Dp140 and/or Dp71 genotype. Meta-analysis of the prevalence ratio (PR) of genotype comparisons was conducted for each disorder. RESULTS: Ten studies were included in the systematic review. In BMD, Dp140+ vs. Dp140- and Dp71+ vs. Dp71- were associated with developmental disorders with a PR of 0.11 (0.04, 0.34) and 0.22 (0.07, 0.67), respectively. In DMD, Dp140+/Dp71+ vs. Dp140- /Dp71- had a PR of 0.40 (0.28, 0.57), and Dp71+ vs. Dp71- had a PR of 0.47 (0.36, 0.63) for ADHD. However, there was no association of genotype with ASD, only a trend was observed for Dp71+ vs. Dp71-, with a PR of 0.61 (0.35, 1.06). Moreover, the data showed no association of these isoforms with emotional-related disorders. CONCLUSIONS: In BMD, Dp140 and Dp71 could be associated with developmental disorders, while ADHD might be associated with the Dp71 genotype in DMD. Further research is needed regarding Dp140 and Dp71, especially in DMD for ASD.

Protocol of the MOVI-ageing randomized controlled trial: a home-based e-Health intervention of cognitively demanding exercise for the improvement of cardiorespiratory fitness and cognitive function in older individuals.

Objective: To describe the protocol of the MOVI-ageing randomized controlled trial, a home-based eHealth intervention of cognitive-demanding exercise for older adults, in improving global cognitive function and basic cognitive functions, cardiorespiratory fitness, and muscle fitness. Methods: This randomized controlled trial will include participants identified in the social centers of Cuenca and Talavera de la Reina who agree to participate and provide informed consent. Adults aged 60-80 years of both genders retired regardless of the reason for retirement, who do not meet frailty criteria according to Fried criteria, and without cognitive impairment will be invited to participate. This study will be developed in two phases: (i) a 12-week randomized efficacy/feasibility trial and (ii) a large-scale implementation randomized trial phase with a 12-week follow-up following similar procedures. In addition, a qualitative study on barriers to and facilitators of the implementation of the physical exercise intervention using eHealth for older people will be conducted. Participants will have access to a platform including videos of cognitively demanding physical exercise. The participants will be remotely and off-line guided through the physical exercise intervention, and the research team will be able to check the degree of compliance with the program and its correct execution. The participants will receive feedback on their compliance with the routines and reinforcement messages. Implications: The implementations of the findings and their inclusion in guidelines may directly impact in older people's life, and relatives, through the prevention of morbidity and the reduction of years lost to disability. These benefits may be reflected in the reduction of economic expenditure by reducing the demand for social and health care services. Ethics: The Clinical Research Ethics Committee of the 'Virgen de la Luz' Hospital in Cuenca approved the study protocol (registration number: 2022/PI3222). In addition, this protocol was previously registered in Clinicaltrials.gov (Number: NCT05928078).

Ultrasound-guided versus traditional method for peripheral venous access: an umbrella review.

BACKGROUND: Short peripheral catheters (SPC) insertion technique has a high failure rate, one of the reasons why the ultrasound (US)-guided method has been proposed as a valid alternative to traditional technique in SPC insertion. This umbrella review aims to synthesize the available evidence comparing the US-guided method with the traditional method on SPC insertion in terms of effectiveness, safety and patient satisfaction. METHODS: An umbrella review addressing the comparison between US-guided versus traditional method for SPC insertion in which only systematic reviews of all comparative study designs were eligible was carried out. Previous systematic reviews and meta-analyses were systematically searched in MEDLINE, EMBASE, Web of Science and Cochrane Library. Methodological quality was assessed with AMSTAR-2 tool. The quality of evidence per association was assessed using the GRADE criteria and was stablished as high, moderate, low and very low. RESULTS: Twelve systematic reviews with a range of 75-1860 patients were included. Moderate certainty evidence supports the positive effect of US-guided method on first-attempt success rate and number of attempts. There is moderate certainty evidence that US-guided method does not reduce the time spent in SPC insertion. Low certainty evidence supports that US-guided method improves both overall success rates and patient satisfaction. Emergency department was the main hospital department where these findings were reported. CONCLUSIONS: The best current evidence indicates that US-guided method for SPC insertion is postulated as a valid alternative for both adult and pediatric population, especially in patients with difficult venous access and in hospital departments where optimal vascular access in the shortest time possible is critical. TRIAL REGISTRATION: PROSPERO: CRD42021290824.

Anxiety-Induced Sleep Disturbance and Associated Lifestyle Behaviors According to Sex in Argentine Adolescents.

Purpose: The aim of the current study was twofold: first, to determine the prevalence of anxiety-induced sleep disturbances among Argentine adolescents according to sex, and second, to identify the association between these sleep disturbances and lifestyle behaviors in this population. Methods: This is a cross-sectional study with data from the Global School-based Student Health Survey (GSHS) in Argentina (2018). A total of 32,393 adolescents (aged 12-17 years; 53.4% girls) were included in the final analysis. Anxiety-induced sleep disturbances were assessed with the question "During the past 12 months, how often have you been so worried about something that you could not sleep at night?" Results: The prevalence of anxiety-induced sleep disturbances was higher in girls (17.4%) than in boys (7.9%) (p < 0.001). In boys, results indicated that those who used marijuana (cannabis) (odds ratio [OR] = 1.46, 95% confidence interval [CI] 1.08-1.98), used amphetamine or methamphetamine (OR = 2.19, 95% CI 1.28-3.77), walked or biked to or from school (OR = 1.53, 95% CI 1.19-1.96), and spent 3 h or more in sedentary behaviors (OR = 1.35, 95% CI 1.05-1.74) were more likely to report anxiety-induced sleep disturbances. In girls, those who ate from a fast-food restaurant (OR = 1.24, 95% CI 1.05-1.47), consumed alcoholic beverages (OR = 1.45, 95% CI 1.19-1.75), smoked cigarettes (OR = 2.09, 95%CI 1.05-4.14), consumed any tobacco product (OR = 1.47, 95% CI 1.19-1.82), used amphetamine or methamphetamine (OR = 2.08, 95% CI 1.33-3.26), and those who spent 3 h or more in sedentary behaviors (OR = 1.32, 95% CI 1.11-1.57) were more likely to report frequent anxiety-induced sleep disturbances. Conclusion: In conclusion, considerable sex differences were observed with respect to the prevalence of anxiety-related sleep disturbances and associated lifestyle aspects.

The Safety and Efficacy of Calcitonin Gene-Related Peptide (CGRP) Monoclonal Antibodies for the Preventive Treatment of Migraine: A Protocol for Multiple-Treatment Systematic Review and Meta-Analysis.

BACKGROUND: Migraine is a common and disabling primary headache disorder, associated with many medical comorbidities, highly prevalent, with complex treatment and management. Currently, monoclonal antibodies targeting the trigeminal sensory neuropeptide, calcitonin gene-related peptide (CGRP), are available. The aim of this protocol is to provide a review comparing the effects and safety profile of different monoclonal antibodies in migraine patients. METHODS: The literature search will be performed through the MEDLINE, Embase, CENTRAL, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP), Web of Science and Scopus databases, following the PICO strategy. Real World studies and randomized clinical trials assessing the effect of monoclonal antibodies against CGRP interventions (erenumab, eptinezumab, fremanezumab and galcanezumab) on monthly migraine days (MMD), monthly headache days (MHD), headache impact test (HIT-6) and triptan days of use (TriD) will be included. In Real World studies, the DerSimonian and Laird method will be used to calculate pooled estimates of the mean change difference and in randomized clinical trials, a network meta-analysis will be performed to estimate the comparative effects of different monoclonal antibodies against CGRP. RESULTS: The findings of this study will be reported in a peer-reviewed journal. CONCLUSIONS: This study will provide evidence to health professionals on the efficacy and safety of different monoclonal antibodies against CGRP on the outcomes studied.

Intima Media Thickness and Cognitive Function Among Adults: Meta-Analysis of Observational and Longitudinal Studies.

Background Carotid structural changes measured by intima media thickness (IMT) have been related to cognitive complaints during aging. Therefore, the aims of this meta-analysis were (1) to elucidate the relationship between vascular status, measured as IMT, and cognitive domains distinguishing between global cognition, executive functions, memory and attention; and (2) to explore whether demographic (ie, age and sex), clinical (ie, body mass index and IMT baseline values), and procedure characteristics influence this association. Methods and Results We performed a systematic review of MEDLINE (via PubMed), Scopus, and Web of Science databases from their inception to June 2021. Studies meeting the following inclusion criteria were included: (1) the participants were adults; (2) the exposure was carotid IMT; (3) the outcome was cognitive function, including global cognition, executive function, memory, and attention measured using standardized tests; and (4) the study design was cross-sectional or longitudinal including unadjusted and adjusted analyses. A total of 19 cross-sectional and 15 longitudinal studies were included and demographic (age and sex), clinical (body mass index and baseline IMT values), and procedure characteristics were analyzed as potential mediator or moderators of the association. Conclusions Our data support negative associations between IMT and cognitive function in cross-sectional studies. The association between IMT and cognition lost significance in longitudinal studies and when controlling for covariates in cross-sectional studies. Finally, the strength of these associations seems not to be modified by age, sex, body mass index, and baseline IMT values. This systematic review and meta-analysis adds to the evidence supporting the use of IMT as a measure for identifying patients at risk of cognitive decline.