Objectively Measured Physical Activity in Children With Developmental Coordination Disorder: A Systematic Review and Meta-analysis.

OBJECTIVE: To conduct a systematic review and meta-analysis to understand the difference in objectively measured physical activities (PAs) between children with and without developmental coordination disorder (DCD). DATA SOURCES: A systematic literature search of 4 databases (PubMed, Science Direct, Web of Science, and Cochrane library) was conducted in July 2023. STUDY SELECTION: Studies that met the following criteria were considered classified children with DCD based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), DSM-IV-Text Revision, or DSM-V diagnosis criteria, evaluated PA using objective measurements and provided the amount of time spent in PA and/or sedentary behavior, included a control group of typically developing children, and written in English. DATA EXTRACTION: Data extracted from all included studies were: first author's surname and publication year, study design, country, total sample size, the measure of PA, the intensity of PA, categories of PA level, and main finding(s). DATA SYNTHESIS: Twelve articles met the inclusion criteria for the systematic review, 10 of which were included in the meta-analysis. The overall mean difference in moderate-to-vigorous PA (MVPA) between 2 groups was -0.17 (95% CI, -0.25 to -0.09), (I2=48.7%, P=.029). A subgroup analysis by age (ie, school-aged vs. preschool) showed a significant pooled effect size with no heterogeneity in school-aged children (ie, 6-14y) (standardized mean difference=-0.27, 95% CI, -0.38 to -0.16, I2=43.1%, P=.08). CONCLUSIONS: Children with DCD spent significantly less time participating in MVPA, particularly those aged between 6 and 14 years. These findings highlight the need for increased awareness among parents and physicians regarding insufficient participation in PA among children with DCD.

Association between self-efficacy, spiritual well-being and the willingness to provide spiritual care among nursing staff in Taiwan: a cross-sectional study.

BACKGROUND: Spiritual care plays a significant role in holistic patient care, addressing not only physical ailments but also attending to patients' emotional and spiritual well-being. While the importance of spiritual care in nursing is widely recognized, there is often a gap in understanding nurses' willingness to provide such care. This cross-sectional study aimed to explore the association between self-efficacy, spiritual well-being, and willingness to provide spiritual care among nursing staff. METHODS: The study conducted a cross-sectional survey of full-time registered nurses at a hospital in Taiwan from January 2019 to December 2019. A sample comprising 168 nurses was selected for participation in the study through a random sampling method. In addition to collecting demographic variables, the assessment tools used in the study include the General Self-Efficacy Scale (GSES) for measuring self-efficacy, the Spiritual Index of Well-Being Chinese Version (SIWB-C) for evaluating spiritual well-being, and the Spiritual Care Needs Inventory (SCNI) to gauge willingness to provide spiritual care. RESULTS: Most participants in the study were female, accounting for 98.2% (n = 165). The mean age of all 168 nurses was 37.1 ± 9.3 years. Additionally, most participants held a Bachelor's degree (79.2%, n = 133) and possessed clinical experience was 10.5 ± 9.3 years. Through logistic regression analysis, it was found that regardless of whether participants have received sufficient spiritual care training, both GSES and SIWB-C remain influential factors in determining the provision of spiritual care. CONCLUSIONS: Collaboration between healthcare management and nursing staff is essential for fostering a healthcare environment that not only appreciates the physical and spiritual dimensions of patient care but also prioritizes the enhancement of nurses ' self-efficacy and well-being.

Effects of short- and long-term exposure to atmospheric pollution on COVID-19 risk and fatality: analysis of the first epidemic wave in northern Italy.

The effects of exposure to atmospheric pollution on the incidence and mortality due to COVID-19 have been studied but not for sulfur dioxide (SO2) in most studies. However, most studies failed to consider important cofounding factors in the estimation of health effects of air pollution. The objective of the study was to assess the short- and long-term effects of air pollution on the COVID-19 risk and fatality in Lombardy and Veneto. Air pollutants were studied based on monitoring station information in Lombardy and Veneto from January 2013 to May 2020. The daily number of cases and deaths of COVID-19 were collected from the reports of the Italian Ministry of Health in Italy. A generalized linear model with the generalized estimating equation method was used to evaluate the effects of short- and long-term exposure to air pollution on the COVID-19 outbreak in Lombardy and Veneto. After adjusting for other covariates, we found that short-term exposure to PM2.5 and PM10 had a tendency to increase the incidence and mortality of COVID-19 than long-term exposure, while for other air pollutants, including SO2 and NO2, long-term exposure was more significant than short-term exposure. Both short- and long-term exposure of SO2 resulted in increased health effects on COVID-19 pandemic. Our findings suggest that exposure to atmospheric pollution has a significant impact on COVID-19 pandemic and call for further researches to deeply investigate this topic.

Association between asthma and risk of benign prostatic hyperplasia: a retrospective population-based study.

OBJECTIVE: The association between asthma and benign prostatic hyperplasia (BPH) has rarely been explored. We investigated whether male asthmatic patients had an increased risk of BPH by conducting this retrospective nationwide population-based study. METHODS: We utilized data derived from the National Health Insurance Research Database (NHIRD) in Taiwan. A total of 9778 male patients aged >40 years who were newly diagnosed with asthma between 2000 and 2006 were included in the asthma group. Male enrollees without asthma were selected as the non-asthma group from the same database. Both the groups were followed up until the end of 2013. We performed Cox proportional hazard regression analysis to estimate the risk of BPH and transurethral resection of the prostate (TURP) in the male patients with asthma compared with that in those without asthma. RESULTS: The risk of BPH and TURP in the asthma group was 1.40-fold (95% confidence interval [CI] = 1.30-1.42) and 1.30-fold (95% CI= 1.31-1.50) higher than that in the non-asthma group, respectively, after adjusting for comorbidities, relevant medications and number of annual outpatient visits. CONCLUSIONS: The male patients with asthma were found to have a higher risk of BPH than did those without asthma.

Particulate Matter Increases the Severity of Bleomycin-Induced Pulmonary Fibrosis through KC-Mediated Neutrophil Chemotaxis.

BACKGROUND: Although particular matter (PM) increases incidence and severity of idiopathic pulmonary fibrosis, the underlying mechanism remains elusive. METHODS: The effects of PM were evaluated in a murine model of bleomycin-induced pulmonary fibrosis. Mice were divided into four groups, receiving: (1) Saline (control), (2) bleomycin, (3) PM, or (4) bleomycin plus PM (Bleo+PM). Additional groups of Bleo+PM mice were treated with sivelestat (an inhibitor of neutrophil elastase) or reparixin (a C-X-C motif chemokine receptor 2 antagonist), or were genetically modified with keratinocyte chemoattractant (KC) deletion. RESULTS: Pulmonary fibrosis was not observed in the control or PM groups. Bleomycin induced pulmonary fibrosis within 14 days. The Bleo+PM group showed worse pulmonary fibrosis when compared to the bleomycin group. Analyses of immune cell profile and chemokine/cytokine concentrations at day 2-bronchoalveolar lavage fluid (BALF) revealed that the Bleo+PM group had increased neutrophil number and elastase level and KC concentration compared to the bleomycin group. Neutrophil elastase activated the Smad2/Smad3/α-SMA pathway to induce collagen deposition, while sivelestat abrogated the increased severity of pulmonary fibrosis caused by PM. Chemotaxis assay revealed that BALF of the Bleo+PM group recruited neutrophil, which was dependent on KC. Further, genetic KC deletion or pharmaceutical inhibition of KC binding to CXCR2 with reparixin ameliorated the PM-induced increased severity of pulmonary fibrosis. CONCLUSIONS: These data provide evidence that the PM-induced increased severity of pulmonary fibrosis depends on KC-mediated neutrophil chemotaxis and give additional mechanic insight that will aid in the development of therapeutic strategies.

Herbal medicine containing aristolochic acid and the risk of hepatocellular carcinoma in patients with hepatitis B virus infection.

It was suspected that aristolochic acid-induced mutations may be associated with hepatitis B virus (HBV), playing an important role in liver carcinogenesis. The purpose of this study was to investigate the association between the use of Chinese herbs containing aristolochic acid and the risk of hepatocellular carcinoma (HCC) among HBV-infected patients. We conducted a retrospective, population-based, cohort study on patients older than 18 years who had a diagnosis of HBV infection between January 1, 1997 and December 31, 2010 and had visited traditional Chinese medicine clinics before one year before the diagnosis of HCC or the censor dates. A total of 802,642 HBV-infected patients were identified by using the National Health Insurance Research Database in Taiwan. The use of Chinese herbal products containing aristolochic acid was identified between 1997 and 2003. Each patient was individually tracked from 1997 to 2013 to identify incident cases of HCC since 1999. There were 33,982 HCCs during the follow-up period of 11,643,790 person-years and the overall incidence rate was 291.8 HCCs per 100,000 person-years. The adjusted hazard ratios (HRs) were 1.13 (95% confidence interval [CI], 1.11-1.16), 1.21 (95% CI, 1.13-1.29), 1.37 (95% CI, 1.24-1.50) and 1.61 (95% CI, 1.40-1.84) for estimated aristolochic acid of 1-250, 251-500, 501-1,000 and more than 1,000 mg, respectively, relative to no aristolochic acid exposure. Our study found a significant dose-response relationship between the consumption of aristolochic acid and HCC in patients with HBV infection, suggesting that aristolochic acid which may be associated with HBV plays an important role in the pathogenesis of HCC.

Gender differences in effects of obesity and asthma on adolescent lung function: Results from a population-based study.

OBJECTIVE: To investigate lung function associated with asthma and body mass index (BMI) among adolescents at 96 northern Taiwan junior high schools participating in an asthma screening program. METHODS: The questionnaires and lung function test results measured for 3669 boys and 3523 girls were included in this study for data analysis. Measures of forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1) and FEV1/FVC ratio were compared by sex, asthma status and BMI. RESULTS: Overall mean FVC levels were similar between students with and without asthma, 3.71 L vs. 3.71 L for boys (p = 0.991) and 2.79 vs. 2.78 for girls (p = 0.517). The overall mean FEV1 levels were also similar between girls with and without asthma. Asthmatic boys had lower FEV1 than non-asthmatic boys. Mean FEV1/FVC was significantly lower in students with asthma than those without asthma. Mean FVC and FEV1 increased with BMI in both sexes. A lower mean FEV1/FVC was observed among students with asthma and high BMI, and was more pronounced in boys than in girls. Multivariable regression analysis also showed that FEV1/FVC ratios were negatively associated with asthma and high BMI, stronger in boys than in girls for asthma (ß = -2.176 (standard errors (SE) = 0.268) vs. -1.085 (SE = 0.258) and for BMI (ß = -0.309 (SE = 0.025) vs. -0.218 (SE = 0.029)). CONCLUSION: This northern Taiwan study suggests that FEV1/FVC is negatively associated with asthma and high BMI in adolescents, stronger for boys than for girls.

Fetal Growth, Obesity, and Atopic Disorders in Adolescence: a Retrospective Birth Cohort Study.

BACKGROUND: Developmental status at birth and subsequent obesity have been implicated in the development of childhood atopic dermatitis (AD) and allergic rhinitis (AR). METHODS: The current study analysed the cohort data of 74 688 junior high school students from a national retrospective birth cohort study in Taiwan. A random 10% sample was selected from singleton livebirths with complete data on the analytical variables of interest. Atopic disorders, including AD and AR, were assessed by questionnaires (International Study of Asthma and Allergies in Childhood). Logistic regression analyses were applied with adjustments for related risk factors. RESULTS: Among subjects mainly 13-15 years of age, the estimated prevalence was 7.6% for AD and 22.4% for AR. While the role of fetal growth in allergic disorders was less evident, the risk of developing AD and AR were both influenced by a combination of fetal growth status and adolescent body mass index (BMI). Compared with those with normal fetal growth and school-aged BMI, the risk of developing AD increased 64% among adolescents with both restricted fetal growth and high BMI (odds ratio 1.64, 95% confidence interval 1.37, 1.97). The risk for this combination was higher than that for either restricted fetal growth or high BMI alone. Nevertheless, the overall interaction between BMI and fetal growth status on atopic disorders did not reach statistical significance. CONCLUSIONS: Excessive weight gain could be an important risk factor related to developing atopic dermatitis and allergic rhinitis during adolescence, especially among infants born small for gestational age.

Chronic exposure to particulate matter and risk of cardiovascular mortality: cohort study from Taiwan.

BACKGROUND: Evidence on the association between long-term exposure to air pollution and cardiovascular mortality is limited in Asian populations. METHODS: We conducted a cohort study on the association between fine particulate matter (PM2.5) and cardiovascular mortality using 43,227 individuals in a civil servants health service in Taiwan. Each participant was assigned an exposure level of particulate matter based on their district of residence using air pollution data collected by the Taiwan Environmental Protection Agency and with modeling using geographic information systems. The participants were followed up from 1989 to 2008 and the vital status was ascertained from death records. Cox regression models were used to adjust for confounding factors. RESULTS: The district-level average of PM2.5 ranged from 22.8 to 32.9 µg/m(3) in the study area. After a median follow-up of 18 years, 1992 deaths from all causes including 230 cardiovascular deaths occurred. After adjustment for potential confounders, PM2.5 levels were not significantly associated with mortality from cardiovascular disease [Hazard Ratio (HR) 0.80; 95 % Confidence Interval (CI), 0.43 to 1.50 per 10 µg/m(3) increase in PM2.5] or all causes (HR 0.92; 95 % CI, 0.72 to 1.17 per 10 µg/m(3) increase in PM2.5). The results were similar when the analysis was restricted to the urban areas and when the PM2.5 measurement was changed from the period average (2000-2008) to annual average. DISCUSSION: Our findings are different from those in prior cohort studies conducted in Asia where ambient air pollutionwas associated with an increased risk of cardiovascular mortality. The high background level of air pollutionin our study area and the small number of event cases limited the power of this study. CONCLUSIONS: In this population-based cohort study in Taiwan, we found no evidence of increased risk for all-cause or cardiovascular mortality with long-term exposure to PM2.5.

Low serum zinc is associated with elevated risk of cadmium nephrotoxicity.

BACKGROUND: Despite animal evidence suggests that zinc modulates cadmium nephrotoxicity, limited human data are available. OBJECTIVE: To test the hypothesis that low serum zinc concentrations may increase the risk of cadmium-mediated renal dysfunction in humans. METHODS: Data from 1545 subjects aged 20 or older in the National Health and Nutrition Examination Survey (NHANES), 2011-2012 were analyzed. Renal function was defined as impaired when estimated glomerular filtration rate (eGFR) fell below 60 ml/min/1.73 m(2) and/or the urinary albumin-to-creatinine ratio surpassed 2.5 in men and 3.5mg/mmol in women. RESULTS: Within the study cohort, 117 subjects had reduced eGFR and 214 had elevated urinary albumin. After adjusting for potential confounders, subjects with elevated blood cadmium (>0.53 µg/L) were more likely to have a reduced eGFR (odds ratio [OR]=2.21, 95% confidence interval [CI]: 1.09-4.50) and a higher urinary albumin (OR=2.04, 95% CI: 1.13-3.69) than their low cadmium (<0.18 µg/L) peers. In addition, for any given cadmium exposure, low serum zinc is associated with elevated risk of reduced eGFR (OR=3.38, 95% CI: 1.39-8.28). A similar increase in the odds ratio was observed between declining serum zinc and albuminuria but failed to reach statistical significance. Those with lower serum zinc/blood cadmium ratios were likewise at a greater risk of renal dysfunction (p<0.01). CONCLUSIONS: This study results suggest that low serum zinc concentrations are associated with an increased risk of cadmium nephrotoxicity. Elevated cadmium exposure is global public health issue and the assessment of zinc nutritional status may be an important covariate in determining its effective renal toxicity.

Low birth weight and environmental tobacco smoke increases the risk of wheezing in adolescents: a retrospective cohort study.

BACKGROUND: Low birth weight (LBW) and environmental tobacco smoke (ETS) exposure are each associated with wheezing in children. This study was designed to examine the combined association of LBW and ETS with wheezing. METHODS: A retrospective birth cohort analysis linked with a national survey of allergic disorders among 1,018,031 junior high school students in Taiwan (1995-1996) was analyzed. The reported incidence of wheezing (yes or no) and ETS exposure (4 categories: 0, 1-20, 21-40 and greater than or equal to 41 household cigarettes per day) were obtained from validated questionnaires. Multiple logistic regression models were used to assess the associations of interest. RESULTS: There were 844,003 (83%) subjects analyzed after the exclusion criteria. LBW was associated with an increased risk of reporting ever wheezing (odds ratio [OR] = 1.08, 95% confidence interval [CI] = 1.01-1.16), current wheezing (OR = 1.09, 95% CI = 1.00-1.20) and wheezing with exercise (OR = 1.11, 95% CI = 1.02-1.21) within the smoke-free cohort. Higher ETS exposure correlated to a higher risk of wheezing (ever, current and with exercise). With ETS exposure, adolescents from the lowest birth weight cohorts were more likely to report wheezing (ever, current and with exercise). CONCLUSIONS: ETS and LBW each has been related to increasing public health risk for respiratory symptoms among adolescents. Furthermore, LBW may aggravate the risk among those exposed to ETS. LBW, ETS and associated respiratory impairments may deserve special attention as part of a comprehensive environmental health risk assessment directed toward prevention and intervention.

A nationwide population-based study of the inflammatory bowel diseases between 1998 and 2008 in Taiwan.

BACKGROUND: The incidence of the inflammatory bowel diseases (IBD), ulcerative colitis (UC) and Crohn's disease (CD), has been increasing in Asia. We probed the nationwide registered database to assess the incidence, prevalence, gender distribution, age of diagnosis and the survival status of IBD patients in Taiwan. METHODS: A retrospective study was conducted to analyze the registered database compiled by the National Health Insurance provided by the Department of Health, Taiwan, from January 1998 through December 2008. RESULTS: A total of 1591 IBD patients were registered from 1998 to 2008 in Taiwan (CD: 385; UC: 1206). The incidence of CD increased from 0.19/100,000 in 1998 to 0.24/100,000 in 2008. The incidence of UC increased from 0.61/100,000 in 1998 to 0.94/100,000 in 2008. The prevalence of CD increased from 0.19/100,000 in 1998 to 1.78/100,000 in 2008. The prevalence of UC increased from 0.61/100,000 in 1998 to 7.62/100,000 in 2008. Male to female ratio for CD was 2.22 and 1.64 for UC. Age of registered for CD was predominantly between 20 to 39, and for UC between 30 to 49 years of age. The standardized mortality ratio (95% CI) was 4.97 (3.72-6.63) for CD and 1.78 (1.46-2.17) for UC, from 1998 to 2008 in Taiwan. CONCLUSIONS: Using the Taiwan nationwide database for IBD, the incidence and prevalence of IBD in Taiwan significantly increased from 1998 to 2008. The mortality rate was higher for CD patients than UC patients, and both were higher than the general population.

Prediction of risk of ischemic heart disease in first-diagnosed systemic lupus erythematosus patients in taiwan: is air pollution exposure a risk factor?

BACKGROUND: Air pollution is a key public health factor with the capacity to induce diseases. The risk of ischemia heart disease (IHD) in those suffering from systemic lupus erythematosus (SLE) from air pollution exposure is ambiguous. This study aimed to: (1) determine the hazard ratio (HR) of IHD after the first-diagnosed SLE and (2) examine the effects of air pollution exposure on IHD in SLE for 12 years. METHODS: This is a retrospective cohort study. Taiwan's National Health Insurance Research Database and Taiwan Air Quality Monitoring data were used in the study. Cases first diagnosed with SLE in 2006 cases without IHD were recruited as the SLE group. We randomly selected an additional sex-matched non-SLE cohort, four times the size of the SLE cohort, as the control group. Air pollution indices by residence city per period were calculated as the exposure. Life tables and Cox proportional risk models of time-dependent covariance were used in the research. RESULTS: This study identified patients for the SLE group (n = 4,842) and the control group (n = 19,368) in 2006. By the end of 2018, the risk of IHD was significantly higher in the SLE group than in the control group, and risks peaked between the 6th and 9th year. The HR of incidence IHD in the SLE group was 2.42 times that of the control group. Significant correlations with risk of developing IHD were noted for sex, age, CO, NO2, PM10, and PM2.5, of which PM10 exposure had the highest risk of IHD incidence. CONCLUSIONS: Subjects with SLE were at a higher risk of IHD, especially those in the 6th to 9th year after SLE diagnosis. The advanced cardiac health examinations and health education plan should be recommended for SLE patients before the 6th year after SLE diagnosed.

Prevalence of Presbyphonia in Older Adults With Dysphonia: A Systematic Review and Meta-Analysis.

PURPOSE: This study aims to investigate the prevalence of presbyphonia among older adults who report voice complaints. METHOD: We conducted a systematic search of five medical databases to identify studies that reported on presbyphonia as the cause of voice disorders in older adults. The pooled prevalence was calculated using random-effects models and presented as percentages with 95% confidence intervals (CI). The degree of heterogeneity among studies was assessed using I2 statistics. Subgroup analyses were performed to identify the sources of heterogeneity. RESULTS: Out of 764 abstracts from five libraries, 11 studies were included in this systematic review. The pooled prevalence of presbyphonia among older adults with voice disorders is 17.78% (95% CI [12.69, 23.51]). We conducted a subgroup analysis on studies that used laryngeal visualization to confirm the diagnosis for all patients and found that the prevalence of presbyphonia was lower in studies with unrestrictive inclusion criteria (12.84%, 95% CI [8.38, 18.08]) compared to studies with restricted inclusion criteria (22.59%, 95% CI [14.49, 31.88]). CONCLUSIONS: This study suggests that voice disorders in older adults have multiple causes, not predominantly presbyphonia. Overestimation of presbyphonia prevalence occurs if certain diagnoses are excluded at recruitment. This study emphasizes the importance of recognizing the diverse underlying etiologies of dysphonia in older adults; therefore, comprehensive examination and accurate diagnosis are crucial. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.24263029.

Is acupuncture safe in the ICU? A systematic review and meta-analysis.

Background and purpose: The safety of interventions for critically ill patients is a crucial issue. In recent years, several studies have treated critically ill patients with acupuncture. However, the safety of acupuncture in this setting remains to be systematically measured. Methods: In May 2022, the electronic databases of PubMed and the Cochrane Library were searched for studies comparing acupuncture interventions to control interventions in critically ill patients. Study outcomes examined the incidence of severe adverse events (AEs), minor AEs, adverse reactions, ICU stays, and 28-day mortality. Results: A total of 31 articles were analyzed, and no serious AEs related to acupuncture treatment were identified. No significant differences were found between the groups in the meta-analysis of minor AEs (risk ratio [RR] 5.69 [0.34, 96.60], P = 0.23, I2 = 76%). A reduced risk in the incidence of adverse reactions following acupuncture intervention was evidenced (RR 0.33 [0.22, 0.50], P = 0.00001, I2 = 44%). The patients in the acupuncture arm spent significantly less time in the intensive care unit (ICU) (Mean difference -1.45 [-11.94, -10.97], P = 0.00001, I2 = 56%) and also exhibited lower 28-day mortality rates (odds ratio 0.61 [0.48, 0.78], P = 0.0001, I2 = 0%). Conclusion: There is no evidence to indicate a higher risk of severe or minor AEs in patients who receive acupuncture. Acupuncture demonstrated favorable results in both ICU stay and 28-day mortality measurements, in addition to presenting with fewer adverse reactions compared to routine ICU care. However, the low certainty of the evidence resulting from a high risk of bias in the included studies merits substantial consideration, and further research is still warranted. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=142131, identifier: CRD42020142131.

Acupuncture reduces mechanical ventilation time in critically ill patients: A systematic review and meta-analysis of randomized control trials.

BACKGROUND: Mechanical Ventilation (MV) is an essential life support machine, frequently utilized in an Intensive Care Unit (ICU). Recently, a growing number of clinical trials have investigated the effect of acupuncture treatment on MV outcomes. OBJECTIVES: This study investigated the safety and efficacy of acupuncture treatment for critically ill patients under MV. METHODS: In this systematic review and meta-analysis of randomized controlled trials, the efficacy of acupuncture related interventions was compared to routine ICU treatments, and sham/control acupuncture as control interventions applied to ICU patients undergoing MV. The databases of PubMed, Cochrane Library, and Web of Science were extensively searched in the month of April 2022. The primary outcome measurements were defined as total MV time, ICU length of stay, and mortality. The Cochrane Collaboration risk of bias tool was employed to analyze the severity of bias. The meta-analysis was conducted using Review Manager 5.3 software. The quality of evidence was evaluated according to the GRADE approach. RESULTS: A total of 10 clinical trials were included in this investigation. When comparing the performance of acupuncture-related interventions to that of the reported control interventions, the results of the meta-analysis revealed a significant reduction in the total number of MV days as well as the duration of ICU length of stay following acupuncture treatment (MD -2.06 [-3.33, -0.79] P = 0.001, I2 = 55 %, MD-1.26 [-2.00, -0.53] P = 0.0008, I2 = 77 %, respectively). A reduction in the total mortality was similarly observed (RR = 0.67 [0.47, 0.94] P = 0.02, I2 = 0 %). CONCLUSION: This systematic review and meta-analysis identified a noteworthy reduction in the total MV days, time spent in the ICU, as well as the total mortality following acupuncture related interventions. However, the small sample size, risk of bias and existing heterogeneity should be taken into consideration. The results of this study are promising and further investigations in this field are warranted.

Prevalence of Voice Disorders in Older Adults: A Systematic Review and Meta-Analysis.

PURPOSE: Voice disorders significantly impair the ability to communicate effectively and reduce the quality of life in older adults; however, its prevalence has not been well established. The aim of our research was to investigate the prevalence and associated factors of voice disorders among the older population. METHOD: Five medical databases were systematically searched for studies that reported the prevalence of voice disorders in older adults. The overall prevalence was exhibited in proportions and 95% confidence intervals (CIs) utilizing random-effects models. Heterogeneity was measured using I 2 statistics. RESULTS: Of 930 articles screened, 13 fulfilled the eligibility criteria, including 10 studies in community-based settings and three in institutionalized settings. An overall prevalence of voice disorders in older adults was estimated to be 18.79% (95% CI [16.34, 21.37], I 2 = 96%). Subgroup analysis showed a prevalence of 33.03% (95% CI [26.85, 39.51], I 2 = 35%) in institutionalized older adults, which was significantly higher than that in the community-based older adults with 15.2% (95% CI [12.65, 17.92], I 2 = 92%). Some factors that influenced the reported prevalence were identified, including types of survey, the definition of voice disorders, sampling methods, and the mean age of the population among included studies. CONCLUSIONS: The prevalence of voice disorders in the older population depends on various factors but is relatively common in older adults. The findings of this study accentuate the necessity for researchers to standardize the protocol for reporting geriatric dysphonia as well as for older adults to express their voice-related problems so that they will receive appropriate diagnosis and treatment.

Acupuncture effect on dumping syndrome in esophagus cancer patients with feeding jejunostomy: A study protocol for a single blind randomized control trial.

INTRODUCTION: Esophagus cancer patients are at risk for malnourishment. Feeding jejunostomy is used in advanced esophagus cancer patients in order to support and supplement the patients' nutrition needs. In dumping syndrome, the food is rapidly introduced into the intestine at a rate that is faster than normal, it is associated with both digestive system and vasoactive symptoms. Dumping syndrome has an association with both esophagus cancer patients and feeding jejunostomy. In the mid and long term, dumping syndrome is an important issue that contributes to the risk of malnourishment in advanced esophagus cancer patients. In recent studies, acupuncture was effective in regulating digestive symptoms. Acupuncture is considered to be a safe intervention, that was previously shown to be effective in treating digestive-related symptoms. METHODS: Sixty advanced esophageal cancer patients post-feeding jejunostomy will be divided into 2 equal groups, an intervention group (n = 30) and a control group (n = 30). Patients in the intervention group will receive acupuncture using the following acupoints: ST36 (Zusanli), ST37 (Shangjuxu), ST39 (Xiajuxu), PC6 (Neiguan), LI4 (Hegu), and Liv 3 (Taichung). Patients in the control group will receive shallow acupuncture on 12 non-acupoints (sham points), 1 cm from the above mention points. Patients and assessors will be blind to trial allocation. Both groups will receive acupuncture twice a week for 6 weeks. The main outcome measurements are: body weight, BMI, Sigstad's score, and the Arts' dumping questionnaire. DISCUSSION: There are no previous studies that have examined the use of acupuncture on patients with dumping syndrome. This single-blind randomized control trial will investigate the effect of acupuncture on dumping syndrome in advanced esophagus cancer patients with feeding jejunostomy. The results will determine if verum acupuncture can affect dumping syndrome and prevent weight loss.

Body mass index may modify asthma prevalence among low-birth-weight children.

Childhood asthma, a growing health concern, has been associated with low birth weight and elevated body mass index. This study tested the hypothesis that overweight and obese adolescents with a history of low birth weight are at even greater risk of developing asthma. A cohort of 75,871 junior high school students was screened for asthma during 1995-1996 in Taiwan. Birth weight and estimated gestational age were obtained from the birth registry. Logistic regression and simple regression analyses were adjusted for confounding variables. Asthma was more prevalent in those with birth weights below 3,000 g and higher adolescent body mass indexes. Furthermore, those with both characteristics were consistently most likely to have asthma. Whether the asthma diagnosis among low-birth-weight subjects was assigned by physicians or medical questionnaire, the risks were elevated for both overweight (physician diagnosis: odds ratio = 1.41; medical questionnaire: odds ratio = 1.25) and obese (physician diagnosis: odds ratio = 1.38; medical questionnaire: odds ratio = 1.47) boys as well as overweight (physician diagnosis: odds ratio = 1.63; medical questionnaire: odds ratio = 1.30) and obese (physician diagnosis: odds ratio = 1.44; medical questionnaire: odds ratio = 1.32) girls (P < 0.05). Low birth weight predisposes one to develop asthma, and excess body mass amplifies the risk. A sex difference was observed. This study suggests that prenatal care and nutritional counseling could reduce asthma prevalence.

Clinical characteristics and electrodiagnostic features in patients with carpal tunnel syndrome, double crush syndrome, and cervical radiculopathy.

Similar unilateral neck and upper limb symptoms are often due to various entrapment neuropathies; carpal tunnel syndrome (CTS) and cervical radiculopathy (CR) are common causes among them. Therefore, we investigated the clinical characteristics and electrodiagnostic features of patients with carpal tunnel syndrome, cervical radiculopathy, and both conditions, called double crush syndrome (DCS). The medical records and electrodiagnostic reports of 866 patients with suspected CTS and CR visited a tertiary-care hospital were retrospectively analyzed. After excluding 101 patients with confounding conditions, 151 (20%) patients were diagnosed to have sole cases of CTS; 362 (47%) patients were diagnosed to have sole cases of CR; 198 (26%) patients were diagnosed to have DCS, while 54 (7%) patients had mere symptoms. Sole cases of CR had the highest incidences of neck pain, upper back pain, wrist and hand weakness. Female patients had the highest incidences of all the diseases in their sixth decade. Male patients had comparably distinguished high occurrence of all the diseases in their fifth to sixth decades. Although comparison of nerve conduction studies between patients with mere symptoms and patients with sole cases of CTS or DCS showed statistical differences, comparison between the latter two revealed no difference. We found most patients referred for electrodiagnostic studies had cervical radiculopathy. High concomitant occurrence of CTS and CR suggests cautious evaluation of patients with upper limb symptoms is important, because the management of these conditions is quite different.