Effects of exercise on fitness in adults with intellectual disability: a protocol of an overview of systematic reviews.

INTRODUCTION: Adults with intellectual disability (ID) have lower physical fitness levels than their peers without disabilities, representing a risk to their health since physical activity and cardiorespiratory fitness are directly related to better health and quality of life. Therefore, it is essential to determine the effects that exercise can have on them, as adults with ID present high comorbidities and lower life expectancy, altogether with lower rates of physical activity. The current overview of systematic reviews aims to provide an outline of the exercise benefits in health-related and skill-related fitness in adults with ID. METHODS AND ANALYSIS: Research will be conducted in PubMed, CENTRAL, EMBASE, PEDro, SPORTDiscus and CINAHL. The search terms will be categorised through population (eg, adult, ID); intervention (eg, exercise, physical activity) and outcomes (eg, cardiorespiratory fitness, body composition, muscular strength, muscular endurance, flexibility, balance, power, speed, agility, coordination, mobility and reaction time). Each database will be searched from their earliest available record up to 30 September 2021.Inclusion criteria will be: systematic reviews including at least one RCT that compare exercise interventions with a control group or another type of intervention; measure of fitness using objectives methods; inclusion of adults with ID (≥18 years old), and published in any language, with at least their abstract in English, Spanish, French and/or Portuguese. ETHICS AND DISSEMINATION: To our knowledge, our overview will be the first of its kind to address the topic in people with ID. The results could be used to determine which fitness components can be improved by exercise and to provide a valuable tool to develop comprehensive exercise programmes specific to people with ID. Ethical approval is not required. The knowledge generated will be disseminated electronically and in print and presented at conferences. PROSPERO REGISTRATION NUMBER: CRD42021237580.

Recommendations for prevention of infection in systemic autoimmune rheumatic diseases.

OBJECTIVES: To develop recommendations for the prevention of infection in adult patients with systemic autoimmune rheumatic diseases (SARD). METHODS: Clinical research questions relevant to the objective of the document were identified by a panel of experts selected based on their experience in the field. Systematic reviews of the available evidence were conducted, and evidence was graded according to the Scottish Intercollegiate Guidelines Network criteria. Specific recommendations were made. RESULTS: Five questions were selected, referring to prevention of infection by Pneumocystis jirovecii with trimethoprim/sulfamethoxazole, primary and secondary prophylactic measures against hepatitis B virus, vaccination against human papillomavirus, vaccination against Streptococcus pneumoniae and vaccination against influenza virus, making a total of 18 recommendations, structured by question, based on the evidence found for the different SARD and/or expert consensus. CONCLUSIONS: There is enough evidence on the safety and efficacy of vaccinations and other prophylactic measures against the microorganisms reviewed in this document to specifically recommend them for patients with SARD.

Recommendations for prevention of infection in systemic autoimmune rheumatic diseases. / Recomendaciones SER sobre prevención de infección en enfermedades reumáticas autoinmunes sistémicas.

OBJECTIVES: To develop recommendations for the prevention of infection in adult patients with systemic autoimmune rheumatic diseases (SARD). METHODS: Clinical research questions relevant to the objective of the document were identified by a panel of experts selected based on their experience in the field. Systematic reviews of the available evidence were conducted, and evidence was graded according to the Scottish Intercollegiate Guidelines Network criteria. Specific recommendations were made. RESULTS: Five questions were selected, referring to prevention of infection by Pneumocystis jirovecii with trimethoprim/sulfamethoxazole, primary and secondary prophylactic measures against hepatitis B virus, vaccination against human papillomavirus, vaccination against Streptococcus pneumoniae and vaccination against influenza virus, making a total of 18 recommendations, structured by question, based on the evidence found for the different SARD and/or expert consensus. CONCLUSIONS: There is enough evidence on the safety and efficacy of vaccinations and other prophylactic measures against the microorganisms reviewed in this document to specifically recommend them for patients with SARD.

Thromboprophylaxis in elective spinal surgery: A protocol for systematic review.

BACKGROUND: Venous thromboembolism (VTE) is a serious, sometimes life-threatening complication that can occur following spine surgery. The incidence of VTE, and the optimal type and timing of thromboprophylaxis for this complication in elective spine surgery is a matter of debate. OBJECTIVE: To perform a systematic review with the aim of clarifying the efficacy and adverse effects of mechanical and chemical prophylaxis for preventing thromboembolic complications in elective spine surgery for conditions other than trauma and malignant disease. METHODS/DESIGN: A search strategy of related articles up to March 2018 was designed and executed in Medline and Embase. PATIENTS: adolescents (>10 years) and adults undergoing elective surgery for spinal deformity or degenerative disease (from C1 to S1). INTERVENTION: Perioperative mechanical and chemical thromboprophylaxis. Studies could be randomized controlled trials or observational studies that reported data on any relevant clinical outcomes. RESULTS: In total, 2451 uniquecitations were identified and 35 studies were ultimately included in the systematic review. The overall mean incidence of complications was 3.7% for deep venous thrombosis, 0.0% for pulmonary embolism, and 3.7% for bleeding in chemoprophylaxis group; 2.9% for deep venous thrombosis, 0.4% for pulmonary embolism and 0.0% for bleeding in mechanoprophylaxis; and 0.7% for deep venous thrombosis, 0.1% for pulmonary embolism and 0.2% for bleeding in mixed prophylaxis group with no specific data on these rates for the type of patient and type and location of surgery. None of the articles retrieved provided information on the adolescent population. DISCUSSION AND CONCLUSIONS: The poor design and high variability among the studies regarding characteristics of study population, details of interventions, and definitions of outcomes, determines a low quality of the available evidence and limits the interpretation of the results. We were unable to identify a clear advantage of one type of thromboprophylaxis over the other, although there was an increased risk of bleeding with chemoprophylaxis, which could favor the use of mechanoprophylaxis in this scenario.

Eficacia de la acupuntura en las enfermedades reumáticas que afectan el raquis: revisión sistemática / Efficacy of acupuncture in rheumatic diseases with spine involvement: Systematic review

Las enfermedades reumáticas de afectación axial que cursan con dolor cervical y lumbar son muy prevalentes y conllevan un importante consumo de recursos sanitarios. La acupuntura es un procedimiento médico avalado por la Organización Mundial de la Salud con un amplio abanico de indicaciones. Nuestro objetivo fue revisar la evidencia sobre la eficacia de la acupuntura en estas enfermedades. Se realizó búsqueda sistemática: MEDLINE, CENTRAL y EMBASE (mayo de 2017): 535 citas, incluimos 4 revisiones globales (45 revisiones sistemáticas) y 3 revisiones sistemáticas (70 ensayos clínicos).La acupuntura mejora el dolor cervical y la funcionalidad de forma inmediata y a corto plazo. También es eficaz en lumbalgia aguda y crónica como primera línea terapéutica, comparada con placebo, y como coadyuvante de otros tratamientos convencionales. Es una intervención segura. Los resultados no son concluyentes en radiculopatías (cervicales y lumbares), estenosis canal lumbar y espondilitis anquilosante. Faltan estudios bien diseñados con evaluación a medio y largo plazo

Rheumatic diseases involving the spine, mainly cervical and lumbar spine, are highly prevalent, and consume considerable health resources. Acupuncture is a medical procedure endorsed by the WHO, with a wide spectrum of medical applications. The aim of this study was to review the evidence on acupuncture efficacy in these diseases. A literature search was performed in MEDLINE, CENTRAL and EMBASE (May 2017): 535 citations. We included four global reviews(45 systematic reviews) and three Systematic Reviews(70 clinical trials). Acupuncture improved cervical pain and functionality both immediately and in the short term. It also proved effective in the treatment of acute and chronic low back pain as the first therapeutic line, compared with placebo, and as an adjunct to other conventional treatments. Acupuncture is a safe intervention. However, acupuncture efficacy in radiculopathies (cervical, lumbar), lumbar spinal stenosis and ankylosing spondylitis is still inconclusive. Well-designed studies with medium and long-term evaluation are required

Efficacy of acupuncture in rheumatic diseases with spine involvement: Systematic review. / Eficacia de la acupuntura en las enfermedades reumáticas que afectan el raquis: revisión sistemática.

Rheumatic diseases involving the spine, mainly cervical and lumbar spine, are highly prevalent, and consume considerable health resources. Acupuncture is a medical procedure endorsed by the WHO, with a wide spectrum of medical applications. The aim of this study was to review the evidence on acupuncture efficacy in these diseases. A literature search was performed in MEDLINE, CENTRAL and EMBASE (May 2017): 535 citations. We included four global reviews(45 systematic reviews) and three Systematic Reviews(70 clinical trials). Acupuncture improved cervical pain and functionality both immediately and in the short term. It also proved effective in the treatment of acute and chronic low back pain as the first therapeutic line, compared with placebo, and as an adjunct to other conventional treatments. Acupuncture is a safe intervention. However, acupuncture efficacy in radiculopathies (cervical, lumbar), lumbar spinal stenosis and ankylosing spondylitis is still inconclusive. Well-designed studies with medium and long-term evaluation are required.