Effectiveness of Body Weight-Supported Gait Training on Gait and Balance for Motor-Incomplete Spinal Cord Injuries: A Systematic Review with Meta-Analysis.

OBJECTIVE: This review aims to analyse the effectiveness of body weight-supported gait training for improving gait and balance in patients with motor-incomplete spinal cord injuries. METHOD: Relevant articles were systematically searched in electronic databases to identify randomised controlled trials of body weight-supported gait training (either with methods of robotic, manual, and functional electrical stimulation assistance) versus conventional physical therapy or no intervention. Subjects were >16 years-old with motor-incomplete spinal cord injury (AIS C or D). Primary outcomes were gait-related parameters (functionality, endurance, and speed) and balance. Quality of life was included as a secondary outcome. Articles were selected up to 31 December 2023. RESULTS: Fifteen studies met the inclusion criteria (n = 673). Nine studies used robotic assistance, four trials performed manual assistance, one study functional electrical stimulation assistance, and one trial performed the intervention without guidance. Robot-assisted body weight-supported gait training improved walking functionality (SMD = 1.74, CI 95%: 1.09 to 2.39), walking endurance (MD = 26.59 m, CI 95% = 22.87 to 30.31), and balance (SMD = 0.63, CI 95% = 0.24 to 1.02). CONCLUSIONS: Body weight-supported gait training is not superior to conventional physiotherapy in gait and balance training in patients with motor-incomplete spinal cord injury. However, body weight-supported gait training with robotic assistance does improve walking functionality, walking endurance, and balance, but not walking speed.

Comparative effect of antihypertensive drugs in improving arterial stiffness in adults with hypertension (RIGIPREV study). A network meta-analysis.

Aims: To synthesize and evaluate the available scientific evidence on the efficacy of antihypertensive drugs on arterial stiffness in patients with hypertension by using a network meta-analysis approach. Methods: A systematic search of the MEDLINE (via PubMed), Scopus, and Web of Science databases was conducted to identify experimental studies addressing the effect of different antihypertensive drugs on arterial stiffness parameters (pulse wave velocity [PWV] and augmentation index [AIx]) in adults with hypertension. Comparative evaluation of the effect of antihypertensive drugs was performed by conducting a standard pairwise meta-analysis and a network meta-analysis for direct and indirect comparisons between antihypertensive drugs and placebo/other antihypertensive drugs. Analyses were performed including studies of any duration and only studies longer than 6 months length. Results: Seventy-six studies were included in the main analysis and considering only studies longer than 6 months length, thiazide diuretics, ACEIs, ARBs, the ACEI/ARB combination, the ACEI/CCB combination, and the ARB/CCB combination showed a higher effect on reducing PWV, and ACEIs and ARBs on reducing AIx. Conclusion: Our research provides evidence that antihypertensive medications are an effective way to treat arterial stiffness in adults with hypertension. Based on our findings, patients with hypertension who have greater levels of arterial stiffness may benefit from using thiazide diuretics, ACEIs, ARBs, the ACEI/ARB combination, the ACEI/CCB combination, and the ARB/CCB combination. Systematic Review Registration: PROSPERO (CRD42021276360).

High-Fiber Diet and Crohn's Disease: Systematic Review and Meta-Analysis.

Crohn's disease (CD) is a subtype of inflammatory bowel disease (IBD). CD is a health problem in Western countries such as the US and European nations and is an idiopathic disease; however, certain cases of CD have been associated with intestinal dysbiosis. A systematic review with a meta-analysis was carried out to determine the efficacy of a diet rich in fiber with or without cointervention to improve remission rates for CD. The literature in the PubMed, Scopus, Web of Science, and ClinicalTrials databases was reviewed. The quality of the studies was evaluated using the Johanna Briggs Institute (JBI) scale. This review was conducted in accordance with the structure outlined in the PRISMA statement. In addition, a meta-analysis was performed with a 95% confidence interval (CI) and a random effects model. Eleven studies were included, totaling 2389 patients with CD. Applying a diet rich in fiber with or without the administration of routine therapies improved CD remission rates. Data regarding CD activity, remission time, and adverse effects derived from fiber consumption were analyzed. Consumption of fiber in the diet could improve remission rates for CD patients who receive or do not receive other treatment to maintain remission.

Effects of Resistance Exercise on Neuroprotective Factors in Middle and Late Life: A Systematic Review and Meta-Analysis.

Neuroprotective factors are involved in brain functioning. Although physical exercise has been shown to have a positive influence on these factors, the effect of resistance exercise on them is not well known. This systematic review and meta-analysis aimed to 1) estimate the efficacy of resistance exercise on major neuroprotective factors, such as insulin-like growth factor-1 (IGF-1), brain-derived neurotrophic factor (BDNF), and vascular endothelial growth factor (VEGF), in middle and late life and 2) determine whether the effect is dose dependent. A systematic search was conducted in CINAHL, Cochrane CENTRAL, MEDLINE, Scopus, PEDro, SPORTDiscus, and Web of Science up to November 2022. Random effects models were used to estimate standardized mean differences (SMDs) and their respective 95% confidence intervals (CI) for the effect of resistance exercise on peripheral IGF-1, BDNF or VEGF levels in older adults. Thirty randomized clinical trials with 1247 subjects (53.25% women, 45-92 years) were included in the systematic review, and 27 were selected for the meta-analysis. A significant effect of resistance exercise on IGF-1 levels was observed (SMD: 0.48; 95% CI: 0.27, 0.69), being more effective when performing 3 sessions/week (SMD: 0.55; 95% CI: 0.31, 0.79) but not on BDNF (SMD: 0.33; 95% CI: -0.29, 0.94). The effect on VEGF could not be determined due to the scarcity of studies. Our data support the resistance training recommendation in middle and late life, at a frequency of at least 3 sessions/week, to mitigate the neurological and cognitive consequences associated with aging, mainly through IGF-1.

Dating violence, violence in social networks, anxiety and depression in nursing degree students: A cross-sectional study.

AIM: To determine the prevalence and risk factors for dating violence and the correlations between dating violence and violence in social networks, anxiety and depression among nursing students. DESIGN: A cross-sectional and correlational study. METHODS: This study was conducted with nursing degree students at Spanish university during May 2021. A total of 248 nursing students completed an online survey. The online survey included sociodemographic variables, the Conflict in Adolescent Dating Relationships Inventory, the Social Network Violence Scale and the Hospital Anxiety and Depression Scale. Chi-squared test, Pearson's correlation and logistic regression were used. RESULTS: Of the participants, 13.3% were men and 86.7% were women. A total of 53.2% had experienced and/or perpetrated dating violence. About violence in social networks, 22.2% of the participants had perpetrated it, and 20.2% had been victims of it. Strong correlations were found between experiencing and perpetrating dating violence. Significant associated factors were cohabitation with a partner, alcohol consumption, socioeconomic status and history of dating violence. CONCLUSIONS: Dating violence is a serious problem given its high prevalence among the surveyed nursing students, who, as future health professionals, must know how to recognize and react to possible cases of abuse. IMPACT: The study results add to international literature that men and women university nursing students are equally susceptible to intimate partner violence and report similar prevalence of dating violence. Also, dating violence is correlated with increased levels of anxiety and depression. It seems to be necessary to implement training programmes that help minimize the problem and identify possible cases.

"Fat but Fit" Paradox and Cardiometabolic Risk in Children: The Role of Physical Activity.

Background: The "fat but fit" paradigm suggests that high fitness levels counteract the negative consequences of obesity on cardiometabolic risk, nevertheless, this paradigm has been less studied in children. Objectives: To analyze the relationship between "fat but fit" categories and cardiometabolic risk factors in school children, and to examine whether the intensity of physical activity (PA) is related with the fat but fit (FF) category in which the child is classified. Methods: We analyzed the baseline measurements of 312 school children aged 9-11 years involved in the clinical trial MOVI-daFit!, including adiposity parameters (BMI, waist circumference, and body fat mass percentage), cardiorespiratory fitness (CRF), blood pressure parameters, PA, and biochemical parameters (blood lipid profile, insulin, C-reactive protein, and glycosylated hemoglobin). Results: The cluster analysis of body fat mass percentage and VO2 max estimate z-scores agreed with the four categories of the "fat but fit" paradigm: fat unfit (FU), unfat unfit (UU), FF, and unfat fit (UF). Analysis of variance (ANOVA) models indicated that children in the FF and UF clusters had better levels of biochemical parameters [high-density lipoprotein cholesterol (HDL-c), triglycerides (TG), TG/HDL-c, insulin], vigorous PA amount and metabolic syndrome (MetS) index than their peers in the FU and UU cluster categories (p < 0.05). Conclusions: Our results reinforce the "fat but fit" paradigm proving that CRF levels can counteract the effect of obesity on some cardiometabolic risk factors (HDL-c, TG, TG/HDL-c, insulin, PA, and MetS) in school children. ClinicalTrials.gov Identifier: NCT03236337.

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.

Longitudinal Study of the Mental Health, Resilience, and Post-Traumatic Stress of Senior Nursing Students to Nursing Graduates during the COVID-19 Pandemic.

This study analyzed changes in the psychological health of students who were in the final year of their nursing degree during the COVID-19 pandemic and later served as nursing professionals in hospitals. Methods: A prospective longitudinal study was conducted over two periods of time (the first in April 2020 and the second 6 months later, in December 2020) with 296 students for a T0 baseline (rate response 68.83%) and 92 students for a T1 post-test sample (response rate 31.08%). The data were electronically collected using the Hospital Anxiety and Depression Scale, the Life Satisfaction Questionnaire, the Resilience Scale, and a post-traumatic stress questionnaire. The mean age of the sample participants was 24.17 years (SD = 5.51), and 89.11% were female. During the pandemic, 14.11% of students showed scores that indicated depression, and 32.61% showed scores that indicated anxiety. In December 2020, 86.5% of the participants were working as nurses, and the percentages of those with anxiety (12%) and depression (4.3%) were significantly lower than in the first sample period. A total of 20.7% of the participants had post-traumatic stress. High scores for resilience were significantly associated with better quality of life and lower levels of anxiety, depression, and post-traumatic stress. Conclusions: Although the percentages of participants with anxiety and depression decreased, they still presented with mental health problems.

The role of protein intake in the relationship between egg consumption and body composition in young adults. A mediation analysis.

BACKGROUND & AIMS: To date, the literature examining the effects of whole-egg consumption on health outcomes focuses primarily on cardiovascular health markers; however, a significant gap exists in the literature about how egg consumption may influence body composition indicators. The aim of this study was to estimate the association between egg consumption and body composition indicators and to examine whether this relationship is mediated by protein intake in young adults. METHODS: A cross-sectional study was conducted involving 355 first-year university students (aged 18-30 years) from a Spanish public university. Body composition was measured using bioimpedance and dual-energy X-ray absorptiometry (DXA) and fitness components were determined using the course-navette test. Egg consumption and protein intake (both in g/day/kg of body weight) were determined using a 137-item Food-Frequency Questionnaire. ANCOVA models were used to test the mean differences in body composition indicators (body mass index [BMI], ratio waist circumference/height [WC/height], body fat mass percentage, and body lean mass percentage) by egg consumption categories (<1 egg/week, 1-4 eggs/week, ≥5 eggs/week). Hayes's PROCESS macro was used for mediation analyses. RESULTS: Participants reporting high egg consumption (≥5 eggs/week) showed significantly lower BMI, WC/height and body fat mass percentage values and higher body lean mass percentage values than those reporting low egg consumption (<1 egg/week) (p < 0.05). However, these relationships were not maintained after adjusting for protein intake. Protein intake acted as a full mediator of the relationships of egg consumption with BMI (indirect effect [IE] = -1.19; 95% CI [-3.33; -0.36]), WC/height (IE = -0.01; 95% CI [-0.04; -0.01]) and body lean mass percentage (IE = 2.99; 95% CI [1.26; 5.73]) as a partial mediator of the relationship be-tween egg consumption and body fat mass percentage (IE = -2.19; 95% CI [-4.92; -0.46]). CONCLUSIONS: The association between egg consumption and body composition is mediated by protein intake. This finding is important from a public health perspective, suggesting that higher egg consumption (≥5 eggs/week) may lead to a healthier body composition, especially due to higher protein intake.

Best Exercise Options for Reducing Pain and Disability in Adults With Chronic Low Back Pain: Pilates, Strength, Core-Based, and Mind-Body. A Network Meta-analysis.

OBJECTIVE: To determine which type of exercise is best for reducing pain and disability in adults with chronic low back pain (LBP). DESIGN: Systematic review with a network meta-analysis (NMA) of randomized controlled trials (RCTs). LITERATURE SEARCH: Six electronic databases were systematically searched from inception to July 2021. STUDY SELECTION CRITERIA: RCTs testing the effects of exercise on reducing self-perceived pain or disability in adults (aged 18-65 years) with chronic LBP. DATA SYNTHESIS: We followed the PRISMA-NMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses, incorporating NMAs of health care interventions) statement when reporting our NMA. A frequentist NMA was conducted. The probability of each intervention being the most effective was conducted according to surface under the cumulative ranking curve (SUCRA) values. RESULTS: We included 118 trials (9710 participants). There were 28 head-to-head comparisons, 7 indirect comparisons for pain, and 8 indirect comparisons for disability. Compared with control, all types of physical exercises were effective for improving pain and disability, except for stretching exercises (for reducing pain) and the McKenzie method (for reducing disability). The most effective interventions for reducing pain were Pilates, mind-body, and core-based exercises. The most effective interventions for reducing disability were Pilates, strength, and core-based exercises. On SUCRA analysis, Pilates had the highest likelihood for reducing pain (93%) and disability (98%). CONCLUSION: Although most exercise interventions had benefits for managing pain and disability in chronic LBP, the most beneficial programs were those that included (1) at least 1 to 2 sessions per week of Pilates or strength exercises; (2) sessions of less than 60 minutes of core-based, strength, or mind-body exercises; and (3) training programs from 3 to 9 weeks of Pilates and core-based exercises. J Orthop Sports Phys Ther 2022;52(8):505-521. Epub: 19 June 2022. doi:10.2519/jospt.2022.10671.

Impact of physical exercise in advanced-stage cancer patients: Systematic review and meta-analysis.

Health professionals predict that the number of people who will suffer and die from oncological diseases will continue to increase. It is vitally important to provide comprehensive care to these patients and prescribe physical exercise programs as adjuvant therapy. The objective of this systematic review was to determine the impact of physical exercise on advanced-stage cancer patients. A literature search was performed in eight different databases. This search focused on randomized controlled trials (RCTs) published during the last 10 years. To assess the methodological quality of the sample of 15 RCTs finally obtained, the PEDro scale was used. Aerobic and strength training methods were used. The combination of both aerobic and strength training methods was the most frequently reported. Likewise, different physical and psychological variables were recorded, from which improvements were seen in fatigue, independence, quality of life and sleep, among others. The participation in physical exercise programs by advanced-stage cancer patients has a positive impact on health. Providing these programs serves as adjuvant therapy, facilitating the comprehensive care of patients. Similarly, aerobic, strength or mixed training programs increase the muscle mass of patients and therefore reduce hypotonia, the main side effect during the advanced-stages of cancer.

Body position for preventing ventilator-associated pneumonia for critically ill patients: a systematic review and network meta-analysis.

BACKGROUND: The evidence about the best body position to prevent ventilator-associated pneumonia (VAP) is unclear. The aim of this study was to know what the best body position is to prevent VAP, shorten the length of intensive care unit (ICU) and hospital stay, and reduce mortality among patients undergoing mechanical ventilation (MV). METHODS: We performed a network meta-analysis of randomized controlled trials including intubated patients undergoing MV and admitted to an ICU. The assessed interventions were different body positions (i.e., lateral, prone, semi-recumbent) or alternative degrees of positioning in mechanically ventilated patients. RESULTS: Semi-recumbent and prone positions showed a risk reduction of VAP incidence (RR: 0.38, 95% CI: 0.25-0.52) and mortality (RR: 0.70, 95% CI: 0.50-0.91), respectively, compared to the supine position. The ranking probabilities and the surface under the cumulative ranking displayed as the first best option of treatment the semi-recumbent position to reduce the incidence of VAP (71.4%), the hospital length of stay (68.9%), and the duration of MV (67.6%); and the prone position to decrease the mortality (89.3%) and to reduce the ICU length of stay (59.3%). CONCLUSIONS: Cautiously, semi-recumbent seems to be the best position to reduce VAP incidence, hospital length of stay and the duration of MV. Prone is the most effective position to reduce the risk of mortality and the ICU length of stay, but it showed no effect on the VAP incidence. Registration PROSPERO CRD42021247547.

The role of daytime napping on salivary cortisol in children aged 0-5 years: a systematic review and meta-analysis.

Cortisol levels are implicated in emotional and cognitive development in children. However, it is not clear whether daytime napping influences cortisol levels in early childhood. This systematic review and meta-analysis aimed to synthesize the available evidence regarding the association between daytime napping and salivary cortisol in early childhood. The Medline, Embase, Web of Science, PsycINFO, and Cochrane Collaboration databases were searched for observational and experimental studies reporting data about napping behavior and salivary cortisol in children 0-5 years of age. Salivary cortisol levels were analyzed in three situations: CAR, cortisol awakening response from nap awakening; PRE-POST, before and after a daytime nap; and DIURNAL, from morning awakening to bedtime. Five studies showed a significant CAR after napping (mean difference, MD: 0.11µg/mL; 95% confidence interval, CI: 0.04, 0.18). In the PRE-POST analysis, a small decrease was observed for at-home naps (MD: -0.05 µg/mL; 95% CI: - 0.09, - 0.02) but not for at-childcare naps (MD: 0.04 µg/mL; 95% CI: - 0.01, 0.09). A similar pattern of DIURNAL salivary cortisol decrease was observed when children took a nap (MD: - 0.34 µg/mL; 95% CI: - 0.41, - 0.28) and when they did not sleep during the day (MD: - 0.28 µg/mL; 95% CI: - 0.38, - 0.19). CONCLUSIONS: Daytime napping plays a minor role in the fluctuation of salivary cortisol levels during the day. The conditions of the home or the childcare environment under which napping occurs might have a greater influence on cortisol levels than daytime napping itself in early childhood. PROSPERO Identifier: CRD42020212249. WHAT IS KNOWN: • The regulation of sleep involves circadian rhythmicity of cortisol secretion via activation of the HPA axis and a subsequent release of cortisol upon morning awakening followed by a decline throughout the day. WHAT IS NEW: • The available evidence supports the occurrence of a cortisol awakening response after a daytime nap. • A small decrease in cortisol after napping was observed when the nap occurred at home but not at childcare. • The conditions of the home or childcare environment under which the nap occurs and the activities before and after napping may have a greater influence on cortisol levels than napping itself.

Effectiveness of Fixed-Dose Combination Therapy (Polypill) Versus Exercise to Improve the Blood-Lipid Profile: A Network Meta-analysis.

BACKGROUND: Both exercise and polypills are recommended treatments to improve the blood-lipid profile. OBJECTIVE: The aim of this study was to compare head-to-head the effectiveness of polypill and exercise strategies in improving the blood-lipid profile in high-risk cardiovascular patients. METHODS: We performed an electronic search in Web of Science, EMBASE, Cochrane Database of Systematic Reviews, MEDLINE and SPORTDiscus, from inception to August 2021. Randomized controlled trials (RCTs) testing the effectiveness of exercise interventions or treatment with fixed-dose combination therapy (polypill) in improving the blood-lipid profile in adults with atherosclerotic cardiovascular disease or presenting at least one well recognized cardiovascular risk factor were included. RESULTS: A total of 131 RCTs were included: 15 and 116 studies analyzing the effects of polypills and exercise, respectively, on blood-lipid levels. Both exercise and polypill strategies were effective in reducing low-density lipoprotein cholesterol (LDL-c) and total cholesterol (TC), but only exercise interventions improved high-density lipoprotein cholesterol (HDL-c) and triglyceride levels compared with the control group. The results of the network meta-analyses showed that the polypill without antiplatelet therapy was the most effective pharmacological treatment for improving the lipid profile, while aerobic interval exercise was the most effective exercise intervention. CONCLUSIONS: Considering that both polypills and exercise are effective in reducing LDL-c and TC but only exercise improves HDL-c and triglycerides, and that exercise provides further health benefits (e.g., increases in physical fitness and decreases in adiposity), it seems reasonable to recommend exercise as the first treatment option in dyslipidemia when the patient's general condition and symptoms allow it. PROSPERO REGISTRATION NUMBER: CRD42019122794.

Effect of Exercise on Fatigue in Multiple Sclerosis: A Network Meta-analysis Comparing Different Types of Exercise.

OBJECTIVE: A network meta-analysis (NMA) of current evidence was conducted to determine if physical exercise has a positive influence on multiple sclerosis (MS) fatigue and type of exercise with the largest effect on fatigue also according to disease severity. DATA SOURCES: MEDLINE, Embase, SPORTDiscus, Physiotherapy Evidence Database, Cochrane Library, and Web of Science. The search strategy combined relevant terms related to (1) MS; (2) clinical trials; (3) exercise; and (4) fatigue from inception to February 2021. STUDY SELECTION: Randomized controlled trials concerning the effectiveness of different types of exercise on total and physical fatigue in people with MS were included. DATA EXTRACTION: The data were extracted into predesigned data extraction tables. Risk of bias was evaluated with the Cochrane Risk of Bias tool (RoB 2.0), and the Grading of Recommendations, Assessment, Development, and Evaluation tool was used to evaluate the quality of the evidence. DATA SYNTHESIS: A total of 58 studies were examined. Data were pooled using a random-effects model. A ranking of 7 and 8 different exercise interventions for physical and total fatigue scores, respectively, was achieved. The highest effects for pairwise comparisons were for combined exercise and resistance training vs control (ranging between -0.74 and -1.24). In the NMA, combined exercise (-1.51; 95% confidence interval [CI], -2.01 to -1.01) and resistance training (-1.15; 95% CI, -1.81 to -0.49) compared with the control group achieved the highest effects for physical and total fatigue, respectively. CONCLUSIONS: Exercise should be considered an effective fatigue management strategy. Among the different exercise modalities, combined exercise is the most effective exercise modality for improving both physical and total fatigue. Resistance training is also an effective exercise for total fatigue among people diagnosed with MS.