Effectiveness Of Activity Interventions Research Articles

Effect of Virtual Reality on Balance in Individuals With Parkinson Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Virtual reality (VR) is a frequently used intervention for the rehabilitation of individuals with neurological disorders. The aims of this review were to identify the short-term effect of VR on balance and to compare it with the effect of active interventions in individuals with Parkinson disease (PD). Searches for relevant articles available in English were conducted using the MEDLINE (via PubMed), EMBASE, CENTRAL, CINAHL, PsycINFO, and Physiotherapy Evidence Database databases from inception until March 2019. All randomized controlled trials comparing the effect of training with VR and the effect of training without VR on balance in individuals with PD were included. Two authors independently extracted data, assessed the methodological quality, and evaluated the evidence quality of the studies. Fourteen randomized controlled trials including 574 individuals were eligible for qualitative analyses, and 12 of the studies involving 481 individuals were identified as being eligible for meta-analyses. Compared with active interventions, the use of VR improved the Berg Balance Scale score (mean difference=1.23; 95% CI=0.15 to 2.31; I2=56%). The Dynamic Gait Index and Functional Gait Assessment results were also significant after the sensitivity analyses (mean difference=0.69; 95% CI=0.12 to 1.26; I2=0%). Both provided moderate statistical evidence. However, the Timed "Up & Go" Test and the Activities-Specific Balance Confidence Scale did not differ significantly. Publication bias and diversity in the interventions were the main limitations. Existing moderate evidence of the effectiveness of VR with the Berg Balance Scale, Dynamic Gait Index, and Functional Gait Assessment for individuals with PD was promising. Although the differences did not reach the clinically important change threshold, VR was comparable to active interventions and could be considered an adjuvant therapy for balance rehabilitation in individuals with PD.

Physical Activity Intervention Effects on Sedentary Time in Spanish-Speaking Latinas

Latinas have high rates of sedentary behavior and related health disparities, but it is unknown if interventions to increase physical activity will also reduce sedentary time. The current study examined changes in objectively measured sedentary time among Latinas in a randomized controlled trial of a physical activity intervention. Spanish-speaking Latinas (N = 202) were randomized to an exercise or wellness group and wore an accelerometer at baseline, 6 months, and 12 months. Participants were sedentary on an average of 8.86hours per day (SD = 2.60) at baseline. The intervention group had significantly greater increases in sedentary time compared with the control group, with the intervention group engaging in 146 more minutes per week of sedentary time at 6 months and 254 minutes per week of sedentary time at 12 months than the control group (P = .02). The intervention effect on sedentary behavior remained after controlling for moderate to vigorous physical activity. Additionally, time spent in moderate to vigorous physical activity was positively associated with more sedentary time (P = .04). An intervention to increase moderate to vigorous physical activity resulted in greater sedentary time, raising concerns regarding compensation and highlighting the need for interventions to address both physical activity and sedentary behavior to improve public health.

Regional Influenza Prediction with Sampling Twitter Data and PDE Model.

The large volume of geotagged Twitter streaming data on flu epidemics provides chances for researchers to explore, model, and predict the trends of flu cases in a timely manner. However, the explosive growth of data from social media makes data sampling a natural choice. In this paper, we develop a method for influenza prediction based on the real-time tweet data from social media, and this method ensures real-time prediction and is applicable to sampling data. Specifically, we first simulate the sampling process of flu tweets, and then develop a specific partial differential equation (PDE) model to characterize and predict the aggregated flu tweet volumes. Our PDE model incorporates the effects of flu spreading, flu recovery, and active human interventions for reducing flu. Our extensive simulation results show that this PDE model can almost eliminate the data reduction effects from the sampling process: It requires lesser historical data but achieves stronger prediction results with a relative accuracy of over 90% on the 1% sampling data. Even for the more aggressive data sampling ratios such as 0.1% and 0.01% sampling, our model is still able to achieve relative accuracies of 85% and 83%, respectively. These promising results highlight the ability of our mechanistic PDE model in predicting temporal–spatial patterns of flu trends even in the scenario of small sampling Twitter data.

Randomized controlled trial of physical activity intervention effects on fatigue and depression in multiple sclerosis: Secondary analysis of data from persons with elevated symptom status

BackgroundPhysical activity interventions have yielded reductions in fatigue and depressive symptoms among persons with multiple sclerosis(MS) who have not been screened for elevated baseline symptoms scores. PurposeThis short communication describes a secondary analysis of data from a previous randomized controlled trial (RCT) and focused on physical activity intervention effects on fatigue and depression among persons with MS who had elevated baseline symptom scores. MethodOf the 76 persons who completed the RCT, 64(84%) had baseline fatigue severity scale(FSS) scores indicating elevated levels of fatigue(n = 30,intervention; n = 34,control), and 26(34%) had baseline hospital anxiety and depression scale, depression(HADS-D) scores indicating elevated depressive symptoms (n = 13,intervention; n = 13,control). The physical activity intervention was delivered over a 6-month period, and the control condition was a 6-month waitlist. The participants completed the FSS and HADS-D as part of baseline and follow-up battery of assessments. ResultsThere was a statistically significant change in FSS scores favoring the physical activity intervention, and the effect size of 0.73 was larger than reported in a previous meta-analysis of RCTs of physical activity and fatigue in MS of 0.45(95%CI=.22,.68). We observed a statistically significant change in HADS-D scores favoring the physical activity intervention, and the effect size of 1.21 was larger than reported in a previous meta-analysis of RCTs of physical activity and depression in MS of 0.36(95%CI=.18,.54). ConclusionSuch results provide preliminarily support for the application of physical activity interventions for the “treatment” of fatigue and/or depression in MS, pending subsequent confirmatory efficacy or effectiveness trials.

Long-term follow-up and objective physical activity measurements of community-based physical interventions in adults: a systematic review and meta-analysis

BackgroundPhysical inactivity is a global public health concern. Systematic reviews indicate that interventions can increase short-term physical activity levels. However, long-term health benefits require sustained physical activity increases and systematic review evidence from interventions with objective measures of physical activity beyond 12 months is lacking. This review aimed to identify and describe randomised trials in adults with objective physical activity measures and follow-up beyond 12 months and evaluate the extent to which intervention effects are sustained beyond 12 months MethodsWe searched MEDLINE, EMBASE, PsycINFO, Web of Science, Cochrane Library, CINAHL, and ASSIA between Jan 1, 2000, and April 16, 2018, restricting our search to publications in English, with a combination of the key search terms “physical activity”, “objective physical activity measures”, and “randomised controlled trial”. We included trials reporting long-term effects (≥12 months) on objective physical activity (step count and moderate-to-vigorous physical activity) with community-based participants, aged 18 years and older, without specific medical conditions. Studies in which control participants received physical activity interventions were excluded. Two independent reviewers completed data extraction. We did meta-analyses using random effects models and at different follow-up points. Outcomes were daily step counts and weekly minutes of moderate-to-vigorous activity. This study was registered with PROSPERO, CRD42017075753. FindingsOf the 17 233 unique records identified by our search, we included nine studies in the review and five in the meta-analyses. Interventions included individual walking programmes, group-based sessions, and a school volunteering programme. Follow-up ranged from 12 months to 4 years. The age range of participants was 18–89 years. We observed physical activity increases at 12 months for intervention group participants versus control participants in steps per day (mean difference 554 steps, 95% CI 384–724, p<0·0001; 2446 participants in four studies) and weekly minutes of moderate-to-vigorous physical activity (35 min, 27–43; p<0·0001; 2647 participants in four studies). This increase was sustained up to 4 years for both steps per day (494 steps, 251–738; p<0·0001; 1944 participants in four studies) and weekly minutes of moderate-to-vigorous physical activity (25 min, 13–37; p<0·0001; 1458 participants in three studies). InterpretationWe found evidence of physical activity intervention effects beyond 12 months, sustained up to 4 years for both steps per day and minutes of moderate-to-vigorous physical activity, with important implications for potential long-term health benefits. However, few physical activity interventions with objective measures had follow-up beyond 12 months. FundingNone

A Systematic Review on the Effectiveness of Active Recovery Interventions on Athletic Performance of Professional-, Collegiate-, and Competitive-Level Adult Athletes.

Ortiz Jr, RO, Sinclair Elder, AJ, Elder, CL, and Dawes, JJ. A systematic review on the effectiveness of active recovery interventions on athletic performance of professional-, collegiate-, and competitive-level adult athletes. J Strength Cond Res 33(8): 2275-2287, 2019-Active recovery (AR) is a popular approach to enhancing athlete recovery from participation through physical action, and it has a perceived benefit in the recovery of athletes' enhancement of postexertional physiological status; however, it is unclear whether these recovery techniques enhance athletic performance. The purpose of this systematic review was to examine the effects of AR interventions conducted postexertion on athletic performance among professional, collegiate, and competitive adult athletes. Articles were collected via 4 online databases restricted to publication in English between 1998 and 2014. After the evaluation of overlap among the databases and abstract review, 150 potential eligible studies remained. Twenty-six articles involving 471 subjects remained after full analysis. The primary exclusion factor was absence of AR types of interest or measures of performance. The review resulted in a wide variety of findings indicating the vagueness in AR approach and outcome measures, making it difficult to draw specific conclusions. The review demonstrated that AR interventions lasting 6-10 minutes revealed consistently positive effects on performance. The appropriate intensity level of AR sessions was inconclusive in the literature; however, blood lactate clearance rate as a recovery marker appeared unreliable. The review suggests that there are positive psychological outcomes from AR sessions, a need to determine if AR should be individualized in its application, and weak evidence regarding the efficacy of postexercise AR, particularly relating to performance. Future research is needed for reliable and accurate markers for fatigue, physiological recovery, performance, and markers of intensity and duration for AR interventions.

A systematic literature review of early posttraumatic interventions for victims of violent crime

Abstract Criminal acts are the most common traumatic events to which the general population is exposed. Developing clinical guidelines for preventing posttraumatic stress disorder (PTSD) among victims of violent crime would help to reduce the mental health costs related to these events. The goal of the current article was to systematically review published studies on the efficacy of early interventions for victims of violent crime. Of the twelve selected studies, six evaluated the efficacy of cognitive behavioral therapy (CBT), four evaluated psychological debriefing (PD) and two evaluated another type of intervention (i.e., video). Our review found modest and inconsistent effects of active early interventions. CBT appeared to be the most promising early intervention when compared to an assessment condition or a progressive relaxation group, but relatively equivalent to supportive counselling. No proof of efficacy was found for PD compared to other interventions or a control group. A psychoeducational video for rape victims appeared to help a subgroup of victims. The assessment conditions and PD led to similar reductions in posttraumatic symptoms, while CBT had a greater impact. Further research is needed in order to develop early interventions to prevent PTSD, improve quality of life, and reduce healthcare costs.

The Effect of Active Physical Training Interventions on Reactive Postural Responses in Older Adults: A Systematic Review.

A variety of physical interventions have been used to improve reactive balance in older adults. To summarize the effectiveness of active treatment approaches to improve reactive postural responses in community-dwelling older adults. Systematic review guided by PRISMA guidelines. A literature search included the databases PubMed, OVID, CINAHL, ClinicalTrials.gov, OTseeker, and PEDro up to December 2017. Randomized controlled trials that evaluated quantitative measures of reactive postural responses in healthy adults following participation in an active physical training program were included. Of 4,481 studies initially identified, 11 randomized controlled trials covering 313 participants were selected for analysis. Study designs were heterogeneous, preventing a quantitative analysis. Nine of the 11 studies reported improvements in reactive postural responses. Several clinically feasible training methods have the potential to improve reactive postural responses in older adults; however, conclusions on the efficacy of treatment methods are limited because of numerous methodological issues and heterogeneity in outcomes and intervention procedures.

Are school-based physical activity interventions effective and equitable? A systematic review and meta-analysis of cluster randomised controlled trials

BackgroundChildhood obesity is increasing globally, with widening inequalities by socioeconomic status and sex. The aim of this study was to assess the efficacy of school-based physical activity interventions on children's daily moderate-to-vigorous physical activity (MVPA), and variations in efficacy by sex and socioeconomic status. MethodsWe systematically searched six electronic databases (ERIC, EMBASE, OVID Medline, PsycINFO, Scopus, SPORTDiscus) from inception to Feb 24, 2017. Search terms included “children”, “physical activity”, “cluster-randomized controlled trial”, and “accelerometer”. Inclusion was restricted to trials published in English of school-based physical activity interventions with accelerometer-assessed MVPA across the full day. After duplicate data extraction and quality assessment, lead authors were sent re-analysis requests. For each trial a mean change score from baseline to follow-up was calculated for daily minutes of accelerometer-assessed MVPA, for the main effect, by sex, and by socioeconomic status. Effects were pooled in random effects meta-analyses. Heterogeneity was explored with meta-regressions and subgroup meta-analyses. This study is registered with PROSPERO, CRD42017062565. Findings25 trials met the inclusion criteria; 17 trials (9044 participants) of predominantly multicomponent (88%), multisetting interventions (77%) provided relevant data and were included in meta-analyses. There was no effect of activity interventions on MVPA (standardised mean difference [SMD] 0·02, 95% CI −0·07 to 0·11). There was no evidence of differential efficacy by sex (SMD girls 0·07, 95% CI −0·07 to 0·21; boys 0·05, −0·09 to 0·19) or socioeconomic status (low −0·01, −0·12 to 0·11; middle −0·06, −0·17 to 0·05; high −0·01, −0·13 to 0·11). InterpretationThis review provides strong evidence that current school-based efforts do not increase young people's daily physical activity, with no difference in effect across sex and socioeconomic status. This is the first meta-analysis, to our knowledge, of children's physical activity interventions to pool accelerometer data with comparable outcome metrics. Our findings conflict with most previous syntheses, which have included substantial self-report data and reported positive effects. Further assessment, maximisation of implementation fidelity, and consideration of wider (including health) benefits is needed before these interventions can be concluded to have no contribution to make to children's health promotion. Until then we recommend that interventions are limited to research contexts. FundingMedical Research Council, British Heart Foundation, Cancer Research UK, Economic and Research Council, National Institute for Health Research, Wellcome Trust, Gates Cambridge.

Improving safe street-crossing behaviors among primary school students: a randomized controlled trial.

Background: Child pedestrian injury is a global public health concern. Our aim in the present study was to investigate the effects of active learning-based educational intervention on street-crossing behavior among male primary school students in Mehriz county, Iran.Methods: In this randomized controlled trial, 90 first grade elementary school students(experiment = 50, control group = 48) participated. The "ASSURE Model" was applied to design the template of this active learning-based educational program, which was implemented for the experiment group in eight sessions. Behaviors of the students about ‘’looking for vehicles on the street’’, "being cautious of dangers’’ and ‘’crossing from safe places’’ were observed and documented in actual traffic environments before, 1 week, and 6 months after intervention.Results: One week and 6 months after the intervention, the experiment group’s performance in all 3 behaviors were significantly improved (P < 0.001). Distraction-adjusted differences in the mean scores of behaviors between the experiment (Mean = 2.62) and control (Mean = 3.19)groups before and 6 months after intervention (Mean in experiment groups = 6.3, Mean in control group = 4.24) were also statistically significant (P < 0.001).Conclusion: Our educational intervention was found to be helpful in promoting the street crossing behaviors of primary school-aged children. School healthcare professionals may apply active learning education as the core category of their interventional programs to promote street-crossing behaviors among primary school students.

The effect of operating room active warming intervention on maternal hypothermia after planned cesarean

Objective To explore the effect of operating room active warming intervention on maternal hypothermia after planned cesarean. Methods According to the random number table method, from December 2016 to December 2017, 92 patients after heart failure were divided into the control group of 45 patients and the experimental group with 47 patients. Patients in the control group were conducted with the routine warming intervention, while warmed IV fluids combined with forced-air warming as active warming intervention was processed in the experimental group. The core temperature, the incidence of hypothermia, bedside shivering assessment scale, thermal comfort scores and new-born Apgar score between the two groups of patients were compared. Results Compared with the control group, the field of core temperature were significantly higher than those in the control group (F=5.96, P 0.05). Conclusion Operating room active warming intervention may have a beneficial effect on maternal hypothermia after planned cesarean, but the relevant efficacy was not shown in thefield of Apgar score. Key words: Active warming intervention; Cesarean section; Maternal hypothermia

Effectiveness of an Interdisciplinary Health Education Intervention on Metabolic Syndrome in Community Residents: A Study of Four Towns in Northern Taiwan

Metabolic syndrome, a widespread condition in Taiwan, increases the risks of cardiovascular diseases. Cardiovascular disease is the second leading cause of death in Taiwan after cancer. Thus, this health problem is a priority issue of concern. To study the effects of active intervention of interdisciplinary health education on the prevalence of metabolic syndrome in community residents. This longitudinal study was conducted from 2014 to 2015 on 661 participants who were all over 30 years old and living in four towns in northern Taiwan. The data were collected into two steps. In the first step, participants completed a blood study, body measurement, and pretest questionnaires and participated in the entire course of metabolic syndrome health education. The results of the blood test and body measurement were blinded to the experienced metabolic physicians before and after the education courses. In the second step, one year after administering the interdisciplinary health education course, the participants repeated the blood study, body measurement, and posttest questionnaires. 1. The participants had a higher incidence of metabolic syndrome. However, gender and marital status had no significant correlation with metabolic syndrome. Higher education levels were associated with a lower prevalence of metabolic syndrome. 2. The average scores for literacy rose from 2.30 pretest to 5.65 posttest. There were significant correlations (p < .05) between pretest and posttest health education. 3. The diagnosis of metabolic syndrome in this study changed from 215 participants (32.5%) to 170 participants (25.7%) between pretest and posttest (p < .05). 4. active health education had significant and positive effects on the cessation of smoking and chewing betel nut (p <.05). The active interdisciplinary health education intervention used in this study significantly decreased the smoking and betel-nut chewing habits and decreased the overall risk of metabolic syndrome in participants. Therefore, providing active health education on metabolic syndrome holds the potential to significantly decrease the prevalence of metabolic syndrome in at-risk populations. In addition, healthcare providers should make appropriately targeted health education more accessible to elderly patients who are prone to metabolic syndrome. Finally, the cessation of chewing betel nut should be seen as a major factor in the prevention and alleviation of metabolic syndrome.

Utilising active play interventions to promote physical activity and improve fundamental movement skills in children: a systematic review and meta-analysis

BackgroundChildren’s physical activity levels are low and efforts to improve their physical activity levels have proven difficult. Freely chosen and unstructured physical activity (active play) has the potential to be promoted in a variety of settings and potentially every day of the year in contrast to other physical activity domains, but active play interventions are an under-researched area. Therefore, the primary aim of this systematic review was to determine the effect of active play interventions on children’s physical activity levels, particularly moderate-to-vigorous intensity physical activity (MVPA), and fundamental movement skills (FMS).MethodsStudies were included if they were solely or predominantly active play randomised, or cluster randomised controlled trials that targeted children aged 3–12 years. They had to report on at least one of the following outcomes: objectively measured physical activity, FMS, cognition and weight status. During December 2016, four databases (PE Index, SPORTDiscus, Medline and ERIC) were searched for relevant titles. Duplicates and irrelevant titles and abstracts were removed. The included studies had their quality assessed using the Effective Public Health Practice Project (EPHPP) tool. Suitable studies were combined in a meta-analysis using a random-effect model. A narrative synthesis was conducted for all outcomes.ResultsOf the 4033 records, 91 studies were eligible for full text screening, of which 87 were removed, leaving four studies (representing five papers). The meta-analysis of two studies highlighted there was no significant effect of active play interventions on MVPA. However, the narrative synthesis suggested that active play interventions may increase total volume of physical activity. Only two studies examined the effect of active play interventions on children’s FMS, one study examined effects on weight status and none examined effects on cognition.ConclusionsDue to the small number of eligible studies and their heterogeneity, the review could not draw firm conclusions on the effect of active play interventions on children’s physical activity levels. High-quality active play interventions, targeting different times of the day (school and after school) in different populations and settings, and with a wider range of outcomes, are required to determine the potential of active play.

Active Case Finding for Communicable Diseases in Prison Settings: Increasing Testing Coverage and Uptake Among the Prison Population in the European Union/European Economic Area.

Prison populations are disproportionally affected by communicable diseases when compared with the general community because of a complex mix of socioeconomic determinants and environmental factors. Tailored and adequate health care provision in prisons has the potential to reach vulnerable and underserved groups and address their complex needs. We investigated the available evidence on modalities and effectiveness of active case-finding interventions in prisons by searching PubMed, Embase, and the Cochrane Library for records on prison and active case finding with no language limit. Conference abstracts and unpublished research reports also were retrieved. We analyzed the findings by testing modality, outcomes, and study quality. The included 90 records—63 peer-reviewed, 26 from gray literature, and 1 systematic review—reported variously on viral hepatitis, human immunodeficiency virus, sexually transmitted infections, and tuberculosis. No records were retrieved for other communicable diseases. Provider-initiated opt-in testing was the most frequently investigated modality. Testing at entry and provider-initiated testing were reported to result in comparatively higher uptake ranges. However, no comparative studies were identified that reported statistically significant differences between testing modalities. Positivity rates among tested inmates ranged broadly but were generally high for all diseases. The evidence on active case finding in correctional facilities is limited, heterogeneous, and of low quality, making it challenging to draw conclusions on the effect of different testing modalities. Scale-up of provider-initiated testing in European correctional facilities could substantially reduce the undiagnosed fraction and, hence, prevent additional disease transmission in both prison settings and the community at large.

The Effect of Exercise and Social Activity Interventions on Nutritional Status in Older Adults with Dementia Living in Nursing Homes: A Randomised Controlled Trial.

Examine the effects of a 24-week exercise intervention against a social intervention on body weight, body mass index (BMI) and nutritional status in PWD living in nursing homes. Randomized controlled trial. Ninety-one older people with dementia living in nursing homes. Exercise (n=44) or social-based activities (n=47), taking place twice per week, for 60 minutes/session, during 24 weeks. Nutritional status was measured with the mini-nutritional assessment (MNA), weight and BMI. After the 24-week intervention, none of MNA (B-coeff. 1.28; 95% CI -2.55 to 0.02), weight (-0.06; -1.58 to 1.45) and BMI (-0.05; -0.85 to 0.74) differed significantly between groups after adjustment for multiplicity. In the social group, MNA significantly improved while it remained stable in the exercise group. The percentage of at-risk and malnourished patients reduced in both groups by more than 6%. The results suggest that social activities have as good effects as exercise activities on nutritional status in PWD nursing home residents.

Effectiveness of active school transport interventions: a systematic review and update

BackgroundActive school transport (AST) is a promising strategy to increase children’s physical activity. A systematic review published in 2011 found large heterogeneity in the effectiveness of interventions in increasing AST and highlighted several limitations of previous research. We provide a comprehensive update of that review.MethodsReplicating the search of the previous review, we screened the PubMed, Web of Science, Cochrane, Sport Discus and National Transportation Library databases for articles published between February 1, 2010 and October 15, 2016. To be eligible, studies had to focus on school-aged children and adolescents, include an intervention related to school travel, and report a measure of travel behaviors. We assessed quality of individual studies with the Effective Public Health Practice Project quality assessment tool, and overall quality of evidence with the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach. We calculated Cohen’s d as a measure of effect size.ResultsOut of 6318 potentially relevant articles, 27 articles reporting 30 interventions met our inclusion criteria. Thirteen interventions resulted in an increase in AST, 8 found no changes, 4 reported inconsistent results, and 5 did not report inferential statistics. Cohen’s d ranged from −0.61 to 0.75, with most studies reporting “trivial-to-small” positive effect sizes. Three studies reported greater increases in AST over longer follow-up periods and two Safe Routes to School studies noted that multi-level interventions were more effective. Study quality was rated as weak for 27/30 interventions (due notably to lack of blinding of outcome assessors, unknown psychometric properties of measurement tools, and limited control for confounders), and overall quality of evidence was rated as low. Evaluations of implementation suggested that interventions were limited by insufficient follow-up duration, incomplete implementation of planned interventions, and limited access to resources for low-income communities.ConclusionsInterventions may increase AST among children; however, there was substantial heterogeneity across studies and quality of evidence remains low. Future studies should include longer follow-ups, use standardized outcome measures (to allow for meta-analyses), and examine potential moderators and mediators of travel behavior change to help refine current interventions.Trial registrationRegistered in PROSPERO: CRD42016033252

Perioperative, local and systemic warming in surgical site infection: a systematic review and meta-analysis.

Surgical site infection (SSI) is a common cause of postoperative morbidity. Perioperative hypothermia may contribute to surgical complications including increased risk of SSI. In this systematic review and meta-analysis, the effectiveness of active and passive perioperative warming interventions to prevent SSI was compared with standard (non-warming) care. Ovid MEDLINE; Ovid EMBASE; EBSCO CINAHL Plus; The Cochrane Wounds Specialised Register, and The Cochrane Central Register of Controlled Trials were searched, with no restrictions on language, publication date or study setting for randomised controlled trials (RCTs) and cluster RCTs. Adult patients undergoing elective or emergency surgery under general anaesthesia, receiving any active or passive warming intervention perioperatively were included. Selection, risk of bias assessment and data extraction were performed by two review authors, independently. Outcomes studied were SSI (primary outcome), inpatient mortality, hospital length of stay and pain (secondary outcomes). We identified four studies, including 769 patients. The risk ratio (RR) for SSI in warming groups was 0.36 [95% confidence interval (CI): 0.23, 0.56; p<0. 001]. Length of hospitalisation was 1.13 days less in warming groups [95% CI: -3.07, 5.33; p=0.600]. The RR for mortality in the warming groups was 0.77 [95% CI: 0.17, 3.43; p=0.730]. A meta-analysis for pain outcome could not be conducted. This review provides evidence in favour of active warming to prevent SSI, but insufficient evidence of active warming to reduce length of hospital stay and mortality. Benefits of passive warming remain unclear and warrant further research.

Effectiveness of Active Warming Intervention for Women Undergoing Cesarean Section: A Systematic Review and Meta-analysis

Purpose The aim of this study was to synthesize the best available evidence for active warming interventions during cesarean section. Methods A database search was done for randomized controlled trials utilizing active warming interventions. Maternal temperature, shivering and neonatal temperature were evaluated as outcome variables. Data were analyzed using Cochrane Review Manager software Version 5.3. Results Thirteen studies including 1306 patients were reviewed. The degree of lowering of maternal temperature decreased in the warmed fluids (MD 0.51; p=.004) and warming mattress interventions (MD 0.22; p<.001) compared with control groups. Incidence of shivering was also lower in the active warming group (OR 0.55; p=.003). There was no statistically significant difference in maternal temperature with a forced air warming intervention (MD 0.64; p=.15) or in neonatal temperature (MD 0.12; p=.26). Conclusion Findings show that with warmed fluids and warming mattresses applied during cesarean sections maternal temperature decline was reduced and also the incidence of shivering declined, but no significant effect was observed for forced air warming interventions. These findings provide a basis for developing a warming guideline for women having a cesarean section and will help to improve the quality of care for cesarean section patients. 주요어: ì œì™•ì ˆê°œ, ì €ì²´ì˜¨, 체온, ì „ìœ¨, ê³ ì°° Key words: Cesarean section, Hypothermia, Temperature, Shivering, Review

Comparative Effectiveness of Different Pharmacological Interventions for the Treatment of Minimal Hepatic Encephalopathy: A Systematic Review With Network Meta-analysis

Background and Aims: Minimal hepatic encephalopathy (MHE) is the mildest presentation of hepatic encephalopathy (HE), which includes a spectrum of neuropsychiatric manifestations ranging from subtle cognitive decline to deep coma. MHE has been shown to impair quality of life, predict overt HE (OHE), and even death. Various treatment modalities including lactulose, rifaximine, probiotics, branched chain amino acids and ammonia scavengers have shown benefit in MHE. However, due to a paucity of comparative studies, a clear consensus on the optimal treatment of MHE is yet to be reached. To address this deficiency, we evaluated the comparative effectiveness of all agents used for treatment of MHE using a network meta-analysis, combining direct and indirect treatment comparisons of all available randomized clinical trials(RCTs). Methods: We performed a systematic search of the PubMed, EMBASE, OvidSP and CENTRAL databases for RCTs of adults with MHE that compared the effectiveness of active interventions [Lactulose, l-Ornithine l-Aspartate (LOLA), rifaximine, pre-/pro-/synbiotics (PPS), branched chain amino acids(BCAA), alone or in combination] with each other or placebo. We used Bayesian network meta-analysis to combine direct and indirect evidence to estimate odds ratios (ORs) between treatments, and used Grading of Recommendations Assessment, Development and Evaluation criteria to appraise quality of evidence. Results: We identified 27 RCTs (2056 participants) comparing 5 different interventions for reversal of minimal HE and 21 RCTs (1162 participants) comparing 4 different interventions to prevent the development of overt HE. In network meta-analysis, in the order of superiority, rifaximine [odds ratio (OR), 8.14; 95% predictive interval (PrI), 4.49–14.74], lactulose (OR, 5.64; 95% PrI, 3.64–8.73), probiotics + lactulose (OR, 4.72; 95% PrI, 1.22–18.28), LOLA (OR, 4.43; 95% PrI, 2.39–8.22), PPS (OR, 4.37; 95% PrI, 2.66–7.19) and BCAA (OR, 2.16; 95% PrI, 1.03–4.56), showed significant improvement in reversal of minimal HE compared to placebo or no intervention. Rifaximin was superior to BCAA (OR, 0.27; 95% PrI, 0.10–0.69), PPS (OR, 0.54; 95% PrI, 0.28–1.03), LOLA (OR, 0.54; 95% PrI, 0.26–1.14), probiotics + lactulose (OR, 0.58; 95% PrI, 0.14–2.38, lactulose (OR, 0.69; 95% PrI, 0.38–1.25) in reversing MHE. In terms of prevention of development of OHE, LOLA (OR 0.16; 95% PrI, 0.04–0.64), lactulose (OR, 0.21; 95% PrI, 0.09–0.48), PPS (OR, 0.25; 95% PrI, 0.11–0.59), but not rifaximine (OR 0.44; 95% PrI, 0.09–2.04), significantly reduced the risk when compared to placebo or no treatment. However, none of the agents were found to be superior to the others in prevention of OHE. Conclusion: There is a moderate quality evidence to suggest that rifaximine followed by lactulose are the most effective interventions for reversal of MHE. For prevention of development of OHE, LOLA (low quality) followed by lactulose (moderate quality) were most effective. Lactulose is the only agent that is effective both in improving reversal of minimal HE and reducing the risk of development of overt HE (Figure 1, Figure 2).Figure 2SUCRA plots of the under the cumulative ranking curves for all treatments in (a) minimal HE reversal network and (b) development of overt HE network.View Large Image Figure ViewerDownload Hi-res image Download (PPT) The authors have none to declare.

More than one road leads to Rome: A narrative review and meta-analysis of physical activity intervention effects on cognition in youth

A growing body of research indicates that physical activity (PA) positively impacts cognitive function in youth. However, not all forms of PA benefit cognition equally. The purpose of this review was to determine the effect of different types of chronic PA interventions on cognition in children and adolescents. A systematic search of electronic databases and examination of the reference lists of relevant studies resulted in the identification of 28 studies. Seven categories of PA were identified, based on all possible combinations of three types of PA (aerobic, motor skill, cognitively engaging), and four comparison groups (no treatment, academic, traditional physical education (PE), aerobic). Effect sizes were calculated based on means and SDs at the post-test using Hedge’s g formula, which includes a correction for small sample bias. Each study was only entered once in each intervention-comparator category. Full data were provided from 21 studies (28 effect sizes; n = 2042 intervention; n = 2002 comparison group). Overall, chronic PA interventions had a significant small-to-moderate effect on cognition (0.46). Moderate significant positive effects were identified when PA interventions were compared to no treatment (0.86) or academic content (0.57). A non-significant effect was noted when PA interventions were compared to traditional PE (0.09) or aerobic group (0.80). However, high heterogeneity in pooled effect sizes suggests that important differences in the qualitative characteristics of the PA intervention and comparison interventions may exist. Effect sizes based on comparisons between different types of PA interventions and comparison groups are discussed in order to identify possible directions for future investigations. We conclude that chronic PA interventions have a positive impact on cognitive function in youth, but more systematic research is needed in this area.