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Frontiers in Psychiatry 2023Investigation on the association between attention deficit hyperactivity disorder (ADHD) and primary reflexes is in the initial stage, with considerable differences in... (Review)
Review
INTRODUCTION
Investigation on the association between attention deficit hyperactivity disorder (ADHD) and primary reflexes is in the initial stage, with considerable differences in the findings. This study evaluated the association between ADHD and primitive reflexes using systematic review and meta-analysis.
METHODS
Data were obtained from PubMed, Cochrane Library, Web of Science, EBSCO (Medical Literature Analysis and Retrieval System Online, American Psychological Association Psyclnfo, and Education Resources Information Center), Embase, Scopus, and ProQuest. Articles were searched from the date of inception of the respective databases to January 01, 2023, and StataCorp Stata (version 15) was used for the analysis.
RESULTS
Four articles with 229 samples were included in the meta-analysis. Results showed a significant positive and moderate correlation between ADHD and primitive reflexes, particularly asymmetric tonic neck reflex: summary value = 0.48, 95% CI = 0.27-0.64; symmetric tonic neck reflex: summary value = 0.39, 95% CI = 0.25-0.52. Overall, findings from the sub-group analysis indicate that the behavioral problem measuring tool (Conners' scale), sex, and primitive reflex test could significantly moderate the relationships between ADHD and ATNR and STNR primitive reflexes.
CONCLUSION
ADHD symptoms in children are closely related to the non-integration of (a)symmetric tonic neck primitive reflexes. Longitudinal or experimental studies should be conducted to reveal the causal relationship between ADHD and primitive reflexes in the future.
PubMed: 37484683
DOI: 10.3389/fpsyt.2023.1175974 -
Pediatric Reports Aug 2023Rare Diseases (RDs) in adolescents are characterized by low frequency and clinical heterogeneity, are chronic and deliberating and demand a multidisciplinary approach as... (Review)
Review
Rare Diseases (RDs) in adolescents are characterized by low frequency and clinical heterogeneity, are chronic and deliberating and demand a multidisciplinary approach as well as costly and specialized treatments. Comprehending patients' and parents' needs through a mixed systematic review is essential for healthcare system planning. This mixed systematic review explored barriers to and facilitators of effective care for adolescents with RDs as perceived by patients and their parents. Three databases (2008-2023) were searched and twenty-five articles were selected and critically appraised with the Mixed Methods Appraisal Tool (MMAT; version 2018). The review followed a convergent integrated approach for data extraction according to Joanna Briggs Institute's (JBI) mixed method systematic review (MMSR) methodology. Subsequent reflexive thematic analysis categorized the barriers and facilitators into five levels (intrapersonal, interpersonal, institutional, community and public policy) following the conceptual framework of the socio-ecological model for healthcare promotion. Barriers on the institutional and public policy level stood out as the most frequently reported, resulting in unmet care needs and frustrating family dynamics. National and regional healthcare policies are rarely actually linked to pragmatic intervention programs with a measurable impact on patients' welfare. Targeted strategies involving primary care infrastructure and personnel for better coordination and management of the disease are discussed.
PubMed: 37606447
DOI: 10.3390/pediatric15030043 -
BMC Medical Informatics and Decision... Jul 2023With the in-depth application of machine learning(ML) in clinical practice, it has been used to predict the mortality risk in patients with traumatic brain... (Meta-Analysis)
Meta-Analysis
PURPOSE
With the in-depth application of machine learning(ML) in clinical practice, it has been used to predict the mortality risk in patients with traumatic brain injuries(TBI). However, there are disputes over its predictive accuracy. Therefore, we implemented this systematic review and meta-analysis, to explore the predictive value of ML for TBI.
METHODOLOGY
We systematically retrieved literature published in PubMed, Embase.com, Cochrane, and Web of Science as of November 27, 2022. The prediction model risk of bias(ROB) assessment tool (PROBAST) was used to assess the ROB of models and the applicability of reviewed questions. The random-effects model was adopted for the meta-analysis of the C-index and accuracy of ML models, and a bivariate mixed-effects model for the meta-analysis of the sensitivity and specificity.
RESULT
A total of 47 papers were eligible, including 156 model, with 122 newly developed ML models and 34 clinically recommended mature tools. There were 98 ML models predicting the in-hospital mortality in patients with TBI; the pooled C-index, sensitivity, and specificity were 0.86 (95% CI: 0.84, 0.87), 0.79 (95% CI: 0.75, 0.82), and 0.89 (95% CI: 0.86, 0.92), respectively. There were 24 ML models predicting the out-of-hospital mortality; the pooled C-index, sensitivity, and specificity were 0.83 (95% CI: 0.81, 0.85), 0.74 (95% CI: 0.67, 0.81), and 0.75 (95% CI: 0.66, 0.82), respectively. According to multivariate analysis, GCS score, age, CT classification, pupil size/light reflex, glucose, and systolic blood pressure (SBP) exerted the greatest impact on the model performance.
CONCLUSION
According to the systematic review and meta-analysis, ML models are relatively accurate in predicting the mortality of TBI. A single model often outperforms traditional scoring tools, but the pooled accuracy of models is close to that of traditional scoring tools. The key factors related to model performance include the accepted clinical variables of TBI and the use of CT imaging.
Topics: Humans; Brain Injuries, Traumatic; Sensitivity and Specificity; Multivariate Analysis; Hospital Mortality; Machine Learning
PubMed: 37507752
DOI: 10.1186/s12911-023-02247-8 -
Journal of Clinical Anesthesia Sep 2023This systematic review and meta-analysis aimed to assess the superiority of airway nerve blocks versus airway anesthesia without nerve blocks for awake tracheal... (Meta-Analysis)
Meta-Analysis
STUDY OBJECTIVE
This systematic review and meta-analysis aimed to assess the superiority of airway nerve blocks versus airway anesthesia without nerve blocks for awake tracheal intubation (ATI).
DESIGN
Systematic review and meta-analysis of randomized controlled trials (RCTs).
SETTING
All studies that assessed the superiority of airway anesthesia technique for awake tracheal intubation were searched in PubMed, Web of Science, Cochrane Library, Ovid Medline, Embase and Chinese databases (including China National Knowledge Infrastructure, Wanfang database, and VIP databases) and trial registry databases from their inception to December 2022.
PATIENTS
Adult patients included in randomized controlled trials comparing airway anesthesia with or without airway nerve blocks for ATI.
INTERVENTIONS
Airway nerve (including superior laryngeal nerve, glossopharyngeal nerve, or recurrent laryngeal nerve) blocks for ATI.
MEASUREMENTS
The primary outcome was the intubation time. Secondary outcomes were quality of intubating conditions (including patient reaction to placement of the flexible scope and tracheal tube, coughing and gagging, and patient satisfaction) and overall complications during ATI.
MAIN RESULTS
Fourteen articles with 658 patients were identified for analysis. When compared with airway anesthesia without nerve blocks, airway nerve blocks significantly reduced intubation time (standardized mean difference [SMD] -2.57, 95% CI -3.59- -1.56, p < 0.00001), improved anesthesia quality of ATI with higher no reaction to placement of the flexible scope and tracheal tube (relative risk [RR] 9.87; 95% CI 4.10-23.75, p < 0.00001), lower cough or gag reflex during intubation (RR 0.35, 95% CI 0.27-0.46, p < 0.00001), higher excellent patient satisfaction rate (RR 1.88, 95% CI 1.05-3.34, p = 0.03), and lower overall complications (RR 0.29, 95% CI 0.19-0.45, p < 0.00001). The overall quality of evidence was moderate.
CONCLUSIONS
Based on current published evidence, airway nerve blocks provide better airway anesthesia quality for ATI with a shorter intubation time, better intubation conditions including higher no reaction to placement of the flexible scope and tracheal tube, lower cough or gag reflex during intubation, higher excellent patient satisfaction, and lower overall complications.
Topics: Adult; Humans; Cough; Wakefulness; Anesthesia, General; Intubation, Intratracheal; Nerve Block
PubMed: 37054484
DOI: 10.1016/j.jclinane.2023.111122 -
Brazilian Journal of Otorhinolaryngology 2023To analyze, by means of a systematic review and meta-analysis, the proportion of patients with Meniere's disease who have altered caloric test and vHIT, as well as to... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To analyze, by means of a systematic review and meta-analysis, the proportion of patients with Meniere's disease who have altered caloric test and vHIT, as well as to determine the prevalence of altered caloric test and normal vHIT dissociation in the diagnosis of Meniere's disease.
METHODS
The literature search had no restriction regarding the period of publication on the following indexed data platforms: PubMed, PubMed PMC, BVS-Bireme, Web of Science, Embase and Cochrane Library. Articles that evaluated patients with Meniere's disease who underwent caloric test and vHIT were included. Two researchers independently conducted the analysis of the articles, promoting the selection and capture of data, following the recommendations of the PRISMA method, and complying with the criteria for articles inclusion and exclusion defined in the research protocol. In case of disagreement during the selection process, a third researcher was included for analysis.
RESULTS
From a total of 427 initial studies, the researchers selected 12 articles, published between 2014 and 2021, with a total of 708 patients evaluated, with a mean age of 52.72 years old. The prevalence of patients with Meniere's disease with altered caloric reflex test was 64% (95% CI 57%‒71%), while the prevalence of altered vHIT was only 28% (95% CI 16%-40%). The prevalence of the altered caloric test + normal vHIT dissociation was 47% (95% CI 37%-57%).
CONCLUSION
The video head impulse test and the caloric test are valuable tools for vestibular assessment. The dissociation of findings between these two tests in patients with Meniere's disease was more prevalent in this meta-analysis and may be a result of the tonotopy of specialized hair cells in the ampullary crest. The prevalence of altered caloric test was 64% and anormal vHIT was 28%. The dissociation caloric asymmetry and normal vHIT was observed in 47% of the patients.
Topics: Humans; Middle Aged; Meniere Disease; Head Impulse Test; Caloric Tests; Reflex, Vestibulo-Ocular; Hair Cells, Auditory
PubMed: 37354884
DOI: 10.1016/j.bjorl.2023.101279 -
EFORT Open Reviews Feb 2024The aim of the study was to analyze the effects of functional or biomechanical bandages, whether elastic or inelastic, in Chronic Ankle Instability (CAI).
Effectiveness of functional or biomechanical bandages with athletic taping and kinesiotaping in subjects with chronic ankle instability: a systematic review and meta-analysis.
PURPOSE
The aim of the study was to analyze the effects of functional or biomechanical bandages, whether elastic or inelastic, in Chronic Ankle Instability (CAI).
METHODS
This review used PubMed, WoS, SCOPUS, and CINAHL following PRISMA and registering in Prospero. Main PICOS: (1) CAI; (2) intervention, functional/biomechanical bandages; (3) comparison, taping effect versus placebo/no taping, or another functional taping; (4) outcomes, improvement of CAI functionality (dynamic/static balance, ankle kinematic, perception, agility and motor control, endurance and strength; (5) experimental and preexperimental studies. The meta-analyses considered mean and s.d. of the results per variable; effect size (ES) of each study and for each type of intervention. Homogeneity (Q), heterogeneity (H 2 and I 2), and 95% CI were calculated.
RESULTS
In total, 28 studies were selected. Significant differences were found for dynamic balance (66.66%) and static balance (87.5%), ankle kinematics (75.00%), perceptions (88.88%), plantar flexor strength (100%), muscle activity (66.6%), endurance (100%), functional performance (100%), and gait (66.6%). The main results of meta-analyses (eight studies) are as follows - h/M ratio soleus, ES: 0.080, 95% CI: -5.219-5.379; h/M ratio peroneus, ES: 0.070, 95% CI: -6.151-6.291; posteromedial KT, ES: 0.042 95% CI: -0.514-0.598; posteromedial-overall, ES: -0.006 95% CI: -1.071-0.819; mSEBT-KT, ES: 0.057 95% CI: -0.281-0.395; mSEBT-overall, ES: -0.035 95% CI: -0.190-0.590.
CONCLUSIONS
All biomechanical or functional bandages, whether elastic or inelastic, applied in CAI were favorable, highlighting patient perception, dynamic and static balance, kinematics and agility and motor control, for its effectiveness and evidence. Thus, bandages increase ankle functionality. The meta-analyses found no statistical significance. Clinically, soleus muscle activity, h-reflex/M-responses using fibular reposition with rigid tape, and dynamic balance with combined kinesiotaping during the modified star excursion balance test and with the posteromedial direction found improvements.
LEVEL OF EVIDENCE
Level of evidence according to Scottish Intercollegiate Guidelines Network: 1+. Level of evidence according to the Oxford Centre for Evidence-Based Medicine 2011: 1.
PubMed: 38308953
DOI: 10.1530/EOR-23-0129 -
Journal of Neuroengineering and... Aug 2023Understanding of the human body's internal processes to maintain balance is fundamental to simulate postural control behaviour. The body uses multiple sensory systems'... (Review)
Review
Understanding of the human body's internal processes to maintain balance is fundamental to simulate postural control behaviour. The body uses multiple sensory systems' information to obtain a reliable estimate about the current body state. This information is used to control the reactive behaviour to maintain balance. To predict a certain motion behaviour with knowledge of the muscle forces, forward dynamic simulations of biomechanical human models can be utilized. We aim to use predictive postural control simulations to give therapy recommendations to patients suffering from postural disorders in the future. It is important to know which types of modelling approaches already exist to apply such predictive forward dynamic simulations. Current literature provides different models that aim to simulate human postural control. We conducted a systematic literature research to identify the different approaches of postural control models. The different approaches are discussed regarding their applied biomechanical models, sensory representation, sensory integration, and control methods in standing and gait simulations. We searched on Scopus, Web of Science and PubMed using a search string, scanned 1253 records, and found 102 studies to be eligible for inclusion. The included studies use different ways for sensory representation and integration, although underlying neural processes still remain unclear. We found that for postural control optimal control methods like linear quadratic regulators and model predictive control methods are used less, when models' level of details is increasing, and nonlinearities become more important. Considering musculoskeletal models, reflex-based and PD controllers are mainly applied and show promising results, as they aim to create human-like motion behaviour considering physiological processes.
Topics: Humans; Postural Balance; Gait; Motion; Muscles; Reflex
PubMed: 37605197
DOI: 10.1186/s12984-023-01235-3 -
International Journal of Circumpolar... Dec 2023Heart rate variability (HRV) is a useful method to study the autonomic nervous system (ANS) status. As measuring devices have developed and become smaller, many...
Heart rate variability (HRV) is a useful method to study the autonomic nervous system (ANS) status. As measuring devices have developed and become smaller, many researchers have become interested in the possibilities to implement the method for diving medicine research. The aim of this study was to review human ANS responses in cold water diving (water temperature <5°C), and to comprise the current knowledge of HRV studies in diving and hyperbaric exposure into one review article. A literature search was conducted on 5 December 2022, with the search terms "HRV" or "heart rate variability" and "diving" or "diver" or "divers", with search functions of the data bases PubMed and Ovid Medline. Peer reviewed original articles, review articles and case reports were accepted to this review. Twenty-six articles met the pre-defined criteria and were included in this review. Studies from very cold water conditions were rare, but suggested that cold strengthens the ANS responses of diving - especially parasympathetic nervous system (PNS) activity due to the trigeminocardiac reflex and baroreceptor and cardiac stretch receptor activity, caused cold and pressure-induced centralisation of the blood. Overall, studies showed predominant PNS activity when putting the face in water, during immersion and when ambient pressure increased.
Topics: Humans; Heart Rate; Cold Temperature; Temperature; Water
PubMed: 37079282
DOI: 10.1080/22423982.2023.2203369 -
Environmental Research Dec 2023Phthalates are a family of industrial chemicals noncovalently bonded to plastic materials to enhance flexibility and durability. These compounds are extensively used in... (Review)
Review
BACKGROUND
Phthalates are a family of industrial chemicals noncovalently bonded to plastic materials to enhance flexibility and durability. These compounds are extensively used in a variety of consumer products and even in many medical devices. Newborns present a higher susceptibility to phthalates.
OBJECTIVE
To assess the short- and long-term health consequences of exposure to phthalates during the neonatal period.
METHODS
Systematic review in accordance with the PRISMA statements. Eligible articles in English language were searched in MEDLINE, Scopus, ISI Web of Science, and Ovid databases using the following terms: "phthalate", "newborn", and "neonate". Unpublished data were searched in ClinicalTrials.gov website. All in vivo studies of any design published before May 16th, 2023 and fulfilling the following criteria were included: 1) investigations in which preterm and/or term newborns underwent one or more measurement of concentrations of phthalates on biological samples taken during the neonatal period; 2) studies in which quantitative measurement of phthalates was related to any kind of health outcome. Subgroup analysis was conducted by type of outcome. The quality assessment was performed according to the criteria from the "NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies".
RESULTS
11,895 records were identified; finally, 5 articles were included for review. A mixture of phthalates was associated with improved performance on the NNNS summary scales of Attention, Handling, and Non-optimal reflexes before NICU discharge. At 2 months' corrected age, some phthalates were positively associated with problem-solving and gross motor abilities; increased levels of mono (2-ethylhexyl) phthalate, mono (2-ethyl-5-carboxypentyl) phthalate, and sum of di (2-ethylhexyl) phthalate (DEHP) metabolites (∑DEHP and ∑DEHP) were associated with worse fine motor performance. Furthermore, DEHP was associated with transient alteration of gut microbiota and increased IgM production after vaccine. A linear positive association between a mixture of phthalates and slope of the first growth spurt was even reported in preterm newborns. No relationship emerged between phthalates and bronchopulmonary dysplasia. Three studies out of 5 had fair quality.
CONCLUSION
Given some methodological issues and the paucity of related studies, further investigations of flawless quality aimed at clarifying the relationship between early exposure to phthalates and health outcomes are needed.
Topics: Infant, Newborn; Humans; Cross-Sectional Studies; Diethylhexyl Phthalate; Databases, Factual
PubMed: 37821060
DOI: 10.1016/j.envres.2023.117298 -
Frontiers in Pediatrics 2023Massage therapy for preterm newborns has received increasing attention in recent years due to its beneficial clinical outcomes. However, disagreements persist in... (Review)
Review
BACKGROUND
Massage therapy for preterm newborns has received increasing attention in recent years due to its beneficial clinical outcomes. However, disagreements persist in different investigations.
METHOD
We performed a systematic literature search in the Cochrane Library, Embase, PubMed, Web Science, and CINAHL to retrieve randomized controlled trials of premature infants receiving massage therapy and its impact on maternal and infant outcomes. Outcomes were mother-infant attachment, oxygen saturation, motor funtion, reflex, temperature, and calorie intake. The tool developed by the Cochrane collaboration assessed risk bias. With a 95% confidence interval (CI), the integration's results were presented as the mean difference or standardized mean difference. The registration number was CRD42022337849.
RESULTS
Of 940 records retrieved, 15 trials were included. Massage therapy increased oxygen saturation (standardized mean difference (SMD) = 2.00, 95% CI [1.17 to 2.83], < 0.0001). Massage therapy can strengthen mother-infant attachment [SMD = 2.83, 95% CI (2.31 to 3.35), < 0.00001]. Other outcomes, including motor activity, relaxation, caloric intake, and temperature, did not differ significantly.
CONCLUSION
Massage therapy can significantly improve oxygen saturation and strengthen maternal-infant attachment. However, prior to making a recommendation, additional research with a larger sample size and more rigorous design should be conducted due to the heterogeneity of studies in several outcomes.
PubMed: 37719450
DOI: 10.3389/fped.2023.1198730