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Archives of Orthopaedic and Trauma... Nov 2022This article is a systematic review of the literature on elderly aged 80 and over with an ankle fracture. Low energy trauma fractures are a major public health burden in... (Review)
Review
INTRODUCTION
This article is a systematic review of the literature on elderly aged 80 and over with an ankle fracture. Low energy trauma fractures are a major public health burden in developed countries that have aged populations. Ankle fractures are the third most common fractures after hip and wrist fractures. The purpose of this review is to provide an overview of the treatments and the used outcome factors.
METHODS
PubMed, Embase, Cochrane Library, and CINAHL were searched to retrieve relevant studies. Studies published in English or Dutch concerning the treatment of ankle fractures in patients aged 80 and over were included.
RESULTS
Initially 2054 studies were found in the databases. After removing duplicate entries, 1182 remained. Finally, after screening six studies were included, of which three cohorts studies and three case series. Six different treatments were identified and described; ORIF, transarticular Steinmann pin, plaster cast with or without weight-bearing, Gallagher nail and the TCC nail. Furthermore, 32 outcome factors were identified.
DISCUSSION
The various studies show that practitioners are careful with early weight-bearing. However, if we look closely to the results and other literature, this seems not necessary and it could potentially be of great value to implement early weight-bearing in the treatment. Furthermore, quality of life seems underreported in this research field.
CONCLUSIONS
ORIF with plaster cast and permissive weight-bearing should be considered for this population since it seems to be a safe possibility for a majority of the relatively healthy patients aged 80 and over. In cases where surgery is contra-indicated and a plaster cast is the choice of treatment, early weight-bearing seems to have a positive influence on the outcome in the very old patient.
Topics: Aged; Aged, 80 and over; Ankle Fractures; Ankle Joint; Casts, Surgical; Female; Humans; Male; Quality of Life; Treatment Outcome
PubMed: 34546421
DOI: 10.1007/s00402-021-04161-y -
Prevalence and clinical features associated with bipolar disorder polypharmacy: a systematic review.Neuropsychiatric Disease and Treatment 2016Uncertainty exists regarding the prevalence and clinical features associated with the practice of polypharmacy in bipolar disorder (BD), warranting a systematic review... (Review)
Review
BACKGROUND
Uncertainty exists regarding the prevalence and clinical features associated with the practice of polypharmacy in bipolar disorder (BD), warranting a systematic review on the matter.
METHODS
Three authors independently searched major electronic databases from inception till September 2015. Articles were included that reported either qualitative or quantitative data about the prevalence and clinical features associated with polypharmacy in adult cases of BD.
RESULTS
The operative definitions of polypharmacy adopted across varying studies varied, with concomitant use of two or more psychotropic medications or use of four or more psychotropic medications at once being the most common and the most reliable, respectively. Regardless of type or current mood episode polarity of BD, prevalence rates up to 85% and 36% were found using the most permissive (two or more medications at once) and the most conservative (four or more) operative definitions for polypharmacy, respectively. Point prevalence prescription rates of one or more antidepressant or antipsychotic as part of a polypharmacy regimen occurred in up to 45% or 80% of the cases, respectively, according to the most permissive definition of polypharmacy. In contrast, lithium prescription rates ranged from 13% to 33% in BD patients receiving polypharmacy according to conservative and permissive definitions, possibly suggesting a reduced need for augmentation of combination strategies for those cases of BD with a favorable lifetime lithium response and/or long-lasting treatment as well as less likelihood of lithium response over the time most severe cases possibly exposed to a more complex polypharmacy overall.
LIMITATIONS
"Apples and oranges" bias; publication bias for most recently introduced compounds.
CONCLUSION
Polypharmacy is common among people with BD across varying type and mood episode phases of illness. Special population, including BD patients at high risk of familial load for suicidal behavior, solicit further research as well as the plausible "protective" role of lithium toward polypharmacy in BD. The PROSPERO registration number is CRD42014015084.
PubMed: 27099503
DOI: 10.2147/NDT.S100846 -
Addiction (Abingdon, England) Sep 2016People with mental illnesses and substance abuse disorders are important targets for smoking cessation interventions. Mental health professionals (MHPs) are ideally... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND AIMS
People with mental illnesses and substance abuse disorders are important targets for smoking cessation interventions. Mental health professionals (MHPs) are ideally placed to deliver interventions, but their attitudes may prevent this. This systematic review therefore aimed to identify and estimate quantitatively MHPs attitudes towards smoking and main barriers for providing smoking cessation support and to explore these attitudes in-depth through qualitative synthesis.
METHODS
The online databases AMED, EMBASE, Medline, PsychINFO, HMIC and CINAHL were searched in March 2015 using terms relating to three concepts: 'attitudes', 'mental health professionals' and 'smoking cessation'. Quantitative or qualitative studies of any type were included. Proportions of MHPs' attitudes towards smoking and smoking cessation were pooled across studies using random effects meta-analysis. Qualitative findings were evaluated using thematic synthesis.
RESULTS
Thirty-eight studies including 16 369 participants were eligible for inclusion. Pooled proportions revealed that 42.2% [95% confidence interval (CI) = 35.7-48.8] of MHPs reported perceived barriers to smoking cessation interventions, 40.5% (95% CI = 30.4-51.0) negative attitudes towards smoking cessation and 45.0% (95% CI = 31.9-58.4) permissive attitudes towards smoking. The most commonly held beliefs were that patients are not interested in quitting (51.4%, 95% CI = 33.4-69.2) and that quitting smoking is too much for patients to take on (38%, 95% CI = 16.4-62.6). Qualitative findings were consistent with quantitative results, revealing a culture of smoking as 'the norm' and a perception of cigarettes as a useful tool for patients and staff.
CONCLUSIONS
A significant proportion of mental health professionals hold attitudes and misconceptions that may undermine the delivery of smoking cessation interventions; many report a lack of time, training and confidence as main barriers to addressing smoking in their patients.
Topics: Attitude of Health Personnel; Comorbidity; Health Personnel; Humans; Mental Disorders; Smoking; Smoking Cessation; Tobacco Smoking
PubMed: 27003925
DOI: 10.1111/add.13387 -
Psychological Reports Apr 2023The concept 'parenting styles' has been widely examined to understand the etiology of narcissism for decades. This study aimed to systematically review the empirical... (Review)
Review
The concept 'parenting styles' has been widely examined to understand the etiology of narcissism for decades. This study aimed to systematically review the empirical research literature regarding the association between perceived parenting styles and narcissism. In this study, Ebscohost, Wiley Online Library, Taylor&Francis, Springer Link, PubMed, PsycNet, ScienceDirect, and Google Scholar databases were searched using identified keywords. An extensive database search resulted in 75 identified publications. Of these, 60 were scrutinized, and in the end, ten studies were included in the review for data synthesis. To reach a common conceptualization on the parenting styles, the results were evaluated based on Baumrind's typology. As a result of this systematic review, we can conclude that there is a relationship between narcissism and parenting styles. In particular, perceived permissive parenting was positively correlated with narcissism. However, the relationship between narcissism and other parenting styles is more complex. Therefore, more high-quality empirical studies are needed to investigate the relationship between parenting and narcissism.
Topics: Humans; Young Adult; Parenting; Narcissism; Authoritarianism
PubMed: 34404305
DOI: 10.1177/00332941211041010 -
Diabetologia Jan 2016We aimed to investigate the role of insulin in regulating human skeletal muscle metabolism in health and diabetes. (Meta-Analysis)
Meta-Analysis Review
AIMS/HYPOTHESIS
We aimed to investigate the role of insulin in regulating human skeletal muscle metabolism in health and diabetes.
METHODS
We conducted a systematic review and meta-analysis of published data that examined changes in skeletal muscle protein synthesis (MPS) and/or muscle protein breakdown (MPB) in response to insulin infusion. Random-effects models were used to calculate weighted mean differences (WMDs), 95% CIs and corresponding p values. Both MPS and MPB are reported in units of nmol (100 ml leg vol.)(-1) min(-1).
RESULTS
A total of 104 articles were examined in detail. Of these, 44 and 25 studies (including a total of 173 individuals) were included in the systematic review and meta-analysis, respectively. In the overall estimate, insulin did not affect MPS (WMD 3.90 [95% CI -0.74, 8.55], p = 0.71), but significantly reduced MPB (WMD -15.46 [95% CI -19.74, -11.18], p < 0.001). Overall, insulin significantly increased net balance protein acquisition (WMD 20.09 [95% CI 15.93, 24.26], p < 0.001). Subgroup analysis of the effect of insulin on MPS according to amino acid (AA) delivery was performed using meta-regression analysis. The estimate size (WMD) was significantly different between subgroups based on AA availability (p = 0.001). An increase in MPS was observed when AA availability increased (WMD 13.44 [95% CI 4.07, 22.81], p < 0.01), but not when AA availability was reduced or unchanged. In individuals with diabetes and in the presence of maintained delivery of AA, there was a significant reduction in MPS in response to insulin (WMD -6.67 [95% CI -12.29, -0.66], p < 0.05).
CONCLUSIONS/INTERPRETATION
This study demonstrates the complex role of insulin in regulating skeletal muscle metabolism. Insulin appears to have a permissive role in MPS in the presence of elevated AAs, and plays a clear role in reducing MPB independent of AA availability.
Topics: Diabetes Mellitus, Type 2; Humans; Insulin; Insulin Resistance; Muscle Proteins; Muscle, Skeletal; Phenylalanine; Signal Transduction
PubMed: 26404065
DOI: 10.1007/s00125-015-3751-0 -
Obesity Reviews : An Official Journal... Oct 2014Excessive sedentary time is detrimentally linked to obesity, type 2 diabetes, cardiovascular disease and premature mortality. Studies have been investigating the use of... (Meta-Analysis)
Meta-Analysis Review
Excessive sedentary time is detrimentally linked to obesity, type 2 diabetes, cardiovascular disease and premature mortality. Studies have been investigating the use of activity-permissive workstations to reduce sedentary time in office workers, a highly sedentary target group. This review systematically summarizes the evidence for activity-permissive workstations on sedentary time, health-risk biomarkers, work performance and feasibility indicators in office workplaces. In July 2013, a literature search identified 38 relevant peer-reviewed publications. Key findings were independently extracted by two researchers. The average intervention effect on sedentary time was calculated via meta-analysis. In total, 984 participants across 19 field-based trials and 19 laboratory investigations were included, with sample sizes ranging from n = 2 to 66 per study. Sedentary time, health-risk biomarkers and work performance indicators were reported in 13, 23 and 23 studies, respectively. The pooled effect size from the meta-analysis was -77 min of sedentary time/8-h workday (95% confidence interval = -120, -35 min). Non-significant changes were reported for most health- and work-related outcomes. Studies with acceptability measures reported predominantly positive feedback. Findings suggest that activity-permissive workstations can be effective to reduce occupational sedentary time, without compromising work performance. Larger and longer-term randomized-controlled trials are needed to understand the sustainability of the sedentary time reductions and their longer-term impacts on health- and work-related outcomes.
Topics: Health Promotion; Humans; Interior Design and Furnishings; Motor Activity; Obesity; Occupational Health; Posture; Sedentary Behavior; Workplace
PubMed: 25040784
DOI: 10.1111/obr.12201 -
Child: Care, Health and Development Sep 2016Low socio-economic status (SES) is a significant risk factor for childhood overweight and obesity (COWOB) in high-income countries. Parents to young children buffer and... (Review)
Review
BACKGROUND
Low socio-economic status (SES) is a significant risk factor for childhood overweight and obesity (COWOB) in high-income countries. Parents to young children buffer and accentuate social and cultural influences, and are central to the development of this disease. An understanding of the parent-related mechanisms that underlie the SES-COWOB relationship is needed to improve the efficacy of prevention and intervention efforts.
OBJECTIVE
A systematic review of relevant literature was conducted to investigate the mechanisms by which levels of SES (low, middle and high) are associated to COWOB, by exploring mediation and interaction effects.
METHOD
Six electronic databases were searched yielding 5155 initial records, once duplicates were removed. Studies were included if they investigated COWOB, SES, parent-related factors and the multivariate relationship between these factors. Thirty studies were included. Factors found to be mediating the SES-COWOB relationship or interacting with SES to influence COWOB were categorized according to an ecological systems framework, at child, parent, household and social system level factors.
RESULTS
High parent body mass index, ethnicity, child-care attendance, high TV time (mother and child), breastfeeding (early weaning), food intake behaviours and birthweight potentially mediate the relationship between SES and COWOB. Different risk factors for COWOB in different SES groups were found. For low SES families, parental obesity and maternal depressive symptoms were strong risk factors for COWOB, whereas long maternal working hours and a permissive parenting style were risk factors for higher SES families. None of the studies investigated parental psychological attributes such as attitudes, beliefs, self-esteem and so on as potential mechanisms/risk factors.
CONCLUSIONS
Families from different SES groups have different risk and protective factors for COWOB. Prevention and intervention efforts may have improved efficacy if they are tailored to address specific risk factors within SES.
Topics: Attitude to Health; Child; Child Nutritional Physiological Phenomena; Child of Impaired Parents; Humans; Overweight; Parent-Child Relations; Parenting; Pediatric Obesity; Risk Factors; Social Class
PubMed: 27316858
DOI: 10.1111/cch.12356 -
Scientific Reports Mar 2016To identify the best lung ventilation strategy for acute respiratory distress syndrome (ARDS), we performed a network meta-analysis. The Cochrane Central Register of... (Meta-Analysis)
Meta-Analysis Review
To identify the best lung ventilation strategy for acute respiratory distress syndrome (ARDS), we performed a network meta-analysis. The Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, CINAHL, and the Web of Science were searched, and 36 eligible articles were included. Compared with higher tidal volumes with FiO2-guided lower positive end-expiratory pressure [PEEP], the hazard ratios (HRs) for mortality were 0.624 (95% confidence interval (CI) 0.419-0.98) for lower tidal volumes with FiO2-guided lower PEEP and prone positioning and 0.572 (0.34-0.968) for pressure-controlled ventilation with FiO2-guided lower PEEP. Lower tidal volumes with FiO2-guided higher PEEP and prone positioning had the greatest potential to reduce mortality, and the possibility of receiving the first ranking was 61.6%. Permissive hypercapnia, recruitment maneuver, and low airway pressures were most likely to be the worst in terms of all-cause mortality. Compared with higher tidal volumes with FiO2-guided lower PEEP, pressure-controlled ventilation with FiO2-guided lower PEEP and lower tidal volumes with FiO2-guided lower PEEP and prone positioning ventilation are associated with lower mortality in ARDS patients. Lower tidal volumes with FiO2-guided higher PEEP and prone positioning ventilation and lower tidal volumes with pressure-volume (P-V) static curve-guided individual PEEP are potential optimal strategies for ARDS patients.
Topics: Humans; Lung; Network Meta-Analysis; Respiratory Distress Syndrome; Respiratory Function Tests; Ventilation
PubMed: 26955891
DOI: 10.1038/srep22855 -
BMC Anesthesiology Feb 2017Oliguria is associated with a decreased kidney- and organ perfusion, leading to organ damage and increased mortality. While the effects of correcting oliguria on renal... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Oliguria is associated with a decreased kidney- and organ perfusion, leading to organ damage and increased mortality. While the effects of correcting oliguria on renal outcome have been investigated frequently, whether urine output is a modifiable risk factor for mortality or simply an epiphenomenon remains unclear. We investigated whether targeting urine output, defined as achieving and maintaining urine output above a predefined threshold, in hemodynamic management protocols affects 30-day mortality in perioperative and critical care.
METHODS
We performed a systematic review with a random-effects meta-analyses and meta-regression based on search strategy through MEDLINE, EMBASE and references in relevant articles. We included studies comparing conventional fluid management with goal-directed therapy and reporting whether urine output was used as target or not, and reporting 30-day mortality data in perioperative and critical care.
RESULTS
We found 36 studies in which goal-directed therapy reduced 30-day mortality (OR 0.825; 95% CI 0.684-0.995; P = 0.045). Targeting urine output within goal-directed therapy increased 30-day mortality (OR 2.66; 95% CI 1.06-6.67; P = 0.037), but not in conventional fluid management (OR 1.77; 95% CI 0.59-5.34; P = 0.305). After adjusting for operative setting, hemodynamic monitoring device, underlying etiology, use of vasoactive medication and year of publication, we found insufficient evidence to associate targeting urine output with a change in 30-day mortality (goal-directed therapy: OR 1.17; 95% CI 0.54-2.56; P = 0.685; conventional fluid management: OR 0.74; 95% CI 0.39-1.38; P = 0.334).
CONCLUSIONS
The principal finding of this meta-analysis is that after adjusting for confounders, there is insufficient evidence to associate targeting urine output with an effect on 30-day mortality. The paucity of direct data illustrates the need for further research on whether permissive oliguria should be a key component of fluid management protocols.
Topics: Critical Care; Fluid Therapy; Humans; Oliguria; Regression Analysis
PubMed: 28187752
DOI: 10.1186/s12871-017-0316-4 -
Obesity Reviews : An Official Journal... Mar 2017Parenting style may be an important determinant of an individual's future weight status. However, reviews that evaluate the relationship between parenting style and... (Review)
Review
BACKGROUND
Parenting style may be an important determinant of an individual's future weight status. However, reviews that evaluate the relationship between parenting style and weight-related outcomes have not focused on prospective studies.
METHODS
We systematically searched PubMed, Embase and PsychInfo for studies published between 1995 and 2016 that evaluated the prospective relationship between parenting style experienced in childhood and subsequent weight outcomes.
RESULTS
We identified 11 prospective cohort studies. Among the eight studies that categorized parenting style into distinct groups (i.e. authoritative, authoritarian, permissive and neglectful), five provided evidence that authoritative parenting was associated with lower body mass index gains. Among the six highest quality studies, four suggested a protective role of authoritative parenting style against adverse weight-related outcomes. However, only one study controlled for a comprehensive set of confounders, and the small number of studies conducted within certain age groups precluded our ability to ascertain critical periods when parenting style is most strongly related to child weight.
CONCLUSIONS
The present literature supports the idea that authoritative parenting may be protective against later overweight and obesity, although findings are mixed. More prospective cohort studies of longer durations, with more sophisticated methods that examine age-varying relationships, and that control for a comprehensive set of confounders, are needed.
Topics: Authoritarianism; Body Mass Index; Body Weight; Databases, Factual; Humans; Obesity; Observational Studies as Topic; Overweight; Parent-Child Relations; Parenting; Parents; Permissiveness
PubMed: 28086262
DOI: 10.1111/obr.12497