Search

We systematically reviewed the association of ambient air pollution with blood pressure (BP) as a primary outcome in adolescents (10-19 years). Five databases (Ovid Medline, Ovid Embase, Web of Science, The Cochrane Library, and LILACS) were searched for relevant articles published up to August 2022. Meta-analyses were conducted using STATA v17 (Protocol - OSF Registries https://doi.org/10.17605/OSF.IO/96G5Q). Eight studies (5 cohort, 3 cross-sectional) with approximately 15,000 adolescents were included. Data from 6 studies were suitable for inclusion in the meta-analyses. In sub-group analyses, non-significant positive associations were observed for cohort studies assessing long-term exposure to PM

Objectives: to assess the effects of vitamin D supplementation during pregnancy on the outcomes of vitamin D concentration in newborns, length at birth, overall health (Apgar), birth weight and maternal vitamin D concentration after childbirth. Methods: this research was conducted in the electronic databases of MEDLINE, LILACS, EMBASE and Cochrane Library until December 2020, using the terms “vitamin D”, “pregnancy”, “vitamin D deficiency”, “infant”, “newborn” and their synonyms. Randomized controlled trials were searched by evaluating the effects of maternal vitamin D supplementation in neonates. The data was analyzed on RevMan 5.4 software and the quality of evidence on GRADE. Results: the newborn’s overall health condition was presented as Apgar, with a mean difference (MD) of 0.15 (CI95%=0.06-0.25; p=0.002; I2=0%, two studies, 648 participants, moderate quality evidence) at the first minute and 0.11 (CI95%=0.04-0.17; p=0.001; I2=0%, two studies, 648 participants, moderate quality evidence) at the fifth minute. Significant effects were also presented at the length at birth considering any supplemented dose (MD=0.19; CI95%=0.08-0.30; p=0.0010; I2=0%, 1452 participants, low quality evidence) and birth weight in doses higher than 4000IU/day (MD=257.05 (CI95%=137.81-376.29; p

Background: Human colostrum has been used in a number of investigations when preterm human infants cannot, for any reason, breastfeed directly from their mothers. One of the growing fields in these investigations is colostrum therapy, which consists of exposing the oropharyngeal mucosa of these preterm newborns to small amounts of raw colostrum. Research Aim: To critically review the scientific evidence about colostrum therapy in premature infants and to explore its influences on the immune system. Methods: This systematic review was performed according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA statement). The following databases were searched for potentially eligible studies up to March 10, 2021: Medline, Scopus, Web of Science, Cochrane Library, Embase. Two reviewers independently screened all titles, abstracts, and full texts for eligibility. Results: A total of 12 studies with 996 participants were included. A significant difference in lactoferrin levels in the urine was found ( SMD 0.70; 95% CI [0.03,1.36]; p = .04; I² = 65% two studies, 112 participants, very low-quality evidence). Conclusion: Colostrum seems to result in increasing lactoferrin levels in the urine of premature newborns after 1 week of intervention. Clinical Trial Registration: The study was registered at PROSPERO with the number CRD42017073624, submitted on August 9, 2017.

Compared with non-Indigenous populations, Indigenous populations experience worse health across many outcomes, including non-communicable diseases, and they are three times more likely to live in extreme poverty. The objectives were to identify (1) the content, implementation, and duration of the intervention; (2) the evaluation designs used; (3) the outcomes reported; and (4) the enablers and the challenges. Using the PRISMA-ScR guidelines, a search of research databases and grey literature was conducted. Seven studies met the inclusion criteria. Papers reported on acceptability, nutrition knowledge, fruit and vegetable intake, self-efficacy, motivation, and preference concerning fruit and vegetable, diet, and gardening. No study measured all outcomes. All papers reported on acceptability, whether implicitly or explicitly. The evaluation used mostly pre- and post-intervention assessments. The effect of gardening on nutrition and gardening knowledge and fruit and vegetable intake was inconclusive, and was related to a general lack of robust evaluations. Applying the He Pikinga Waiora Framework, however, revealed strong evidence for community engagement, cultural centeredness, integrated knowledge translation and systems thinking in increasing the acceptability and feasibility of gardening in Indigenous communities. Despite environmental challenges, the evidence signaled that gardening was an acceptable intervention for the Indigenous communities.

Background Cancer cachexia is a multifactorial syndrome characterised by an ongoing loss of skeletal muscle mass, with or without a loss of fat mass, leading to progressive functional impairment. Physical exercise may attenuate cancer cachexia and its impact on patient function. This is the first update of an original Cochrane Review published in Issue 11, 2014, which found no studies to include. Objectives To determine the effectiveness, acceptability and safety of exercise, compared with usual care, no treatment or active control, for cancer cachexia in adults. Search methods We searched CENTRAL, MEDLINE, Embase, and eight other databases to March 2020. We searched for ongoing studies in trial registries, checked reference lists and contacted experts to seek relevant studies. Selection criteria We sought randomised controlled trials in adults with cancer cachexia, that compared a programme of exercise alone or in combination with another intervention, with usual care, no treatment or an active control group. Data collection and analysis Two review authors independently assessed titles and abstracts for relevance and extracted data on study design, participants, interventions and outcomes from potentially relevant articles. We used standard methodological procedures expected by Cochrane. Our primary outcome was lean body mass and secondary outcomes were adherence to exercise programme, adverse events, muscle strength and endurance, exercise capacity, fatigue and health-related quality of life. We assessed the certainty of evidence using GRADE and included two Summary of findings tables. Main results We included four new studies in this update which overall randomised 178 adults with a mean age of 58 (standard deviation (SD) 8.2) years. Study sample size ranged from 20 to 60 participants and in three studies the proportion of men ranged from 52% to 82% (the fourth study was only available in abstract form). Three studies were from Europe: one in the UK and Norway; one in Belgium and one in Germany. The remaining study was in Canada. The types of primary cancer were head and neck (two studies), lung and pancreas (one study), and mixed (one study). We found two comparisons: exercise alone (strength-based exercise) compared to usual care (one study; 20 participants); and exercise (strength-based exercise/endurance exercise) as a component of a multimodal intervention (pharmacological, nutritional or educational (or a combination) interventions) compared with usual care (three studies, 158 participants). Studies had unclear and high risk of bias for most domains. Exercise plus usual care compared with usual care We found one study (20 participants). There was no clear evidence of a difference for lean body mass (8 weeks: MD 6.40 kg, 95% CI -2.30 to 15.10; very low-certainty evidence). For our secondary outcomes, all participants adhered to the exercise programme and no participant reported any adverse event during the study. There were no data for muscle strength and endurance, or maximal and submaximal exercise capacity. There was no clear evidence of a difference for either fatigue (4 to 20 scale, lower score was better) (8 weeks: MD -0.10, 95% CI -4.00 to 3.80; very low-certainty evidence) or health-related quality of life (0 to 104 scale, higher score was better) (8 weeks: MD 4.90, 95% CI -15.10 to 24.90; very low-certainty evidence). Multimodal intervention (exercise plus other interventions) plus usual care compared with usual care We found three studies but outcome data were only available for two studies. There was no clear evidence of a difference for lean body mass (6 weeks: MD 7.89 kg, 95% CI -9.57 to 25.35; 1 study, 44 participants; very low-certainty evidence; 12 weeks: MD -2.00, 95% CI -8.00 to 4.00; one study, 60 participants; very low-certainty evidence). For our secondary outcomes, there were no data reported on adherence to the exercise programme, endurance, or maximal exercise capacity. In one study (44 participants) there was no clear evidence of a difference for adverse events (patient episode report) (6 weeks: risk ratio (RR) 1.18, 95% CI 0.67 to 2.07; very low-certainty evidence). Another study assessed adverse events but reported no data and the third study did not assess this outcome. There was no clear evidence of a difference in muscle strength (6 weeks: MD 3.80 kg, 95% CI -2.87 to 10.47; 1 study, 44 participants; very low-certainty evidence; 12 weeks MD -5.00 kg, 95% CI -14.00 to 4.00; 1 study, 60 participants; very low-certainty evidence), submaximal exercise capacity (6 weeks: MD -16.10 m walked, 95% CI -76.53 to 44.33; 1 study, 44 participants; very low-certainty evidence; 12 weeks: MD -62.60 m walked, 95% CI -145.87 to 20.67; 1 study, 60 participants; very low-certainty evidence), fatigue (0 to 10 scale, lower score better) (6 weeks: MD 0.12, 95% CI -1.00 to 1.24; 1 study, 44 participants; very low-certainty evidence) or health-related quality of life (0 to 104 scale, higher score better) (12 weeks: MD -2.20, 95% CI -13.99 to 9.59; 1 study, 60 participants; very low-certainty evidence). Authors' conclusions The previous review identified no studies. For this update, our conclusions have changed with the inclusion of four studies. However, we are uncertain of the effectiveness, acceptability and safety of exercise for adults with cancer cachexia. Further high-quality randomised controlled trials are still required to test exercise alone or as part of a multimodal intervention to improve people's well-being throughout all phases of cancer care. We assessed the certainty of the body of evidence as very low, downgraded due to serious study limitations, imprecision and indirectness. We have very little confidence in the results and the true effect is likely to be substantially different from these. The findings of at least three more studies (one awaiting classification and two ongoing) are expected in the next review update.

Objetivo: analisar a relação custo-efetividade do tratamento da Anemia Falciforme (AF) em uso de Hidroxiureia. Método: estudo de avaliação econômica, com abordagem quantitativa, descritivo e analítico, por meio de uma coorte retrospectiva. A ser desenvolvido nos principais serviços de referência em Campo Grande/MS. Mediante três fases: revisão sistemática de literatura, com análise por odds ratio, modelo de efeito randômico inverso e qui-quadrado; coleta secundária de dados em prontuários e no DATASUS com análise por qui-quadrado ou teste exato de Fisher; análise de custo-efetividade por modelo de decisão analítica de Markov e teste t de Student. Encontra-se aprovada pelo Comitê de ética da UFMS, sob parecer n. 2.892.100. Resultados esperados: Produzir indicadores para subsidiar o aprimoramento de políticas públicas, auxiliar na tomada de decisões e condutas terapêuticas.

According to previous epidemiological studies, we can reduce the thickness of epicardial fat and improve cardiovascular risk factors through exercise, and the changes may depend on the form of exercise. We systemically reviewed published studies that evaluated exercise intervention on epicardial adipose tissue (EAT) levels. We included randomized controlled trials (RCTs) comparing one exercise with another exercise or diet for the treatment to reduce EAT. We used fixed effects models for meta-analyses; effects of exercise on outcomes were described as mean differences (MD) or standardized difference of means (SMD) was used, their 95% confidence intervals (CI). Five RCTs were included (n = 299), 156 in exercise group and 143 in the control. In comparison to the control group, exercise significantly reduced EAT (SMD - 0.57, 95%CI - 0.97 to - 0.18) and waist circumference (MD - 2.95 cm, 95%CI - 4.93 to - 0.97). Exercise did not have an effect on BMI (MD - 0.23 kg/m

BACKGROUND: Acute respiratory infections (ARIs) last for less than 30 days and are the most common acute diseases affecting people. Exercise has been shown to improve health generally, but it is uncertain whether exercise may be effective in reducing the occurrence, severity, and duration of ARIs. This is an update of our review published in 2015. OBJECTIVES: To evaluate the effectiveness of exercise for altering the occurrence, severity, or duration of acute respiratory infections. SEARCH METHODS: We searched CENTRAL (2020, Issue 2), MEDLINE (1948 to March week 1, 2020), Embase (1974 to 05 March 2020), CINAHL (1981 to 05 March 2020), LILACS (1982 to 05 March 2020), SPORTDiscus (1985 to 05 March 2020), PEDro (searched 05 March 2020), OTseeker (searched 05 March 2020), and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.gov (searched 05 March 2020). SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi‐RCTs (method of allocation that is not truly random, e.g. based on date of birth, medical record number) of exercise for ARIs in the general population. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data from the included trials using a standard form. One review author entered data, which a second review author checked. We contacted trial authors to request missing data. There were sufficient differences in the populations trialed and in the nature of the interventions to use the random‐effects model (which makes fewer assumptions than the fixed‐effect model) in the analysis. MAIN RESULTS: We included three new trials for this update (473 participants) for a total of 14 trials involving 1377 adults, published between 1990 and 2018. Nine trials were conducted in the USA, and one each in Brazil, Canada, Portugal, Spain, and Turkey. Sample sizes ranged from 16 to 419 participants, aged from 18 to 85 years. The proportion of female participants ranged from 52% to 100%. Follow‐up duration ranged from 1 to 36 weeks (median = 12 weeks). Moderate‐intensity aerobic exercise (walking, bicycling, treadmill, or a combination) was evaluated in 11 trials, and was most commonly prescribed at least three times a week for 30 to 45 minutes. There was no difference between exercise and no exercise in the number of ARI episodes per person per year (risk ratio (RR) 1.00, 95% confidence interval (CI) 0.77 to 1.30; 4 trials; 514 participants; low‐certainty evidence); proportion of participants who experienced at least one ARI over the study period (RR 0.88, 95% CI 0.72 to 1.08; 5 trials; 520 participants; low‐certainty evidence); and the number of symptom days per episode of illness (mean difference (MD) −0.44 day, 95% CI −2.33 to 1.46; 6 trials; 557 participants; low‐certainty evidence). Exercise reduced the severity of ARI symptoms measured on the Wisconsin Upper Respiratory Symptom Survey (WURSS‐24) (MD −103.57, 95% CI −198.28 to −8.87; 2 trials; 373 participants; moderate‐certainty evidence) and the number of symptom days during follow‐up period (MD −2.24 days, 95% CI −3.50 to −0.98; 4 trials; 483 participants; low‐certainty evidence). Excercise did not have a significant effect on laboratory parameters (blood lymphocytes, salivary secretory immunoglobulin, and neutrophils), quality of life outcomes, cost‐effectiveness, and exercise‐related injuries. There was no difference in participant dropout between the intervention and control groups. Overall, the certainty of the evidence was low, downgraded mainly due to limitations in study design and implementation, imprecision, and inconsistency. Seven trials were funded by public agencies; five trials did not report funding; and two trials were funded by private companies. AUTHORS' CONCLUSIONS: Exercise did not reduce the number of ARI episodes, proportion of participants experiencing at least one ARI during the study, or the number of symptom days per episode of illness. However, exercise reduced the severity of ARI symptoms (two studies) and the number of symptom days during the study follow‐up period (four studies). Small study size, risk of bias, and heterogeneity in the populations studied contributed to the uncertainty of the findings. Larger trials that are designed to avoid risk of bias associated with participant selection, blinding of outcomes assessors, and with adequate reporting of all outcomes proposed for measurement in trials, would help to provide more robust evidence.

BACKGROUND: Lower urinary tract symptoms caused by benign prostatic obstruction (LUTS/BPO) represents one of the most common clinical complaints in men. Physical activity might represent a viable first‐line intervention for treating LUTS/BPO. OBJECTIVES: To assess the effects of physical activity for lower urinary tract symptoms caused by benign prostatic obstruction (LUTS/BPO). SEARCH METHODS: We performed a comprehensive search of multiple databases (CENTRAL, MEDLINE, Embase, Web of Science, LILACS, ClinicalTrials.gov, and WHO ICTRP); checked the reference lists of retrieved articles; and handsearched abstract proceedings of conferences with no restrictions on the language of publication or publication status from database inception to 6 November 2018. SELECTION CRITERIA: We included published and unpublished randomised controlled and controlled clinical trials that included men diagnosed with LUTS/BPO. We excluded studies in which medical history suggested non‐BPO causes of LUTS or prior invasive therapies to physical activity or that used electrical stimulation. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed study eligibility, extracted data, and assessed the risk of bias of included studies. We assessed primary outcomes (symptom score for LUTS; response rate, defined as 20% improvement in symptom score; withdrawal due to adverse events) and secondary outcomes (change of medication use; need for an invasive procedure; postvoid residual urine). We assessed the quality of the evidence using the GRADE approach. MAIN RESULTS: We included six studies that randomised 652 men over 40 years old with moderate or severe LUTS. The four different comparisons were as follows: Physical activity versus watchful waiting Two RCTs randomised 119 participants. The interventions included tai chi and pelvic floor exercise. The evidence was overall of very low quality, and we are uncertain about the effects of physical activity on symptom score for LUTS (mean difference (MD) ‐8.1, 95% confidence interval (CI) ‐13.2 to ‐3.1); response rate (risk ratio (RR) 1.80, 95% CI 0.81 to 4.02; 286 more men per 1000, 95% CI 68 fewer to 1079 more); and withdrawal due to adverse events (RR 1.00, 95% CI 0.59 to 1.69; 0 fewer men per 1000, 95% CI 205 fewer to 345 more). Physical activity as part of self‐management programme versus watchful waiting Two RCTs randomised 362 participants. Pelvic floor exercise was one of multiple intervention components. The evidence was of very low quality, and we are uncertain about the effects of physical activity for symptom score for LUTS (MD ‐6.2, 95% CI ‐9.9 to ‐2.5); response rate (RR 2.36, 95% CI 1.32 to 4.21; 424 more men per 1000, 95% CI 100 more to 1000 more); and withdrawal due to adverse events (risk difference 0.00, 95% CI ‐0.05 to 0.06; 65 fewer men per 1000, 95% CI 65 fewer to 65 fewer). Physical activity as part of weight reduction programme versus watchful waiting One RCT randomised 130 participants. An unclear type of intense exercise was one of multiple intervention components. The evidence was of very low quality, and we are uncertain about the effects for symptom score for LUTS (MD ‐1.1, 95% CI ‐3.5 to 1.3); response rate (RR 1.20, 95% CI 0.74 to 1.94; 67 more men per 1000, 95% CI 87 fewer to 313 more); and withdrawal due to adverse events (RR 1.63, 95% CI 1.03 to 2.57; 184 more men per 1000, 95% CI 9 more to 459 more). Physical activity versus alpha‐blockers One RCT randomised 41 participants to pelvic floor exercise or alpha‐blockers. The evidence was of very low quality, and we are uncertain about the effects for symptom score for LUTS (MD 2.8, 95% CI ‐0.9 to 6.4) and response rate (RR 0.80, 95% CI 0.55 to 1.15; 167 fewer men per 1000, 95% CI 375 fewer to 125 more). The evidence was of low quality for withdrawal due to adverse events; the effects for this outcome may be similar between interventions (RR 0.86, 95% CI 0.06 to 12.89; 7 fewer men per 1000, 95% CI 49 fewer to 626 more). AUTHORS' CONCLUSIONS: We rated the quality of the evidence for most of the effects of physical activity for LUTS/BPO as very low. We are therefore uncertain whether physical activity affects symptom scores for LUTS, response rate, and withdrawal due to adverse events. Our confidence in the estimates was lowered due to study limitations, inconsistency, indirectness, and imprecision. Additional high‐quality research is necessary.

Background/objectives The detection of dental caries in the early stages, particularly on the occlusal surfaces, has become a mainstay of contemporary clinical practice. The objective of the study was to verify the accuracy of laser fluorescence (LF) for caries detection. Methods A comprehensive search of the MEDLINE (PubMed), EMBase, Cochrane Central Register of Controlled Trials, IBECS, BIOSIS, Web of Science, SCOPUS, Congress Abstracts and Grey literature databases was undertaken from 1980 through January 2016. We included cross-sectional studies that evaluated laser fluorescence in caries diagnoses in vitro and compared them with histological analyses. Results A total of 39 articles were included in the meta-analysis, which included 2082 caries sites. The pooled sensitivity was 0.71 (0.69, 0.73), and the specificity was 0.81 (0.73, 0.82). The DOR was 14.93 (11.2, 19.9). A summary receiver operating characteristic curve (SROC) was constructed. The area under the curve was 0.865. Conclusion This meta-analysis showed that LF in vitro had the ability to diagnose occlusal caries lesions in permanent teeth and enamel and dentin caries. This article is protected by copyright. All rights reserved

Testing Treatments is a book written to help everyone understand why testing treatments is so important, why treatment tests have to be fair, and how everyone can help to promote better research for better health care. The book proved to be very popular and its second edition has already been translated into a dozen languages, with more translations in the pipeline. The texts of the original English and all the translations are feely downloadable from Testing Treatments interactive at www.testingtreatments.org. The editors of all the different language websites have established an TTi Editorial Alliance, to share experiences and provide each other with mutual support. The TTi Editorial Alliance seeks to promote a world in which health professionals, patients and the public use reliable research to inform their health decisions. Its missions are (i) To promote a global network, involving members of the public in partnership with professionals, to communicate and discuss basic principles and general knowledge about testing treatments; (ii) to help the public increase critical thinking and skills in accessing, apprehending, appraising and using research evidence; and (iii) to help patients and the public to participate more actively in health research.

This study analyzes the reliability and validity of obesogenic built environments related to physical activity and chronic noncommunicable diseases through Google Maps in a heterogeneous urban area (i.e., residential and commercial, very poor and very rich) in Sao Paulo (SP), Brazil. There are no important differences when comparing virtual measures with street audit. Based on Kappa statistic, respectively for validity and reliability, 78% and 80% of outcomes were classified as nearly perfect agreement or substantial agreement. Virtual measures of geoprocessing via Google Maps provided high validity and reliability for assessing built environments.

Aim: We performed a systematic review to map the evidence and analyze the effect of whey protein supplementation in the elderly submitted to resistance training.Methods: A comprehensive search on Medline, LILACS, EMBASE, and the Cochrane Library for relevant publications was conducted until August 2015. The terms used in the search were: “Resistance training”; “Whey protein”; “Elderly”.Results: A total of 632 studies were screened. Five studies were included composing a sample of 391 patients. The supplement whey protein was associated with higher total protein ingestion 9.40 (95% CI: 4.03–14.78), and with an average change in plasma leucine concentration. The supplementation was also associated with increased mixed muscle protein synthesis 1.26 (95% CI: 0.46–2.07) compared to the control group.Conclusion: We observed an increase in total protein intake, resulting in increased concentration of leucine and mixed muscle protein fractional synthesis rate.

Objective We performed a systematic review and meta-analysis to estimate brain-derived neurotrophic factor (BDNF) level in patients with major depressive disorder (MDD) after electroconvulsive therapy (ECT). Method A comprehensive search of the Cochrane Library, MEDLINE, LILACS, Grey literature, and EMBASE was performed for papers published from January 1990 to April 2016. The following key terms were searched: “major depressive disorder”, “unipolar depression”, “brain-derived neurotrophic factor”, and “electroconvulsive therapy”. Results A total of 252 citations were identified by the search strategy, and nine studies met the inclusion criteria of the meta-analysis. BDNF levels were increased among patients with MDD after ECT (P value = 0.006). The standardized mean difference was 0.56 (95% CI: 0.17–0.96). Additionally, we found significant heterogeneity between studies (I 2 = 73%). Conclusion Our findings suggest a potential role of BDNF as a marker of treatment response after ECT in patients with MDD.

Background Bipolar disorder (BD) is a neuropsychiatric disorder characterized by recurrent episodes of mania/hypomania, affecting more than 1% of the world population. S100B is a calcium-binding protein, mostly produced and secreted by astrocytes in the CNS that participate in several cellular responses. Previous studies have shown that patients with bipolar disorder had higher peripheral S100B levels than healthy individuals, suggesting a potential role for S100B BD. Methods In this study, a systematic and quantitative meta-analysis of studies S100B serum was performed according to the guidelines PRISMA-statement to confirm the increase of serum S100B in patients with manic bipolar disorder. Results We included in the meta-analysis two studies that reported the mean and standard deviation of serum S100B 52 patients manic BP and 52 control studies. Our results showed higher levels of S100B peripheral TB patients compared with healthy controls. In this meta-analysis, we found evidence that serum S100B are increased in patients with bipolar disorder. Conclusion In conclusion, several studies have observed morphological abnormalities in the brains of bipolar disorder patients, changes in the peripheral S100B levels in mood disorders were described, and this protein could be a putative marker for damage to the brain. Thus, in this meta-analysis we have found evidence, based on two studies of 52 patients and 52 healthy controls, that the serum concentrations of S100B are increased in bipolar disorder patients.

BACKGROUND Lower urinary tract symptoms caused by benign prostatic obstruction (LUTS/BPO) represents one of the most common clinical complaints in men. Physical activity might represent a viable first-line intervention for treating LUTS/BPO. OBJECTIVES To assess the effects of physical activity for lower urinary tract symptoms caused by benign prostatic obstruction (LUTS/BPO). SEARCH METHODS We performed a comprehensive search of multiple databases (CENTRAL, MEDLINE, Embase, Web of Science, LILACS, ClinicalTrials.gov, and WHO ICTRP); checked the reference lists of retrieved articles; and handsearched abstract proceedings of conferences with no restrictions on the language of publication or publication status from database inception to 6 November 2018. SELECTION CRITERIA We included published and unpublished randomised controlled and controlled clinical trials that included men diagnosed with LUTS/BPO. We excluded studies in which medical history suggested non-BPO causes of LUTS or prior invasive therapies to physical activity or that used electrical stimulation. DATA COLLECTION AND ANALYSIS Two review authors independently assessed study eligibility, extracted data, and assessed the risk of bias of included studies. We assessed primary outcomes (symptom score for LUTS; response rate, defined as 20% improvement in symptom score; withdrawal due to adverse events) and secondary outcomes (change of medication use; need for an invasive procedure; postvoid residual urine). We assessed the quality of the evidence using the GRADE approach. MAIN RESULTS We included six studies that randomised 652 men over 40 years old with moderate or severe LUTS. The four different comparisons were as follows:Physical activity versus watchful waitingTwo RCTs randomised 119 participants. The interventions included tai chi and pelvic floor exercise. The evidence was overall of very low quality, and we are uncertain about the effects of physical activity on symptom score for LUTS (mean difference (MD) -8.1, 95% confidence interval (CI) -13.2 to -3.1); response rate (risk ratio (RR) 1.80, 95% CI 0.81 to 4.02; 286 more men per 1000, 95% CI 68 fewer to 1079 more); and withdrawal due to adverse events (RR 1.00, 95% CI 0.59 to 1.69; 0 fewer men per 1000, 95% CI 205 fewer to 345 more).Physical activity as part of self-management programme versus watchful waitingTwo RCTs randomised 362 participants. Pelvic floor exercise was one of multiple intervention components. The evidence was of very low quality, and we are uncertain about the effects of physical activity for symptom score for LUTS (MD -6.2, 95% CI -9.9 to -2.5); response rate (RR 2.36, 95% CI 1.32 to 4.21; 424 more men per 1000, 95% CI 100 more to 1000 more); and withdrawal due to adverse events (risk difference 0.00, 95% CI -0.05 to 0.06; 65 fewer men per 1000, 95% CI 65 fewer to 65 fewer).Physical activity as part of weight reduction programme versus watchful waitingOne RCT randomised 130 participants. An unclear type of intense exercise was one of multiple intervention components. The evidence was of very low quality, and we are uncertain about the effects for symptom score for LUTS (MD -1.1, 95% CI -3.5 to 1.3); response rate (RR 1.20, 95% CI 0.74 to 1.94; 67 more men per 1000, 95% CI 87 fewer to 313 more); and withdrawal due to adverse events (RR 1.63, 95% CI 1.03 to 2.57; 184 more men per 1000, 95% CI 9 more to 459 more).Physical activity versus alpha-blockersOne RCT randomised 41 participants to pelvic floor exercise or alpha-blockers. The evidence was of very low quality, and we are uncertain about the effects for symptom score for LUTS (MD 2.8, 95% CI -0.9 to 6.4) and response rate (RR 0.80, 95% CI 0.55 to 1.15; 167 fewer men per 1000, 95% CI 375 fewer to 125 more). The evidence was of low quality for withdrawal due to adverse events; the effects for this outcome may be similar between interventions (RR 0.86, 95% CI 0.06 to 12.89; 7 fewer men per 1000, 95% CI 49 fewer to 626 more). AUTHORS' CONCLUSIONS We rated the quality of the evidence for most of the effects of physical activity for LUTS/BPO as very low. We are therefore uncertain whether physical activity affects symptom scores for LUTS, response rate, and withdrawal due to adverse events. Our confidence in the estimates was lowered due to study limitations, inconsistency, indirectness, and imprecision. Additional high-quality research is necessary.

To compare the efficacy of cardiovascular training (CT) with resistance training (RT) in improving the health-related quality of life (HRQoL) and physical function of patients with systemic lupus erythematosus (SLE).A randomized controlled trial was conducted with participants randomly allocated to either a CT (n = 21), RT (n = 21), or control group (n = 21). The outcomes assessed were: HRQoL using the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), severity of depression using the Beck Depression Inventory (BDI), disease activity using the SLE Disease Activity Index (SLEDAI), and aerobic capacity using a 12-minute walk test (T12).Sixty-three patients (61 women and two men), aged 42.9 ± 14.4 years, with a mean body mass index (BMI) of 28.7 ± 10.6 kg/m(2), disease duration of 3.8 ± 3.3 years, and not physically active participated in the study. HRQoL improved for both exercise groups but was superior in the RT group. There was no significant difference in physical function between the intervention groups, except for aerobic capacity. Neither training programme was associated with a change in disease activity.Exercise intervention proved to be better than not exercising. CT was better than RT in improving HRQoL.

Background Physical Activity in the workplace has received special attention from researchers who are looking to promote lifelong health and well-being. The workplace is being investigated as a possible place to assess and create strategies to help people to become healthier. The transtheoretical model and stages of change has been adapted as a tool to assess the stages of behavioral change towards exercising. Objective To assess the change in health behavior following a three-month exercise program based in the workplace. Methods A quasi-experimental study design was used in which 165 employees participated in the study. An intervention program of workplace exercise was applied for three months. Participants were assessed through the transtheoretical model and stages of change questionnaire before and after intervention to understand changes in their position on the behavioral change continuum. Results The number of employees who were physically active increased after the workplace exercise intervention (13.9% , 95% CI 9.5 to 20.1; P = 0.009). There was a significant decrease in the proportion of employees in the pre-contemplation stage (-6.1% , 95% CI 3.3 to 10.8; P = 0.045) and contemplation stage (-11.5% , 95% CI 7.5 to 17.3; P = 0.017), and a significant increase in the action stage (10.9% , 95% CI 7.0 to 16.6; P = 0.003). Conclusions Engaging in workplace exercise has a significant positive effect on health behavior and willingness to become more physically active.

Background Acute respiratory infections (ARIs) last for less than 30 days and are the most common acute diseases affecting people. Exercise has been shown to improve health generally, but it is uncertain whether exercise may be effective in reducing the occurrence, severity, and duration of ARIs. This is an update of our review published in 2015. Objectives To evaluate the effectiveness of exercise for altering the occurrence, severity, or duration of acute respiratory infections. Search methods We searched CENTRAL (2020, Issue 2), MEDLINE (1948 to March week 1, 2020), Embase (1974 to 05 March 2020), CINAHL (1981 to 05 March 2020), LILACS (1982 to 05 March 2020), SPORTDiscus (1985 to 05 March 2020), PEDro (searched 05 March 2020), OTseeker (searched 05 March 2020), and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.gov (searched 05 March 2020). Selection criteria Randomised controlled trials (RCTs) and quasi-RCTs (method of allocation that is not truly random, e.g. based on date of birth, medical record number) of exercise for ARIs in the general population. Data collection and analysis Two review authors independently extracted data from the included trials using a standard form. One review author entered data, which a second review author checked. We contacted trial authors to request missing data. There were sufficient differences in the populations trialed and in the nature of the interventions to use the random-effects model (which makes fewer assumptions than the fixed-effect model) in the analysis. Main results We included three new trials for this update (473 participants) for a total of 14 trials involving 1377 adults, published between 1990 and 2018. Nine trials were conducted in the USA, and one each in Brazil, Canada, Portugal, Spain, and Turkey. Sample sizes ranged from 16 to 419 participants, aged from 18 to 85 years. The proportion of female participants ranged from 52% to 100%. Follow-up duration ranged from 1 to 36 weeks (median = 12 weeks). Moderate-intensity aerobic exercise (walking, bicycling, treadmill, or a combination) was evaluated in 11 trials, and was most commonly prescribed at least three times a week for 30 to 45 minutes. There was no difference between exercise and no exercise in the number of ARI episodes per person per year (risk ratio (RR) 1.00, 95% confidence interval (CI) 0.77 to 1.30; 4 trials; 514 participants; low-certainty evidence); proportion of participants who experienced at least one ARI over the study period (RR 0.88, 95% CI 0.72 to 1.08; 5 trials; 520 participants; low-certainty evidence); and the number of symptom days per episode of illness (mean difference (MD) -0.44 day, 95% CI -2.33 to 1.46; 6 trials; 557 participants; low-certainty evidence). Exercise reduced the severity of ARI symptoms measured on the Wisconsin Upper Respiratory Symptom Survey (WURSS-24) (MD -103.57, 95% CI -198.28 to -8.87; 2 trials; 373 participants; moderate-certainty evidence) and the number of symptom days during follow-up period (MD -2.24 days, 95% CI -3.50 to -0.98; 4 trials; 483 participants; low-certainty evidence). Excercise did not have a significant effect on laboratory parameters (blood lymphocytes, salivary secretory immunoglobulin, and neutrophils), quality of life outcomes, cost-effectiveness, and exercise-related injuries. There was no difference in participant dropout between the intervention and control groups. Overall, the certainty of the evidence was low, downgraded mainly due to limitations in study design and implementation, imprecision, and inconsistency. Seven trials were funded by public agencies; five trials did not report funding; and two trials were funded by private companies. Authors' conclusions Exercise did not reduce the number of ARI episodes, proportion of participants experiencing at least one ARI during the study, or the number of symptom days per episode of illness. However, exercise reduced the severity of ARI symptoms (two studies) and the number of symptom days during the study follow-up period (four studies). Small study size, risk of bias, and heterogeneity in the populations studied contributed to the uncertainty of the findings. Larger trials that are designed to avoid risk of bias associated with participant selection, blinding of outcomes assessors, and with adequate reporting of all outcomes proposed for measurement in trials, would help to provide more robust evidence.

Background Cancer cachexia is a complex syndrome characterized by an ongoing loss of skeletal muscle mass and progressive functional impairment. A proactive management approach is recommended, including physical exercise to maintain function via modulation of muscle metabolism, insulin sensitivity and levels of inflammation. The review aimed to determine the safety, acceptability and effectiveness of exercise in adults with cancer cachexia. Secondary aims, subject to the data availability, were to compare effectiveness according to the characteristics of the study intervention or population. Methods We sought randomised controlled trials (RCTs) in adults meeting international criteria for cancer cachexia, comparing a programme of exercise as a sole or adjunct intervention to usual care or an active control. CENTRAL, MEDLINE, EMBASE, DARE and HTA, ISI Web of Science, LILACS, PEDro, SciVerse SCOPUS, Biosis Previews PreMEDLINE and Open Grey databases were searched up to June 2014. Two authors independently assessed studies for eligibility. Results We screened 3154 separate titles and abstracts, and reviewed 16 full-texts. Corresponding authors were contacted to determine if samples met cachexia staging criteria. Most authors did not explore this concept. No trial met review eligibility criteria. We were unable to perform a meta-analysis to determine any effects from exercise intervention. Conclusion Despite a strong rationale for the use of exercise, there is insufficient evidence to determine safety and effectiveness in patients with cancer cachexia. Findings from ongoing studies are awaited. Assessment of cachexia domains, ideally against international criteria, is required for future trials of exercise and supportive care interventions.

Background Asthma is a common condition characterised by airway inflammation and airway narrowing, which can result in intermittent symptoms of wheezing, coughing and chest tightness, possibly limiting activities of daily life. Water-based exercise is believed to offer benefits for people with asthma through pollen-free air, humidity and effects of exercise on physical function. Objectives To evaluate the effectiveness and safety of water-based exercise for adults with asthma. Search methods We searched the Cochrane Airways Group Specialised Register of Trials (CAGR), the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Allied and Complementary Medicine Database (AMED), PsycINFO, the Latin American and Caribbean Health Science Information Database (LILACS), the Physiotherapy Evidence Database (PEDro), the System for Information on Grey Literature in Europe (SIGLE) and Google Scholar on 13 May 2014. We handsearched ongoing clinical trial registers and meeting abstracts of the American Thoracic Society (ATS), the European Respiratory Society (ERS) and the British Thoracic Society (BTS). Selection criteria We included all randomised controlled trials (RCTs) of adults with asthma comparing a water-based exercise group versus one or more of the following groups: usual care, land-based exercise, non-exercise. Data collection and analysis Two review authors (AJG, VS) independently extracted data from the primary studies using a standard form developed for this purpose, which includes methods, participants, interventions and outcomes. We contacted trial authors to request additional data. Data were input by one review author and were double-checked by a second review author. Main results In this systematic review, we provide a narrative synthesis of available evidence from three small studies including 136 adult participants. The studies were at high risk of bias. No meta-analysis was possible because of methodological and interventional heterogeneity between included studies. The primary outcomes of quality of life and exacerbations leading to use of steroids were not reported by these studies. For exacerbations leading to health centre/hospital visits, uncertainty was wide because a very small number of events was reported (in a single study). Secondary outcomes symptoms, lung function, changes in medication and adverse effects, where available, described for each included study. The overall quality of the studies was very low, and no clear differences were noted between water-based exercise and comparator treatments. Therefore, we remain very uncertain about the effects of water-based exercise for adults with asthma. Authors' conclusions The small number of participants in the three included studies, the clinical and methodological heterogeneity observed and the high risk of bias assessed mean that we are unable to assess the place of water-based exercise in asthma. Randomised controlled trials are needed to assess the efficacy and safety of water-based exercise for adults with asthma. For future research, we suggest greater methodological rigour (participant selection, blinding of outcome assessors, reporting of all outcomes analysed and registering of the study protocol).

Reason for Withdrawal Authors have made no progress with this protocol. No new authors are being sought to take over this protocol as this protocol has been merged with another protocol (Thyregod HGH, Moller CH, Sondergaard L, Gluud C, Steinbruchel DA. Transcatheter versus optimal medical treatment and surgical aortic valve replacement for aortic valve stenosis (Protocol). Cochrane Database of Systematic Reviews 2013, Issue 4. Art. No.: CD010488. DOI: 10.1002/14651858.CD010488). To view the published versions of this article, please click the 'Other versions' tab.

OBJETIVO: Avaliar as medidas preventivas recomendadas durante a assistência aos pacientes sintomáticos respiratórios, com tuberculose pulmonar. MÉTODOS: Estudo exploratório-descritivo, retrospectivo, desenvolvido a partir deinformações coletadasnos arquivosde pacientes sintomáticos respiratórios, com diagnóstico de saída tuberculose pulmonar. RESULTADOS: O número de casos de tuberculose no município durante o período do estudo foi de 65, 29 (44,6%) destes casos foram diagnosticados durante a internação. Quanto as medidas de biossegurança, durante a admissão dos 29 casos diagnosticados, foram encontrados registros de precaução por aerossóis nos prontuários de 13 (44,8%) pacientes. CONCLUSÃO: Os dados mostram que os profissionaisde enfermagem, que trabalham nos hospitais, continuam expostos aorisco de infecção latente. OBJECTIVE: To evaluate preventive measures recommended during patient care for respiratory symptoms, with pulmonary tuberculosis. METHODS: Exploratory-descriptive study, retrospective, developed from information collected in medical records of patients with respiratory symptoms, diagnosed with pulmonary tuberculosis. RESULTS: The number of tuberculosis cases in the city diagnosed during hospitalization during the study period was 65,29 (44.6%). As for the biosecurity measures during the hospitalization of 29 diagnosed cases, early aerosol were found in medical records in 13 (44.8%) patients. CONCLUSION: Data show that nursing professionals, working in hospitals, still exposed to risks of latent infection. Fundação Hermínio Ometto Universidade Federal de São Paulo (UNIFESP) Universidade Federal de São Paulo, EPE, São Paulo, Brazil SciELO

CONTEXTO E OBJETIVO: A tomada de decisão em saúde é complexa e deve envolver o profissional de saúde, o paciente e a evidência de melhor nível. A velocidade de geração da informação cria barreiras para manter-se atualizado. Diante disso, metodologistas propuseram um novo tipo de estudo, as overviews de revisões sistemáticas (OoRs). O objetivo é introduzir e demonstrar o papel das OoRs na síntese de informações para profissionais da área da saúde, gestores, pesquisadores e pacientes. TIPO DE ESTUDO E LOCAL: Estudo de série temporal realizado no Centro Cochrane do Brasil, em conjunto com o Programa de Pós-Graduação em Medicina Interna e Terapêutica da Disciplina de Medicina de Urgência e Medicina Baseada em Evidências do Departamento de Medicina da Universidade Federal de São Paulo (UNIFESP). MÉTODOS: Para mostrar o crescimento das publicações que fornecem evidência com alto nível e assim justificar a importância das OoRs na síntese e integração das informações, três filtros para desenhos de estudos foram aplicados em duas bases de dados. Uma equação de predição do número esperado de publicações foi desenvolvida e aplicada. RESULTADOS: Na presente década, o número de ensaios clínicos randomizados no Medline poderá chegar a 2.863.203 e o número de revisões sistemáticas poderá chegar a 174.262. Nove OoRs e 15 protocolos de OoRs foram publicados na Biblioteca Cochrane. CONCLUSÕES: Com o crescimento exponencial das publicações, demonstrado neste estudo, um novo tipo de estudo, direcionado especialmente aos decisores em saúde, foi proposto, a OoRs, o qual poderá reduzir incertezas para a tomada de decisão e gerar uma nova hierarquia na pirâmide de evidências. CONTEXT AND OBJECTIVE: Healthcare decision-making is complex and should involve healthcare professionals, patients and the best level of evidence. The speed of information production creates barriers against keeping up to date. In this light, methodologists have proposed a new type of study: overviews of systematic reviews (OoRs). The aim here was to introduce and demonstrate the role of OoRs in information synthesis for healthcare professionals, managers, researchers and patients. DESIGN AND SETTING: Time-series study conducted at the Brazilian Cochrane Center, jointly with the Postgraduate Program on Internal Medicine and Therapeutics, Discipline of Emergency Medicine and Evidence-Based Medicine, Department of Medicine, Federal University of São Paulo. METHODS: To show the growth in the numbers of published papers that provide high-level evidence and thus demonstrate the importance of OoRs for synthesis and integration of information, three filters for study designs were applied to two databases. An equation for predicting the expected number of published papers was developed and applied. RESULTS: Over the present decade, the number of randomized controlled trials in Medline might reach 2,863,203 and the number of systematic reviews might reach 174,262. Nine OoRs and 15 OoRs protocols have been published in the Cochrane Library. CONCLUSIONS: With the exponential growth of published papers, as shown in this study, a new type of study directed especially towards healthcare decision-makers was proposed, named overview of systematic reviews. This could reduce the uncertainties in decision-making and generate a new hierarchy in the pyramid of evidence. Federal University of São Paulo Program on Internal Medicine and Therapeutics Brazilian Cochrane Centre Brazilian Cochrane Centre Itapeva Social and Agrarian Sciences College EPM-UNIFESP Federal University of São Paulo UNIFESP, Program on Internal Medicine and Therapeutics EPM-UNIFESP SciELO

O objetivo do presente trabalho é analisar a qualidade de vida (QV) de acadêmicos de Educação Física de ambos os sexos e de diferentes estados brasileiros. Participaram do estudo 85 estudantes de Ponta Grossa-PR (46 do sexo masculino e 39 do sexo feminino) e 61 estudantes de Campinas-SP (31 do sexo masculino e 30 do sexo feminino). A QV foi mensurada pelo WHOQOL-bref, para análise dos resultados foi utilizada a sintaxe australiana e a consistência interna através do coeficiente Alfa de Cronbach. Para localizar as diferenças foi utilizado o teste de Kruskal-Wallis, seguido do teste de Mann-Whitney com o valor de p corrigido pela técnica de Bonferroni. A QV foi satisfatória e com os menores valores para o domínio ambiental, foram encontradas diferenças significativas entre os grupos para todos os domínios. Pode-se inferir a necessidade do investimento em políticas públicas.