Publications by authors named "Diana P Pozuelo-Carrascosa"

47 Publications

EFFECT OF EXERCISE ON FATIGUE IN MULTIPLE SCLEROSIS: A NETWORK META-ANALYSIS COMPARING DIFFERENT TYPES OF EXERCISE.

Arch Phys Med Rehabil 2021 Sep 9. Epub 2021 Sep 9.

Universidad de Castilla La-Mancha. Health and Social Research Center, Cuenca, Spain; Universidad de Castilla La-Mancha. Facultad de Enfermería de Cuenca. Cuenca, Spain; Rehabilitation in Health Research Center (CIRES), Universidad de las Americas, Santiago, Chile.

Objective: A network meta-analysis (NMA) of current evidence was conducted to determine if physical exercise has a positive influence on multiple sclerosis (MS) fatigue and type of exercise with the largest effect on fatigue also according to disease severity.

Data Sources: MEDLINE, EMBASE, SPORTDiscus, PEDro, Cochrane Library and Web of Science. The search strategy combined relevant terms related to: a) multiple sclerosis; b) clinical trials; c) exercise; and d) fatigue, from inception to February 2021.

Study Selection: Randomized controlled trials concerning the effectiveness of different types of exercise on total and physical fatigue in people with MS were included.

Data Extraction: The data were extracted into predesigned data extraction tables. Risk of bias was evaluated with the Cochrane Risk of Bias tool (RoB 2.0) and to evaluate the quality of the evidence, the Grading of Recommendations, Assessment, Development and Evaluation tool was used.

Data Synthesis: A total of 58 studies were examined. Data were pooled using a random effects model. A ranking of seven and eight different exercise interventions for physical and total fatigue scores, respectively, was achieved. The highest effects for pairwise comparisons were for combined exercise and resistance training versus control (ranging between -0.74 and -1.24). In the NMA, combined exercise (-1.51; 95% CI: -2.01, -1.01) and resistance training (-1.15; 95% CI -1.81, -0.49) compared to the control group achieved the highest effects for physical and total fatigue, respectively.

Conclusion: Exercise should be considered an effective fatigue management strategy. Among the different exercise modalities, combined exercise is the most effective exercise modality for improving both, physical and total fatigue. Resistance training is also an effective exercise for total fatigue among people diagnosed with MS.
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http://dx.doi.org/10.1016/j.apmr.2021.08.008DOI Listing
September 2021

High-Intensity Interval Training and Cardiometabolic Risk Factors in Children: A Meta-analysis.

Pediatrics 2021 Sep 8. Epub 2021 Sep 8.

Health and Social Research Center.

Context: High-intensity interval training (HIIT) has been widely used to prevent and treat cardiovascular risk factors in adolescents and adults; nevertheless, the available evidence in children is scarce.

Objective: To synthesize evidence regarding the effectiveness of HIIT interventions on improving cardiovascular risk factors and cardiorespiratory fitness (CRF) in children from 5 to 12 years old.

Data Sources: We searched 5 databases, Medline, Embase, SPORTDiscus, the Cochrane Library, and Web of Science.

Study Selection: Randomized controlled trials (RCTs) evaluating the effectiveness of HIIT interventions on cardiometabolic risk factors and CRF in children were included.

Data Extraction: Meta-analyses were conducted to determine the effect of HIIT on body composition, cardiometabolic and CRF variables in comparison with nontraining control groups.

Results: A total of 11 RCTs and 512 participants were included. The results of the meta-analysis revealed a significant improvement in peak oxygen uptake (standardized mean difference [SMD] = 1.05, 95% confidence interval [CI] = 0.34 to 1.77; = .004), in total cholesterol (SMD = -1.50, 95% CI = -2.51 to -0.48; = .004), in low-density lipoprotein cholesterol (SMD = -1.76, 95% CI = -3.12 to -0.40; = .011) and triglycerides (SMD = -1.29, 95% CI = -2.40 to -0.19; = .022) levels.

Limitations: Because of the small number of available RCTs, it was not possible to conduct a subgroup analysis or a linear meta-regression analysis.

Conclusions: HIIT is a feasible and time-efficient approach for improving CRF, total cholesterol, low-density lipoprotein cholesterol, and triglycerides levels in children.
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http://dx.doi.org/10.1542/peds.2021-050810DOI Listing
September 2021

Pilates improves physical performance and decreases risk of falls in older adults: a systematic review and meta-analysis.

Physiotherapy 2021 Sep 7;112:163-177. Epub 2021 Jun 7.

Universidad de Castilla La-Mancha, Health and Social Research Center, Cuenca, Spain; Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile.

Background: Falls are the leading cause of injury-related deaths in older adults. Physical exercise is a suitable strategy to reduce the risk of falls, but there is little research on the effectiveness of specific exercise modalities.

Objectives: To estimate the effectiveness of Pilates compared to habitual or non-exercise on physical performance and the risk of falls in older adults.

Data Sources: Five databases were searched through April 15, 2021.

Study Selection: Randomized controlled trial in people aged ≥60 years.

Outcomes: balance, strength, flexibility, functionality, and risk of falls.

Data Synthesis: Pooled standardized mean differences were calculated using a random-effects model. Subgroup analyses based on Pilates' modality, the existence of a detailed exercise protocol, supervision by a certified instructor, and overall risk of bias were performed.

Results: Thirty-nine studies were included in the systematic review and meta-analyses. The meta-analyses indicated a moderate effect of Pilates on balance (ES=0.36; 95% CI=0.21 to 0.50), strength (ES=0.63; 95% CI=0.44 to 0.81), flexibility (ES=0.41; 95% CI=0.16 to 0.67), and functionality (ES=0.51; 95% CI=0.32 to 0.72) as well as a large effect on the risk of falls (ES=0.90; 95% CI=0.41 to 1.38) in older adults when compared with control groups. The level of certainty of the findings was low for balance, flexibility, and functionality and moderate for strength and falls.

Conclusion And Implications Of Key Findings: Pilates may promote the autonomy of older people in their daily living activities. Systematic Review Registration Number PROSPERO CRD42018116452.
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http://dx.doi.org/10.1016/j.physio.2021.05.008DOI Listing
September 2021

Maintenance of Maternal Breastfeeding up to 6 Months: Predictive Models.

J Pers Med 2021 May 11;11(5). Epub 2021 May 11.

Multidisciplinary Research Group in Care (IMCU), UCLM. Av. Carlos III s/n., 45071 Toledo, Spain.

Background: There is evidence of the benefits of exclusive breastfeeding (EBF) but maintaining EBF for the minimum recommended time of 6 months is challenging.

Aims: This study aimed to determine the prevalence of breastfeeding types in a Spanish setting, explore the influencing factors, and analyze the relationships between the reasons for EBF cessation and the EBF durations achieved.

Method: This longitudinal descriptive study included 236 healthy children with standard weight followed up by the public health system. A baseline survey and three telephone interviews (1, 3, and 6 months) were conducted.

Results: The prevalence of EBF at 6 months was 19.49%. The mean age of the mothers was 32.3 (±5.3). The variables influencing EBF maintenance were the prior decision to practice EBF ( = 0.03), the belief that EBF is sufficient ( = 0.00), not offering water or fluid to the child ( = 0.04), delaying pacifier use ( < 0.001), a longer gestation time ( = 0.05), and previous experience with practicing EBF for more than 6 months ( = 0.00). The reason for the earliest EBF cessation (mean 52.63 ± 56.98 days) was the mother's lack of self-efficacy ( = 0.05).

Conclusion: Knowing the reasons for EBF cessation among mothers is important for helping mothers and preventing early weaning. A safe environment and support can prevent early weaning.
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http://dx.doi.org/10.3390/jpm11050396DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8151230PMC
May 2021

Effectiveness of Pulmonary Rehabilitation in Interstitial Lung Disease, Including Coronavirus Diseases: A Systematic Review and Meta-analysis.

Arch Phys Med Rehabil 2021 Apr 29. Epub 2021 Apr 29.

Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain; Universidad de Castilla-La Mancha, Facultad de Fisioterapia y Enfermería, Toledo, Spain; Universidad de Castilla-La Mancha, Grupo de Investigación Multidisciplinar en Cuidados (IMCU), Campus de Fábrica de Armas, Toledo, Spain.

Objective: A meta-analysis of randomized controlled trials (RCTs) was conducted to determine the effect of pulmonary rehabilitation on functional capacity and quality of life in interstitial lung diseases, including those caused by coronaviruses.

Data Sources: MEDLINE, EMBASE, SPORTDiscus, Cochrane Library, Web of Science, and MedRxiv from inception to November 2020 were searched to identify documents.

Study Selection: Publications investigating the effect of pulmonary rehabilitation on lung function (forced vital capacity [FVC]), exercise capacity (6-minute walk distance [6MWD]), health related quality of life (HRQOL), and dyspnea were searched.

Data Extraction: The data were extracted into predesigned data extraction tables. Risk of bias was evaluated with the Cochrane Risk of Bias tool (RoB 2.0).

Data Synthesis: A total of 11 RCTs with 637 interstitial lung disease patients were eligible for analyses. The pooled effect sizes of the association for pulmonary rehabilitation were 0.37 (95% confidence interval [CI], 0.02-0.71) for FVC, 44.55 (95% CI, 32.46-56.64) for 6MWD, 0.52 (95% CI, 0.22-0.82) for HRQOL, and 0.39 (95% CI, -0.08 to 0.87) for dyspnea. After translating these findings considering clinical improvements, pulmonary rehabilitation intervention increased predicted FVC by 5.5%, the 6MWD test improved by 44.55 m, and HRQOL improved by 3.9 points compared with baseline values. Results remained similar in sensitivity analyses.

Conclusions: Although specific evidence for pulmonary rehabilitation of coronavirus disease 2019 patients has emerged, our data support that interstitial lung disease rehabilitation could be considered as an effective therapeutic strategy to improve the functional capacity and quality of life in this group of patients.
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http://dx.doi.org/10.1016/j.apmr.2021.03.035DOI Listing
April 2021

Relationship between both cardiorespiratory and muscular fitness and health-related quality of life in children and adolescents: a systematic review and meta-analysis of observational studies.

Health Qual Life Outcomes 2021 Apr 21;19(1):127. Epub 2021 Apr 21.

Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Castilla-La Mancha, Spain.

Background: No review to date has evaluated the association between physical fitness and health-related quality of life (HRQoL) in healthy children and adolescents. The aims of this systematic review and meta-analysis were to examine the relationship between both cardiorespiratory fitness (CRF) and muscular fitness (MF) and HRQoL in healthy subjects under 18 years of age and to describe the dimensions of HRQoL in which these relationships are more robust.

Methods: The Medline, Embase, Cochrane Library, SCIELO, SPORTDiscus and PEDro databases were systematically searched to collect observational studies that examined the relationship between CRF and HRQoL and between MF and HRQoL in participants under 18 years of age without any diagnosed medical condition. Pooled effect sizes (ES) were estimated for the associations between both CRF and MF and the various HRQoL dimensions.

Results: The pooled ES (95% CI) estimates for the relationship between CRF and HRQoL were as follows: 0.19 (0.10 to 0.27) for physical well-being, 0.19 (0.07 to 0.32) for psychological well-being, 0.20 (- 0.14 to 0.55) for perceived health status, 0.10 (0.00 to 0.20) for self-perception/self-esteem, 0.07 (- 0.05 to 0.19) for quality of family relationship, 0.14 (0.04 to 0.25) for quality of peer relationship, 0.17 (0.04 to 0.29) for everyday functioning at school and 0.20 (0.12 to 0.28) for total HRQoL score. The pooled ES (95% CI) estimates for the relationship between MF and HRQoL were: 0.25 (0.12 to 0.37) for physical well-being, 0.11 (0.04 to 0.17) for psychological well-being, 0.08 (0.01 to 0.15) for quality of family relationship, 0.14 (0.03 to 0.25) for quality of peer relationship, and 0.09 (0.03 to 0.14) for total HRQoL score.

Conclusions: Our data suggest that both CRF and MF are positively associated with HRQoL, mainly in physical, psychological and peer relationships. Moreover, CRF is positively associated with school dimensions and MF is positively associated with family relationships. Trail registration Protocol PROSPERO registration number: CRD42015025823.
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http://dx.doi.org/10.1186/s12955-021-01766-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8059195PMC
April 2021

Resting Heart Rate as a Predictor of Cancer Mortality: A Systematic Review and Meta-Analysis.

J Clin Med 2021 Mar 25;10(7). Epub 2021 Mar 25.

Health and Social Care Research Center, Universidad de Castilla-La Mancha, 16071 Cuenca, Spain.

This work was aimed to synthetize the evidence available about the relationship between resting heart rate (RHR) and the risk of cancer mortality. A computerized search in the Medline, EMBASE, Web of Science, and Cochrane Library databases from their inception to 24 September 2020 was performed. We performed three meta-analyses: (1) cancer mortality comparing the "less than 60 bpm" and "more than 60 bpm" categories; (2) cancer mortality comparing "less than 60 bpm", "60 to 80 bpm", and "more than 80 bpm" categories; and (3) analysis for 10-12 and 20 bpm increase in RHR and risk of cancer mortality. Twenty-two studies were included in the qualitative review, and twelve of them met the inclusion criteria for the meta-analysis. Our results showed a positive association between RHR and the risk of cancer mortality. This association was shown in a meta-analysis comparing studies reporting mean RHR values below and above 60 bpm, when comparing three RHR categories using less than 60 bpm as the reference category and, finally, in dose response analyses estimating the effect of an increase of 10-12 bpm in RHR, both in men and in women. In conclusion, a low RHR is a potential marker of low risk of cancer mortality.
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http://dx.doi.org/10.3390/jcm10071354DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8037294PMC
March 2021

Physical Activity, Mental Health and Consumption of Medications in Pre-Elderly People: The National Health Survey 2017.

Int J Environ Res Public Health 2021 01 26;18(3). Epub 2021 Jan 26.

Facultad de Fisioterapia y Enfermería, Campus de Fábrica de Armas, Universidad de Castilla-La Mancha, Av de Carlos III, nº 21, 45071 Toledo, Spain.

The promotion of Physical Activity (PA) is an important public health goal to reduce comorbidity and diseases associated with aging such as anxiety and depression. To investigate the association between level of PA, mental health and the consumption of medications among a representative cohort of Spanish pre-elderly people. Cross-sectional study with 5977 participants aged 50 to 64 years who participated in the National Health Survey in Spain 2017. The levels of PA were evaluated using the International Physical Activity Questionnaire and the mental conditions were measured by the Goldberg Health Questionnaire-12 (GHQ-12). The chi-square test was used for qualitative variables; Pearson's correlation was conducted between GHQ-12 score with different quantitative variables; and a logistic regression was used to determine the association between PA and mental health with the sociodemographic characteristics. The participants were 51.9% women and 48.1% men with a mean age of 56.79 years, and 35.5% of participants had a low level of PA. A low level of PA was associated with cases of mental health vulnerability, anxiety and depression (in women), the consumption of more medications and greater multimorbidity. It is important that people reach old age with an optimal health status in order to reduce age-related disability and morbidity. More than a third of the Spanish pre-elderly do not reach the levels of PA recommended by the WHO. People who had low level of PA consumed more medications and had higher mental health vulnerability and greater multimorbidity.
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http://dx.doi.org/10.3390/ijerph18031100DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7908116PMC
January 2021

Factors Associated with the Abandonment of Exclusive Breastfeeding before Three Months.

Children (Basel) 2020 Dec 16;7(12). Epub 2020 Dec 16.

Grupo de Investigación Multidisciplinar en Cuidados (IMCU), UCLM, Av. Carlos III s/n., 45071 Toledo, Spain.

The commencement and maintenance of exclusive breastfeeding (EB) are dependent on several mother-infant factors. To analyse the prevalence of EB during four different periods and to analyse the factors that can affect its maintenance, we performed a prospective, observational, longitudinal study of 236 mothers and their child between 37 and 42 weeks of gestation and weighing more than 2.5 kg. Four interviews were conducted (T1: on discharge, T2: at 15 days, T3: at one month, T4: at three months). The results showed that EB decreased considerably at three months (69.5% vs. 47.46%). The factors that reduced the risk of abandonment were as following: having decided before giving birth that one wants to offer breastfeeding (T2: odds ratio (OR): 0.02, = 0.001), T3 (OR: 0.04, = 0.001) and T4 (OR: 0.07, = 0.01)) and having previous experience with EB (T2 (OR: 0.36, = 0.01), T3 (OR: 0.42 = 0.02) and T4 (OR: 0.51, = 0.03)). The factors that increased the risk of EB abandonment were offering feeding bottles in the hospital (T2 (OR: 11. 06, = 0.001); T3 (OR: 5.51, = 0.001) and T4 (OR: 4.43, = 0.001)) and thinking that the infant is not satisfied (T2 (OR: 2.39, = 0.01) and T3 (OR: 2.34, = 0.01)). In conclusion, the abandonment of EB in the first three months is associated with sociodemographic and clinical variables and psychological factors such as insecurity and doubts of the mother during the process and the absence of a favourable close environment.
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http://dx.doi.org/10.3390/children7120298DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7766654PMC
December 2020

Health-Related Quality of Life in Levothyroxine-Treated Hypothyroid Women and Women without Hypothyroidism: A Case-Control Study.

J Clin Med 2020 Nov 27;9(12). Epub 2020 Nov 27.

Facultad de Fisioterapia y Enfermería de Toledo, Universidad de Castilla la Mancha, 45005 Toledo, Spain.

The use of levothyroxine is not always related to the elimination of the symptoms of hypothyroidism. The aim of this study is to compare the health-related quality of life (HRQOL) of a group of hypothyroid women under levothyroxine treatment with that of a group of non-hypothyroid women.

Methodology: A case-control study was performed. We used convenience sampling. The case group consisted of 152 levothyroxine-treated hypothyroid women; the control group consisted of 238 women without hypothyroidism disorders. All of the participants were euthyroid according to the clinical practice guidelines. We used as instruments the Short Form-12 questionnaire (SF-12v1) and a sociodemographic questionnaire.

Results: Hypothyroid women scored significantly lower in HRQOL in SF-12v1 mental and physical components than the control group (mental component summary: 41.23 ± 12.12 vs. 46.45 ± 10.22, 0.001; physical component summary: 49.64 ± 10.16 vs. 54.75 ± 5.76, 0.001). body mass index (BMI) and age showed an influence on the physical component ( 0.001 in both variables). Adjusted for age and BMI, hypothyroidism was still related to worse scores ( 0.001).

Conclusion: Despite being euthyroid, women with hypothyroidism showed a poorer quality of life than women without hypothyroidism. Health professionals need to assess the HRQOL of women with hypothyroidism. Further research on HRQOL and hypothyroidism is needed.
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http://dx.doi.org/10.3390/jcm9123864DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7761108PMC
November 2020

The accuracy of toe brachial index and ankle brachial index in the diagnosis of lower limb peripheral arterial disease: A systematic review and meta-analysis.

Atherosclerosis 2020 12 1;315:81-92. Epub 2020 Oct 1.

Universidad de Castilla-La Mancha. Health and Social Research Center, Cuenca, Spain; Universidad de Castilla-La Mancha, Facultad de Enfermería, Cuenca, Spain.

Background And Aims: We aimed to compare the diagnostic accuracy of ankle brachial index (ABI) and toe brachial index (TBI) for peripheral arterial disease (PAD) in a wide spectrum of PAD populations and reference standard tests, and to examine variables influencing heterogeneity in the estimates.

Methods: Systematic searches in EMBASE, MEDLINE, Web of Science and the Cochrane Library databases were performed, from inception to January 2020. Hierarchical summary receiver operating characteristic curves (HSROC) were used to summarize the pooled test performance.

Results: Thirty five (patient-level: 1318 patients, limb-level: 5637 limbs) and nine studies (patient-level: 294 patients, limb-level: 826 limbs) were included in ABI and TBI meta-analyses, respectively. The QUADAS-2 tool identified many studies with high risk of bias, especially in the "patient selection" domain. Pooled estimates for ABI in detecting 50% or greater stenosis were sensitivity = 61% (95% CI: 55-69), specificity = 92% (95% CI: 89-95) and dOR = 16.5 (95% CI: 11.5-23.6). Similarly, TBI yielded sensitivity = 81% (95% CI: 70-94), specificity = 77% (95% CI: 66-90) and dOR = 13.1 (95% CI: 7.0-24.8). In a direct comparison of seven studies jointly analyzing ABI and TBI, TBI showed better overall diagnostic accuracy (16.4 vs 11.0 in dOR) at the expense of sensitivity (82% vs 52%), while specificity (77% vs 94%) performed worse in TBI than ABI. Heterogeneity was large in sensitivity for ABI, with variables as different reference standard tests, smoking habit and PAD prevalence accounting for such variability. Similarly, gender, different index test cut-offs and sample size influenced the heterogeneity in TBI specificity.

Conclusions: Though ABI and TBI showed similar diagnostic performance to diagnose PAD, TBI showed far better sensitivity than ABI, especially in "challenging populations", as those exhibiting calcification.
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http://dx.doi.org/10.1016/j.atherosclerosis.2020.09.026DOI Listing
December 2020

Poor Sleep Quality Decreases Concurrent Training Benefits in Markers of Metabolic Syndrome and Quality of Life of Morbidly Obese Patients.

Int J Environ Res Public Health 2020 09 18;17(18). Epub 2020 Sep 18.

Quality of Life and Wellness Research Group API4, Laboratory of Human Performance, Department of Physical Activity Sciences, Universidad de Los Lagos, Osorno 5290000, Chile.

Sleep quality (SQ) plays a role in multiple activities of daily living, but little is known about its role in concurrent training [CT, high-intensity interval (HIIT) plus resistance training (RT)] adaptations for metabolic syndrome (MetS) and health-related quality of life (HRQoL) markers. The aim of the present study was to determine the effects of a 20-week CT programme on MetS and HRQoL markers according to the SQ of morbidly obese patients. Twenty-nine morbidly obese patients were allocated to one of two groups: good sleep quality (GSQ, n = 15, 38.07 ± 12.26 years) and poor sleep quality (PSQ, n = 14, 40.79 ± 11.62 years). HRQoL, body mass index, waist circumference (WC), systolic and diastolic blood pressure (SDP and DBP, respectively), and plasma outcomes were measured. The GSQ group reported significant changes (pre- vs. post-intervention) in WC (114.0 ± 3.1 vs. 110.4 ± 3.4 cm, p = 0.012), systolic blood pressure (SBP) (137.0 ± 4.3 vs. 125.6 ± 1.8 mmHg, p = 0.006), and HRQoL general health (51.33 ± 21.08 vs. 64.33 ± 16.24, p = 0.020). By contrast, the PSQ group showed significant changes only in SQ (9.00 ± 2.42 vs. 5.36 ± 2.84, p = 0.004). Morbidly obese PSQ patients showed a lower response for improving MetS and HRQoL markers after a 20-week CT programme than GSQ peers. However, there was a greater effect size for decreasing WC and SBP in favour of the GSQ compared with the PSQ group, suggesting that there are limitations to CT benefits on these outcomes in the PSQ group. These results call for more complex future studies.
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http://dx.doi.org/10.3390/ijerph17186804DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7558448PMC
September 2020

Effectiveness of Respiratory Muscle Training for Pulmonary Function and Walking Ability in Patients with Stroke: A Systematic Review with Meta-Analysis.

Int J Environ Res Public Health 2020 07 24;17(15). Epub 2020 Jul 24.

Faculty of Physiotherapy and Nursing of Toledo, University of Castilla-La Mancha, 45005 Toledo, Spain.

: Neurological dysfunction due to stroke affects not only the extremities and trunk muscles but also the respiratory muscles. : to synthesise the evidence available about the effectiveness of respiratory muscle training (RMT) to improve respiratory function parameters and functional capacity in poststroke patients. : a systematic electronic search was performed in the MEDLINE, EMBASE, SPORTDiscus, PEDro and Web of Science databases, from inception to May 2020. : randomised controlled trials (RCTs) that examined the effects of RMT versus non-RMT or sham RMT in poststroke patients. We extracted data about respiratory function, respiratory muscle strength and functional capacity (walking ability, dyspnea, balance, activities of daily life), characteristics of studies and features of RMT interventions (a type of RMT exercise, frequency, intensity and duration). Two reviewers performed study selection and data extraction independently. : nineteen RCTs met the study criteria. RMT improved the first second forced expiratory volume (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF), maximal expiratory pressure (MEP), maximal inspiratory pressure (MIP) and walking ability (6 min walking test), but not Barthel index, Berg balance scale, and dyspnea. : RMT interventions are effective to improve respiratory function and walking ability in poststroke patients.
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http://dx.doi.org/10.3390/ijerph17155356DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7432552PMC
July 2020

Exercise versus fixed-dose combination therapy for cardiovascular risk factors control and atherosclerotic disease prevention: a network meta-analysis protocol.

BMJ Open 2020 07 8;10(7):e036734. Epub 2020 Jul 8.

Social and Health Care Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain.

Introduction: Despite the consistent evidence of the benefits of physical activity on preventing atherosclerotic cardiovascular diseases (ASCVD) and some cardiovascular risk factors, such as hypertension and dyslipidaemia, the prescription of drugs remains the most widely used approach to prevent ASCVD in clinical settings. The purpose of this study protocol is to provide a meta-synthesis methodology for comparing the effect of fixed-dose combination therapy and physical exercise on controlling cardiovascular risk factors and preventing ASCVD.

Methods And Analysis: This protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols and the recommendations of the Cochrane Collaboration Handbook. We plan to conduct a computerised search in Medline, Web of Science, Embase, Cochrane Database of Systematic Reviews and SPORTDiscus from inception to May 2020 for studies testing the effectiveness of physical exercise or fixed-dose combination drug therapy in preventing ASCVD, all-cause and cardiovascular mortality and controlling some cardiovascular risk factors (hypertension and dyslipidaemia). Since performing network meta-analyses (NMA) is a statistical approach that allows direct and indirect comparisons of interventions, where sufficient studies are included, we plan to perform the following NMA comparing the effect of fixed-dose combination therapy and physical exercise interventions on (1) improving lipid profile, (2) reducing blood pressure, (3) preventing cardiovascular events and all-cause and cardiovascular mortality and (4) improving compliance with the therapeutic strategy and reducing adverse events.

Ethics And Dissemination: Ethical approval will not be needed because data included in the NMA will be extracted from published trials that meet accepted ethical standards. The results will be published in academic peer-reviewed journals, and the evidence gathered by this project could be included in the preventive cardiovascular disease guidelines.

Prospero Registration Number: CRD42019122794.
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http://dx.doi.org/10.1136/bmjopen-2019-036734DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7348467PMC
July 2020

Accuracy of Pulse Wave Velocity Predicting Cardiovascular and All-Cause Mortality. A Systematic Review and Meta-Analysis.

J Clin Med 2020 Jul 2;9(7). Epub 2020 Jul 2.

Universidad de Castilla-La Mancha, Health and Social Research Center, 16071 Cuenca, Spain.

Increased arterial stiffness has been associated with an increased risk of developing cardiovascular diseases and all-cause mortality. Pulse wave velocity (PWV) is an innovative and affordable measurement of arterial stiffness which may be an accessible tool to estimate mortality risk; however, no meta-analysis has estimated its predictive performance for cardiovascular and all-cause mortality. Moreover, reference values for PWV have only been established by consensus for healthy populations. The aim of this review was to estimate PWV and especially carotid femoral PWV performance predicting cardiovascular and all-cause mortality as well as comparing the resulting cfPWV thresholds with already established values in order to increase its validity. Original studies measuring PWV thresholds and its association with cardiovascular and all-cause mortality were systematically searched. The DerSimonian and Laird method was used to compute pooled estimates of diagnostic odds ratio (dOR), and overall test performances were summarized in hierarchical summary receiver operating characteristic curves (HSROC). Six studies were included in the meta-analysis. The pooled dOR values for the predictive performance of cfPWV were 11.23 (95 % CI, 7.29-1.29) for cardiovascular mortality and 6.52 (95% CI, 4.03-10.55) for all-cause mortality. The area under the HSROC curve for cfPWV was 0.75 (95% CI, 0.69-0.81) for cardiovascular mortality and 0.78 (95% CI, 0.74-0.83) for all-cause mortality, where the closest cut-off point to the summary point was 10.7 and 11.5, respectively. This systematic review and meta-analysis demonstrates that cfPWV is a useful and accurate cardiovascular mortality predictor and that its previously estimated reference values for estimating risk may be used in high-risk populations.
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http://dx.doi.org/10.3390/jcm9072080DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7408852PMC
July 2020

Effectiveness of hallux valgus surgery on patient quality of life: a systematic review and meta-analysis.

Acta Orthop 2020 08 14;91(4):450-456. Epub 2020 May 14.

Health and Social Research Center, Universidad de Castilla La Mancha, Cuenca, Spain.

Background and purpose - The quality of life (QoL) of patients with hallux valgus (HV) usually improves postoperatively. Evidence regarding the effect of HV surgery on different domains of patient QoL remains inconclusive. This systematic review and meta-analysis estimates the effect of HV surgery on patient QoL through distinguishing effects on physical domains (comprising physical function and body pain domains) using the EuroQol-5D, short form (SF) health survey-12, and SF-36 QoL scales and a visual analogue scale (VAS) score and mental and social domains using QoL scales.Patients and methods - MEDLINE, EMBASE, Cochrane Library, and Web of Science databases were systematically searched from inception to March 2019 for studies on the effect of HV surgery on patient QoL. A standardized mean difference score was calculated for each specific QoL domain (mental, social, pain, physical, and VAS) using Cohen's d index. The pooled effect size (ES) was estimated using a random-effects model based on the DerSimonian and Laird method.Results - From 12 published studies selected, the estimated pooled ES for QoL was 1.01 (95% confidence interval [CI] 0.52-1.51; I = 87%) for body pain and 0.43 (CI 0.31-0.55, I = 35%) for physical function. Regarding the composite mental and social domains of QoL, the pooled ES estimates were 0.24 (CI 0.00-0.47, I = 80%) and 0.42 (CI 0.21-0.63, I = 6.4%), respectively. The pooled difference in means for the VAS score was -4.1 (CI -4.5 to -3.6, I = 90%).Interpretation - Our data showed that HV surgery decreased patients' perceptions regarding pain. Furthermore, the data confirmed that HV surgery increased patients' QoL, particularly concerning physical and social domains.
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http://dx.doi.org/10.1080/17453674.2020.1764193DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8023907PMC
August 2020

Barriers and Facilitators Perceived by Spanish Experts Concerning Nursing Research: A Delphi Study.

Int J Environ Res Public Health 2020 05 6;17(9). Epub 2020 May 6.

Centro de Estudios Sociosanitarios, Facultad de Enfermería de Cuenca, Universidad de Castilla-La Mancha, 16071 Cuenca, Spain.

The identification of research priorities in line with current health needs and nursing competencies is a priority. Nevertheless, barriers and facilitators perceived by nurses to performing nursing research have scarcely been investigated. The main aim of this study was to explore the situation in nursing research in Spain, as perceived by Spanish experts. A Delphi study technique in two phases was applied using an online survey tool. A panel of 20 nursing experts in nursing, teaching and management positions participated. The strengths highlighted were the possibility of reaching the PhD level, the possibility of receiving continuous training in research methodology, and access to scientific knowledge through the Internet. The weaknesses identified were the lack of Spanish nursing journals in which to publish the research results, the lack of funding in nursing care research, and the lack of connection between the healthcare institutions and the university. According to the experts, elements that could enhance leadership in research are the creation of nursing research units in hospitals, the economic recognition of nurses with PhDs, and considering research work as part of their daily tasks in clinical settings. The idea of being subordinated to physicians still remains in nurses' ways of thinking.
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http://dx.doi.org/10.3390/ijerph17093224DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7246773PMC
May 2020

Arterial Stiffness and Cognition Among Adults: A Systematic Review and Meta-Analysis of Observational and Longitudinal Studies.

J Am Heart Assoc 2020 03 28;9(5):e014621. Epub 2020 Feb 28.

Universidad de Castilla-La Mancha Health and Social Research Center Cuenca Spain.

Background To estimate the strength of the cross-sectional and longitudinal association between arterial stiffness, measured by pulse-wave velocity, and cognitive function, distinguishing between global cognition, executive functions, and memory and to examine the influence of demographic, clinical, and assessment characteristics on this relationship. Methods and Results Systematic review of MEDLINE (via PubMed), Scopus, and WOS databases from their inception to March 2019, to identify cross-sectional and longitudinal studies on the association between pulse-wave velocity and cognitive domains (ie, global cognition, executive functions, and memory) among adult population. A total of 29 cross-sectional and 9 longitudinal studies support the negative relationship between arterial stiffness and cognitive function, including global cognition, executive function, and memory. Demographic, clinical, and assessment characteristics did not substantially modify the strength of this association. Conclusions Evidence reveals a negative association between arterial stiffness, measured using pulse-wave velocity, and cognition, specifically executive function, memory, and global cognition. This association seems to be independent of demographic, clinical, and assessment characteristics. These results accumulate evidence supporting that pulse-wave velocity assessment could be a useful tool to identify individuals at high risk of cognitive decline or early stages of cognitive decline, to implement interventions aimed at slowing the progression to dementia.
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http://dx.doi.org/10.1161/JAHA.119.014621DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7335587PMC
March 2020

The effectiveness of high-intensity interval training on body composition, cardiorespiratory fitness, and cardiovascular risk factors in children: A protocol for a systematic review.

Medicine (Baltimore) 2020 Feb;99(8):e19233

Universidad de Castilla-La Mancha, Health and Social Research Center.

Background: No previous systematic review has examined the effect of high-intensity interval training (HIIT) interventions on body composition, cardiometabolic risk factors and cardiorespiratory fitness (CRF) in healthy schoolchildren from 5 to 12 years old.

Methods: This study will be conducted by following the guideline of the preferred reporting items for systematic review and meta-analysis protocols. An electronic search in MEDLINE (via PubMed), EMBASE (via Scopus), SPORTDiscus, Cochrane Library and Web of Science databases of all dates from inception will be conducted. We will include randomized controlled trials aimed to assess the effectiveness of HIIT to improve cardiometabolic risk factors, body composition, and CRF in children. Two authors will perform the study selection and data collection; disagreements will be solved by a third reviewer. The methodological quality of studies will be assessed by the Cochrane Collaboration's tool for assessing risk of bias (RoB2). Data analysis and synthesis will be performed by Comprehensive Meta-analysis Software and StataSE software, version 15.

Conclusion: The results should be disseminated through publication in a peer-reviewed journal. Since the data used in systematic reviews of this type will be extracted exclusively from published studies, approval form and ethics committee will not be required.
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http://dx.doi.org/10.1097/MD.0000000000019233DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7034648PMC
February 2020

Subglottic secretion drainage for preventing ventilator-associated pneumonia: an overview of systematic reviews and an updated meta-analysis.

Eur Respir Rev 2020 Mar 12;29(155). Epub 2020 Feb 12.

Health and Social Care Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain.

Although several guidelines recommend subglottic secretion drainage as a strategy for prevention of ventilator-associated pneumonia (VAP), its use is not widespread. With the aim to assess the effectiveness of subglottic secretion drainage for preventing VAP and to improve other outcomes such as mortality, duration of mechanical ventilation and length of stay in the intensive care unit (ICU) or hospital, an electronic search of the Cochrane Library, MEDLINE, Web of Science and Embase was undertaken. Nine systematic reviews with meta-analysis (in the overview of reviews) and 20 randomised controlled trials (in the updated meta-analysis) were included.In the overview of reviews, all systematic reviews with meta-analysis included found a positive effect of subglottic secretion drainage in the reduction of incidence of VAP. In the updated meta-analysis, subglottic secretion drainage significantly reduced VAP incidence (risk ratio (RR) 0.56, 95% CI 0.48-0.63; I=0%, p=0.841) and mortality (RR 0.88, 95% CI 0.80-0.97; I=0%, p=0.888).This is the first study that has found a decrease of mortality associated with the use of subglottic secretion drainage. In addition, subglottic secretion drainage is an effective measure to reduce VAP incidence, despite not improving the duration of mechanical ventilation and ICU and/or hospital length of stay.
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http://dx.doi.org/10.1183/16000617.0107-2019DOI Listing
March 2020

Aerobic fitness and academic achievement: A systematic review and meta-analysis.

J Sports Sci 2020 Mar 31;38(5):582-589. Epub 2020 Jan 31.

Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain.

This study aims to quantify the association between aerobic fitness and academic achievement, and determine how different aerobic fitness tests and individual demographic characteristics may modify this association. It includes 41 cross-sectional and 7 longitudinal studies focusing on children and adolescents, from MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database and Web of Science. Pooled effect sizes (ES) were estimated for the association between aerobic fitness and specific domains of academic achievement. Subgroup analyses and meta-regressions were based on aerobic fitness tests and demographic characteristics. The ES for the association between aerobic fitness with language/reading-skills, mathematics-related skills and composite scores, were 0.23 (95% CI: 0.12; 0.34); 0.27 (95% CI: 0.19; 0.36) and 0.28 (95% CI: 0.12; 0.45), respectively. Subgroup analyses by aerobic fitness test modified these associations; additionally, analyses by sex or age showed differences between boys and girls as well as between children and adolescents. Finally, meta-regressions revealed a slight effect of body mass index on these associations. Cardiorespiratory fitness is positively associated with academic achievement. Associations were dependent on demographic and aerobic fitness test characteristics, being stronger in boys than in girls, and in children than in adolescents.: PROSPERO CRD42017069677.
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http://dx.doi.org/10.1080/02640414.2020.1720496DOI Listing
March 2020

Relationship between exclusive breastfeeding and cardiorespiratory fitness in children and adolescents: A meta-analysis.

Scand J Med Sci Sports 2020 May 20;30(5):828-836. Epub 2020 Jan 20.

Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain.

Background: Exclusive breastfeeding has been examined as a determinant factor of cardiorespiratory fitness in children and adolescents; however, previous research has reported certain gaps and controversial conclusions related to the real effect of breastfeeding on cardiorespiratory fitness. The aim of this systematic review and meta-analysis was to assess the relationship between breastfeeding, in terms of duration and exclusivity, and cardiorespiratory fitness in schoolchildren and adolescents aged four to 18 years.

Methods: MEDLINE, EMBASE, Web of Science, and Cochrane Library were searched systematically from their inception to December 2019. Observational studies addressing the association between breastfeeding and cardiorespiratory fitness in children and adolescents were included. The random-effects method was used to estimate the pooled effect sizes and their respective 95% confidence intervals for all exclusive breastfeeding categories and cardiorespiratory fitness. Positive values indicated a direct relationship between exclusive breastfeeding and cardiorespiratory fitness.

Results: Eight published articles were included (a total of 16 862 children and adolescents, aged from seven to 15 years). The pooled effect sizes for exclusive breastfeeding categories on cardiorespiratory fitness were as follows: 0.01 (-0.07 to 0.09) for less than 3 months; 0.09 (0.00 to 0.19) for 3-6 months; 0.07 (-0.01 to 0.16) for less than 6 months; and 0.14 (0.02 to 0.27) for more than 6 months.

Conclusions: The best current evidence indicates that longer exclusive breastfeeding is positively associated with higher cardiorespiratory fitness during childhood and adolescence.
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http://dx.doi.org/10.1111/sms.13622DOI Listing
May 2020

Associations between Dairy Intake, Body Composition, and Cardiometabolic Risk Factors in Spanish Schoolchildren: The Cuenca Study.

Nutrients 2019 Dec 3;11(12). Epub 2019 Dec 3.

Centro de Estudios Socio-Sanitarios, Universidad de Castilla-La Mancha, 16071 Cuenca, Spain.

Full-fat dairy has been traditionally associated with obesity and cardiovascular disease (CVD); however, recent evidence shows that the amount of dairy intake might have a beneficial effect over these pathologies, regardless of their fat content. The aim of this study was to examine the association between the intake of dairy products (including milk with different fat contents) with both adiposity and serum lipid concentration, adjusted by cardiorespiratory fitness (CRF), in Spanish schoolchildren. A cross-sectional study of 1088 children, aged 8 to 11 years, was conducted in which anthropometric variables (body mass index (BMI), waist circumference (WC), fat mass percentage (FM%) and fat mass index (FMI)), blood lipid profile, and dairy intake (using a food frequency questionnaire), and CRF (through a 20-m shuttle run test) were measured. Results showed that children with lower BMI, WC, FM%, and FMI had higher whole-fat milk intake and lower skimmed and semi-skimmed milk intake than children with higher BMI, WC, FM%, and FMI. Children with normal levels of triglycerides and high density lipoproteins (HLD) cholesterol consumed more whole-fat milk and less reduced-fat milk than children with dyslipidemic patterns. These relationships persisted after adjustment for CRF. Our findings suggest that full-fat milk intake should be promoted in children without obesity or high cardiometabolic risk.
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http://dx.doi.org/10.3390/nu11122940DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6950103PMC
December 2019

Effect of different types of exercise on health-related quality of life during and after cancer treatment: a protocol for a systematic review and network meta-analysis.

BMJ Open 2019 11 3;9(11):e031374. Epub 2019 Nov 3.

Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain.

Introduction: Cancer (and survival) is known to affect the quality of life. Strategies as physical activity and exercise during and after cancer may improve health-related qualify of life (HRQOL) outcomes and are, therefore, of clinical and public health importance. To the best of our knowledge, comparative evidence of the effect of the different types of exercise on improving HRQOL in cancer patients has not been synthesised thus far. We aim to conduct a systematic review and network meta-analysis in order to synthesise all available evidence regarding the effect of different types of exercise interventions on HRQOL during and after cancer treatment.

Methods And Analysis: MEDLINE (via PubMed), Web of Science, Embase, The Cochrane Library and SPORTDiscus will be searched from inception to December 2018 for relevant randomised controlled trials (RCTs) and non-RCTs. Studies assessing physical activity and exercise interventions in cancer patients (during treatment) and survivors (after treatment) will be selected. Two independent reviewers will identify eligible studies. After quality appraisal and data extraction, we will conduct meta-analyses for outcomes of interest, including data from mental and physical dimensions of cancer-specific and/or generic HRQOL questionnaires. Risk of bias assessments will be completed using the Quality Assessment Tool for Quantitative Studies. Study heterogeneity will be measured by the I statistic. Bayesian (and traditional approach) network meta-analysis will be performed when possible to determine the comparative effect of the different physical activity or exercise interventions.

Ethics And Dissemination: This systematic review and network meta-analysis will synthesise evidence on the effect of different types of exercise interventions on HRQOL during and after cancer treatment. The results will be disseminated by publication in a peer-reviewed journal and through scientific conferences and symposia. Ethical approval will not be required because the data used for this work will be exclusively extracted from published studies.

Prospero Registration Number: CRD42019125028.
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http://dx.doi.org/10.1136/bmjopen-2019-031374DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6858167PMC
November 2019

Relationship between breast feeding and motor development in children: protocol for a systematic review and meta-analysis.

BMJ Open 2019 09 17;9(9):e029063. Epub 2019 Sep 17.

Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain.

Introduction: The recommendations of most health organisations encourage mothers to keep exclusive breast feeding during the first 6 months and combining breast feeding with complementary feeding at least during the first and second years, due to the numerous immunologic, cognitive developmental and motor skill benefits that breast feeding confers. Although the influence of breast feeding on motor development during childhood has been studied, the findings are inconsistent, and some studies have even reported no effect. This manuscript presents a protocol for a systematic review and meta-analysis, with the aim of reviewing the relationship between breast feeding and motor skill development in children in terms of duration, exclusivity or non-exclusivity of breast feeding.

Methods And Analysis: The search will be conducted using Medline (via PubMed), EMBASE, Web of Science and Cochrane Library from inception to December 2019. Observational studies (cross-sectional and follow-up studies) written in English or Spanish that investigate the association between breast feeding and motor development in children will be included. This systematic review and meta-analysis protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. The Critical Appraisal Checklist for Analytical Cross-Sectional Studies and The Newcastle-Ottawa Quality Assessment Scale for longitudinal studies will be used to assess the quality of included studies. The effect of breast feeding on motor skill development will be calculated as the primary outcome. Subgroup analyses will be carried out based on the characteristics of motor skill development and the population included.

Ethics And Dissemination: Ethical approval is not required because the data used will be obtained from published studies, and there will be no concerns about privacy. The findings from this study will be relevant information regarding the association of breast feeding with motor development in children and could be used encourage to improve breastfeeding rates. The results will be published in a peer-reviewed journal.

Prospero Registration Number: CRD42018093706.
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http://dx.doi.org/10.1136/bmjopen-2019-029063DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6756461PMC
September 2019

Prevalence of Overweight and Obesity among European Preschool Children: A Systematic Review and Meta-Regression by Food Group Consumption.

Nutrients 2019 Jul 23;11(7). Epub 2019 Jul 23.

Centro de Estudios Socio-Sanitarios, Universidad de Castilla-La Mancha, 16071 Cuenca, Spain.

The aim of this review was to estimate the prevalence of overweight and obesity among European children aged 2-7 years from 2006 to 2016 and to analyze these estimations by gender, country, and food group consumption. We searched CINAHL, EMBASE, MEDLINE, and Web of Science databases from their inception until 27 February 2019 including cross-sectional studies and baseline measurements of cohort studies with overweight and obesity defined according to the International Obesity Task Force criteria. Both the inverse-variance fixed-effects method and the DerSimonian and Laird random effects method were used to determinate pooled prevalence estimates and their respective 95% confidence intervals (CIs). A total of 32 studies ( = 197,755 children) with data from 27 European countries were included. Overall, the pooled prevalence estimates of overweight/obesity in European children (aged 2-7 years) during the period 2006-2016 was 17.9% (95% CI: 15.8-20.0), and the pooled prevalence estimate of obesity was 5.3% (95% CI: 4.5-6.1). Southern European countries showed the highest prevalence of excess weight. Additional measures to address the obesity epidemic in early life should be established, especially in European countries where the prevalence of excess weight is very high.
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http://dx.doi.org/10.3390/nu11071698DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6682909PMC
July 2019

Exercise vs metformin for gestational diabetes mellitus: Protocol for a network meta-analysis.

Medicine (Baltimore) 2019 Jun;98(25):e16038

Universidad de Castilla - La Mancha, Health and Social Research Center, Cuenca, Spain.

Introduction: The purpose of this protocol is to provide a network meta-analysis methodology that compares the effects of metformin and physical exercise in the prevention and treatment of gestational diabetes mellitus (GDM) and its associated fetal and maternal morbidity.

Methods And Analysis: This protocol conforms to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) and the recommendations of the Cochrane Collaboration Handbook. An electronic search will be conducted in MEDLINE, EMBASE, Web of Science and the Cochrane Library, from the inception until July 2019. There will be no language restrictions. The Cochrane Collaboration tool for assessing risk of bias (RoB2) and the quality assessment tool for quantitative studies will be used. The Grading of Recommendations, Assessment, Development and Evaluation scale will be used to evaluate the strength of the evidence. A Bayesian network meta-analysis will be carried out, which allows direct and indirect comparison of the interventions, for the risk of GDM, prematurity, caesarean section, macrosomia, hypertensive disorders, insulin requirement, and differences in basal glucose, maternal weight, and weight of the newborn.

Discussion: With this protocol, a methodology is established that resolves the limitations of previous meta-analysis. It will be possible to determine the difference of effect between physical exercise and metformin in the main outcomes of the GDM, as well as the type and intensity of the exercise, and the dose of metformin, more effective.

Ethics And Dissemination: The data included in the network meta-analysis will be obtained from trials that meet accepted ethical standards and the Declaration of Helsinki. The results will be published in a peer-reviewed journal. The evidence obtained could be included in the guidelines of clinical practice in pregnancy.

Strengths And Limitations: A comprehensive methodology is established for the analysis, through network meta-analysis, of the comparative efficacy of metformin and physical exercise in gestational diabetes mellitus. The results obtained could help medical professionals by establishing the best evidence-based interventions which may be recommended for these population groups.

Registration Number: PROSPERO CRD42019121715.
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http://dx.doi.org/10.1097/MD.0000000000016038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6636956PMC
June 2019

Oscillometric and Doppler Ankle Brachial Indexes as predictors of all-cause mortality in a Primary Care population.

Int Angiol 2019 Jun 30;38(3):256-263. Epub 2019 May 30.

University of Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain -

Background: Doppler Ankle Brachial Index (ABI), the non-invasive reference standard for peripheral arterial disease (PAD) in Primary Care, has proved good capacity to predict all-cause mortality. However, the role of oscillometric ABI is uncertain. This study aims to evaluate the ability of oscillometric and Doppler ABI to predict all-cause mortality in a Primary Care population.

Methods: Oscillometric and Doppler ABI were measured in 203 consecutive subjects with ≥1 cardiovascular risk factors or intermittent claudication. Pathologic ABI was defined when ABI was ≤0.9 or ≥1.4, and when the oscillometer was unable to record a value (oscillometric error). All-cause mortality was ascertained through examination of electronic medical records or telephone contact.

Results: After analyzing 602.9 subjects/year, all-cause mortality was recorded in 17 (8.4%) patients. Kaplan-Meier survival curves for oscillometric (Log-Rank test χ2=66.02, P<0.001) and Doppler ABI (Log-Rank test χ2=42.30, P<0.001) showed that a pathologic ABI is associated with all-cause mortality. After adjusting for covariates, the hazard ratio in multivariable Cox regression were 4.52 (95% CI: 1.67-12.18, P=0.003) and 2.08 (95% CI: 0.83-5.18, P=0.117) for oscillometric and Doppler ABI models, respectively. When introducing oscillometric and Doppler ABI simultaneously in the Cox regression model, only oscillometric ABI was an independent predictor with a hazard ratio=7.90 (95% CI: 1.79-34.83, P=0.006). Regarding Doppler ABI, no significant differences were found in all-cause mortality between low ABI (≤0.9) and calcified ABI (≥1.4), (Log-Rank test χ2=0.98, P=0.322).

Conclusions: Oscillometric ABI predicted all-cause mortality in a Primary Care population even better than Doppler ABI, irrespective of cardiovascular risk factors. Oscillometric ABI, due to a high feasibility, could routinely identify high-risk patients to implement preventive measures.
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http://dx.doi.org/10.23736/S0392-9590.19.04167-1DOI Listing
June 2019

Comparative effect of statins and types of physical exercise on arterial stiffness: Protocol for network meta-analysis.

Medicine (Baltimore) 2019 May;98(20):e15484

Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain.

Introduction: The purpose of this study protocol is to provide the methodology for a review to compare the effect of statins vs physical exercise interventions and the effect of different types of physical exercise, on reducing arterial stiffness associated with cardiovascular diseases and mortality.

Methods And Analysis: The literature search will be conducted in MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Web of Science databases from their inception until July 31, 2019. We will include randomized controlled trials, nonrandomized experimental studies, and controlled pre-post studies assessing the effect in the general population of statins and physical exercise interventions on arterial stiffness measured by pulse wave velocity. The Cochrane Collaboration's tool and the Quality Assessment Tool for Quantitative Studies will be used to assess the risk of bias for studies included in the systematic review. A Bayesian network meta-analysis will be carried out to determine the comparative effect of the different physical exercise interventions and/or statin intervention.

Ethics And Dissemination: This study will generate evidence about the effectiveness of both statins and exercise on reducing arterial stiffness that potentially can be transferred to patients and practitioners. Moreover, in light of the importance of reducing arterial stiffness for preventing cardiovascular disease, the evidence provided by this study will be potentially suitable to be included in cardiovascular clinical practice guidelines.

Strengths And Limitations: This protocol describes the methods of a study examining, using network meta-analysis strategies, the efficacy of statins and different types of exercise on improving arterial stiffness, which is an early marker of atherosclerosis. The results of this study could immediately help clinicians to recommend the best evidence-based intervention to their patients to reduce arterial stiffness and, as a consequence, prevent major complications, such as heart failure, stroke, or myocardial infarction.

Trial Registration Number: PROSPERO CRD42019123120.
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http://dx.doi.org/10.1097/MD.0000000000015484DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6531074PMC
May 2019

MOVI-daFIT! Intervention: Rationale and design of a cluster randomized controlled trial testing the effects on improving adiposity, cognition, and subclinical atherosclerosis by increasing cardiorespiratory fitness in children.

Medicine (Baltimore) 2019 Mar;98(9):e14737

Universidad de Castilla-La Mancha, School of Education, Ciudad Real, Spain.

Introduction: High-intensity interval training (HIIT) programs have demonstrated positive effects on cardiorespiratory fitness and cardiometabolic parameters, but their impact on other health parameters (such as body mass and fat) and cognition remains unclear. This paper presents the rationale and methods of a HIIT after-school physical activity (PA) intervention (MOVI-daFIT!) on reducing fat mass and cardiovascular risk, and improving physical fitness, executive function, and academic achievement among children aged 9 to 11 years old.

Methods: A cluster randomized controlled trial (RCT), including 10 schools from Cuenca province, Spain, was designed. Schools were randomly assigned to the MOVI-daFIT! intervention and to the control group. Children were evaluated at the beginning (September 2017) and at the end (June 2018) of the school year. Children in the intervention group were involved in 60-minute after-school sessions 4 days per week developed in the school setting. Each session consisted of 15 minutes of set-up and warm-up games, 28 minutes of games using the HIIT protocol, and 10 minutes of cool down. In addition, children in the intervention and control groups received 2 regular 50-minute physical education sessions per week, as it is compulsory by law in Spanish schools.

Conclusion: This study will determine the effect of an after-school physical activity intervention (MOVI-daFIT!), designed as a HIIT program, on reducing fat mass and cardiovascular risk, and improving fitness and cognition, including executive function and academic achievement.
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http://dx.doi.org/10.1097/MD.0000000000014737DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6831241PMC
March 2019
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