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Effects of active video games on physical function in independent community-dwelling older adults: A systematic review and meta-analysis

J Adv Nurs. 2021 Dec 21. doi: 10.1111/jan.15138. Online ahead of print.

ABSTRACT

AIM: To analyse the effects of active video games on physical function in independent community-dwelling older adults.

DESIGN: Systematic review and meta-analysis of randomized controlled trials.

DATA SOURCES: The CINAHL, LILACS, Medline, Proquest and Scopus databases were consulted, with no restriction by year of publication.

REVIEW METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The meta-analysis was performed using RevMan software.

RESULTS: The analysis included 22 randomized controlled trials with a total of 1208 participants (all ≥55 years old). In our meta-analyses, the effects produced by playing the active video games (mean differences) were statistically significant for the variables Gait speed and Timed up-and-go. The differences between the control and experimental groups were not significant in the following tests: 6-minute walk, 30-second chair stand, balance (measured with the Berg Balance Scale), cadence, grip strength, knee extension strength, 8-Foot Up-and-Go or velocity.

CONCLUSIONS: Physical exercise from participation in active video games has beneficial effects on two clinical parameters (Gait speed and Timed up-and-go) in independent community-dwelling older adults. However, the effects on other parameters do not differ from those obtained with conventional exercise training. Therefore, the clinical significance of these benefits is limited.

IMPACT: Older adults usually perform little physical activity. In consequence, researchers have increasingly considered alternatives to traditional forms of exercise. One such is that provided by active video games, which can be a source of stimulation, encouraging adherence and motivation in exercise programmes. Our review shows that active video games can improve gait speed and mobility, but in other respects obtain no differences from conventional exercises. Further tailored randomized clinical trials should be undertaken with diverse populations of older adults to evaluate different physical function variables to determine the most appropriate training approach and its optimal design and duration.

PMID:34935178 | DOI:10.1111/jan.15138

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A propensity score-matched, real-world comparison of ustekinumab vs vedolizumab as a second-line treatment for Crohn’s disease. The Cross Pennine study II

Aliment Pharmacol Ther. 2021 Dec 22. doi: 10.1111/apt.16742. Online ahead of print.

ABSTRACT

BACKGROUND: The optimal choice of biological agents after failure of anti-tumour-necrosis-factor-(TNF)α agent in Crohn’s disease (CD) is yet to be defined.

AIMS: To assess the effectiveness and safety of ustekinumab compared to vedolizumab as second-line treatment in CD patients who failed anti-TNFα therapy.

METHODS: Retrospective analysis of clinical response and remission at 14 and 52 weeks to ustekinumab by physician global assessment (PGA). A propensity score-matched analysis with a cohort treated with vedolizumab was performed.

RESULTS: Of 282 patients (mean age 40 ± 15, F:M ratio 1.7:1) treated with ustekinumab, clinical response or remission was reached by 200/282 patients (70.9%) at 14 weeks, and 162/259 patients (62.5%) at 52 weeks. Overall, 74 adverse events occurred, of which 26 were labelled as serious (8.3 per 100 person-year). After exclusion of patients without prior anti-TNFα exposure and patients previously exposed to vedolizumab or ustekinumab, we analysed 275/282 patients (97.5%) on ustekinumab and 118/135 patients (87.4%) on vedolizumab. Propensity score analysis revealed that at 14 weeks, patients treated with ustekinumab were 38% (95% CI 25%-50%; P < 0.001) more likely to achieve clinical remission, while at 52 weeks, the difference of 9% (95% CI -15% to 33%; P = 0.462) was not significant.

CONCLUSIONS: Ustekinumab was effective and well tolerated in this real-world cohort. While ustekinumab proved more effective at 14-weeks, we found no statistically significant differences at 52 weeks compared to vedolizumab.

PMID:34935160 | DOI:10.1111/apt.16742

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Robust group sequential designs for trials with survival endpoints and delayed response

Biom J. 2021 Dec 21. doi: 10.1002/bimj.202000169. Online ahead of print.

ABSTRACT

Randomized clinical trials in oncology typically utilize time-to-event endpoints such as progression-free survival or overall survival as their primary efficacy endpoints, and the most commonly used statistical test to analyze these endpoints is the log-rank test. The power of the log-rank test depends on the behavior of the hazard ratio of the treatment arm to the control arm. Under the assumption of proportional hazards, the log-rank test is asymptotically fully efficient. However, this proportionality assumption does not hold true if there is a delayed treatment effect. Cancer immunology has evolved over time and several cancer vaccines are available in the market for treating existing cancers. This includes sipuleucel-T for metastatic hormone-refractory prostate cancer, nivolumab for metastatic melanoma, and pembrolizumab for advanced nonsmall-cell lung cancer. As cancer vaccines require some time to elicit an immune response, a delayed treatment effect is observed, resulting in a violation of the proportional hazards assumption. Thus, the traditional log-rank test may not be optimal for testing immuno-oncology drugs in randomized clinical trials. Moreover, the new immuno-oncology compounds have been shown to be very effective in prolonging overall survival. Therefore, it is desirable to implement a group sequential design with the possibility of early stopping for overwhelming efficacy. In this paper, we investigate the max-combo test, which utilizes the maximum of two weighted log-rank statistics, as a robust alternative to the log-rank test. The new test is implemented for two-stage designs with possible early stopping at the interim analysis time point. Two classes of weights are investigated for the max-combo test: the Fleming and Harrington (1981) Gρ,γ weights and the Magirr and Burman (2019) modest (τ∗) weights.

PMID:34935177 | DOI:10.1002/bimj.202000169

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Dentoskeletal effects of early class III treatment protocol based on timing of intervention in children

Prog Orthod. 2021 Dec 22;22(1):49. doi: 10.1186/s40510-021-00392-2.

ABSTRACT

BACKGROUND: To detect the optimal timing of intervention based on different cervical vertebral maturation stage (CS1-2 vs. CS3-4) for the treatment of Class III malocclusion with early Class III protocol.

METHODS: A total sample of 43 patients (23 females, 20 males) ranging between 7 and 13 years of age with dentoskeletal Class III malocclusion treated with the modified SEC III (Splints, Elastic and Chincup) protocol divided into two groups based on the cervical vertebral maturation stages (CS1-2 and CS3-4) was included in this retrospective observational longitudinal study. Patient compliance was assessed using a 2-point Likert scale. Statistical comparisons between the two groups were performed with independent sample t tests.

RESULTS: No statistically significant differences for any of the cephalometric variables describing the baseline dentoskeletal features were found between the two groups except for the mandibular unit length that was significantly greater in the pubertal group (P = 0.005). The modified SEC III protocol produced favorable sagittal outcomes in both groups, whereas no statistically significant T1-T2 changes were found between the CS1-2 and CS3-4 groups for any of the angular and linear measurements. No significant differences were found in the prevalence rates of the degree of collaboration between the two groups (P = 1.000).

CONCLUSIONS: No significant differences between prepubertal and pubertal patients were found in the sagittal and vertical dentoskeletal changes with the modified SEC III protocol. Thus, this early Class III treatment produced similar favorable effects in growing subjects regardless of the cervical vertebral maturation stages from CS1 to CS4.

PMID:34935091 | DOI:10.1186/s40510-021-00392-2

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Effects of shifts in response preferences on characteristics of representation and real-time processing: An application to the Hering illusion

Atten Percept Psychophys. 2021 Dec 21. doi: 10.3758/s13414-021-02397-9. Online ahead of print.

ABSTRACT

The multidimensional generalization of signal detection theory known as General Recognition Theory (GRT, Ashby & Townsend, Psychological Review, 93, 154-179 1986) has been used to model and characterize the ways in which changes in encoded perceptual information and the application of decisional operators can produce patterns in behavior that are consistent with notions such as configural processing and representation. In particular, a set of studies (e.g., Cornes et al.,, 2011; Wenger & Ingvalson; 2002, 2003) have shown how decisional influences might exert themselves in situations of configural perception, such that effects such as the Thatcher illusion can be obtained by way of shifts in decisional criteria. The present investigation brought to bear the combined tools of GRT and Systems Factorial Technology (SFT, Little et al.,, 2017; Townsend & Nozawa, 1995) with a classical illusion, to show that it is possible to induce a shift in a decisional criterion by way of varying payoffs and that this shift is accompanied by regular changes in the workload capacity statistic. The combined sets of analyses on the same stimuli reveal orderly effects on the decisional criteria (i.e., the signal detection parameter c), report independence (suggesting perceptual independence), invariant measures of sensitivity (i.e., the signal detection parameter [Formula: see text]),and exhaustive parallel processing accompanied by super capacity. We therefore propose wider use of the combined sets of tools, further exploration of the ability of decisional alterations to affect processing times while leaving accuracy largely unscathed, and reaching out to explore more of the information processing mechanisms of classical illusions.

PMID:34935122 | DOI:10.3758/s13414-021-02397-9

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Trauma Exposures, Resilience Factors, and Mental Health Outcomes in Persons Granted Asylum in the U.S. for Claims Related to Domestic Violence and Persecution by Organized Gangs

J Immigr Minor Health. 2021 Dec 21. doi: 10.1007/s10903-021-01324-2. Online ahead of print.

ABSTRACT

Survivors of domestic violence (DV) and of violence perpetrated by organized gangs (GV) face barriers to legal protection under U.S. asylum law. We abstracted data from 132 affidavits based on forensic medical evaluations of asylum seekers granted legal protection in the U.S. on the basis of DV and/or GV. We described claimants’ trauma exposures and resilience factors and used multiple logistic regression to quantify associations with Diagnostic and Statistical Manual-5 (DSM-5) diagnoses and improvement in mental health. People seeking asylum based on DV and/or GV have endured multiple types of trauma with significant impacts on their mental health. New experiences of trauma following migration to the U.S. were common and associated with DSM-5 diagnoses. Conversely, resilience factors were associated with improved mental health. Policies that aim to reduce ongoing trauma in the U.S. and to bolster resilience factors may promote asylee mental health and well-being.

PMID:34935087 | DOI:10.1007/s10903-021-01324-2

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Aortic arch type, a novel morphological indicator and the risk for acute type B aortic dissection

Interact Cardiovasc Thorac Surg. 2021 Dec 22:ivab359. doi: 10.1093/icvts/ivab359. Online ahead of print.

ABSTRACT

OBJECTIVES: Aortic arch type is a readily recognizable and obtainable morphological feature of the aorta that does not require complex measurements. The goal of this study was to evaluate whether aortic arch type is a comparable and alternative morphological parameter for predicting acute type B aortic dissection (aTBAD) by comparing the prognostic value of the aortic arch type with that of other morphological parameters such as aortic length, angulation and tortuosity index.

METHODS: The patients with aTBAD (n = 216) were matched 1:1 with a control group (n = 263) by propensity score matching. The morphological data of the ascending aorta and the aortic arch, which included diameter, length, angulation and tortuosity index, were collected on a three-dimensional aortic model using 3mensio Vascular software. The aortic arch type was identified by the vertical distance from the origin of the brachiocephalic trunk to the top of the arch. The binary logistic regression models were analysed to determine the independent geometric variables related to the aTBAD. The nonparametric approach was performed to assess whether there were statistical differences between the area under the receiver operating characteristic curves (AUC) of the models.

RESULTS: After propensity score matching, 151 matched pairs of patients were selected. The diameters at the sinotubular junction and the mid-ascending aorta, the ascending aorta length and the ascending aorta angulation in the aTBAD group were significantly greater than those of the controls. Compared with the control group, the diameters at the proximal aortic arch, mid-aortic arch and distal aortic arch, the angulation and the tortuosity index of the aortic arch were significantly greater in the aTBAD group. The proportion of the type III arch in the patients with aTBAD is higher than that of the type I arch and the type II arch (χ2 = 70.187; P < 0.001). Binary logistic regression analysis showed that the diameter at the mid-aortic arch, the ascending aorta length, the aortic arch angulation and the tortuosity index were independently related to the aTBAD with an AUC value of 0.887. Another binary logistic regression analysis indicated that the diameter at the mid-aortic arch and the aortic arch type were independent correlative variables associated with the aTBAD with an AUC of 0.874. No significant difference was observed in the prognostic value of receiver operating characteristic curves between the 2 models (P = 0.716).

CONCLUSIONS: The type III arch, which has the characteristics of aortic elongation, incremental angulation and tortuosity index, is a comparable and alternative identifier for patients at high risk for aTBAD.

PMID:34935037 | DOI:10.1093/icvts/ivab359

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Cognitive and functional deficits are associated with white matter abnormalities in two independent cohorts of patients with schizophrenia

Eur Arch Psychiatry Clin Neurosci. 2021 Dec 21. doi: 10.1007/s00406-021-01363-8. Online ahead of print.

ABSTRACT

BACKGROUND: Significant evidence links white matter (WM) microstructural abnormalities to cognitive impairment in schizophrenia (SZ), but the relationship of these abnormalities with functional outcome remains unclear.

METHODS: In two independent cohorts (C1, C2), patients with SZ were divided into two subgroups: patients with higher cognitive performance (SZ-HCP-C1, n = 25; SZ-HCP-C2, n = 24) and patients with lower cognitive performance (SZ-LCP-C1, n = 25; SZ-LCP-C2, n = 24). Healthy controls (HC) were included in both cohorts (HC-C1, n = 52; HC-C2, n = 27). We compared fractional anisotropy (FA) of the whole-brain WM skeleton between the three groups (SZ-LCP, SZ-HCP, HC) by a whole-brain exploratory approach and an atlas-defined WM regions-of-interest approach via tract-based spatial statistics. In addition, we explored whether FA values were associated with Global Assessment of Functioning (GAF) scores in the SZ groups.

RESULTS: In both cohorts, mean FA values of whole-brain WM skeleton were significantly lower in the SCZ-LCP group than in the SCZ-HCP group. Whereas in C1 the FA of the frontal part of the left inferior fronto-occipital fasciculus (IFOF) was positively correlated with GAF score, in C2 the FA of the temporal part of the left IFOF was positively correlated with GAF score.

CONCLUSIONS: We provide robust evidence for WM microstructural abnormalities in SZ. These abnormalities are more prominent in patients with low cognitive performance and are associated with the level of functioning.

PMID:34935072 | DOI:10.1007/s00406-021-01363-8

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The incidence of ectopic/heterotopic pregnancies after blastocyst-stage frozen-thawed embryo transfers compared with that after cleavage-stage: a Society for Assisted Reproductive Technologies Clinical Outcomes Reporting System study

F S Rep. 2021 Jul 3;2(4):421-427. doi: 10.1016/j.xfre.2021.06.010. eCollection 2021 Dec.

ABSTRACT

OBJECTIVE: To investigate whether there is a difference in the ectopic/heterotopic pregnancy rate of blastocyst-stage frozen-thawed embryo transfers (FETs) compared with that of cleavage-stage FETs.

DESIGN: A retrospective cohort study.

SETTING: Not applicable.

PATIENTS: Women undergoing autologous FETs at either the blastocyst stage (n = 118,572) or the cleavage stage (n = 117,619), as reported to the Society for Assisted Reproductive Technology from 2004 to 2013.

INTERVENTIONS: None.

MAIN OUTCOME MEASURES: Pregnancy outcomes, specifically ectopic pregnancy rates and heterotopic pregnancy rates.

RESULTS: Among those who became pregnant, there was a significantly lower incidence of ectopic/heterotopic pregnancies in blastocyst-stage FETs versus that in cleavage-stage FETs (0.8% vs. 1.1%). The differences in ectopic/heterotopic pregnancy rates remained statistically significant after controlling for confounders such as tubal factor infertility and number of embryos transferred.

CONCLUSIONS: Blastocyst-stage FET was associated with a lower ectopic/heterotopic pregnancy rate compared with cleavage-stage FET.

PMID:34934982 | PMC:PMC8655396 | DOI:10.1016/j.xfre.2021.06.010

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Can high antimüllerian hormone mitigate some of the age-related decline in live birth rates? The association between antimüllerian hormone and live birth among women over 40 undergoing in vitro fertilization

F S Rep. 2021 Sep 8;2(4):440-447. doi: 10.1016/j.xfre.2021.08.009. eCollection 2021 Dec.

ABSTRACT

OBJECTIVE: To examine the association between serum antimüllerian hormone (AMH) and live birth among women aged ≥41 years undergoing in vitro fertilization (IVF).

DESIGN: Retrospective cohort study using the 2012-2014 Society for Assisted Reproductive Technology Clinic Outcome Reporting System database.

SETTING: Fertility clinics reporting to the Society for Assisted Reproductive Technology.

PATIENTS: The analysis included 7,819 patients aged ≥41 years who underwent a first fresh, autologous IVF cycle during the study period. Cycles with preimplantation genetic testing were excluded.

INTERVENTIONS: None.

MAIN OUTCOME MEASURES: Live birth rate.

RESULTS: The empirical distribution of AMH was examined, and extreme values were observed. Therefore, the natural logarithm transformation of AMH (log-AMH) was used in all analyses. Before adjustment for covariates, a one-unit increase in log-AMH was associated with doubling of the odds of live birth up to a log-AMH of -0.34 (equivalently, AMH, 0.71 ng/mL; odds ratio [OR], 2.02; 95% confidence interval [CI], 1.66-2.46). Above an AMH level of 0.71 ng/mL, the odds of live birth increased by only 40% with each unit increase in log-AMH (OR, 1.40; 95% CI, 1.22-1.61). After adjusting for covariates, the odds of live birth increased by 91% with each unit increase in log-AMH up to -0.34 (AMH, 0.71 ng/mL; OR, 1.91; 95% CI, 1.56-2.34). Above an AMH level of 0.71 ng/mL, the odds of live birth increased by only 32% with each unit increase in log-AMH (OR, 1.32; 95% CI, 1.15-1.53).

CONCLUSIONS: Among women aged ≥41 years undergoing fresh, autologous IVF, the odds of live birth significantly increase with increasing serum AMH level. As the AMH level increases above 0.71 ng/mL, the association maintains statistical significance, but the effect size is diminished.

PMID:34934985 | PMC:PMC8655414 | DOI:10.1016/j.xfre.2021.08.009