• Ipsen Willadsen posted an update 6 months ago

    Purpose Identify the types and dosage of vestibular stimulation interventions in persons with cerebral palsy (CP), and establish the efficacy of these interventions on balance and function.Materials and Methods This systematic review followed Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols to search for studies evaluating vestibular stimulation interventions in persons with CP. Information sources included MEDLINE, Embase, CINAHL, Cochrane Central Register of Controlled Trials, clinicaltrials.gov and the World Health Organisation registry. Methodological quality was assessed by two independent reviewers using the Methodological Index of Non-Randomised Studies (MINORS) and Cochrane Risk of Bias Tool.Results Five articles were included. Three randomised studies were judged to have high risk of bias in at least one domain of the Cochrane Risk of Bias Tool. Two non-randomised studies were rated as low methodological quality using the MINORS tool. All studies used exercise-based vestibular stimulation, but there was little homogeneity regarding dosage. Findings related to efficacy of vestibular stimulation were inconsistent.Conclusions Clinical practice recommendations cannot be made due to lack of high quality studies and heterogeneity of treatment protocols. Future research should address theory-driven selection of intervention, establish dosage, use psychometrically robust tools and include all ages of persons with CP.IMPLICATIONS FOR REHABILITATIONOptimal intervention parameters for vestibular stimulation cannot be determined from existing literature.Further studies to describe vestibular stimulation intervention components and duration are warranted.In practice, use of valid and reliable balance and gross motor function outcome measures are essential if using vestibular stimulation techniques with people with CP, as the efficacy of these interventions has not been clearly demonstrated.Investigation of electrical Vestibular Nerve Stimulation in people with CP is warranted.Obesity and type 2 diabetes are major health problems affecting hundreds of millions of people. Caloric overfeeding with calorie-dense food ingredients like sugars may contribute to these chronic diseases. Sugar research has also identified mechanisms via which conventional sugars like sucrose and fructose can adversely influence metabolic health. To replace these sugars, numerous sugar replacers including artificial sweeteners and sugar alcohols have been developed. Rare sugars became new candidates to replace conventional sugars and their health effects are already reported in individual studies, but overviews and critical appraisals of their health effects are missing. This is the first paper to provide a detailed review of the metabolic health effects of rare sugars as a group. Especially allulose has a wide range of health effects. Tagatose and isomaltulose have several health effects as well, while other rare sugars mainly provide health benefits in mechanistic studies. OTS514 Hardly any health claims have been approved for rare sugars due to a lack of evidence from human trials. Human trials with direct measures for disease risk factors are needed to allow a final appraisal of promising rare sugars. Mechanistic cell culture studies and animal models are required to enlarge our knowledge on understudied rare sugars.Introduction Cancer causes thousands of deaths worldwide each year. Therefore, monitoring of health status and the early diagnosis of cancer using noninvasive assays, such as the analysis of molecular biomarkers in urine, is essential. However, effective biomarkers for early diagnosis of cancer have not been established in many types of cancer.Areas covered In this review, we discuss recent findings with regard to the use of urine composition as a biomarker in eleven types of cancer. We also highlight the use of urine biomarkers for improving early diagnosis.Expert opinion Urinary biomarkers have been applied for clinical application of early diagnosis. The main limitation is a lack of integrated approaches for identification of new biomarkers in most cancer. The utilization of urinary biomarker detection will be promoted by improved detection methods and new data from different types of cancers. With the development of precision medicine, urinary biomarkers will play an increasingly important clinical role. Future early diagnosis would benefit from changes in the utilization of urinary biomarkers.BACKGROUND Insufficient sleep is common in youth with type 1 diabetes (T1D) and parents, likely secondary to diabetes-related disturbances, including fear of hypoglycemia, nocturnal glucose monitoring, hypoglycemia, and device alarms. Hybrid closed-loop (HCL) systems improve glycemic variability and potentially reduce nocturnal awakenings. METHODS Adolescents with T1D (N=37, Mean age 13.9 yrs, 62% female, mean HbA1c 8.3%) and their parents were enrolled in this observational study when starting the Medtronic 670G HCL system. Participants completed study measures (sleep and psychosocial surveys and actigraphy with sleep diaries) before starting auto mode and approximately 3 months later. RESULTS Based on actigraphy data, neither adolescents’ nor parents’ sleep characteristics changed significantly pre-post device initiation. Adolescents’ mean total sleep time decreased from 7hrs 16 min (IQR ) to 7hrs 9 min (IQR ), while parents’ total sleep time decreased from 6hrs 47 min (IQR ) to 6hrs 38 min (IQR ). Although there were no significant differences in most of the survey measures, there was a moderate effect for improved sleep quality in parents and fear of hypoglycemia in adolescents. In addition, adolescents reported a significant increase in self-reported glucose monitoring satisfaction. Adolescents averaged 44.7% use of auto mode at 3 months. CONCLUSIONS Our data supports previous research showing youth with T1D and their parents are not achieving the recommended duration of sleep. Lack of improvement in sleep may be due to steep learning curves involved with new technology. We observed moderate improvements in parental subjective report of sleep quality despite no change in objective measures of sleep duration. Further evaluation of sleep with long-term HCL use and larger sample size is needed.

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