Metabolic Syndrome in Children With Myelomeningocele and the Role of Physical Activity: A Narrative Review of the Literature.

Objectives: The purpose of this review is to describe the current scientific literature on the prevalence of metabolic syndrome in children with myelomeningocele and to gain insight into the baseline levels of aerobic fitness, endurance, and strength in this population in order to identify gaps in knowledge, suggest potential primary prevention strategies, and provide recommendations for future studies. Methods: A literature review of articles published in English and French between 1990 and April 2020 was conducted. Results: Obese adolescents with myelomeningocele have an increased prevalence of components of the metabolic syndrome. Children and adolescents with myelomeningocele have decreased aerobic fitness and muscular strength, decreased lean mass, and increased fat mass, all of which, when combined with higher levels of physical inactivity, put them at higher risk of developing metabolic syndrome and cardiovascular diseases. Conclusion: Until more research is conducted, addressing weight-related challenges and promoting healthy habits (such as optimal activity levels) could be easily integrated into yearly myelomeningocele clinics. An actionable suggestion might be to systematically weigh and measure children in these clinics and utilize the results and trends as a talking point with the parents and children. The follow-up appointments could also be used to develop physical activity goals and monitor progress. We recommend that the health care practitioner tasked with this intervention (physician, nurse, etc.) should be aware of locally available accessible sports platforms and have knowledge of motivational interviewing to facilitate removal of perceived barriers to physical activity.

Decreasing pressure injuries and acute care length of stay in patients with acute traumatic spinal cord injury.

OBJECTIVES: Identifying factors associated with the occurrence of pressure injuries (PI) during acute care and with longer length of stay (LOS), focusing on modifiable factors that can be addressed and optimized by the acute rehabilitation team. DESIGN: Prospective cohort study. SETTING: A single Level-1 trauma center specialized in SCI care. PARTICIPANTS: A cohort of 301 patients with acute TSCI was studied. OUTCOME MEASURES: The primary outcome was the occurrence of PI during acute care stay. The secondary outcome was acute care LOS. Bivariate and multivariate logistic or linear regression analyses were performed to determine the association between non-modifiable factors and outcomes (PI of any stage and acute LOS), whereas bivariate and hierarchical multivariate logistic or linear regression analyses were used for modifiable factors. RESULTS: When controlling for the level and severity of the TSCI, the occurrence of pneumonia (OR = 2.1, CI = 1.1-4.1) was significantly associated with the occurrence of PI. When controlling for the level and severity of the TSCI, the occurrence of medical complications (PI, urinary tract infection and pneumonia) and lesser daily therapy resulted in significantly longer acute care LOS (P < .001). CONCLUSIONS: Prevention of PI occurrence and the optimization of the acute care LOS represent crucial challenges of the acute rehabilitation team, as they are significantly associated with higher functional outcomes. Patients who develop pneumonia may benefit from more aggressive prevention strategies to reduce PI occurrence. Systematic protocols for the prevention of complications as well as greater volume of therapy interventions should be considered to optimize the acute care LOS.

Severe acitretin-induced diffuse idiopathic skeletal hyperostosis: a case report.

Diffuse idiopathic skeletal hyperostosis (DISH), also known as Forestier-Rotes-Querol disease, is a systemic noninflammatory disease characterized by ossification of the entheses. DISH predominantly affects the spine. Although peripheral involvement is also often reported, it rarely affects patients' function. A 77-year-old man presented to our emergency department because of incapacitating pain and stiffness in the spine and hips. The patient had been diagnosed with biopsy-proven mycosis fungoides 3 years earlier and had been treated with oral acitretin at 25 to 50 mg daily since diagnosis. However, the patient gradually developed a severely limited range of motion in his spine and hips (left > right), significantly impairing his mobility and activities of daily living. Cervical and dorsolumbar radiographs showed extensive ossification along the anterior longitudinal ligament; this finding was compatible with DISH and had not been present in radiographs taken 3 years earlier. Pelvic radiographs showed multiple enthesophytes predominantly around the coxofemoral joints. DISH has been reported as a possible long-term adverse effect of acitretin. Despite optimal conservative treatment, the patient remained severely impaired and thus finally underwent extensive osteophyte excision and total hip replacement on the left side. His acitretin therapy was also stopped to prevent further progression of his DISH.

The evolution of a Canadian Hypertension Education Program recommendation: the impact of resistance training on resting blood pressure in adults as an example.

Ever since the first set of hypertension recommendations which were generated from the Canadian Hypertension Education Program, lifestyle and health behaviour have been a key focus. An initial recommendation focused on the benefits of aerobic exercise to reduce resting blood pressure (BP). However, until the 2013 edition, resistance exercise (RT) was not included. The current article describes a meta-analysis that was conducted which helped inform the creation of the newly introduced recommendation. Literature searches were conducted in 4 electronic databases. Inclusion criteria included: (1) randomized controlled trials with 4-week minimum, RT-alone intervention arms; (2) BP-lowering as the primary outcome; (3) human, adult participants; and (4) reporting control data, baseline, and postintervention resting systolic BP and diastolic BP. Nine studies (11 intervention groups, 452 participants) were identified. The analyses indicated that diastolic BP was significantly reduced (-2.2 mm Hg; 95% confidence interval, -3.9 to -0.5) in those randomized to RT compared with control participants. In contrast, no statistically significant change in systolic BP (-1.0 mm Hg; 95% confidence interval, -3.4 to 1.4) was observed. None of the studies found RT to increase BP and no adverse effects of RT were explicitly reported. Results suggest that participation in RT is not harmful and does not increase BP. However, more evidence is needed before recommending RT as a specific BP-lowering therapy.

Efficacy of interventions to improve adherence to inhaled corticosteroids in adult asthmatics: impact of using components of the chronic care model.

BACKGROUND: Adherence to inhaled corticosteroids (ICS) remains poor among asthmatics, yet little is known about the efficacy of interventions to improve adherence. Implementing the Chronic Care Model (CCM) components among patients with respiratory disorders has been associated with an improvement in outcomes, yet little is known about its effects on ICS adherence in asthmatics. OBJECTIVE: We conducted a systematic review to assess the efficacy of interventions to improve ICS adherence among adult-asthmatics, and whether the use of CCM components (i.e., teaching self-management skills, providing decision support, delivery system design, and clinical information systems) resulted in greater ICS adherence. METHODS: All English language articles testing the efficacy of an intervention including ICS medication on outcome from MEDLINE and PsychINFO databases through Aug-2010 were reviewed. Interventions were categorized based on the inclusion of CCM components. We standardized treatment effects to obtain effect-size's (ES's) and we combined the ES's of studies according to the number of CCM components included in their interventions. RESULTS: Eighteen studies met inclusion criteria. Inclusion of a greater number of CCM components within interventions was associated with stronger effects on ICS adherence outcomes, with interventions featuring one, two, and four CCM components having medium (ES = 0.29; 95%CI, 0.16-0.42), large (0.53; 0.40-0.66), and very-large (0.83; 0.69-0.98) effects respectively. CONCLUSIONS: Findings provide support for using the CCM as a framework for the design and implementation of interventions to improve adherence among adult-asthmatics.