Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials.

OBJECTIVE: To identify the optimal dose and modality of exercise for treating major depressive disorder, compared with psychotherapy, antidepressants, and control conditions. DESIGN: Systematic review and network meta-analysis. METHODS: Screening, data extraction, coding, and risk of bias assessment were performed independently and in duplicate. Bayesian arm based, multilevel network meta-analyses were performed for the primary analyses. Quality of the evidence for each arm was graded using the confidence in network meta-analysis (CINeMA) online tool. DATA SOURCES: Cochrane Library, Medline, Embase, SPORTDiscus, and PsycINFO databases. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Any randomised trial with exercise arms for participants meeting clinical cut-offs for major depression. RESULTS: 218 unique studies with a total of 495 arms and 14 170 participants were included. Compared with active controls (eg, usual care, placebo tablet), moderate reductions in depression were found for walking or jogging (n=1210, κ=51, Hedges' g -0.62, 95% credible interval -0.80 to -0.45), yoga (n=1047, κ=33, g -0.55, -0.73 to -0.36), strength training (n=643, κ=22, g -0.49, -0.69 to -0.29), mixed aerobic exercises (n=1286, κ=51, g -0.43, -0.61 to -0.24), and tai chi or qigong (n=343, κ=12, g -0.42, -0.65 to -0.21). The effects of exercise were proportional to the intensity prescribed. Strength training and yoga appeared to be the most acceptable modalities. Results appeared robust to publication bias, but only one study met the Cochrane criteria for low risk of bias. As a result, confidence in accordance with CINeMA was low for walking or jogging and very low for other treatments. CONCLUSIONS: Exercise is an effective treatment for depression, with walking or jogging, yoga, and strength training more effective than other exercises, particularly when intense. Yoga and strength training were well tolerated compared with other treatments. Exercise appeared equally effective for people with and without comorbidities and with different baseline levels of depression. To mitigate expectancy effects, future studies could aim to blind participants and staff. These forms of exercise could be considered alongside psychotherapy and antidepressants as core treatments for depression. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018118040.

An umbrella review of the benefits and risks associated with youths' interactions with electronic screens.

The influence of electronic screens on the health of children and adolescents and their education is not well understood. In this prospectively registered umbrella review (PROSPERO identifier CRD42017076051 ), we harmonized effects from 102 meta-analyses (2,451 primary studies; 1,937,501 participants) of screen time and outcomes. In total, 43 effects from 32 meta-analyses met our criteria for statistical certainty. Meta-analyses of associations between screen use and outcomes showed small-to-moderate effects (range: r = -0.14 to 0.33). In education, results were mixed; for example, screen use was negatively associated with literacy (r = -0.14, 95% confidence interval (CI) = -0.20 to -0.09, P ≤ 0.001, k = 38, N = 18,318), but this effect was positive when parents watched with their children (r = 0.15, 95% CI = 0.02 to 0.28, P = 0.028, k = 12, N = 6,083). In health, we found evidence for several small negative associations; for example, social media was associated with depression (r = 0.12, 95% CI = 0.05 to 0.19, P ≤ 0.001, k = 12, N = 93,740). Limitations of our review include the limited number of studies for each outcome, medium-to-high risk of bias in 95 out of 102 included meta-analyses and high heterogeneity (17 out of 22 in education and 20 out of 21 in health with I2 > 50%). We recommend that caregivers and policymakers carefully weigh the evidence for potential harms and benefits of specific types of screen use.

Evidências de validade da versão adaptada para o português do questionário TPACK Survey for Meaningful Learning / Validity evidence of the adapted Portuguese version of the TPACK Survey for Meaningful Learning / Evidencias de validez de la versión adaptada para el portugués del cuestionario TPACK Survey for Meaningful Learning

Ancorado no modelo teórico Technological Pedagogical Content Knowledge, o presente estudo apresenta os resultados do processo de adaptação transcultural e verificação das evidências de validade para o instrumento TPACK Survey for Meaningful Learning. Participaram 472 professores de Biologia do Estado do Rio de Janeiro. Os resultados obtidos demonstraram que houve boa compreensão e aceitação das assertivas adaptadas. As análises estatísticas realizadas indicam que a versão brasileira apresenta evidências de validade e confiabilidade, possibilitando a disponibilização de um instrumento de avaliação inédito no contexto brasileiro, em relação a percepção do professor acerca das suas diferentes bases de conhecimento. (AU)

Anchored in the theoretical Technological Pedagogical Content Knowledge model, this study presents results of the transcultural adaptation process and verification of validity evidence for the TPACK Survey for Meaningful Learning. A total of 472 Biology professors from the state of Rio de Janeiro participated in the study. Results showed a good understanding and acceptance of the adapted assertions. Statistical analyses indicate that the Brazilian version presents validity and reliability evidence, making it possible to provide an unprecedented evaluation tool in the Brazilian context, in relation to the professors' perception of their different knowledge bases. (AU)

Basado en el modelo teórico Technological Pedagogical Content Knowledge, este estudio presenta los resultados de la adaptación transcultural y verificación de las evidencias de validez para el instrumento TPACK Survey for Meaningful Learning. Participaron 472 profesores de Biología del Estado de Río de Janeiro. Los resultados mostraron que existe buena comprensión y aceptación de las asertivas adaptadas. Los análisis estadísticos realizados indican que la versión brasileña presenta evidencias de validez y confiabilidad, posibilitando la disponibilidad de un instrumento de evaluación inédito en el contexto brasileño, con relación a la percepción del profesor sobre sus diferentes bases de conocimiento. (AU)

The interference of body position with vibration transmission during training on a vibrating platform / A interferência da posição corporal na transmissibilidade vibratória durante o treinamento com plataforma vibratória

Whole-body vibration training on vibrating platforms is widely used for physical exercise, health promotion and physical rehabilitation. The position on the platform is one of the factors responsible for the transmission of vibrations to the body segments of individuals. Therefore, the objective of this study was to compare the characteristics of vibrations transmitted to the body segments of adults between two body positions and different vibration intensities. Twenty intentionally selected subjects (10 men and 10 women), with a mean age of 27.8 ± 2.9 years, participated in the study. The data were acquired with a triaxial accelerometer attached to the subject's body using a vibrating platform at frequencies of 20, 35, 50, and 70 Hz and displacement amplitudes of 2.0 and 6.0 mm in the extended and flexed positions. Descriptive and inferential statistics was applied (p ≤ 0.05). Significant differences in the vibration magnitude and transmissibility were observed between body positions at all intensities analyzed, with greater attenuation of vibrations in the flexed position, especially during passage of the vibratory stimulus through the lower limbs. It was concluded that the body position adopted by the subjects on the vibrating platform directly affects the transmission of vibration. The flexed position was found to be the most suitable for the application of this training method by ensuring better body stability on the platform and promoting more effective attenuation of vibrations, thus preventing the occurrence of unintended acceleration in the head.

O treinamento vibratório de corpo inteiro sobre plataformas vibratórias tem sido muito difundido nos contextos do treinamento físico, promoção da saúde e reabilitação física, sendo o posicionamento sobre a plataforma um dos fatores responsáveis pela transmissão das vibrações às estruturas corporais dos indivíduos. Desta forma, o objetivo geral deste estudo foi comparar as características das vibrações transmitidas às estruturas corporais de adultos em duas posições corporais em diferentes intensidades de vibração. Vinte sujeitos (10 homens e 10 mulheres) com média de idade de 27,8 ± 2,9 anos, foram selecionados de forma intencional. Os dados foram adquiridos com acelerômetros triaxiais fixados ao corpo dos sujeitos sobre uma plataforma vibratória, nas frequências de 20, 35, 50 e 70Hz e amplitudes de deslocamento de 2,0 e 6,0mm, na posição estendida (PE) e posição flexionada (PF). Foi aplicada estatística descritiva e inferencial (p≤0,05). Foram identificadas diferenças estatisticamente significativas na magnitude e transmissibilidade vibratória entre as posições corporais, em todas as intensidades analisadas, com maior atenuação das vibrações na PF, principalmente, durante a passagem dos estímulos vibratórios pelos membros inferiores. Pode-se concluir que a posição corporal adotada pelos sujeitos sobre a plataforma vibratória interfere diretamente na transmissibilidade das vibrações, sendo a PF a mais adequada para aplicação desse método de treinamento, por garantir uma melhor estabilidade corporal sobre a plataforma e promover uma atenuação mais efetiva das vibrações, evitando, assim, a ocorrência de acelerações indesejadas na cabeça.

Reduction mammoplasty improves body posture and decreases the perception of pain.

Women with hypertrophic breasts often experience body pain and posture problems, which tend to be reduced or even eliminated after reduction mammoplasty. The present study aimed to analyze the effects of reduction mammoplasty on anthropometric variables, body posture and pain in women with breast hypertrophy. Eleven women (mean [± SD] age 31.3±10.4 years) participated in the present study. Anthropometric variables, body posture and pain perception were evaluated pretest, and 60 (post60) and 90 (post90) days after reduction mammoplasty. Commercially available posture analysis software was used to analyze the following variables: acromial horizontal alignment (AHA), angle between acromial and anterior superior iliac spines (A-AAIS), vertical alignment of right (R) and left (L) trunk (VAT), vertical alignment of R and L body (VAB) and horizontal alignment of R and L pelvis (HAP). Descriptive statistics and ANOVA for repeated measures were used, and effect sizes (ES) were measured; the level of significance was set at P<0.05. There were no significant differences in anthropometric variables among the assessments. Only HAP-R showed a significant decrease; however, when analyzed, ES, VAT- L and HAP- L in post60, and VAT-R, VAT-L, HAP-R, HAP-L and VAB-L in post90 showed large ES after mammoplasty (ES>0.70). There were significant reductions in pain at post60 and post90 in the neck, cervical spine, back, shoulder and arm (P<0.05). Following mammoplasty, an improvement in body posture, primarily in the alignment of shoulders, trunk and pelvis, and a decrease in pain in the upper limbs and spine, were observed.

Les femmes qui ont une hypertrophie mammaire ont souvent des douleurs et des problèmes de posture, qui ont tendance à diminuer ou même à disparaître après une mammoplastie par réduction mammaire. La présente étude visait à analyser les effets d'une mammoplastie par réduction mammaire sur les variables anthropométriques, la posture et la douleur chez des femmes présentant une hypertrophie mammaire. Onze femmes (âge moyen [± ÉT] de 31,3±10,4 ans) ont participé à la présente étude. Les chercheurs ont évalué les variables anthropométriques, la posture et la perception de la douleur avant l'intervention, puis 60 jours (après 60 jours) et 90 jours (après 90 jours) après la mammoplastie par réduction mammaire. Les chercheurs ont utilisé un logiciel commercial d'analyse de la posture pour évaluer les variables suivantes : alignement horizontal acromial (AHA), angle entre les épines iliaques supérieures acromiales et antérieures (A-ÉIAAS), alignement vertical du tronc (AVT) du côté droit (D) et gauche (G), alignement vertical du corps (AVC) du côté D et G et alignement horizontal du bassin (AHB) du côté D et G. Ils ont utilisé les statistiques descriptives et l'analyse de variance pour les mesures répétées et mesuré l'ampleur de l'effet (AE). Ils ont établi le seuil de signification à P<0,05. Il n'y avait pas de différence significative des variables anthropométriques entre les évaluations. Seul l'AHB-D a révélé une diminution importante, mais à l'analyse, l'AE, l'AVT-G et l'AHB-G après 60 jours, ainsi que l'AVT-D, l'AVT-G, l'AHB-D, l'AHB-G et l'AVC-G après 90 jours ont révélé une importante AE après la mammoplastie (AE>0,70). Les chercheurs ont constaté d'importantes réductions de la douleur dans le cou, la colonne cervicale, le dos, les épaules et les bras après 60 jours et 90 jours (P<0,05). Après la mammoplastie, on observait une amélioration de la posture, surtout dans l'alignement des épaules, du tronc et du bassin, et une diminution de la douleur dans les membres supérieurs et la colonne vertébrale.

Avaliação preliminar da associação do vírus da imunodeficiência humana (HIV) com as hepatites virais do tipo B e C em dois centros de investigação do Brasil / Preliminary evaluation of the association of immunodeficiency human virus (HIV) with the hepatitis type B and C in two centers of inquiry of Brazil

A associação do HIV com os vírus das hepatites B e C se constitui num evento comum na região estudada, considerando a importância da transmissão parenteral através do uso de drogas injetáveis. No grupo estudado, a média de idade foi de 37 anos (17 e 52), sendo evidenciada uma diferença significativa entre os gêneros masculino e feminino na associação HIV, HBV/HCV (p< 0,05). Não foi observada diferença estatisticamente significativa entre a transmissão sangüínea e sexual (p >0,05). A associação HIV/HCV foi predominante, enquanto em 25% dos casos existia marcador de infecção para o HBV. A associação análogo nucleosídeo (NRTI) e não-análogo (NNRTI) foi utilizada em 61,5% dos casos. Efavirenz entre os não-análogos e Nelfinavir entre os inibidores da protease (IP) foram os mais prescritos. Setenta e oito (78,8%) dos pacientes estavam em tratamento anti-retroviral e 5,8% foram tratados da co-infecção HIV/HCV. Setenta e sete por cento (77%) dos co-infectados HIV/HCV eram genótipo 1 e os demais eram do tipo 3. No momento do diagnóstico, 41,2% dos casos tinham ALT variando entre 65-198 mg/dL. O CD4 após início do tratamento não demonstrou aumento superior a 25%, enquanto a carga viral teve uma queda em torno de 2 logs