Do youth sports prevent pediatric obesity? A systematic review and commentary

Sport is a promising setting for obesity prevention among youth, but little is known about whether it prevents obesity. We reviewed research comparing sport participants with nonparticipants on weight status, physical activity, and diet. Among 19 studies, we found no clear pattern of association between body weight and sport participation. Among 17 studies, we found that sport participants are more physically active than those who do not participate. We found seven studies that compared the diet of sport participants with non-participants. These studies reported that youth involved in sport were more likely to consume fruits, vegetables, and milk, and also more likely to eat fast food and drink sugar-sweetened beverages and consume more calories overall. It is unclear from these results whether sports programs, as currently offered, protect youth from becoming overweight or obese. Additional research may foster understanding about how sport, and youth sport settings, can help promote energy balance and healthy body weight.     

Dental erosion’ prevalence and its relation to isotonic drinks in athletes: a systematic review and meta-analysis

Purpose

To estimate the global prevalence of dental erosion and to evaluate whether there is scientific evidence that the use of isotonic drinks could increase the risk of this condition in athletes.

Methods

This study was registered in the PROSPERO (CRD42018091545) and it was performed following the PRISMA guidelines. A broad search was conducted in the following databases: PubMed, Scopus, Web of Science, Virtual Health Library (Lilacs) and Grey Literature using MeSH and free terms. Manual search was also performed in the references of included studies. Articles published up to October 04, 2019 were included. Two researchers individually selected the studies according to the eligibility criteria and performed data extraction and methodological evaluation. A random effects model was adopted in the meta-analysis.

Results

Nine studies were selected in which three were considered to have a moderate risk of bias and six were considered to have a low risk of bias. The results of the meta-analysis showed that the estimated global prevalence of dental erosion was 47.07% (95% CI 24.025–70.800) in athletes. It also demonstrated that there was no association between the use of isotonic drinks and dental erosion (95% CI 0.00 [??0.07, 0.08; p?=?0.95].

Conclusion

The estimated prevalence of dental erosion in athletes was considered high; however, there was no association between isotonic drink consumption and the prevalence of dental erosion.

     

Health and sports law collide: do professional athletes have an unfettered choice to accept risk of harm?

Is there a positive duty at law to prevent an athlete with a serious medical disability from performance, despite the player accepting the risk? Is high risk of serious injury or death in the athletic context equivalent to euthanasia? Euthanized death is a predictable consequence of deliberate action. Accepting high risk in the athletic context is distinguishable. Athletes are often more likely able to make voluntary decisions without the burdens of incurable pain and clouding medications. Should policy reasons, nonetheless, preclude athletes from accepting high or uncertain risks of serious injury or death? What standard of medical certainty or legal certainty is appropriate regarding the "right to risk"? The higher the risk of serious injury or death and the less the medical uncertainty the more tort law might trump contract principles. In contrast, medically certain outcomes are easier to knowingly and voluntarily assume by way of contract. Waivers are contracts and present a conflict between a person's rights to have freedom to contract and negligence. Contracts shift the risk. An athlete can be disqualified to avoid a significant risk of injury that cannot be eliminated through reasonable medical accommodations. The problem is that physicians tend to be conservative and without any input from informed athletes, many otherwise disabled players would be refused participation, albeit with a high risk. If an athlete is able to seek medical treatment that reduces the risk and does so, an athlete's will to return should not be ignored. The team must substantiate the restriction by justifying a relatively certain and substantial risk. An athlete may agree to accept high risk of serious injury or death through a contractual waiver to insulate others from liability in negligence. Independent legal advice and advice from medical experts ensure that such waivers are legally enforceable. As medical law has broad application, dealing with improving the rights, rules and policies of health care as it relates to the use of advanced medical technologies in potentially vulnerable persons and consequently the right to accept risk, is as important both evaluative and meritorious exercise for all health and legal systems throughout the world.     

Sensory organization for postural control in children with strabismus—A systematic review and meta-analysis

BackgroundPostural control requires the interaction of somatosensory, vestibular and visual systems to prevent disequilibrium. Children with strabismus have an impaired visual input which can lead to postural control deficits.Research questionDoes strabismus affect sensory organization for postural control in children?MethodsA systematic comprehensive search of multiple electronic databases for relevant articles was performed using a predetermined search strategy. Peer-reviewed journal publications that assessed sensory organization and postural performance in children with strabismus were included in this review. Methodological quality of the articles was evaluated using the modified Downs and Black quality assessment tool. A total of 10 articles were included in this review.ResultsEight of the 10 articles reviewed were included in the meta-analysis.Meta-analysis for Centre of Pressure CoP velocity (n = 3) (eyes open, stable support), was statistically significant (P = 0.01) in favor of controls over children with strabismus (MD, 3.08; 95 % CI −0.66, 5.51). Meta-analysis for CoP surface area (n = 5) (eyes open, stable support) was also statistically significant (P < 0.001) in favor of the control group (MD, 130.14; 95 % CI 70.01, 190.260). Meta-analysis with standardized mean difference (n = 6) for eyes open vs closed, stable support was statistically significant (P = 0.02) in favor of eyes open (MD, −0.94; 95 % CI, −1.74, −0.15). Overall, there was a high level of heterogeneity throughout the studies.SignificanceThis is the first systematic review of its kind to collate and synthesize evidence on the effect of strabismus on postural control in children. This review suggests that postural control performance in children with strabismus is inferior to that of age-matched control children. Further investigation is needed to understand the influence of the three sensory systems.     

Prevention of anterior cruciate ligament injuries in sports—Part I: Systematic review of risk factors in male athletes

Purpose

The purpose of this study was to report a comprehensive literature review on the risk factors for anterior cruciate ligament (ACL) injuries in male athletes.

Methods

All abstracts were read and articles of potential interest were reviewed in detail to determine on inclusion status for systematic review. Information regarding risk factors for ACL injuries in male athletes was extracted from all included studies in systematic fashion and classified as environmental, anatomical, hormonal, neuromuscular, or biomechanical. Data extraction involved general characteristics of the included studies (type of study, characteristics of the sample, type of sport), methodological aspects (for quality assessment), and the principal results for each type of risk factor.

Results

The principal findings of this systematic review related to the risk factors for ACL injury in male athletes are: (1) most of the evidence is related to environmental and anatomical risk factors; (2) dry weather conditions may increase the risk of non-contact ACL injuries in male athletes; (3) artificial turf may increase the risk of non-contact ACL injuries in male athletes; (4) higher posterior tibial slope of the lateral tibial plateau may increase the risk of non-contact ACL injuries in male athletes.

Conclusion

Anterior cruciate ligament injury in male athletes likely has a multi-factorial aetiology. There is a lack of evidence regarding neuromuscular and biomechanical risk factors for ACL injury in male athletes. Future research in male populations is warranted to provide adequate prevention strategies aimed to decrease the risk of this serious injury in these populations.

Level of evidence

Systematic review on level I–IV studies, Level IV.     

Is there a specific mutation of p53 gene due to radon exposure? A systematic review

Purpose: To review the existing literature analysing the influence of radon exposure on mutations in tumour protein 53 gene (TP53) in lung cancer patients.

Material and methods: Medline and EMBASE databases along with the International Agency for Research on Cancer (IARC) monographies were revised. Studies that had radon concentration as exposure variable and TP53 mutations as a result variable were included.

Results: Eight studies were obtained, with a total of 578 individuals. They had been carried out on miners and on general population. A 26% of the miners' tumours had a mutation in gene TP53, versus a 24% in the population exposed to residential radon. A predominance of the AGG^ARG→ ATG^MET (Arginine to Methionine) mutation in miners was observed.

Conclusions: The available results are not consistent in order to support the existence of a radon hotspot in TP53 gene. Future research should focus at least on exons 5 to 8, where most of the mutation clusters in lung tumours are observed.     

Optical coherence tomography in the diagnosis of actinic keratosis—A systematic review

BackgroundOptical coherence tomography (OCT) is a real-time non-invasive imaging tool, introduced in dermatology in the late 1990s. OCT uses near-infrared light impulses to produce images which can be displayed in cross-sectional and en-face mode. The technique has been used to image skin diseases especially non-melanoma skin cancer including actinic keratosis (AK). Morphological characteristics of AK can be visualized in OCT images and can be used for diagnosis as well as disease monitoring.MethodsA systematic review of original papers on AK and OCT was performed on 31.03.16 and 24.10.16 in the major databases Pubmed, MEDLINE, EMBASE, Cochrane and Svemed. Through database search and other sources, we identified 1366 titles of which 21 studies met the inclusion criteria and were used for further investigation.Results16/16 Conventional OCT (cross-sectional images) studies described disruption of layers consistent with absence of normal layered architecture in the skin. Thickened epidermis was found in 14/16 studies and white (hyperreflective) streaks and dots were described in 11/16 studies. In High-definition optical coherence tomography (HD-OCT) images disarranged epidermis (cross-sectional images) along with an atypical honeycomb pattern (en-face images) was found in 5/5 studies and well-demarcated dermo-epithelial junction (DEJ) (cross-sectional images) was described in 3/5 studies.ConclusionSeveral morphological characteristics of AKs were identified using Conventional OCT and HD-OCT. It is suggested that these may be used in the diagnosis of AK. Additional validation is however required to establish consensus on the optimal diagnostic criteria.     

The effect of exercise for improving bone health in cancer survivors — A systematic review and meta-analysis

ObjectiveTo evaluate the effectiveness of exercise for improving bone-related outcomes among cancer survivors.DesignSystematic review and meta-analysis.MethodsAn electronic search using the following databases: SPORTDiscus, Science Direct, CINAHL, MEDLINE, Cochrane, Pubmed, Ebscohost, ProQuest Nursing and Allied Health Source.Randomised, controlled, exercise trials involving cancer survivors were eligible. Effect data on bone mineral content (BMC) and density (BMD) outcomes were extracted. Risk of bias was assessed using the Physiotherapy Evidence Database tool. Standardised mean differences (SMD) were calculated to compare differences between exercise and usual care. Subgroup analyses were conducted to assess whether effect differed by exercise mode, intervention length, supervision, treatment, cancer type and risk of bias.ResultsTwenty-six trials were included, with intervention durations ranging between 12 weeks and 2 years. Most trials involved breast cancer (n = 13, 50%), and most interventions were supervised (n = 18, 69%) and evaluated mixed-mode (i.e., combined aerobic and resistance) exercise (n = 13, 50%). Significant effects in favour of exercise (aerobic, resistance, mixed-mode and other exercise) were observed for whole body BMD, hip BMD, trochanter BMD and femoral neck BMD (SMD range: 0.19–0.39, all p < 0.05) compared to usual care.ConclusionParticipation in various modes (aerobic, resistance, mixed-mode and other) of supervised and unsupervised exercise is associated with improvements in BMD. The present results provide evidence for clinicians and other health care professionals (e.g., exercise physiologists and physiotherapists) to recommend exercise for cancer survivors to prevent bone loss during and following treatment.     

The diagnostic value of FDG and amyloid PET in Alzheimer’s disease—A systematic review

PurposeBy 2050 it is projected that 115 million people worldwide will have Alzheimer’s Disease (AD) [1]. Recent attempts have been made to redefine the diagnostic criteria of AD to include markers of neurodegeneration – measurable by FDG-PET – and markers of amyloid accumulation – measurable by amyloid-PET.Materials and methodsA systematic review of the literature was performed to examine the current diagnostic use of amyloid and FDG PET. MEDLINE and EMBASE databases and the Cochrane Database were searched for relevant papersResults and discussionThis search resulted in twenty-nine papers on amyloid imaging, twenty-three papers on FDG-PET and eight papers which utilized both techniques. Both modalities are considered in turn with regards to their diagnostic accuracy, their role in mild cognitive impairment (MCI) and prognostication, their use in the differential diagnosis of AD and their clinical application. As evidenced from the current literature, both amyloid and FDG-PET meet criteria for suitable biomarkers for the diagnosis of AD. They both indicate pathophysiological processes, albeit at different stages of the Alzheimer’s process, and are distinct from normal patterns of aging.ConclusionBoth techniques have been shown to detect AD with high sensitivity and specificity compared to other neurodegenerative processes and cognitively normal age-matched individuals. However, future studies with standardised, uniform thresholds and a lengthier longitudinal follow-up need to be conducted to allow us to make surer conclusions about the future role of PET in clinical practice. In addition, comparison with post-mortem diagnosis, rather than clinical diagnosis with its acknowledged flaws, would result in more powerful statistical outcomes – which is becoming increasingly important given that several disease-modifying AD drugs are now in phase 3 trials.     

The use of the Körperkoordinationstest für Kinder in the talent pathway in youth athletes: A systematic review

ObjectivesIdentifying talented athletes from an early age to accelerate their development requires the investment of substantial resources. Due to the need for multifactorial approaches to talent identification, motor competence assessments are increasingly prevalent in contemporary testing batteries. Therefore, the aim of this review was to evaluate the literature on the use of a product-oriented motor competence assessment tool, the Körperkoordinationstest für Kinder (KTK) in the talent pathway and determine whether it is warranted in such programs.MethodsThree electronic databases (i.e. PubMed, SPORTDiscus and Web of Science) were searched for studies that used at least one component of the KTK to assess motor competence for talent detection, identification, development and selection in athletic populations. A total of 21 articles were included in the review, of which seven used the full version of the KTK and 14 used modified versions or individual components of the battery. The quality of included studies was assessed using a modified version of the Joanna Brigg’s Institute Critical Appraisal Checklist.ResultsThe analysed literature suggests that the KTK can successfully distinguish between athletes of different competition levels and across different sporting domains, however, findings should be interpreted with caution due to the cross-sectional nature of the studies. Furthermore, the moving sideways subtest displayed the greatest discriminative power for athletes of different competition levels. Motor competence was not affected by maturation and did not differ between genders or playing positions.ConclusionsCollectively, these findings suggest that the KTK is a useful motor competence assessment in the talent pathway.     

Observational gait assessment tools in paediatrics – A systematic review

Instrumented gait analysis (IGA) is an expensive technique used to objectively detect gait abnormalities in children. Observational gait assessment is considered as a cost effective alternate for IGA in regular clinical practice. This article is aimed at systematically reviewing the available paediatric gait analysis tools and examines their reliability and validity compared to IGA. This review also examines the structure of these tools, their clinical use and limitations. Articles were searched from PubMed, CINHL, AMED, BNI, EMBASE, PEDro and Cochrane library from the earliest record on the database to December 2012. Hand searches were carried out in a few journals. Studies that examined children's gait using a structured assessment tool were included and analysed for their quality, reliability and validity. Pre-established criteria were used to judge the quality of methodology and reliability and validity. Five observational gait tools for children with Cerebral Palsy (CP) and one for children with Downs Syndrome were identified. Nine studies related to children with CP were enrolled for this review. None of the tools have accomplished the level of IGA's consistency. Edinburgh Visual Gait Score (EVGS) was found to have better reliability and validity than the other tools. Very limited studies were available for most of the gait assessment tools therefore their clinical use cannot be judged based on the existing evidence. EVGS was found to have better concurrent validity and reliability and it should be considered to assess CP gait in regular practice. Future work to investigate the use of low cost technology to improve observers’ accuracy of EVGS is suggested.     

Application and performance of artificial intelligence technology in forensic odontology – A systematic review

Forensic odontology (FO) mainly deals with the identification of the individual through the remains, which mainly includes teeth and jawbones. Artificial intelligence (AI) technology has proven to be a breakthrough in providing reliable information in decision making in forensic sciences. This systematic review aimed to report on the application and performance of AI technology in FO. The data was gathered through searching for the articles in the renowned search engines, which have been published between January 2000 - June 2020. QUADAS-2 was adopted for the risk of bias analysis of the included studies. AI technology has been widely applied in FO for identifying bite-marks, predicting mandibular morphology, gender determination, and age estimation. Most of these AI models are based on either artificial neural networks (ANNs) or convolutional neural networks (CNNs). The results of the studies are promising. Studies have reported that these models display accuracy and precision equivalent to that of the trained examiners. These models can be promising tools when identifying victims of mass disasters and as an additive aid in medico-legal situations.     

Should athletes return to sport after applying ice? A systematic review of the effect of local cooling on functional performance

Applying ice or other forms of topical cooling is a popular method of treating sports injuries. It is commonplace for athletes to return to competitive activity, shortly or immediately after the application of a cold treatment. In this article, we examine the effect of local tissue cooling on outcomes relating to functional performance and to discuss their relevance to the sporting environment. A computerized literature search, citation tracking and hand search was performed up to April, 2011. Eligible studies were trials involving healthy human participants, describing the effects of cooling on outcomes relating to functional performance. Two reviewers independently assessed the validity of included trials and calculated effect sizes. Thirty five trials met the inclusion criteria; all had a high risk of bias. The mean sample size was 19. Meta-analyses were not undertaken due to clinical heterogeneity. The majority of studies used cooling durations > 20 minutes. Strength (peak torque/force) was reported by 25 studies with approximately 75% recording a decrease in strength immediately following cooling. There was evidence from six studies that cooling adversely affected speed, power and agility-based running tasks; two studies found this was negated with a short rewarming period. There was conflicting evidence on the effect of cooling on isolated muscular endurance. A small number of studies found that cooling decreased upper limb dexterity and accuracy. The current evidence base suggests that athletes will probably be at a performance disadvantage if they return to activity immediately after cooling. This is based on cooling for longer than 20 minutes, which may exceed the durations employed in some sporting environments. In addition, some of the reported changes were clinically small and may only be relevant in elite sport. Until better evidence is available, practitioners should use short cooling applications and/or undertake a progressive warm up prior to returning to play.     

Is treadmill walking biomechanically comparable to overground walking? A systematic review

BackgroundThe equivalency of treadmill and overground walking has been investigated in a large number of studies. However, no systematic review has been performed on this topic.Research questionThe aim of this study was to compare the biomechanical, electromyographical and energy consumption outcomes of motorized treadmill and overground walking.MethodsFive databases, ScienceDirect, SpringerLink, Web of Science, PubMed, and Scopus, were searched until January 13, 2021. Studies written in English comparing lower limb biomechanics, electromyography and energy consumption during treadmill and overground walking in healthy young adults (20–40 years) were included.ResultsTwenty-two studies (n = 409 participants) were included and evaluated via the Cochrane Collaboration’s tool. These 22 studies showed that some kinematic (reduced pelvic ROM, maximum hip flexion angle for females, maximum knee flexion angle for males and cautious gait pattern), kinetic (sagittal plane joint moments: dorsiflexor moments, knee extensor moments and hip extensor moments and sagittal plane joint powers at the knee and hip joints, peak backwards, lateral and medial COP velocities and propulsive forces during late stance) and electromyographic (lower limbs muscles activities) outcome measures were significantly different for motorized treadmill and overground walking.SignificanceSpatiotemporal, kinematic, kinetic, electromyographic and energy consumption outcome measures were largely comparable for motorized treadmill and overground walking. However, the differences in kinematic, kinetic and electromyographic parameters should be taken into consideration by clinicians, trainers, and researchers when working on new protocols related to patient rehabilitation, fitness rooms or research as to be as close as possible to the outcome measures of overground walking. The protocol registration number is CRD42021236335 (PROSPERO International Prospective Register of Systematic Reviews).