1,720,990 research outputs found
A Systematic Review of the Microbiome in Children With Neurodevelopmental Disorders
Full text linkBackground and Purpose: A relationship between gut microbiome and central nervous system (CNS), have been suggested. The human microbiome may have an influence on brain's development, thus implying that dysbiosis may contribute in the etiology and progression of some neurological/neuropsychiatric disorders. The objective of this systematic review was to identify evidence on the characterization and potential distinctive traits of the microbiome of children with neurodevelopmental disorders, as compared to healthy children.Methods: The review was performed following the methodology described in the Cochrane handbook for systematic reviews, and was reported based on the PRISMA statement for reporting systematic reviews and meta-analyses. All literature published up to April 2019 was retrieved searching the databases PubMed, ISI Web of Science and the Cochrane Database of Systematic Reviews. Only observational studies, published in English and reporting data on the characterization of the microbiome in humans aged 0-18 years with a neurodevelopmental disorder were included. Neurodevelopmental disorders were categorized according to the definition included in the Diagnostic and Statistical Manual of Mental Disorders, version 5 (DSM-5).Results: Bibliographic searches yielded 9,237 records. One study was identified through other data sources. A total of 16 studies were selected based on their relevance and pertinence to the topic of the review, and were then applied the predefined inclusion and exclusion criteria. A total of 10 case-control studies met the inclusion criteria, and were thus included in the qualitative analysis and applied the NOS score. Two studies reported data on the gut microbiome of children with ADHD, while 8 reported data on either the gut (n = 6) or the oral microbiome (n = 2) of children with ASD.Conclusions: All the 10 studies included in this review showed a high heterogeneity in terms of sample size, gender, clinical issues, and type of controls. This high heterogeneity, along with the small sample size of the included studies, strongly limited the external validity of results. The quality assessment performed using the NOS score showed an overall low to moderate methodological quality of the included studies. To better clarify the potential role of microbiome in patients with neurodevelopmental disorders, further high-quality observational (specifically cohort) studies are needed
Sex and gender differences in the treatment of Alzheimer's disease: A systematic review of randomized controlled trials
No full texttIn recent years, epidemiological, clinical, and biological evidence has drawn the attention on the influenceof sex and gender on Alzheimer’s disease (AD). Nevertheless, not enough attention has been paid totheir impact on treatment outcomes. The present study is aimed at systematically retrieve, review anddiscuss data coming from available randomized placebo-controlled trials (RCTs) on currently marketedtreatments for AD (i.e., cholinesterase inhibitors [ChEIs] and memantine) in order to describe possiblesex and gender differences in their efficacy, safety and tolerability.A systematic review of literature was performed. None of the retrieved studies reported data on theefficacy, safety and tolerability of considered medications separately in male and female patients withAD. We thus analyzed 48 excluded studies of potential interest, that is, almost all of the currently availabletrials on the four considered drugs. Nearly all the considered RCTs recruited a larger number of femaleparticipants to mirror the sexually unbalanced prevalence of AD. Only two studies took into account thepotential influence of sex and gender on treatment efficacy, reporting no significant differences betweenmen and women. None of the studies investigated potential sex and gender differences in the safety andtolerability of the four considered treatments.The existence of sex and gender differences in the efficacy and tolerability of ChEIs and memantine inAD has, to date, drawn limited to no attention. However, a considerable amount of data, with an adequaterepresentativeness in terms of sex/gender distribution, seem to be already available for dedicated anal-yses on this topic. A greater effort should be made to collect and report data on those factors interactingwith sex and gender that may significantly influence clinical manifestations, outcomes, and trajectoriesover time of AD patients
Advances in amyloid-targeting monoclonal antibodies for Alzheimer's disease: clinical and public health issues
No full textIntroduction: Alzheimer's disease (AD) is a major global public health challenge. To date, no treatments have been shown to stop the underlying pathological processes. The cerebral accumulation of amyloid-beta (Ab) is still considered as the primum movens of AD and disease-modifying treatments targeting Ab are reaching - or have already reached - clinical practice. Areas covered: The authors explore the main advancements from Aβ-targeting monoclonal antibodies (mAbs) for the treatment of AD. From a public health perspective, they address ethically relevant issues such as the benevolence and non-maleficence principles. They report on the potential biological and clinical benefits of these drugs, discussing minimal clinically important differences (MCID) and other relevant outcomes. They examine the short- and long-term effects of amyloid-related imaging abnormalities (ARIA), and explore the differences between eligibility criteria in clinical trials, appropriate use recommendations, and prescribing information content. In doing so, they contextualize the discussion on the disagreements among different regulatory authorities. Expert opinion: Although anti-β-amyloid monoclonal antibodies may be effective in selected scenarios, non-negligible knowledge gaps and implementation limits persist. Overcoming these gaps can no longer be postponed if we are to ensure the principles of Quality of Care for patients with cognitive impairment who would be eligible for this class of drugs
The National Italian Guidelines on the diagnosis and treatment of children with pediatric ataxias
No full textAtaxia is a rare neurological condition causing a deficit in the coordination of motor activities, preventing the fluidity of movements. Children with ataxia may show several different ataxic signs, along with difficulties in walking autonomously and ataxic gait often associated with trunk instability. Ataxic signs can be either acute or chronic, and in either case, the diagnosis can be extremely complex. Symptoms and their etiology are often widely heterogeneous, even within the same condition
[From mild cognitive impairment to dementia: what is the role of public health?]
No full textMild cognitive impairment (MCI) is a nosological entity proposed by Petersen in 1999 with the objective of identifying an early stage of dementia. The new diagnostic criteria for dementia, both those promoted by the International Working Group (IWG) and those defined by the National Institute of Aging (NIA), subsequently introduced a new model that starts with a preclinical phase, then proceeds with a prodromal phase, and ends with a phase of dementia. The condition known as subjective cognitive disorder (SCD) is included between the preclinic and the prodromal phases. Most clinicians improperly consider MCI and SCD as diseases, and not as risk factors for dementia. This ambiguous scenario requires the application of a public-health standard. A diagnosis of either SCD or MCI comes with several uncertainties, raising issues pertaining to both the research setting and clinical practice. A large proportion of subjects with either SCD or MCI will never progress to dementia, and part of them may even revert to a normal cognitive profile. Thus, communicating of these diagnoses to a subject has ethical implications that cannot be underestimated. The frequency of these diagnoses in general population is starting to show the characteristics of both the phenomena of over-diagnosis, and consequently over-treatment. Moreover, the new criteria require the use of biomarkers, that are not yet validated for the use in clinical practice. No population studies are currently available performed based on the new diagnostic criteria for dementia. This means that future estimates will probably be more than twice the current ones, and will include also subjects that will not progress to dementia. This undefined framework, thus, urges the implementation of public-health programs aimed at both the primary and secondary prevention of dementias. Moreover, clinical trials on drugs in MCI currently use endpoints based on non-validated biomarkers, thus raising the issue of the external validity. A public guideline would thus be crucial to support clinicians in identifying all the possible causes that can determine a cognitive decline people that are mainly elder, with multiple comorbidities, and taking multiple medications. Moreover, the widespread use of neuro-psychological assessment tools in current clinical practice requires an accurate validation of these instruments
The National Italian Guidelines on the diagnosis and treatment of children with pediatric ataxias
Full text linkBackground: Ataxia is a rare neurological condition causing a deficit in the coordination of motor activities, preventing the fluidity of movements. Children with ataxia may show several different ataxic signs, along with difficulties in walking autonomously and ataxic gait often associated with trunk instability. Ataxic signs can be either acute or chronic, and in either case, the diagnosis can be extremely complex. Symptoms and their etiology are often widely heterogeneous, even within the same condition. Methods: The guideline was developed based on the methodology defined by the Methodological Handbook of the Italian National Guideline System (SNLG) and was reported following the AGREE-II checklist. The SNLG methodology required the adoption of the GRADE approach for the whole development process. To facilitate the implementation of the contents and recommendations from the guideline, two care pathways were developed based on the NICE and the European Pathway Association (EPA) models. Results: The guideline included 28 clinical questions, 4 on the identification and management of acute ataxias, and 24 on the diagnosis and management of chronic ataxias. The document included 44 recommendations, 37 clinical recommendations, and 7 recommendations for research. Conclusion: The working group, despite the lack and methodological limitations of the evidence, deemed as essential to provide indications and recommendations, in particular in some clinically relevant areas. The care pathway was produced as a tool to facilitate the implementation of the contents and recommendations. The interactive version of the pathway is available on the SNLG website along with a leaflet dedicated to families and caregivers
Exploring the association of early life physical activity and risk of dementia: a systematic review
Full text linkINTRODUCTION: Physical activity has been included in the list of twelve modifiable risk factors for dementia, despite conflicting results from observational and controlled studies. In particular it is not clear whether physical inactivity near the time of dementia diagnosis is a consequence or cause of dementia. We review all available studies reporting the possible association between having engaged in PA before 60 years of age and the risk of dementia.
EVIDENCE ACQUISITION: We performed a systematic review based on the methodology reported in the Cochrane handbook for systematic reviews and following the PRISMA statement. Bibliographic searches were carried out on the databases PubMed, ISI Web of Science and the Cochrane Database of Systematic Reviews. Further references were retrieved from published systematic reviews on the same topic. Included studies were assessed using the Newcastle Ottawa scale.
EVIDENCE SYNTHESIS: The bibliographic search yielded 1381 records. A total of 11 studies were included. Three of the included studies were case control studies, while the remaining 8 were cohort studies The overall quality of included studies was high. However, clinical criteria for the diagnosis of dementia, criteria to define and measure and PA and time-reference of exposure were heterogeneous, with some studies considering specific age range of exposure, and other reports dealing with more generic “adult age.”
CONCLUSIONS: This review suggests that there is insufficient evidence to conclude whether PA in early life may affect the incidence of dementia in later life. Studies in this field are very complicated and recognizing the impact of PA in early life given all the confounding factors is very difficult. Further studies are warranted. In these studies, it will be crucial to define the type, quantity and intensity of PA as well as to stratify analysis by sex, cultures and social classes
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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