This systematic review examined longitudinal associations between weight change (weight gain and loss) and both physical and mental aspects of health-related quality of life (HRQOL) compared with stable weight in adults and children of the general population. MEDLINE, EMBASE, PsycINFO and PubMed databases were searched. Longitudinal observational studies measuring HRQOL with six predefined instruments were synthesized according to type of association: weight change and change in HRQOL (change-on-change association) and weight change and HRQOL at follow-up (predictive association). Twenty studies of adults (n = 15) or children (n = 5) were included. Fifteen studies used the SF-12 or SF-36. Results of nine studies in adults examining the change-on-change association were combined through a tallying of 606 analyses. Weight gain was most often associated with reduced physical, but not mental HRQOL, across all baseline body mass index categories and in both men and women. Weight loss may be associated with improved physical, but not mental HRQOL, among adults with overweight and obesity. Weight gain was more strongly associated with HRQOL than weight loss, implicating a greater need for preventative strategies to tackle obesity. Results in children and for the predictive association generally reflected these findings but require further research.
Background Admission stroke severity is an important clinical predictor of stroke outcomes. Pre-stroke physical activity (PA) contributes to stroke prevention and may also be associated with reduced stroke severity. Summarising the evidence to-date will inform strategies to reduce burden after stroke. Aims To summarise the published evidence for the relationship between pre-stroke physical activity (PA) and admission stroke severity and to provide recommendations for future research. Summary of Review MEDLINE, Embase, Emcare, CENTRAL and gray literature databases were searched on February 14, 2020 using search terms related to stroke and pre-stroke PA. We screened 8,152 references and assessed 172 full-text references for eligibility. The final review included seven studies (n=41,800 stroke patients). All studies were observational, assessed pre-stroke PA using self-reported questionnaires, and assessed admission stroke severity using the National Institute of Health Stroke Scale. Pre-stroke PA was associated with milder stroke severity (4/7 studies). Greater pre-stroke PA duration (1/7 studies), intensity (1/7 studies), or amount (3/7 studies) were independently associated with milder stroke severity. Studies ranged between moderate to critical risk of bias, primarily due to confounding factors. Pre-stroke PA was associated with reduced risk factors for severe stroke, distal occlusion, smaller infarcts, and treatment delays. Conclusion Pre-stroke PA may be associated with reduced admission stroke severity. Lack of randomised controlled trials limited causality conclusions. Further investigation is needed to understand the effect of pre-stroke PA on admission stroke severity. â
Very severe Myalgic Encephalomyelitis (ME), (also known as Chronic Fatigue Syndrome) can lead to problems with nutrition and hydration. The reasons can be an inability to swallow, severe gastrointestinal problems tolerating food or the patient being too debilitated to eat and drink. Some patients with very severe ME will require tube feeding, either enterally or parenterally. There can often be a significant delay in implementing this, due to professional opinion, allowing the patient to become severely malnourished. Healthcare professionals may fail to recognize that the problems are a direct consequence of very severe ME, preferring to postulate psychological theories rather than addressing the primary clinical need. We present five case reports in which delay in instigating tube feeding led to severe malnutrition of a life-threatening degree. This case study aims to alert healthcare professionals to these realities.
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