Objective: To study the impact of active video games on Body Mass Index (BMI) in children and adolescents. Design and Methods: A systematic review and meta-analysis. Data were pooled in meta-analysis using the method of random effects or fixed effects, as appropriate, after examination of statistical heterogeneity. Data sources and eligibility criteria for selecting studies. A comprehensive literature research was conducted in Medline (PubMed), ISI web of Knowledge, and SCOPUS up to April 2018, in relation to clinical trials (both controlled and non-controlled) in children and adolescents, whose intervention was based on active video games. Results: The overall intragroup effect of the intervention based on active video games was in favor of the intervention, reaching statistical significance using the fixed effects model: (standardized mean difference (SMD) = −0.138; 95% CI (−0.237 to −0.038), p = 0.007 and was of borderline statistical significance in the random effects model: SMD= −0.191; 95% CI (−0.386 to 0.003), p = 0.053. The individual results of the determinations of the 15 included studies for this analysis showed a high heterogeneity among them (I2 = 82.91%). When the intervention was applied to children and adolescents with greater than or equal to 85 (overweight or obese) BMI percentile showed a greater effect in favor of the active video games: SMD= −0.483, p = 0.012. The overall intra-group effect in the control group was close to zero (SMD = 0.087). With respect to the non-standardized mean difference (MD) between groups, it was also in favor of active video games for both BMI (Kg/m2): DM = −0.317, 95% CI (−0.442 to −0.193), p = < 0.001 and BMI z-score: DM = −0.077, 95% CI (−0.139 to −0.016), p = 0.013. Conclusions: Our meta-analysis show a statistically significant effect in favor of using active video games on BMI in children and adolescents. The clinical relevance of this positive effect must be evaluated.
Objective To determine the prognostic value of cortisol, Dehydroepiandrosterone (DHEA) and Dehydroepiandrosterone-sulfate (DHEAS), together with their ratios (cortisol/DHEA and cortisol/DHEAS), as independent predictors of mortality in septic patients. Methods Prospective cohort study of 139 consecutive patients with a diagnosis of severe sepsis or septic shock. Adrenal hormones were determined within the first 24 hours of the septic process. To determine and compare the predictive ability of each marker for the risk of unfavorable evolution (in-hospital, 28-day and 90-day mortality), ROC (Receiver Operating Characteristic) curves were constructed and the area under the curve (AUC) was determined. As measures of association, adjusted odds ratios (OR) with their 95% confidence intervals (95%CI) were estimated by unconditional logistic regression. Cortisol, DHEA and DHEAS results were compared to lactate, CRP, SOFA and APACHE II Scores. Results Cortisol showed the best predictive ability, with AUCs of 0.758, 0.759 and 0.705 for in-hospital mortality, and 28-day and 90-day mortality, respectively; whereas AUCs for 28 days mortality for SOFA and APACHE II scores, and other biomarkers studied, such as Lactate or CRP, were 0.644, 0.618, 0.643 and 0.647, respectively. Associations between high cortisol levels (>17.5 μg/dL) and mortality were strong and statistically significant for in-hospital and 28-day mortality: adjusted ORs 10.13 and 9.45 respectively, and lower for long term mortality (90 days): adjusted OR 4.26 (95% CI 1.34–13.56), p trend 0.014. Regarding adrenal androgens, only positive associations were obtained for DHEAS and most of these positive associations did not yield statistical significance. Regarding Cortisol/DHEA and cortisol/DHEAS ratios, they did not improve the predictive ability of cortisol. The only exception was the cortisol/DHEAS ratio, which was the best predictor of mortality at 90 days (AUC 0.737), adjusted OR for highest cortisol/DHEAS ratio values 6.33 (95%CI 1.77–22.60), p trend 0.002. Conclusion Basal cortisol measured within the first 24 hours of the septic process was the best prognostic factor for in-hospital and 28-day mortality, even superior to the Sequential Organ Failure Assessment (SOFA) or Acute Physiology and Chronic Health Evaluation II (APACHE II) scores. The cortisol/DHEAS ratio was an independent predictor of long-term mortality.
Objective: To study the impact of active video games on Body Mass Index (BMI) in children and adolescents. Design and Methods: A systematic review and meta-analysis. Data were pooled in meta-analysis using the method of random effects or fixed effects, as appropriate, after examination of statistical heterogeneity. Data sources and eligibility criteria for selecting studies. A comprehensive literature research was conducted in Medline (PubMed), ISI web of Knowledge, and SCOPUS up to April 2018, in relation to clinical trials (both controlled and non-controlled) in children and adolescents, whose intervention was based on active video games. Results: The overall intragroup effect of the intervention based on active video games was in favor of the intervention, reaching statistical significance using the fixed effects model: (standardized mean difference (SMD) = −0.138; 95% CI (−0.237 to −0.038), p = 0.007 and was of borderline statistical significance in the random effects model: SMD= −0.191; 95% CI (−0.386 to 0.003), p = 0.053. The individual results of the determinations of the 15 included studies for this analysis showed a high heterogeneity among them (I 2 = 82.91%). When the intervention was applied to children and adolescents with greater than or equal to 85 (overweight or obese) BMI percentile showed a greater effect in favor of the active video games: SMD= −0.483, p = 0.012. The overall intra-group effect in the control group was close to zero (SMD = 0.087). With respect to the non-standardized mean difference (MD) between groups, it was also in favor of active video games for both BMI (Kg/m 2 ): DM = −0.317, 95% CI (−0.442 to −0.193), p = < 0.001 and BMI z-score: DM = −0.077, 95% CI (−0.139 to −0.016), p = 0.013. Conclusions: Our meta-analysis show a statistically significant effect in favor of using active video games on BMI in children and adolescents. The clinical relevance of this positive effect must be evaluated.has undergone a radical change with the arrival of a new generation of video games, active video games, which involve physical activity since they allow players to interact physically, through their body movements (arms, legs, or the whole body), with the virtual reality that appears on screen through different devices.Individual primary studies and subsequent meta-analyses have focused on the effects of active video games on the promotion of physical activity [3][4][5][6][7][8], energy expenditure , oxygen volume consumption [9,12,15,16,[27][28][29], and heart rate [9,14,15,17,18,[27][28][29][30][31][32]. These studies have shown an increase in heart rate and an increase in oxygen consumption. This energy consumption is statistically significantly higher compared to non-active video games and sedentary activities, despite the variability of the types of active video games, as well as the time spent playing them [5,7,19,[22][23][24][25][26]33].Regarding the effect of active video games on body mass index (BMI), various primary studies [21,31,[33][34][35][36][37][38][39][40][41] have analyzed...
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