•Treatment-resistance carries significant burden in BD.•The existing definitions for resistant mania or bipolar depression are inconsistent.•Ketamine and ECT represent promising avenues in the ...management of resistant BD.
The definitions of treatment-resistant bipolar disorder (TRBD) have varied across studies. Additionally, its management is clinically challenging. An updated synthesis and appraisal of the available evidence is needed.
A systematic search of major electronic databases from inception up to May 25th, 2020, was conducted to identify randomized controlled trials (RCTs) of pharmacological and non-pharmacological interventions for the management of TRBD. When sufficient evidence was available, a meta-analysis was conducted.
Seventeen studies (n = 928 patients) were included in the qualitative synthesis. Fourteen studies (n = 803) assessed treatment-resistant acute bipolar depression (TRBD-De), including five neuromodulatory and nine pharmacological trials. Rapid- vs. standard up-titration of clozapine showed promising efficacy for TRBD mania, without significant adverse events. Electroconvulsive therapy (ECT) was confirmed to be similarly effective for TRBD-De as for treatment-resistant unipolar depression: odd ratio, OR = 0.919 (95%C.I. = 0.44–1.917), I2 = 13.98, p = .822. TRBD-De patients exposed to ketamine at day one post-infusion had high odds of response: OR = 10.682 (95%C.I. = 2.142–53.272), I2 = 0, p = <.005. The pooled drop-out rate in the ketamine trials was 21.2%. Additional evidence is warranted to confirm the potential efficacy of pramipexole or stimulants for TRBD-De.
Publication/measurement bias; exploratory nature of the meta-analyses for interventions that included participants solely with TRBD-De.
Overall, a few interventions are available for TRBD, including pramipexole, ECT, and clozapine, among others. Larger and better-designed trials for TRBD are warranted and should be based on more uniform operational definitions.
PROSPERO registration number: CRD42018114567.
Background
Treatment‐emergent mania (TEM) represents a common phenomenon inconsistently reported across primary studies, warranting further assessment.
Methods
A systematic review and meta‐analysis ...following the Preferred Reporting Items for Systematic Review and Meta‐Analysis (PRISMA) and Meta‐Analysis of Observational Studies in Epidemiology (MOOSE) guidelines were conducted. Major electronic databases were searched from inception to May 2017 to assess the incidence and prevalence rates and clinical features associated with manic switch among bipolar depressed patients receiving antidepressants, using meta‐regression and subgroup analysis.
Results
Overall, 10 098 depressed patients with bipolar disorder (BD) across 51 studies/arms were included in the quantitative analysis. The cumulative incidence of cases (TEM+) among 4767 patients with BD over 15 retrospective studies was 30.9% (95% confidence interval CI 19.6‐45.0%, I2 = 97.9%). The cumulative incidence of TEM+ among 1929 patients with BD over 12 prospective open studies was 14.4% (95% CI 7.4‐26.1%, I2 = 93.7%). The cumulative incidence of TEM+ among 1316 patients with BD over 20 randomized controlled trials (RCTs) was 11.8% (95% CI 8.4‐16.34%, I2 = 73.46%). The pooled prevalence of TEM+ among 2086 patients with BD over four cross‐sectional studies was 30.9% (95% CI 18.1‐47.4%, I2 = 95.6%). Overall, concurrent lithium therapy predicted the lowest TEM rates. Inconsistent operational definitions of TEM were recorded, and the lack of information about age, sex, co‐occurring anxiety, and other clinically relevant moderators precluded further stratification of the results.
Conclusions
Rates of TEM vary primarily depending on study setting, which is concordant with the high degree of heterogeneity of the included records. Forthcoming RCT studies should adopt consistent operational definitions of TEM and broaden the number of moderators, in order to contribute most effectively to the identification of clear‐cut sub‐phenotypes of BD and patient‐tailored pharmacotherapy.
The lifelong education of coaches is one of the priorities of the European Union. Therefore, the purpose of this study was to investigate Italian elite coaches' motivation to engage in a ...sport-related academic education, and its demands, barriers, support, and relocation issues in relation to their dual career (DC) path. Sixteen Italian elite coaches (e.g., certified fourth-level national team coaches, senior team coaches) enrolled in a specifically tailored Bachelor's degree in sports sciences at the University of Rome Foro Italico (Italy) volunteered for this study. A qualitative approach integrating inductive and deductive reasoning, and thematic analysis was applied to participants' responses to an open-ended item survey. Independently from relocation, student-coaches' DC perceptions resulted in 15 lower-order themes further organized in 5 high-er-order themes (e.g., Benefit, Challenge, Expectation, Organization, and Support), each related to the contexts (e.g., Personal, Academic, Sport), the DC dimension (e.g., micro, meso, macro, and policy), and the DC push (e.g., facilitating) /pull (e.g., hindering) factors. The elite coaches' insights emphasize the complexity of the coach lifelong education at university level, and provide valuable information for promoting European and National (e.g., Italian) DC recommendations for elite sportspersons through a cooperation between sport bodies and higher educational institutions.
Despite Dual Careers (sports and education) and mobility of students being priorities in the funding policies of the European Commission, migrating student-athletes report severe challenges and ...decreased performance or dropouts at sport and academic levels. The objective of this study was to depict and assess the perceptions on challenges, support services, and their effectiveness in consideration of specific characteristics of participants and migrations. Based on a meta-synthesis and previous findings, a 50-items questionnaire was developed and completed by 245 student-athletes in 5 European countries. Participants with Dual Careers migration experience (n = 140) were considered for analyses of qualitative and quantitative (ordinal 5pt-Likert-scaled and metric) data on the Dual Career status, migration characteristics, received services, and outcomes. Chi-square-tests were conducted for differences between countries and genders at a significance level of p < .05. Country-related differences were found for experiences and intentions to migrate (X.sup.2 .sub.(12) = 50.52, p<0.001), duration of the migration (X.sup.2 .sub.(16) = 38.20, p = 0.001), financial support (X.sup.2 .sub.(8) = 29.87, p<0.001), and decreased performances in academics (X.sup.2 .sub.(16) = 56.12, p<0.001) and sports (X.sup.2 .sub.(16) = 31.79, p = 0.01). Gender-related difference emerged in financial support (X.sup.2 .sub.(4) = 10.68, p = 0.03), duration of the migration (X.sup.2 .sub.(4) = 14.56, p = 0.01), and decreased academic performance (X.sup.2 .sub.(4) = 10.57, p = 0.03). Tutoring and counselling support was ranked as the most effective support, especially when received from the academic field (4.0±1.0 pt) and others (4.1±0.8 pt), followed by online services from sport and academic sectors (both: 3.9±0.9 pt). Considering the pervasive globalization of sport and education, Dual Career migration can contribute to the development of a European sport culture. The high ratio of migrating student-athletes underlines the relevance of migrations in the field of Dual Careers. This study contributes to the literature by adding insights on practices, challenges, supports, and outcomes perceived by student-athletes migrating in Europe. Moreover, country- and gender-related differences support the consideration of specific characteristics and reveal critical factors in specific target groups. The findings contribute to identifying requirements and effective support measures in Dual Career migrations and can be used to improve support services.
Physiological hand tremors appear to be one of the most common types of tremors that occur during the lifespan. Activities most prominently affected by hand tremors are those involving the movement ...of small muscles, such as fine motor skills, which in turn could be influenced by several factors, including lateral dominance. The difference in skills due to lateral dominance is defined as inter-limb imbalance or inter-limb asymmetry. When this asymmetry is attributed to the tremor and the difference in tremor between the limbs, it could be defined as the inter-limb asymmetry of tremors. This study aimed to evaluate the acute effects of wobble-board hand exercise training on the inter-limb asymmetry of tremors. Thirty-two (eighteen males and fourteen females) participants (age: 25.2 ± 2.6 years, weight: 63.9 ± 10.5 kg, height: 1.66 ± 0.8 m, and BMI: 22.8 ± 2.3 kg/m2) were involved in the study. Before (PRE) and after (POST) the wobble-board hand exercises, postural hand tremor was evaluated using a tri-axial accelerometer fixed under the palm. Recordings were taken for 15 s. One-way Analysis of Variance (ANOVA) was used to examine the effects of hand exercises on inter-limb (dominant vs. non-dominant) asymmetry of tremor in testing time (PRE vs. POST) in relation to sex (male vs. female). The statistical significance was set at p < 0.05. Significant differences were found in physiological hand tremors between limbs (dominant vs. non-dominant) in the PRE evaluation (p = 0.03) independently from sex while no differences were found in the POST evaluation. A significant difference emerged in the PRE evaluation for males (p = 0.04) and females (p = 0.03) in relation to the testing time and preferred hand. This difference was no longer present in the POST evaluation. In conclusion, wobble-board hand exercises could represent an effective strategy to reduce inter-limb asymmetry. These results emphasize the importance of task-specific training to maximize the reduction in inter-limb asymmetry of tremors following wobble-board hand exercises.
Colostrum is the first secretion of mammalian glands during the early period after birth giving. Its components are biologically active and have beneficial effects on new-born growth and well-being. ...Bovine colostrum has the highest concentration of these substances and its supplementation or application may provide health benefits. This systematic review was conducted to update current knowledge on bovine colostrum effects including all administration routes on healthy and sick subjects. Full texts or abstracts of twenty-eight papers as reports of systematic reviews, randomized controlled trials, observational studies and case series were included after searches in Medline, Embase, Cochrane Library and Cinahl databases. The full texts of selected studies were assessed for quality using validated tools and their results were summarized in different categories. Studies were highly heterogeneous as regards to population, intervention, outcome and risk of bias. Bovine colostrum topical application was shown effective on vaginal dryness related symptoms limitation. Its use as food supplement showed interesting effects preventing upper respiratory illness in sportsmen, modulating immune system response and reducing intestinal permeability in healthy and sick subjects. Conflicting results were provided in pediatric population and little evidence is available on its use with older adults. Further studies are mandatory to better understand all factors influencing its activity.
Since 2020 there has been an increase in demand for home workouts. Therefore, different ways of delivering distance training have been proposed to promote “stay active at home.” This study aimed to ...compare the effectiveness of three different training programs consisting of a total of 15 workouts (three sessions per week): supervised livestreaming (LS), unsupervised following a video recording (VR), and unsupervised following a written program (WP). Changes in anthropometric and cardiovascular variables, muscle fitness, and physical activity levels were evaluated. To provide a meaningful analysis for significant comparisons between small groups, mean differences (∆), 95% confidence interval (95% C.I.), and Cohen’s effect sizes (E.S.) were also calculated. The three training modalities increased physical activity levels, with an adherence rate of LS = 93.3%, VR = 86%, and WP = 74%. Although there was no reduction in body weight, waist circumference decreased by 1.3 cm (95% C.I. = −2.1, −0.5; E.S. = 0.170; p < 0.004). Furthermore, where LS, VR, and WP resulted in improvements in muscle fitness, only LS showed changes in cardiovascular variables, such as resting heart rate (∆ = −7.3 bpm; 95% C.I. = −11.9, −2.7; E.S. = 1.296; p < 0.001) and Ruffier’s index (∆ = −2.1bpm; 95% C.I. = −3.5, −0.8; E.S. 1.099; p < 0.001). Remote online training proved its effectiveness over a short period of time. However, supervised training proved to be the most effective, highlighting the importance of an experienced trainer.
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