Readers of The Gerontologist are familiar with population changes and projections that have spurred a surge in gerontological research across disciplines. This proliferation of research increases the ...importance of high-quality review and synthesis for moving research forward and informing policy and practice. We have therefore witnessed an increased number of systematic review publications in the field of gerontology (Shenkin, Harrison, Wilkinson, Dodds, & Ioannidis, 2017). In 2015, The Gerontologist began accepting review articles and as of August 2018, The Gerontologist has received more than 250 review submissions. We are anticipating that this figure will double by the end of 2019. In response to the high number of review submissions and the need for rigorous evaluation, Patricia C. Heyn, PhD, FGSA, joined The Gerontologist’s editorial leadership team in 2017 as the Associate Editor for review articles. Dr. Heyn, an expert in the synthesis and systematic review methodologies, has led efforts to redesign The Gerontologist “Review Articles” section by formulating a clear set of guidelines and instructions for authors interested in submitting review articles to the journal. The goal of the section is to produce and disseminate the best evidence available in the field of gerontology. The purpose of this editorial is to provide to The Gerontologist readers resources and guidance to prepare a high-quality review report that requires a thorough and updated search of the literature.
Abstract
Background and Objectives
People are now spending longer in retirement than ever before and retirement has been found to influence health. This study systematically reviewed the impact of ...retirement on cardiovascular disease (CVD) and its risk factors (metabolic risk factors, blood biomarkers, physical activity, smoking, drinking, and diet).
Research Design and Methods
Longitudinal studies published in Medline, Embase, Social Science Citation Index, PsycINFO, and Social Policy and Practice were searched. No language restrictions were applied if there was an English abstract. Eighty-two longitudinal studies were included after critical appraisals.
Results
Studies in the United States often found no significant effect of retirement on CVD, while studies in European countries, except France, showed a detrimental effect of retirement on CVD. Results from the United States and several European countries consistently show that retirement increase adiposity measures among those retired from physically demanding jobs. For diabetes and hypertension, five out of nine studies suggest no effect of retirement. Retirement has been repeatedly linked to increasing leisure-time physical activity but may reduce work- and transport-related physical activity in turn. Most studies showed that retirement either decreased smoking or had no effect on smoking. The evidence did not show a clear conclusion on drinking. Only a few studies have assessed the impact on diet and blood biomarkers.
Discussion and Implications
Effect of retirement varies according to the health outcomes studied and country of the study population. Policy concerning extending the retirement age needs to focus on ensuring they are suited to the individual.
Aim
To investigate the prevalence of metabolic syndrome and cardiovascular disease (CVD) risk factors and the association between common metabolic markers and Gross Motor Function Classification ...System (GMFCS) levels in ambulatory adults with cerebral palsy (CP).
Method
Metabolic markers and GMFCS levels were evaluated in a cross‐sectional study of 70 ambulatory adults with CP (34 males, 36 females; mean age 24y 5mo SD 5y 4mo, range 18y 6mo–48y 8mo) to determine the prevalence of metabolic syndrome and CVD risk factors, and were compared to age‐matched, population norms from the National Health and Nutrition Examination Survey (NHANES) registry. The Framingham Heart Study (FHS) CVD risk estimation was also used to evaluate an individual's risk for CVD.
Results
Metabolic syndrome was identified in 17.1% of the cohort, higher than the 10% in the NHANES registry. The FHS CVD 30‐year lipid and body mass index (BMI)‐based risk factor results showed that 20% to 40% of the cohort was at greater risk of developing CVD (BMI‐based: 39.7% ‘full’ CVD risk factor; lipid‐based: 26.5% ‘full’ CVD risk factor) as compared to the FHS normative population data. There was a positive correlation between GMFCS level, waist circumference (r=0.28, p=0.02), and waist‐to‐hip ratio (r=0.28, p=0.02).
Interpretation
Adults with CP are at higher risk of CVD and metabolic syndrome compared to the general population, which is probably because of impaired mobility.
What this paper adds
Gross Motor Function Classification System levels can predict cardiovascular disease (CVD) risk factors in adults with cerebral palsy (CP).
Anthropometric measures are significant in predicting CVD risk factors in adults with CP.
Early CVD screening and ongoing risk factor monitoring are important in adults with CP.
Resumen
Prevalencia del síndrome metabólico y factores de riesgo de enfermedad cardiovascular en adultos con parálisis cerebral
Objetivo
Investigar la prevalencia de los factores de riesgo del síndrome metabólico y la enfermedad cardiovascular (ECV) y la asociación entre los marcadores metabólicos comunes y los niveles del Sistema de Clasificación de la Función Motora Gruesa (GMFCS) en adultos ambulatorios con parálisis cerebral (PC).
Método
Los marcadores metabólicos y los niveles de GMFCS se evaluaron en un estudio transversal de 70 adultos ambulatorios con PC (34 varones 36 mujeres; edad media 24 años 5 meses DS 5 años 4 meses, rango 18 años 6 meses‐ 48 años 8 meses) para determinar la prevalencia de metabolismo metabólico El síndrome y los factores de riesgo de ECV, y se compararon con las normas de población según la edad del registro de la Encuesta Nacional de Examen de Salud y Nutrición (NHANES). El cálculo de riesgo de ECV de Framingham Heart Study (FHS) también se utilizó
Resultados
El síndrome metabólico se identificó en el 17,1% de la cohorte, superior al 10% en el registro NHANES. Los resultados del factor de riesgo basado en el índice de masa corporal y de lípidos (IMC) de 30 años de la ECV de FHS mostraron que el 20% al 40% de la cohorte tenía un mayor riesgo de desarrollar ECV (basado en el IMC: 39,7% de factor de riesgo de CVD “completo”; lípidos ‐basado: 26,5% del factor de riesgo de EVD ‘completo’) en comparación con los datos normativos de la población de FHS. Hubo una correlación positiva entre el nivel de GMFCS, la circunferencia de la cintura (r = 0,28, p = 0,02) y la relación cintura‐cadera (r = 0,28, p = 0,02).
Interpretación
Los adultos con PC tienen un mayor riesgo de ECV y síndrome metabólico en comparación con la población general, lo que probablemente se debe a una movilidad reducida.
Resumo
Prevalência de síndrome metabólica e fatores de risco para doença cardiovascular em adultos com paralisia cerebral
Objetivo
Investigar a prevalência de síndrome metabólica e fatores de risco para doença cardiovascular (DCV) e a associação entre marcadores metabólicos comuns e níveis do Sistema de Classificação da Função Motora Grossa (GMFCS) em adultos deambuladores com paralisia cerebral (PC).
Métodos
Marcadores metabólicos e níveis de GMFCS foram avaliados em um estudo transversal de 70 adultos deambuladores com PC (34 homens, 36 mulheres; idade média 24 anos e 5 meses± 5 anos e 4 meses, variação 18 anos e seis meses – 48 anos e 8 meses) para determinar a prevalência de síndrome metabólica e fatores de risco para DCV e foram comparados com normas populacionais do registro de Pesquisa Nacional de Exame de Saúde e Nutrição (PNESN) pareadas pela idade. A estimativa de risco de DCV do estudo cardíaco de Framingham (ECF) também foi utilizada para avaliar o risco individual para DCV.
Resultados
Síndrome metabólica foi identificada em 17,1% da coorte, mais que nos 10% dos registros da PNESN. As estimativas de risco baseadas em ECF DCV de lipídio de 30 anos e índice de massa corporal (IMC) mostraram que de 20% a 40% da coorte estava sob maior risco de desenvolvimento de DCV (baseada no IMC: 39,7%¨fator de risco “completo” para o desenvolvimento de DCV; baseada nos lipídios: 26,5% fator de risco “completo” para o desenvolvimento de DCV) comparados com dados de ECF normativos da população. Houve uma correlação positiva entre nível de GMFCS, circunferência da cintura (r = 0,28, p = 0,02), e relação cintura‐quadril (r = 0,28, p = 0,02).
Interpretação
Adultos com PC apresentam maior risco para DCV e síndrome metabólica comparados à população em geral, o que muito provavelmente relaciona‐se a sua mobilidade prejudicada.
What this paper adds
Gross Motor Function Classification System levels can predict cardiovascular disease (CVD) risk factors in adults with cerebral palsy (CP).
Anthropometric measures are significant in predicting CVD risk factors in adults with CP.
Early CVD screening and ongoing risk factor monitoring are important in adults with CP.
This article is commented on by McPhee on pages 390–391 of this issue.
This article's has been translated into Spanish and Portuguese.
Follow the links from the to view the translations.
There is a need for an overview of systematic reviews (SRs) examining randomized clinical trials (RCTs) of pharmacological interventions in the treatment of intracranial pressure (ICP) post-TBI.
To ...summarize pharmacological effectiveness in decreasing ICP in SRs with RCTs and evaluate study quality.
Comprehensive literature searches were conducted in MEDLINE, PubMed, EMBASE, PsycINFO, and Cochrane Library databases for English SRs through October 2020. Inclusion criteria were SRs with RCTs that examined pharmacological interventions to treat ICP in patients post-TBI. Data extracted were participant characteristics, pharmacological interventions, and ICP outcomes. Study quality was assessed with AMSTAR-2.
Eleven SRs between 2003 and 2020 were included. AMSTAR-2 ratings revealed 3/11 SRs of high quality. Pharmacological interventions included hyperosmolars, neuroprotectives, anesthetics, sedatives, and analgesics. Study samples ranged from 7 to 1282 patients. Hyperosmolar agents and sedatives were beneficial in lowering elevated ICP. High bolus dose opioids had a more deleterious effect on ICP. Neuroprotective agents did not show any effects in ICP management.
RCT sample sizes and findings in the SRs varied. A lack of detailed data syntheses was noted. AMSTAR-2 analysis revealed moderate to high quality in most SRs. Future SRs may focus on streamlined reporting of dosing and clearer clinical recommendations. PROSPERO-Registration: CRD42015017355.
Animal models of exercise and Parkinson's disease (PD) have found that the physiologic use of exercise may interact with the neurodegenerative disease process, likely mediated by brain derived ...neurotrophic factor (BDNF). No reviews so far have assessed the methodologic quality of available intervention studies or have bundled the effect sizes of individual studies on exercise-induced effects on BDNF blood levels in human PD.
We searched MEDLINE, EMBASE, Cochrane Library, PsycINFO and PubMed from inception to June 2017.
Data aggregated from two randomized controlled trials and four pre-experimental studies with a total of 100 ambulatory patients with idiopathic PD (Hoehn/Yahr ≤3) found improvements in BDNF blood concentration levels in all 6 studies (two RCTs and 4 pre-experimental studies). Pooled BDNF level change scores from the 2 RCTs resulted in a significant homogeneous summary effect size (Standardized Mean Difference 2.06, 95% CI 1.36 to 2.76), and a significant heterogeneous SES for the motor part of the UPDRS-III examination (MD -5.53, 95% CI -10.42 to -0.64). Clinical improvements were noted in all studies using a variety of outcome measures.
The evidence-base consists primarily of small studies with low to moderate methodological quality.
This review provides preliminary evidence for the effectiveness of physical exercise treatments for persons with PD on BDNF blood levels. Further research is needed.
Background:
Sternoclavicular dislocations are relatively infrequent and are generally divided into anterior and posterior disruptions, the former being the most common. While posterior ...sternoclavicular joint (PSCJ) injuries are very rare, they may be associated with life-threatening complications. The ideal management of these injuries, particularly in the adolescent population, has not been well described.
Purpose:
Through a meta-analysis of PSCJ injuries in the adolescent, we aimed to (1) describe the epidemiology of PSCJ injuries in relation to the mechanism of injury, associated complications, and treatment preferences; (2) compare the success of closed reduction when attempted <48 versus >48 hours after the initial injury; and (3) compare the outcomes of closed versus open treatment.
Study Design:
Meta-analysis.
Methods:
A thorough review of the English literature was performed to identify all cases of PSCJ dislocations or medial clavicular physeal fractures in patients aged 12 to 18 years. Patient-level data for 140 patients were extracted from 79 studies.
Results:
The mean age of the patients was 15.24 years. Forty-nine patients (35.00%) underwent closed treatment only, 42 (30.00%) open treatment alone, and 47 (33.57%) closed treatment followed by open treatment. Also, 55.8% of closed reductions performed within 48 hours were successful compared with 30.8% of those performed more than 48 hours after injury. After initial treatment, 92.31% of patients treated with closed reduction regained full function without recurrence as compared with 95.83% of patients treated operatively.
Conclusion:
Closed and open methods have proven highly effective for the treatment of PSCJ injuries. However, follow-up data reported in the literature vary considerably. Closed reduction is most effective when attempted less than 48 hours after the initial injury.
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