The aims of the present meta-analysis were to investigate the short- and long-term efficacy, multidimensional outcome, and treatment moderators of biofeedback as a behavioral treatment option for tension-type headache. A literature search identified 74 outcome studies, of which 53 were selected according to predefined inclusion criteria. Meta-analytic integration resulted in a significant medium-to-large effect size (d = 0.73; 95% confidence interval = 0.61, 0.84) that proved stable over an average follow-up phase of 15 months. Biofeedback was more effective than headache monitoring, placebo, and relaxation therapies. The strongest improvements resulted for frequency of headache episodes. Further significant effects were observed for muscle tension, self-efficacy, symptoms of anxiety, depression, and analgesic medication. Moderator analyses revealed biofeedback in combination with relaxation to be the most effective treatment modality; effects were particularly large in children and adolescents. In intention-to-treat and publication-bias analyses, the consistency of these findings was demonstrated. It is concluded that biofeedback constitutes an evidence-based treatment option for tension-type headache.

AIMS:To review scientific evidence related to oral cryotherapy to prevent oral mucositis after cancer therapy.

BACKGROUND:Oral mucositis is a common complication of cancer therapy. In the most severe form of oral mucositis, patients cannot eat or drink at all and must receive nutrition and fluid replacement through parenteral support. Topical cooling of the oral mucosa may be an option for the prevention of oral mucositis.

DESIGN:Systematic review and meta-analysis.

DATA SOURCES:The literature search was performed using the Ovid MEDLINE, Embase, Cochrane Library, and CINAHL Complete electronic databases for articles published up to 2017. The reference lists of all retrieved articles were manually reviewed to identify additional relevant studies.

RESULTS:Of 353 publications, 15 randomized controlled trials, involving 919 cancer patients, conducted between 1994 and 2017 were included in the present meta-analysis. Oral cryotherapy, applied during treatment of solid cancers, led to a statistically lower level (P < .05) of oral mucositis overall, and of the more severe grades (3-4 and 2-4).

CONCLUSIONS:Results of this study provide a scientific basis for oral cryotherapy as a viable nursing intervention that can significantly reduce the occurrence of severe oral mucositis.

BACKGROUND:Acupressure is increasing in popularity as an alternative treatment in obstetrics and gynecology.

OBJECTIVES:To summarize and assess evidence regarding the effects of acupressure on duration of labor and mode of delivery.

SEARCH STRATEGY:Four major databases and Google Scholar were searched using terms related to labor and acupressure, without language restrictions, up to November 2015.

SELECTION CRITERIA:Randomized controlled trials were included if they examined the effect of acupressure at any acupoint during childbirth on duration of labor and/or mode of delivery.

DATA COLLECTION AND ANALYSIS:Two reviewers independently extracted data. The outcome measures were duration of labor and mode of delivery. Random-effects models were used to pool results.

MAIN RESULTS:Thirteen studies were included in meta-analyses. Acupressure increased the chance of vaginal delivery when compared with placebo/no intervention (odds ratio [OR] 2.329, 95% confidence interval [CI] 1.348-4.024, P=0.002; risk difference [RD] 8.9%, 95% CI 2.7%-15.0%, P=0.005). Acupressure decreased the duration of the active phase by 1.310 hours (95% CI -1.738 to -0.882; P<0.001) and the second stage of labor by 5.808 minutes (95% CI -1.615 to -0.807; P<0.001).

CONCLUSIONS:Acupressure could have a role in reducing the rate of cesarean delivery and decreasing the duration of labor in parturient women. However, there is a need for more reliable randomized controlled trials.

OBJECTIVE:To assess the efficacy of acupuncture and moxibustion for asthma by meta-analysis of randomized controlled clinical trials.

METHODS:A literature search in VIP, CNKI, PubMed and HighWire was performed to retrieve clinic trials documents about acupuncture for asthma from 2000 to 2009. The meta-analysis was conducted on RCT and CCT documents that meet the enrolling requirements.

RESULTS:Twenty-two trials including 3058 cases of asthma patients were included in this study. The findings indicates that the total effective rate in acupuncture group was significantly superior to control group [OR 4.18, 95% CI (3.36, 5.20), Z = 12.85, P<0.00001]; there was no significant difference in FEV1 measurements between two groups [OR = 0.20, 95% CI (-0.37, 0.76), Z = 0.68, P = 0.50]; there was profound significant difference in PEFR measurements between two groups [OR = 0.42, 95% CI (0.22, 0.62), Z = 4.06, P<0.0001]; there was profound significant difference in FVC measurements between two groups [OR = 0.45, 95% CI (0.17, 0.72), Z = 3.22, P = 0. 001]; there was profound significant difference in FEV1/FVC measurements between two groups [OR = 9.58, 95% CI (8.14, 11.02), Z = 13.03, P<0.00001].

CONCLUSION:Acupuncture and moxibustion therapy can significantly improve the total effective rate of acupuncture for asthma. PEFR, FVC, FEV1 /FVC can be used as effectiveness indicators for evaluating the treatment for asthma. The FEV1 measurements did not have statistic significance. Due to the small number of RCT/CCT documents, the bias of the literatures and the lack of high-quality, large sample and multi-center reports, further studies are needed to explore the evidence of the findings.

OBJECTIVE:To conduct a systematic review to assess the clinical effectiveness of scalp acupuncture (SA) for stroke.

METHODS:Literature searches were performed in 7 databases up to 16 August 2014, and all the randomized controlled trials (RCTs) in which SA therapy was administered to stroke patients were selected. Methodological quality was assessed using the Jadad score, the Cochrane risk of bias assessment, and the Standards for Reporting Interventions in Clinical Trials of Acupuncture.

RESULTS:Of a total of 2086 papers, 21 RCTs were selected. Meta-analysis revealed significant differences in the total efficacy rates of the SA group and the body acupuncture (BA) group vs the medication group (P<0.002, P<0.000 001, respectively), the SA plus BA group vs the BA group (P<0.001); in the motor function of the SA plus BA group vs the BA group (P = 0.077); and in the nerve function of the SA group vs the SA plus BA group (P<0.0001).

CONCLUSION:The results of our systematic review showed that SA therapy may exhibit effects in treatment efficacy and in the recovery of motor and nervous functions in patients with acute to chronic stroke. However, because of the lack of methodological quality, the thoroughly planned clinical studies are still required.

BACKGROUND AND AIMS:The knowledge of natural history is essential for disease management. We evaluated the natural history (e.g. frequency and characteristics of symptoms and clinical outcome) of gallstones (GS) in a population-based cohort study.

METHODS:A total of 11 229 subjects (6610 men, 4619 women, age-range: 29-69 years, mean age: 48 years) were studied. At ultrasonography, GS were present in 856 subjects (338 men, 455 women) (7.1%). GS were followed by means of a questionnaire inquiring about the characteristics of specific biliary symptoms.

RESULTS:At enrollment, 580 (73.1%) patients were asymptomatic, 94 (11.8%) had mild symptoms and 119 (15.1%) had severe symptoms. GS patients were followed up for a mean period of 8.7 years; 63 subjects (7.3%) were lost to follow up. At the end of the follow up, of the asymptomatic subjects, 453 (78.1%) remained asymptomatic; 61 (10.5%) developed mild symptoms and 66 (11.4%) developed severe symptoms. In subjects with mild symptoms, the symptoms disappeared in 55 (58.5%), became severe in 23 (24.5%), remained stable in 16 (17%); in subjects with severe symptoms, the symptoms disappeared in 62 (52.1%), became mild in 20 (16.8%) and remained stable in 37 (31.1%). A total of 189 cholecystectomies were performed: 41.3% on asymptomatic patients, 17.4% on patients with mild symptoms and 41.3% on patients with severe symptoms.

CONCLUSIONS:This study indicates that: (i) asymptomatic and symptomatic GS patients have a benign natural history; (ii) the majority of GS patients with severe or mild symptoms will no longer experience biliary pain; and (iii) a significant proportion of cholecystectomies are performed in asymptomatic patients. Expectant management still represents a valid therapeutic approach in the majority of patients.

Physical limitations, depression and anxiety are prevalent among older adults. Mild to moderate exercise can promote physical and psychological health and reduce the risk of chronic diseases. Qigong, a type of Chinese traditional medicine exercise, has demonstrated beneficial effects on physical ability and mental health in adults with chronic conditions. The purpose of this review was to systematically assess the effects of Qigong exercise on physical and psychological health outcomes in older adults. A total of 1282 older adults aged 62 to 83 years with depressive symptoms, frailty or chronic medical illnesses were included in this review. The meta-analysis showed that Qigong exercise resulted in significantly improved physical ability compared with active control or usual care (standardized mean difference [SMD]  1.00 and 1.20, respectively). The pooled effects of studies with thrice weekly Qigong sessions had the greatest effect () on physical ability in older adults. Lower quality studies demonstrated larger effect sizes than those of higher quality. Although Qigong exercise showed favorable effects on depression, balance and functioning, the overall effects did not reach statistical significance. No significant adverse events were reported. The findings suggest that the Qigong exercise may be an option for older adults to improve physical ability, functional ability, balance and to lessen depression and anxiety. However, the number of RCTs that enroll older adults is limited. More methodologically sound RCTs are needed to confirm the efficacy of Qigong exercise on physical and psychological health in older adults with chronic illnesses.

QUESTION:Does physical exercise training improve physical function and quality of life in people with cognitive impairment and dementia? Which training protocols improve physical function and quality of life? How do cognitive impairment and other patient characteristics influence the outcomes of exercise training?

DESIGN:Systematic review with meta-analysis of randomised trials.

PARTICIPANTS:People with mild cognitive impairment or dementia as the primary diagnosis.

INTERVENTION:Physical exercise.

OUTCOME MEASURES:Strength, flexibility, gait, balance, mobility, walking endurance, dual-task ability, activities of daily living, quality of life, and falls.

RESULTS:Forty-three clinical trials (n=3988) were included. According to the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) system, the meta-analyses revealed strong evidence in support of using supervised exercise training to improve the results of 30-second sit-to-stand test (MD 2.1 repetitions, 95% CI 0.3 to 3.9), step length (MD 5cm, 95% CI 2 to 8), Berg Balance Scale (MD 3.6 points, 95% CI 0.3 to 7.0), functional reach (3.9cm, 95% CI 2.2 to 5.5), Timed Up and Go test (-1second, 95% CI -2 to 0), walking speed (0.13m/s, 95% CI 0.03 to 0.24), and 6-minute walk test (50m, 95% CI 18 to 81) in individuals with mild cognitive impairment or dementia. Weak evidence supported the use of exercise in improving flexibility and Barthel Index performance. Weak evidence suggested that non-specific exercise did not improve dual-tasking ability or activity level. Strong evidence indicated that exercise did not improve quality of life in this population. The effect of exercise on falls remained inconclusive. Poorer physical function was a determinant of better response to exercise training, but cognitive performance did not have an impact.

CONCLUSION:People with various levels of cognitive impairment can benefit from supervised multi-modal exercise for about 60minutes a day, 2 to 3days a week to improve physical function. [Lam FMH , Huang MZ, Liao LR, Chung RCK, Kwok TCY, Pang MYC (2018) Physical exercise improves strength, balance, mobility, and endurance in people with cognitive impairment and dementia: a systematic review. Journal of Physiotherapy XX: XX-XX].

BACKGROUND:An outbreak of Novel Coronavirus (COVID -19) in Wuhan, China, the epidemic is more widespread than initially estimated, with cases now confirmed in multiple countries.

AIMS:The aim of the meta-analysis was to assess the prevalence of comorbidities in the COVID-19 infection patients and the risk of underlying diseases in severe patients compared to non-severe patients.

METHODS:A literature search was conducted using the databases PubMed, EMBASE, and Web of sciences until February 25, 2020. Risk ratio (OR) and 95% confidence intervals (CIs) were pooled using random-effects models.

RESULTS:Eight studies were included in the meta- analysis, including 46248 infected patients. The result showed the most prevalent clinical symptom was fever ( 91 ± 3, 95% CI 86-97% ), followed by cough (67 ± 7, 95% CI 59-76%), fatigue ( 51 ± 0, 95% CI 34-68% ) and dyspnea ( 30 ± 4, 95% CI 21-40%). The most prevalent comorbidity were hypertension (17 ± 7, 95% CI 14-22%) and diabetes ( 8 ± 6, 95% CI 6-11% ), followed by cardiovascular diseases ( 5 ± 4, 95% CI 4-7% ) and respiratory system disease( 2 ± 0, 95% CI 1-3% ). Compared with the Non-severe patient, the pooled odds ratio of hypertension, respiratory system disease, cardiovascular disease in severe patients were (OR 2.36, 95% CI: 1.46-3.83), (OR 2.46, 95% CI: 1.76-3.44) and (OR 3.42, 95% CI: 1.88-6.22)respectively.

CONCLUSION:We assessed the prevalence of comorbidities in the COVID-19 infection patients and found underlying disease, including hypertension, respiratory system disease and cardiovascular, may be a risk factor for severe patients compared with Non-severe patients.

OBJECTIVE:To determine the preventive and curative effects of manual acupuncture on the symptoms of the common cold.

METHOD:Students and staff in five Japanese acupuncture schools (n=326) were randomly allocated to acupuncture and no-treatment control groups. A specific needling point (Y point) on the neck was used bilaterally. Fine acupuncture needles were gently manipulated for 15 s, evoking de qi sensation. Acupuncture treatments were performed four times during the 2-week experimental period with a 2-week follow-up period. A common cold diary was scored daily for 4 weeks, and a common cold questionnaire was scored before each acupuncture treatment and twice at weekly intervals. A reliability test for the questionnaire was performed on the last day of recording.

RESULTS:Five of the 326 subjects who were recruited dropped out. The diary score in the acupuncture group tended to decrease after treatment, but the difference between groups was not significant (Kaplan-Meier survival analysis, log rank test P=0.53, Cox regression analysis, P>0.05). Statistically significantly fewer symptoms were reported in the questionnaire by the acupuncture group than control group (P=0.024, general linear model, repeated measure). Significant inter-centre (P<0.001, general linear model) and sex (P=0.027, general linear model) differences were also detected. Reliability tests indicated that the questionnaire with 15 items was sufficiently reliable. No severe adverse event was reported.

CONCLUSION:This is the first report of a multi-centre randomized controlled trial of acupuncture for symptoms of the common cold. A significantly positive effect of acupuncture was demonstrated in the summed questionnaire data, although a highly significant inter-centre difference was observed. Needling on the neck using the Japanese fine needle manipulating technique was shown to be effective and safe. The use of acupuncture for symptoms of the common cold symptoms should be considered, although further evidence from placebo controlled RCTs is required.

CONTEXT:Many researchers are interested in the Eastern therapeutic exercise of qigong and tai chi, performed as qigong. A review of systematic studies through April 2010 found evidence supporting tai chi as effective for preventing falls, improving psychological health, and promoting healthy aging.

OBJECTIVE:The review intended to provide an updated survey of recent systematic reviews to establish the current-2016-level of scientific evidence assessing the therapeutic benefits of qigong exercise for clinical applications related to physical health.

METHODS:The data sources included PubMed, SCOPUS, and CINAHL, using the major terms qigong OR tai chi AND review. Studies were included in the review if they (1) were systematic reviews and meta-analyses; (2) had been published as full text in the English language; (3) were published between January 2010 and December 2016; (4) had tai chi or qigong as the primary intervention of interest; (5) addressed a defined, physical-health complaint; and (6) included≥3 randomized clinical trials. Reviews addressing nonclinical topics, mental health, and cognition were excluded.

RESULTS:The extensive search identified 41 relevant systematic reviews and meta-analyses. Five areas of clinical application were supported. The review showed independent research evidence that was sufficient to support tai chi performed as qigong as a primary intervention for balance training and fall prevention. When compared with more traditional interventions, tai chi was found to have equal, and in some instances, superior effects, as well as cost-effectiveness. In addition, qigong, and tai chi performed as qigong, were found to have a complementary or alternative role in management of cancer, chronic obstructive pulmonary disease, Parkinson's disease, and cardiac and cardiovascular disorders.

CONCLUSIONS:A growing body of evidence supports qigong and tai chi performed as qigong as valid complementary or alternative therapeutic exercises. Many aspects of the clinical study and application in this area remain to be explored.

PURPOSE OF REVIEW:Qigong and Tai Chi are two increasingly popular mind-body interventions with the potential to address the multifaceted needs of cancer survivors. The aim of this updated review and meta-analysis was to quantitatively evaluate the treatment effects of Qigong/Tai Chi on cancer survivors since 2014.

RECENT FINDINGS:There were statistically significant and clinically meaningful effects in favor of Qigong/Tai Chi interventions for symptoms of fatigue and sleep quality. There were positive trends, but not statistically significant effects, observed for anxiety, stress, depressive symptoms, and overall quality of life (QOL). Cancer-related cognitive impairment is a common complaint among cancer survivors that has received increasing attention in this area in recent years. Qigong/Tai Chi in cancer care shows great promise with short-term effects in treating many cancer-related symptoms. Further methodologically sound trials with longer follow-up periods and more active control conditions are required, before definitive conclusions can be recommended for cancer patients.

This current meta-analysis review was conducted to examine the effectiveness of Qigong-based therapy on individuals with major depressive disorder. Six electronic databases (PubMed, PsycINFO, Cochrane Library, and Web of Science, Chinese National Knowledge Infrastructure, and Wangfang) were employed to retrieve potential articles that were randomized controlled trials. The synthesized effect sizes (Hedges' g) were computerized to explore the effectiveness of Qigong-based therapy. Additionally, a moderator analysis was performed based on the control type. The pooled results indicated that Qigong-based therapy has a significant benefit on depression severity (Hedges' g = -0.64, 95% CI -0.92 to -0.35,<0. 001, I² = 41.73%). Specifically, Qigong led to significantly reduced depression as compared to the active control groups (Hedges' g = -0.47, 95% CI -0.81 to -0.12,= 0.01, I² = 22.75%) and the passive control groups (Hedges' g = -0.80, 95% CI -1.23 to -0.37,<0.01, I² = 48.07%), respectively. For studies which reported categorical outcomes, Qigong intervention showed significantly improved treatment response rates (OR = 4.38, 95% CI 1.26 to 15.23,= 0.02) and remission rates (OR = 8.52, 95% CI 1.91 to 37.98,= 0.005) in comparison to the waitlist control group. Conclusions: Qigong-based exercises may be effective for alleviating depression symptoms in individuals with major depressive disorder. Future well-designed, randomized, controlled trials with large sample sizes are needed to confirm these findings.

This study investigated the efficacy of medium-term Green Exercise (GE; being physically active within a natural environment) interventions for improving wellbeing, by pooling data collected at the start and end of participants' engagement with a range of GE interventions. Hypotheses were that (i) interventions would show good efficacy for improving wellbeing in the overall sample; (ii) compared to participants reporting 'average to high' wellbeing at the start of their project, participants with 'low' starting wellbeing would report greater improvements post-intervention; and (iii) improvements would significantly differ between age groups. The pooled dataset was categorized in line with UK norms (= 318) and analyzed using a standardized meta-analysis approach. Effect size was large: g = 0.812 (95% CI [0.599, 1.025]), and differences in wellbeing changes associated with project duration, age or sex were not statistically significant. Compared to those reporting 'average-high' starting wellbeing, participants reporting 'low' starting wellbeing exhibited greater improvements (BCa 95% CI [-31.8, -26.5]), with 60.8% moving into the 'average-high' wellbeing category. GE can play an important role in facilitating wellbeing and can provide alternative pathways for health and social care practice. Public health commissioners should consider integrating such interventions for patients experiencing low wellbeing or associated comorbidities.

The purpose of this study was to evaluate the effects of resistance training alone on the systolic and diastolic blood pressure in prehypertensive and hypertensive individuals. Our meta-analysis, followed the guidelines of PRISMA. The search for articles was realized by November 2016 using the following electronic databases: BIREME, PubMed, Cochrane Library, LILACS and SciELO and a search strategy that included the combination of titles of medical affairs and terms of free text to the key concepts: 'hypertension' 'hypertensive', 'prehypertensive', 'resistance training', 'strength training', and 'weight-lifting'. These terms were combined with a search strategy to identify randomized controlled trials (RCTs) and identified a total of 1608 articles: 644 articles BIREME, 53 SciELO, 722 PubMed, 122 Cochrane Library and 67 LILACS. Of these, five RCTs met the inclusion criteria and provided data on 201 individuals. The results showed significant reductions for systolic blood pressure (-8.2 mm Hg CI -10.9 to -5.5;I(2): 22.5% P valor for heterogeneity=0.271 and effect size=-0.97) and diastolic blood pressure (-4.1 mm Hg CI -6.3 to -1.9; I(2): 46.5% P valor for heterogeneity=0.113 and effect size=-0.60) when compared to group control. In conclusion, resistance training alone reduces systolic and diastolic blood pressure in prehypertensive and hypertensive subjects. The RCTs studies that investigated the effects of resistance training alone in prehypertensive and hypertensive patients support the recommendation of resistance training as a tool for management of systemic hypertension.Hypertension Research advance online publication, 3 August 2017; doi:10.1038/hr.2017.69.

BACKGROUND:and purpose Acupuncture has gained increasing attention in the treatment of insulin resistance (IR). This study systematically reviews the efficacy of acupuncture on clinical IR outcomes.

METHODS:Cochrane Central Register of Controlled Trials, Embase, Medline (via OVID), China National Knowledge Infrastructure (CNKI), Wan Fang and China Science and Technology Journal Database (VIP) were searched to collect randomized controlled trials (RCTs) of patients with IR treated by acupuncture. Meta-analysis was performed by RevMan 5.3.

RESULTS:With acupuncture, the homeostasis model assessment of insulin resistance (homa-IR) significantly decreased (mean difference (MD) = -1.04, 95% confidence interval (CI) -1.37 to -0.71; P < 0.00001), as did fasting blood glucose (FBG) (MD = -0.56, 95% CI -0.88 to -0.25; P = 0.0005), 2 h postprandial blood glucose (2hPG) (MD = -0.91, 95% CI -1.62 to -0.20; P = 0.01), and fasting insulin (FINS) (MD = -3.23, 95% CI -4.14 to -2; P < 0.00001). Meanwhile, the insulin sensitivity index (ISI) (MD = 0.36, 95% CI 0.18 to 0.53; P < 0.0001) increased, and fewer adverse events occurred.

CONCLUSION:Acupuncture may improve homa-IR, ISI, FBG, 2hPG and FINS with fewer adverse events than other treatments, making it a viable treatment for IR.

BACKGROUND:According to previous epidemiological studies, there are pros and cons for the relationship between running regularly and changes in resting blood pressure (RBP), and the changes may depend on the form of exercise.

OBJECTIVE:The aims of the current systematic review were to summarize the effects of running regularly on RBP and to investigate the most efficacious form of running in reducing RBP for this purpose.

METHODS:The inclusion criteria were: randomized controlled trials, involving healthy adults or adults with hypertension, the exercise group only performed regular running and the control group did not exercise, and the study reported the mean resting systolic blood pressure (RSBP) and/or diastolic blood pressure (RDBP). The mean difference (MD) in RBP in each trial was defined as follows: (mean value at post-intervention in the exercise group - mean value at baseline in the exercise group) - (mean value at post-intervention in the control group - mean value at baseline in the control group) and was calculated. The weighted MD (WMD) was defined as the synthesis of all MD. A linear meta-regression analysis, exercise intensity[the percentage of maximum heart rate] (%) and total exercise time throughout the intervention (hours) were selected as explanatory variables and the MD in RBP served as the objective variable.

RESULTS:Twenty-two trials (736 subjects) were analyzed. When trials were limited to those involving healthy subjects, the WMD in RBP decreased significantly [RSBP: - 4.2 mmHg (95% confidence intervals (95% CI) - 5.9 to - 2.4); RDBP: - 2.7 mmHg (95% CI - 4.2 to - 1.1)] and did not contain significant heterogeneity (RSBP: P = 0.67, I = 0.0%; DBP: P = 0.38, I = 7.2%). When trials were limited to those involving subjects with hypertension, the WMD in RBP decreased significantly [RSBP: - 5.6 mmHg (95% CI - 9.1 to - 2.1); RDBP: - 5.2 mmHg (95% CI - 9.0 to - 1.4)] but contained significant heterogeneity (RSBP: P = 0.01, I = 62.2%; DBP: P < 0.01, I = 87.7) and a meta-regression analysis showed that the percentage of maximum heart rate was significantly associated with the WMD in RSBP [slope: 0.56 (95% CI 0.21 to 0.92), intercept: - 48.76 (95% CI - 76.30 to - 21.22), R = 0.88] and RDBP [slope: 0.45 (95% CI 0.01 to 0.87), intercept: - 38.06 (95% CI - 72.30 to - 4.08), R = 0.41]. When trials were limited to those involving subjects with hypertension and a mean age ≥ 40 years, a meta-regression analysis showed that total exercise time throughout the intervention was significantly associated with the WMD in RDBP [slope: 0.82 (95% CI 0.54 to 1.09), intercept: - 22.90 (95% CI - 29.04 to - 16.77), R = 0.99].

CONCLUSIONS:Running regularly decreases RBP, but the changes in subjects with hypertension may differ depending on exercise intensity or total exercise time. Therefore, running regularly at moderate intensity and at a restrained volume is recommended to lower RBP in subjects with hypertension.

This article critically reviews HPV vaccine serious adverse events described in pre-licensure randomized trials and in post-marketing case series. HPV vaccine randomized trials were identified in PubMed. Safety data were extracted. Post-marketing case series describing HPV immunization adverse events were reviewed. Most HPV vaccine randomized trials did not use inert placebo in the control group. Two of the largest randomized trials found significantly more severe adverse events in the tested HPV vaccine arm of the study. Compared to 2871 women receiving aluminum placebo, the group of 2881 women injected with the bivalent HPV vaccine had more deaths on follow-up (14 vs. 3, p = 0.012). Compared to 7078 girls injected with the 4-valent HPV vaccine, 7071 girls receiving the 9-valent dose had more serious systemic adverse events (3.3 vs. 2.6%, p = 0.01). For the 9-valent dose, our calculated number needed to seriously harm is 140 (95% CI, 79-653). The number needed tovaccinate is 1757 (95% CI, 131 to infinity). Practically, none of the serious adverse events occurring in any arm of both studies were judged to be vaccine-related. Pre-clinical trials, post-marketing case series, and the global drug adverse reaction database (VigiBase) describe similar post-HPV immunization symptom clusters. Two of the largest randomized HPV vaccine trials unveiled more severe adverse events in the tested HPV vaccine arm of the study. Nine-valent HPV vaccine has a worrisome number needed to vaccinate/number needed to harm quotient. Pre-clinical trials and post-marketing caseseries describe similar post-HPV immunization symptoms.

Acupressure is noninvasive, safe, and appropriate for use among older adults. However, there remains little evidence of the common elements that contribute to the effectiveness of acupressure in promoting the health of older adults. A systematic review using meta-analysis was designed to examine the effects of acupressure on the health promotion in older adults. Studies published between 2012 and 2017 were searched for in 11 electronic databases. Acupressure was highly effective for improving sleep quality and cognitive functioning (0.85, 95% confidence interval [CI] = [0.49, 1.22]; 1.23, 95% CI = [0.88, 1.59]). A slight to moderate effect was found in alleviating constipation (0.37, 95% CI = [0.03, 0.71]), and a moderate effect was found for alleviating pain and improving quality of life (0.71, 95% CI = [0.09, 1.32]; 0.59 95% CI = [0.36, 0.82]).

PURPOSE:This study aims to summarize and critically evaluate the effects of Tai Chi and Qigong (TCQ) mind-body exercises on symptoms and quality of life (QOL) in cancer survivors.

METHODS:A systematic search in four electronic databases targeted randomized and non-randomized clinical studies evaluating TCQ for fatigue, sleep difficulty, depression, pain, and QOL in cancer patients, published through August 2016. Meta-analysis was used to estimate effect sizes (ES, Hedges' g) and publication bias for randomized controlled trials (RCTs). Methodological bias in RCTs was assessed.

RESULTS:Our search identified 22 studies, including 15 RCTs that evaluated 1283 participants in total, 75% women. RCTs evaluated breast (n = 7), prostate (n = 2), lymphoma (n = 1), lung (n = 1), or combined (n = 4) cancers. RCT comparison groups included active intervention (n = 7), usual care (n = 5), or both (n = 3). Duration of TCQ training ranged from 3 to 12 weeks. Methodological bias was low in 12 studies and high in 3 studies. TCQ was associated with significant improvement in fatigue (ES = - 0.53, p < 0.001), sleep difficulty (ES = - 0.49, p = 0.018), depression (ES = - 0.27, p = 0.001), and overall QOL (ES = 0.33, p = 0.004); a statistically non-significant trend was observed for pain (ES = - 0.38, p = 0.136). Random effects models were used for meta-analysis based on Q test and Icriteria. Funnel plots suggest some degree of publication bias. Findings in non-randomized studies largely paralleled meta-analysis results.

CONCLUSIONS:Larger and methodologically sound trials with longer follow-up periods and appropriate comparison groups are needed before definitive conclusions can be drawn, and cancer- and symptom-specific recommendations can be made.

IMPLICATIONS FOR CANCER SURVIVORS:TCQ shows promise in addressing cancer-related symptoms and QOL in cancer survivors.