Despite the increase in the life expectancy of children with CHD, 5 the residual defects remaining after surgery can have a negative impact on morbidity and mortality. 6 This has reoriented the paradigm of therapeutic management with the aim to optimise the

Background Esophageal and gastric cancers are a significant public health problem worldwide, with most patients presenting with advanced-stage disease and, consequently, poor prognosis. Systemic oncological treatments (SOT) have been widely used over more conservative approaches, such as supportive care. Nevertheless, its effectiveness in this scenario is not sufficiently clear. This paper provides an overview of systematic reviews that assessed the effectiveness of SOT compared with the best supportive care (BSC) or placebo in patients with advanced esophageal or gastric cancers in an end-of-life context. Methods We searched MEDLINE, EMBASE, The Cochrane Library, Epistemonikos, and PROSPERO for eligible systematic reviews (SRs) published from 2008 onwards. The primary outcomes were overall survival (OS), progression-free survival (PFS), functional status, and toxicity. Two authors assessed eligibility and extracted data independently. We evaluated the methodological quality of included SRs using the AMSTAR-2 tool and the overlap of primary studies (corrected covered area, CCA). Also, we performed a de novo meta-analysis with data reported for each primary study when it was possible. We assessed the certainty of evidence using the GRADE approach. Results We identified 16 SRs (19 included trials) for inclusion within this overview. Most reviews had a critically low methodological quality, and there was a very high overlap of primary studies. It is uncertain whether SOT improves OS and PFS over more conservative approaches due to the very low certainty of evidence. Conclusions The evidence is very uncertain about the effectiveness of SOT for advanced esophageal or gastric cancers. High-quality SRs and further randomized clinical trials that include a thorough assessment of patient-centered outcomes are needed. Trial registration Open Science Framework, 10.17605/OSF.IO/7CHX6.

Background: Exercise and physical activity (PA) are essential components of the care of cystic fibrosis (CF) patients. Lower PA levels have been associated with worse pulmonary function, aerobic fitness, glycemic control, and bone mineral density. Most people with CF do not engage in the recommended amounts of PA. Objective: To determine the level of PA in children and adolescents with CF. Methods: A systematic review with meta-analysis was conducted without language restrictions in five databases. Were included studies that analyzed PA measured by objective and subjective instruments in children and adolescents with CF. Two independent reviewers analyzed the studies, extracted the data, and assessed the quality of evidence. The risk of bias of the included studies was assessed with the National Heart, Lung, and Blood Institute's risk-of-bias tool. Results: Of the 1535 reports returned by the initial search, 20 articles reporting on 785 patients were included in the data synthesis. The forest plot showed that the CF group had a similar moderate-to-vigorous PA (MVPA) (mean difference, −7.79; 95% CI, −15.65 to 0.08 min/d; P = .05) and sedentary time (mean difference, −50.81; 95% CI, −109.96 to 8.35 min/d; P = .09) to the control group. Conclusion: Children and adolescents with CF have a similar MVPA and sedentary time compared to controls. There are many options, subjective and objective, for assessing PA in this population. Optimal tool selection should guarantee more valid results.

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Background: In children and adolescents with asthma, the disease may reduce the perceived capability to participate in physical activity (PA) contributing to an increase in the sedentary lifestyle. The literature is unclear as to whether children and adolescents with asthma differ their PA levels from their healthy peers.Objective: Our objective was to describe the different methods and instruments used to measure PA and to compare the PA levels of children and adolescents with asthma with those of their healthy peers.Study Design: We conducted a systematic review of five databases. We included studies that compared the PA measured by objective and subjective instruments in children and adolescents with asthma versus controls. Two independent reviewers analyzed the studies, extracted the data, and assessed the quality of evidence.Results: Of the 5966 reports returned by the initial search, 28 articles reporting on 3184 patients were included in the data synthesis. A forest plot showed that both groups had similar values of moderate to vigorous PA (MVPA; mean difference, −0.05 h/day; 95% confidence interval [CI], −0.11-0.01; p = .13), sedentary time (mean difference 0.00 h/day; 95% CI, −0.22-0.23 h/day; p = .99) and steps/day (mean difference 354 steps/day; 95% CI, −563-1270 steps/day; p = .45). Conclusion:Children and adolescents with asthma have similar MVPA, steps/day, and sedentary time compared to the controls. The main instruments used were questionnaires and accelerometers.