The number of children with prenatal opioid exposure to medication for addiction treatment (MAT) with methadone and buprenorphine for maternal opioid use disorder is increasing, but the associations of this exposure with cognitive outcomes are not well understood.
To examine the strength and consistency of findings in the medical literature regarding the association of prenatal exposure to MAT with early childhood cognitive development, particularly when accounting for variables outside MAT exposure.
A search strategy obtained publications from PubMed, CINAHL, PsycINFO, Web of Science, and Embase from January 1972 to June 2019. Reference lists from identified articles were searched.
Inclusion criteria were cohort studies, studies including children aged 1 to 60 months with at least 2 months of prenatal MAT exposure, studies using standardized direct-observation testing scales, and studies reporting means and SDs. Case reports, case series, historical controls, and reviews were excluded.
Two authors independently selected studies for inclusion, extracted data, and assessed study quality. Data extracted included demographic characteristics, covariates, sources of bias, and effect estimates. Meta-analysis was performed using random-effects models. This study was conducted according to the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Data extraction and synthesis were conducted between January 2018 and August 2019.
Cognitive test scores and demographic variability between exposed and unexposed groups.
A total of 16 unique cohorts, described in 27 articles and including 1086 children (485 [44.7%] with MAT exposure), were included in a quantitative synthesis. On meta-analysis, MAT exposure was associated with lower cognitive development scores (pooled standardized mean difference, -0.57; 95% CI, -0.93 to -0.21; I2 = 81%). Multiple subanalyses on demographic characteristics (ie, maternal education, race/ethnicity, socioeconomic status, prenatal tobacco exposure, infant sex) were conducted. In the subanalysis of studies with comparable prenatal exposure to tobacco smoke, the association of MAT exposure with cognitive scores was no longer statistically significant and became homogeneous (standardized mean difference, -0.11; 95% CI, -0.42 to 0.20; I2 = 0%).
In this study, predefined subanalyses demonstrated how poor recruitment, particularly imbalances in maternal tobacco use, could contribute to a negative overall association of cognitive development test scores with prenatal MAT exposure. Promoting tobacco cessation for pregnant women with opioid use disorder should be prioritized in this high-risk population.

Cognitive Outcomes of Young Children After Prenatal Exposure to Medications for Opioid Use Disorder: A Systematic Review and Meta-analysis.

To systematically review the effects of pilates on physical-functional aspects and quality of life of older adults.
We included randomized clinical trials whose participants were older adults, whose intervention was pilates exercises and that used a control group for comparison. The primary outcomes were balance, muscle strength, quality of life. Secondary outcomes were mood, autonomy, and flexibility. The searches were performed in the electronic databases Pubmed, Web of Science, LILACS, Cochrane Library and EMBASE, using terms from MeSH: Aged, elderly, Pilates-Based Exercises, Pilates Training, Pilates, Mat Pilates, Equipment-based Pilates, and synonyms, in May 2020. The meta-analysis, when possible, was performed using the mean and standard deviation values of the groups after the intervention period using the random effects model.
The search rendered 1639 studies, of which 28 articles corresponding to 24 ECRs (897 individuals) were included, most of the studies involved a female population. A meta-analysis was performed only in the balance variable, through the Berg Scale (three RCTs), where there were no significant differences between the intervention and control groups (2.06-95% CI: 1.31, 5.44, I
This review demonstrate that the practice of pilates by older adults may have positive effects on some of the outcomes evaluated, these results should be interpreted with caution (methodological heterogeneity and a part present high risk of bias).

Effects of pilates on physical-functional performance, quality of life and mood in older adults: Systematic review and meta-analysis of randomized clinical trials.

Pilates can be performed by children as a form of exercise to promote healthy growth and development. The increasing use of Pilates as a type of exercise for children or as an adjunct tool in pediatric rehabilitation should be supported by evidence of its benefits. The aim of this systematic review and meta-analysis was to assess the effects of Pilates as an exercise prescription for children and adolescents.
Five electronic databases were searched to identify trials (randomized controlled clinical trials or quasi-experimental studies) with a population of children or adolescents in which Pilates (mat or equipment) was performed as a form of exercise. Studies that investigated outcomes related to health and physical performance was analyzed. Individual trial effects were extracted and pooled for meta-analysis whenever possible. To evaluate the external and internal validity of the studies, we assessed their risk of bias.
Fifteen studies (from 945 records), including 1235 participants, met the eligibility criteria, and were included. The reported outcomes were heterogeneous, so only the effect on flexibility could be included in the meta-analysis (n = 4 studies). A significant positive trend toward improved flexibility for the control group compared with the Pilates group was found (Std. mean difference, 0.54; 95%CI: 0,18, 0.91; p = 0.003).
Few studies have assessed the effect of Pilates on children and adolescents. The lack of appropriate methodological descriptions/controls made it impossible to determine if all of the included studies were of good quality.

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