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In the Amsterdam Growth And Health Longitudinal Study (AGAHLS), a group of approximately 650 12- to 14-year-old boys and girls was followed in their growth, and development of their health their lifestyle including diet, physical activity and smoking. One of the main interests was the change in their aerobic fitness. From 12 to 36 years of age in total, eight repeated measurements were performed to measure peak oxygen uptake (peak VO2). In this study the data of peak VO2 are revisited and extended: We made use of all collected data as a mixed longitudinal design including cross-sectionally measured subjects as well as longitudinally measured subjects. This led to the availability of 1,194 boys and 1356 girls. With generalized estimating equations (GEE) the longitudinal changes with chronological age and differences between boys and girls were analyzed. Teenage boys and girls increased their peak VO2 (ml/min) significantly (p < .001) until age 14 in girls and until age 17 in boys. However peak VO2 relative to bodyweight (peak VO2/BW) had significantly (p < .001) decreased over the whole age range from 12 to 36 in both sexes. Vigorous physical activity (VPA) also showed a decrease and was significantly (p < .001) related with lower peak VO2/BW (Beta = 0.001). This relation was stronger in boys than in girls. Because at the start of AGAHLS no fast responding metabolic instruments were available, future longitudinal studies about aerobic fitness should include also measurement of VO2kinetics. [ABSTRACT FROM AUTHOR]

Summary Background: Primary prevention of overweight is to be preferred above secondary prevention, which has shown moderate effectiveness. Objective: To develop and internally validate a dynamic prediction model to identify young children in the general population, applicable at every age between birth and age 6, at high risk of future overweight (age 8). Methods: Data were used from the Prevention and Incidence of Asthma and Mite Allergy birth cohort, born in 1996 to 1997, in the Netherlands. Participants for whom data on the outcome overweight at age 8 and at least three body mass index SD scores (BMI SDS) at the age of ≥3 months and ≤6 years were available, were included (N = 2265). The outcome of the prediction model is overweight (yes/no) at age 8 (range 7.4‐10.5 years), defined according to the sex‐ and age‐specific BMI cut‐offs of the International Obesity Task Force. Results: After backward selection in a Generalized Estimating Equations analysis, the prediction model included the baseline predictors maternal BMI, paternal BMI, paternal education, birthweight, sex, ethnicity and indoor smoke exposure; and the longitudinal predictors BMI SDS, and the linear and quadratic terms of the growth curve describing a child's BMI SDS development over time, as well as the longitudinal predictors' interactions with age. The area under the curve of the model after internal validation was 0.845 and Nagelkerke R2 was 0.351. Conclusions: A dynamic prediction model for overweight was developed with a good predictive ability using easily obtainable predictor information. External validation is needed to confirm that the model has potential for use in practice. [ABSTRACT FROM AUTHOR]

Background: Self-rated health (SRH) has been found to predict sickness absence (SA). The present study investigated the effect of replacing single-item SRH by a multi-item health measure on SA predictions. Methods: Longitudinal study of 2059 Norwegian nurses with assessments in three waves each separated by 1 year. Health was measured by single-item SRH and multi-item SF-12 in waves 1 and 2. SA was self-reported in all three waves and high SA was defined as more than or equal to 31 SA days within the last 12 months. Predictions of high SA by a model including age, prior SA and single-item SRH were compared with predictions by a model including age, prior SA and multi-item SF-12. Both models were bootstrapped to correct for over-optimism and prospectively validated for their predictions in a new time frame. Results: 1253 nurses (61%) had complete data for analysis. The SF-12 model predicted the risk of high SA more accurately (X2= 4.294; df = 8) and was more stable over time than the SRH model (model X2= 14.495; df = 8). Both prediction models correctly discriminated between high-risk and low-risk individuals in 73% of the cases at wave 2 and in 71% of the cases at wave 3. Conclusions: The accuracy of predictions increased when single-item SRH was replaced by multi-item SF-12, but the discriminative ability did not improve. Single-item SRH suffices to identify employees at increased risk of high SA. [ABSTRACT FROM AUTHOR]

This study analyses distinct trajectories of vital exhaustion (VE; a measure of mental health incorporating signs of stress and depression) over a period of 15 years in healthy adults and investigates further the consequences for markers of low-grade inflammation as indicators of cardiovascular disease risk. Data of 341 participants of the Amsterdam Growth and Health Longitudinal Study were utilized. VE was measured by the Maastricht Questionnaire. Markers of low-grade inflammation included interleukin-6, interleukin-8 and tumour necrosis factor-α. Distinct trajectories of VE were obtained by latent class growth models, and consequences for markers of low-grade inflammation of the trajectories were analysed by linear regressions. We found comparable trajectories of VE for men and women; a 'never vitally exhausted' subgroup (16.9% and 25.1%, respectively), a 'stable preclinical VE' subgroup (51.7% and 68.1%) and a 'chronic VE state' subgroup (31.5% and 6.7%). The subgroups had similar levels of the markers investigated. This study is the first to analyse VE longitudinally in healthy adults and indicates that although distinct trajectories of VE were identified, differential consequences for cardiovascular disease risk were unapparent. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Aim: To assess longitudinally whether smoking tobacco is related to muscle strength in healthy adults and to assess the influence of lifestyle covariates on this relation. Methods: Data were obtained from the observational Amsterdam Growth and Health Longitudinal Study, with four repeated measurements at the ages of 21 (n = 181), 27 (n = 144), 32 (n = 426) and 36 (n = 373) years. Knee muscle strength (KMS) was measured at an angle of 300° per second. Smoking and the covariates physical activity and dietary intake were assessed with a questionnaire. Other covariates included physical fitness and body fat percentage. Cardiopulmonary fitness was assessed with a maximal running test and body fatness with skinfold measurements. Sex-specific longitudinal analyses were carried out using generalized estimating equations. Results: In men and women, an inverse relationship between smoking tobacco and KMS was found. Smoking 100 g of tobacco a week resulted in a reduction of 2.9% in KMS in men and a reduction of 5.0% in women. This relation existed largely independently of lifestyle covariates. Conclusion: This study indicates that smoking is inversely related to skeletal muscle strength in healthy adults. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: To compare childhood arrestees with matched comparison groups on levels of autistic symptoms and to assess the unique predictive value of autistic symptoms for future delinquent behavior in childhood arrestees. Methods: Childhood first-time arrestees ( n = 308, baseline age 10.7 ± 1.5 years) were followed up for 2 years. Autistic symptoms, externalizing disorders and delinquent behavior were assessed yearly. Childhood arrestees were compared on autistic symptoms with matched (age, gender) general population and clinical autism spectrum disorder samples. The predictive value of autistic symptoms for delinquent behavior was analyzed using generalized estimating equations. Results: At each assessment, levels of autistic symptoms in childhood arrestees were in between levels found in the general population and autism spectrum disorder samples. Autistic symptoms were positively associated with delinquent behavior in childhood arrestees, even after adjustment for externalizing disorders: IRR (incidence rate ratio) 1.23; 95% CI 1.11-1.36 and IRR 1.29; 95% CI 1.15-1.45 for core autistic symptoms and total symptom score, respectively. Conclusions: Autistic symptoms are more prevalent in childhood arrestees compared to the general population and are uniquely associated with future delinquent behavior. Attention should, therefore, be given to the possible presence of autism related symptomatology in these children. Implications for diagnostic assessment and intervention need further investigation. [ABSTRACT FROM AUTHOR]

Data from the Longitudinal Aging Study Amsterdam were used to study the relationship between neuroticism and aging. At baseline, cross-sectional analyses of data from 2,117 respondents (aged 55-85 years, M = 70) showed no significant age differences. The magnitude of the 3- and 6-year stability coefficients was high, and 12% of the elderly participants showed a clinically relevant mean level change. Longitudinal multilevel analyses showed a small but statistical significant change with aging, but the mean change was not considered clinically relevant. A U-formed course was found, showing a slight decrease until respondents reached the age of 70. Adjusting the model for physical health-related variables slightly increased the stability. An additional interaction analysis showed that the individual trajectory of neuroticism was not affected by the physical health status. In conclusion, neuroticism remains rather stable in middle and older adulthood, with some apparent increase in late life. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to test the hypothesis that daily physical activity over a period of 15 years has been beneficial to aerobic fitness in young male and female participants (13-27 years) in the Amsterdam Growth and Health Longitudinal Study. Only subjects with the maximal data of six sets of measurements were included (83 male and 98 female participants). Daily physical activity was assessed using a standardized interview on activity and expressed as a weighted activity score. Aerobic fitness was assessed using a maximal running test on a treadmill and measuring the maximal oxygen uptake (VO2max) and the maximal slope of the track (Smax) To assess the longitudinal relationship between daily physical activity and aerobic fitness a real longitudinal analysis was carried out with generalized estimating equations, adjusting for differences in initial aerobic fitness at age 13, and for other lifestyle (dietary intake, smoking and alcohol consumption) and biological parameters (biological age, body fat, blood pressure and concentration of serum cholesterol). A significant relationship (P < 0.01) was observed between daily physical activity and both VO2max and Smax. It can be concluded that the development of aerobic fitness between the age of 13 and 27 years is independently and positively related to daily physical activity in this group of male and female participants in the study. The functional implications, however, are small: a relatively high increase in the weighted physical activity score of 30% over a period of 15 years results in a 2%-5% increase in aerobic fitness. [ABSTRACT FROM AUTHOR]

Objective: To study whether intrauterine application of auto-crosslinked polymers of hyaluronic acid (ACP) gel after dilation and curettage (D&C) improves reproductive outcomes.Design: Follow-up of a prospective randomized trial.Setting: University and university-affiliated teaching hospitals.Patient(s): Women with a miscarriage at <14 weeks' gestation with at least one previous D&C were randomized to D&C plus ACP gel (intervention) or D&C alone (control). A hysteroscopy was performed after 8-12 weeks, and if intrauterine adhesion (IUAs) were encountered, adhesiolysis was executed.Intervention(s): Participants received a questionnaire 30 months after treatment.Main Outcome Measure(s): Ongoing pregnancy and outcome of subsequent pregnancies.Result(s): Ongoing pregnancies were recorded in 74.6% (50/67) of the intervention group versus 67.2% (43/64) of the control group, and in, respectively, 94.3% (50/53) versus 71.7% (43/60) in the women wishing to conceive. The median times to conception leading to a live birth were, respectively, 21.9 versus 36.1 months. Reduced menstrual blood loss was reported in 7.5% (5/67) versus 20.3% (13/64) and dysmenorrhea in 14.9% (10/67) versus 34.4% (22/64), respectively.Conclusion(s): Application of ACP gel following D&C performed after miscarriage seems to have a favorable effect on subsequent reproductive outcomes in women with at least one previous D&C. Given the fact that the study was not powered for reproductive outcomes, the data should be interpreted with caution. The effect may be underestimated due to routine removal of IUAs.Dutch Clinical Trial Registry Number: NTR 3120. [ABSTRACT FROM AUTHOR]

Objective: To answer the questions: Are perinatal reproductive hormone profiles different in case of a twin compared with a singleton pregnancy? Are reproductive endocrine profiles of twin girls influenced by their male co-twin and vice versa?Design: Prospective cohort study from January 2004 to October 2009.Setting: Not applicable.Patient(s): A total of 204 mothers of twins and 248 singleton control subjects, aged >18 years, pregnant with a twin or singleton and no endocrine disease or malignancy.Intervention(s): Blood samples were collected at mid-gestation from the mother and at delivery from the mothers and the umbilical cords. Estrogens, androgens, sex hormone-binding globulin, progesterone, and gonadotropins were measured.Main Outcome Measure(s): Hormonal profiles were compared between singletons and twins, different types of twins, and opposite-sex and same-sex twins.Result(s): Estrogen and progesterone concentrations were higher in mothers of twins compared with singletons, but twin babies had lower estrogen and progesterone concentrations at birth. Opposite-sex twin girls did not have higher androgens in cord blood compared with same-sex twin girls. Boys of an opposite-sex twin had lower luteinizing hormone concentrations compared with dizygotic twin boys with a brother as a co-twin.Conclusion(s): Children from a twin are not overexposed to sex steroids at the time of birth, despite higher concentrations in their mothers, and girls from opposite sex twins do not show androgenic influences from their male co-twin. The female co-twin may influence the hypothalamic-pituitary-testicular axis of her brother via central inhibition. [ABSTRACT FROM AUTHOR]

Objectives: Previous studies show that missing values in multi-item questionnaires can best be handled at item score level. The aim of this study was to demonstrate two novel methods for dealing with incomplete item scores in outcome variables in longitudinal studies. The performance of these methods was previously examined in a simulation study. The two methods incorporate item information at the background when simultaneously the study outcomes are estimated. Study Design and Setting: The investigated methods include the item scores or a summary of a parcel of available item scores as auxiliary variables while using the total score of the multi-item questionnaire as the main focus of the analysis in a latent growth model. That way the items help estimating the incomplete information of the total scores. The methods are demonstrated in two empirical data sets. Results: Including the item information results in more precise outcomes in terms of regression coefficient estimates and standard errors, compared with not including item information in the analysis. Conclusion: The inclusion of a parcel summary is an efficient method that does not overcomplicate longitudinal growth estimates. Therefore, it is recommended in situations where multi-item questionnaires are used as outcome measure in longitudinal clinical studies with incomplete scores because of missing item scores. [ABSTRACT FROM AUTHOR]

To determine the number of steps taken by older patients in hospital and 1 week after discharge; to identify factors associated with step numbers after discharge; and to examine the association between functional decline and step numbers after discharge. Prospective observational cohort study conducted in 2015–2017. Older adults (≥70 years of age) acutely hospitalized for at least 48 hours at internal, cardiology, or geriatric wards in 6 Dutch hospitals. Steps were counted using the Fitbit Flex accelerometer during hospitalization and 1 week after discharge. Demographic, somatic, physical, and psychosocial factors were assessed during hospitalization. Functional decline was determined 1 month after discharge using the Katz activities of daily living index. The analytic sample included 188 participants [mean age (standard deviation) 79.1 (6.7)]. One month postdischarge, 33 out of 174 participants (19%) experienced functional decline. The median number of steps was 656 [interquartile range (IQR), 250–1146] at the last day of hospitalization. This increased to 1750 (IQR 675–4114) steps 1 day postdischarge, and to 1997 (IQR 938–4098) steps 7 days postdischarge. Age [β = −57.93; 95% confidence interval (CI) −111.15 to −4.71], physical performance (β = 224.95; 95% CI 117.79–332.11), and steps in hospital (β = 0.76; 95% CI 0.46–1.06) were associated with steps postdischarge. There was a significant association between step numbers after discharge and functional decline 1 month after discharge (β = −1400; 95% CI –2380 to −420; P =.005). Among acutely hospitalized older adults, step numbers double 1 day postdischarge, indicating that their capacity is underutilized during hospitalization. Physical performance and physical activity during hospitalization are key to increasing the number of steps postdischarge. The number of steps 1 week after discharge is a promising indicator of functional decline 1 month after discharge. [ABSTRACT FROM AUTHOR]

The prevalence of different geriatric syndromes in older home care (HC) recipients is yet to be determined. Dizziness is often regarded as a geriatric syndrome. The natural course of dizziness in older people is still unknown, because of a lack of longitudinal studies. The objective of this study was to investigate the prevalence and persistence of dizziness in HC recipients. Prospective cohort study. Home care organizations in 6 European countries participating in the EU-funded Identifying best practices for care-dependent elderly by Benchmarking Costs and outcomes of community care (IBenC) project. 2616 community-dwelling long-term HC recipients aged 65 years or older. Data were collected at baseline and 6 and 12 months by using the interRAI Home Care instrument (interRAI-HC). Dizziness status was assessed by the number of days people experienced dizziness in the last 3 days (0-3) and later dichotomized for analyses (present or not in the last 3 days). Dizziness persistence was defined as the odds for dizzy people at baseline to also report dizziness at subsequent follow-up moments, compared with people who were not dizzy at baseline. The pattern of dizziness was descriptively analyzed in recipients who completed all measurements. Generalized estimating equations analysis was used to determine the persistence of dizziness symptoms. The prevalence of dizziness of 2616 eligible HC recipients at baseline was 25.1%, ranging from 16.2% (Belgium) to 39.7% (Italy). The majority of dizzy recipients at baseline also experienced dizziness after 6 and 12 months (79.1%). Dizziness persistence was high at 6 months [odds ratio (OR) 57.8, 95% confidence interval (CI) 43.1-77.5] and at 12 months (OR 30.2, 95% CI 22.3-41.1). Dizziness in older HC recipients in Europe is common, and dizziness persistence is high. This warrants a more active approach in treating dizziness in older HC recipients. [ABSTRACT FROM AUTHOR]

Maladaptive cognitions and behaviors may influence symptoms and impairment in patients with persistent somatic symptoms (PSS). Aims of this study were to examine: (i) whether maladaptive cognitions and behaviors are associated with symptom severity and functional health over time; (ii) if these associations are the result of changes within individuals over time or of differences between individuals; (iii) directions of changes within individuals over time. Longitudinal data of a heterogeneous sample of patients with PSS were analyzed (n = 322 patients enrolled in the PROSPECTS cohort study). Cognitive and behavioral responses to symptoms (CBRQ), symptom severity (PHQ-15) and physical and mental functioning (RAND-36 PCS and MCS) were assessed seven times over a five-year period (0, 6 months, 1, 2, 3, 4, 5 year). Longitudinal mixed model and hybrid model analysis with and without time-lag were applied. Maladaptive cognitions and behaviors were associated with more severe symptoms and reduced physical and mental functioning over time. Both changes within individuals over time and differences between individuals were associated with higher symptom severity and reduced physical and mental functioning. The between- subject component was about twice the effect size of the within -subject component. Changes in several specific maladaptive cognitions and behaviors were associated with more severe symptoms and reduced physical and mental functioning later in time and vice versa. This study shows that maladaptive cognitions and behaviors are associated with symptom severity and reduced physical and mental functioning over time in patients with PSS. • Maladaptive cognitions and behaviors were associated with somatic symptom severity over five-year time. • Associations were also found for maladaptive cognitions and behaviors and reduced physical and mental functioning. • Also, within subjects cognitions and behavior may play a role as perpetuating factors. [ABSTRACT FROM AUTHOR]

To examine whether The Ending PyJama (PJ) Paralysis campaign, focused on increasing in-hospital physical activity, affects objectively measured sedentary behavior and physical activity patterns and if these are associated with changes in physical and functional performance in geriatric rehabilitation inpatients. Quasi-experimental study. Within the REStORing health of acutely unwell adulTs (RESORT) observational, longitudinal cohort of geriatric rehabilitation inpatients, the Ending PJ Paralysis campaign was implemented on 2 out of 4 wards. Objectively measured sedentary behavior and physical activity were measured by an inertial sensor (ActivPAL4) for 1 week, comparing control (non-PJ) and intervention (PJ) groups using linear mixed models. Mean sedentary behavior and physical activity measures and their association with physical and functional performance changes were investigated by linear regression analyses, stratified by low vs high performance at admission using the median as a cut-off. A total of 145 (n = 68 non-PJ and n = 77 PJ) inpatients with a mean age of 83.0 (7.7) years (55.9% female inpatients) were included. The median nonupright time was 23.1 [22.1-23.6] and 23.0 [21.8-23.6] hours/day for non-PJ and PJ groups, respectively. Objectively measured sedentary behavior and physical activity measures did not significantly change over measurement days and were independent of the Ending PJ Paralysis campaign. For inpatients with low performance at admission, lower sedentary behavior [B(SE) −0.013 (0.005) to −0.157 (0.045), P <.01] and higher physical activity [B(SE) 0.033 (0.007) to 0.814 (0.200), P <.01] measures were associated with improved physical performance. In addition, lower sedentary behaviour [B(SE) = -0.058 (0.024), P <.05 and higher physical activity [B (SE) 0.060 (0.024) to 0.683 (0.182), P <.05] were associated with improved instrumental functional performance. In geriatric rehabilitation inpatients, the Ending PJ Paralysis campaign did not affect objectively measured sedentary behavior and physical activity patterns. Lower mean sedentary behaviour and higher physical activity measures were associated with improved physical and functional performance in inpatients with low performance. [ABSTRACT FROM AUTHOR]

The researchers aimed to (1) explore the occurrence of psychological resilience in the face of a major life stressor and conflict in older residents of long-term care facilities (LTCFs), and (2) identify factors associated with resilience in this population. Longitudinal cohort study using the Dutch InterRAI-LTCF cohort. Older residents (≥60 years old) of 21 LTCFs in the Netherlands. The researchers selected 2 samples of residents who had at least 2 assessments surrounding (1) an incident major life stressor, or (2) incident conflict with other resident or staff. A resilient outcome was operationalized as not having clinically meaningful mood symptoms at the post-stressor assessment and equal or fewer mood symptoms at the post-stressor relative to the pre-stressor assessment. The researchers used 2 resilience outcomes per stressor: 1 based on observer-reported mood symptoms and 1 based on self-reported mood symptoms. The most important factors from among 21 potential resilience factors for each of the 4 operationalizations of resilience were identified using a backward selection procedure with 2-level generalized estimating equations analyses. Forty-eight percent and 50% of residents were resilient in the face of a major life stressor, based on observer-reported (n = 248) and self-reported (n = 211) mood, respectively. In the face of conflict, 26% and 51% of the residents demonstrated resilience, based on the observer-reported (n = 246) and self-reported (n = 183) mood, respectively. Better cognitive functioning, a strong and supportive relationship with family, participation in social activities, and better self-reported health were most strongly associated with resilience in the face of a major life stressor. Better communicative functioning, absence of psychiatric diagnoses, a strong and supportive relationship with family, not being lonely, social engagement, and not reminiscing about life were most strongly associated with resilience in the face of conflict. Factors with a social aspect appear to be particularly important to psychological resilience in older LTCF residents, and provide a potential target for intervention in the LTCF setting. [ABSTRACT FROM AUTHOR]

Objective: To examine longitudinal associations of multiple physical symptoms with recurrence of depressive and anxiety disorders.Methods: Follow-up data of 584 participants with remitted depressive or anxiety disorders were used from the Netherlands Study of Depressive and Anxiety disorders. Multiple physical symptoms were measured at baseline (T1) and two-year follow-up (T2) by the Four-Dimensional Symptom Questionnaire (4DSQ) somatization subscale. Recurrence of depressive and anxiety disorders was assessed at two-year (T2) and four-year (T4) follow-up with the Composite International Diagnostic Interview. Logistic Generalized Estimating Equations were used to examine associations of multiple physical symptoms with recurrence of depressive and anxiety disorders. Depressive (IDS-SR) and anxiety symptoms (BAI), and other relevant covariates were taken into account.Results: Multiple physical symptoms were significantly associated with recurrence of depression (OR=1.04, 95%CI=1.00-1.08), anxiety (OR=1.07, 95%CI=1.03-1.12), and depressive or anxiety disorders (OR=1.06, 95%CI=1.02-1.10), on average over time. Odds ratios did not change substantially when the IDS-SR mood-cognition and BAI subjective scale were included as covariates.Conclusion: The presence of multiple physical symptoms was positively related to recurrence of depressive and anxiety disorders, independent of depressive and anxiety symptoms. Knowledge of risk factors for recurrence of depressive and anxiety disorders, such as the presence of multiple physical symptoms, could provide possibilities for better targeting interventions to prevent recurrence. [ABSTRACT FROM AUTHOR]

We aimed to explore the effects of the Dutch COVID-19 lockdown (March 20–May 25, 2020) on mood, behavior, and social and cognitive functioning of older residents of long-term care facilities (LTCFs) prospectively. Mixed methods: historically controlled longitudinal cohort study and focus groups. Residents of Dutch LTCFs. Residents who were assessed during and prior to the lockdown were compared to residents of the same wards with 2 assessments prior to the lockdown. We used mixed models and generalized estimating equation analyses to explore differences in changes in mood, withdrawal and aggressive behavior, loneliness and conflict, and cognition and delirium. We also explored whether the effect of the lockdown differed for different subgroups. In 2 online focus groups, LTCF care professionals, ranging from care staff to physicians, reflected on their experiences of the effect of the lockdown and the cohort study results. The lockdown group of 298 residents was compared to the control group of 625 residents. Self-reported mood symptoms showed a slightly greater increase during the lockdown. During the first half of the lockdown, the level of conflict with other residents decreased whereas it increased in the control group. The subgroup with moderate-severe cognitive impairment showed a decrease in withdrawal during the lockdown, whereas the group with no-mild cognitive impairment showed a statistically nonsignificant relative increase. Professionals described great individual variation in the effects of the lockdown on residents. Facilities attempted to preserve the experienced positive effects, for example, by promoting tranquility in shared rooms and continuing to organize individualized ward-based activities. We did not find clinically relevant negative effects of the lockdown on mood, behavior, and social and cognitive functioning in older residents of LTCFs at the group level. Possibly, staff mitigated the negative effects at the group level. Meanwhile, they learned lessons that they continue to apply to enhance resident well-being. [ABSTRACT FROM AUTHOR]

Abstract: Background: The postnatal activation of the hypothalamic–pituitary–gonadal axis is more exaggerated in preterm than in full-term born infants and may be important for future reproductive function. Aim: The objective of this study was to investigate the postnatal activation of the hypothalamic–pituitary–gonadal axis in female very-low-birth-weight infants. Study design: We performed serial measurements of gonadotropin and estradiol levels in urine samples of female very-low-birth-weight infants collected at 1 and 4weeks postnatal age, at 32weeks postmenstrual age, at expected date of delivery and at the corrected age of three and six months. Subjects: Twenty-two very-low-birth-weight infants (gestational age 25.4–30.1weeks), participating in the Neonatal Insulin Replacement Therapy in Europe trial, were included in this study. Outcome measures: Gonadotropin and estradiol levels were measured in serial urine samples. Results: Longitudinal analysis shows that after birth FSH and LH levels increase until 32weeks postmenstrual age (4weeks postnatal age) and then decrease until 3months corrected age (26weeks postnatal age). Estradiol levels decrease from 28weeks postmenstrual age (1week postnatal age) until 6months corrected age (39weeks postnatal age). Conclusions: Serial urine sampling for measurement of gonadotropin and estradiol levels provides an accurate description of the postnatal activation of the hypothalamic–pituitary–gonadal axis in very-low-birth-weight girls. Levels of FSH and LH peak at a mean postmenstrual age of 32weeks (postnatal age of 4weeks) whereas estradiol levels are highest shortly after birth. [Copyright &y& Elsevier]

Abstract: The pathophysiological mechanisms of Parkinson''s disease (PD)-related dementia (PDD) are still poorly understood. Previous studies using electroencephalography (EEG) and magnetoencephalography (MEG) have demonstrated widespread slowing of oscillatory brain activity as a neurophysiological characteristic of PD-related dementia. Here, we use MEG to longitudinally study early changes in oscillatory brain activity in initially nondemented PD patients that may be associated with cognitive decline. Using a longitudinal design, resting-state MEG recordings were performed twice at an approximate 4-year interval in 14 healthy controls and 49 PD patients. Changes in peak frequency and in relative spectral power for 10 brain regions were analyzed in relation to clinical measures of cognitive and motor function. In contrast to healthy controls, PD patients showed a slowing of the dominant peak frequency. Furthermore, analysis per frequency band revealed an increase in theta power over time, along with decreases in alpha1 and alpha2 power. In PD patients, decreasing cognitive performance was associated with increases in delta and theta power, as well as decreases in alpha1, alpha2, and gamma power, whereas increasing motor impairment was associated with a theta power increase only. The present longitudinal study revealed widespread progressive slowing of oscillatory brain activity in initially nondemented PD patients, independent of aging effects. The slowing of oscillatory brain activity strongly correlated with cognitive decline and therefore holds promise as an early marker for the development of dementia in PD. [Copyright &y& Elsevier]

Abstract: Introduction: Studies on the association of vitamin D and bone mineral density (BMD) in adolescence and young adults have shown contrasting results. None of these studies have examined the course and baseline in vitamin D intake. The purpose of this study was to examine the association between baseline and the course of dietary vitamin D intake on the BMD. Methods: Vitamin D intake was assessed 3–8 times between the age of 13 and 36 years in 152 men and 168 women from the Amsterdam Growth and Health Longitudinal Study. The BMD of the femoral neck, lumbar spine, total hip and total body was measured at the age of 36 years with dual-energy X-ray absorptiometry. Linear regression analyses were used to determine the vitamin D intake pattern in time for each subject. The models provide a baseline, course and fluctuation of the vitamin D intake for each subject. These were used in separate regression analyses with the dependent variable BMD. Results: Mean baseline vitamin D was 6.86 (SD: 2.18) μg/day for men and 4.90 (1.19) μg/day for women. Mean course of vitamin D was −0.10 (0.12) μg/day/year and −0.05 (0.18) μg/day/year for men and women respectively. After adjustment for potential confounders and correcting for the other parameters of vitamin D intake, the associations between baseline vitamin D intake and BMD were significant in the total hip (0.018 g/cm2 per −1 μg/day; 95% CI 0.001–0.035) and total body (0.015 per −1 μg/day; 0.001–0.029). The course of vitamin D intake was associated with BMD in the lumbar spine (0.50 g/cm2 per −1 μg/day/year; 0.130–0.867), femoral neck (0.42 g/cm2 per −1 μg/day/year; 0.10–0.743), total body (0.34 g/cm2 per −1 μg/day/year; 0.09–0.59) and total hip (0.44 g/cm2 per −1 μg/day/year; 0.11–0.77) in men. No significant associations were found in women. Conclusion: In men, the level of vitamin D intake in adolescence and the course of vitamin D intake from adolescence into adulthood are positively related with BMD in adulthood. In women, however, no significant associations are found. [Copyright &y& Elsevier]

Acute hospitalization may lead to a decrease in muscle measures, but limited studies are reporting on the changes after discharge. The aim of this study was to determine longitudinal changes in muscle mass, muscle strength, and physical performance in acutely hospitalized older adults from admission up to 3 months post-discharge. A prospective observational cohort study was conducted. This study included 401 participants aged ≥70 years who were acutely hospitalized in 6 hospitals. All variables were assessed at hospital admission, discharge, and 1 and 3 months post-discharge. Muscle mass in kilograms was assessed by multifrequency Bio-electrical Impedance Analysis (MF-BIA) (Bodystat; Quadscan 4000) and muscle strength by handgrip strength (JAMAR). Chair stand and gait speed test were assessed as part of the Short Physical Performance Battery (SPPB). Norm values were based on the consensus statement of the European Working Group on Sarcopenia in Older People. A total of 343 acute hospitalized older adults were included in the analyses with a mean (SD) age of 79.3 (6.6) years, 49.3% were women. From admission up to 3 months post-discharge, muscle mass (−0.1 kg/m2; P =.03) decreased significantly and muscle strength (−0.5 kg; P =.08) decreased nonsignificantly. The chair stand (+0.7 points; P <.001) and gait speed test (+0.9 points; P <.001) improved significantly up to 3 months post-discharge. At 3 months post-discharge, 80%, 18%, and 43% of the older adults scored below the cutoff points for muscle mass, muscle strength, and physical performance, respectively. Physical performance improved during and after acute hospitalization, although muscle mass decreased, and muscle strength did not change. At 3 months post-discharge, muscle mass, muscle strength, and physical performance did not reach normative levels on a population level. Further research is needed to examine the role of exercise interventions for improving muscle measures and physical performance after hospitalization. [ABSTRACT FROM AUTHOR]

After hospitalization, many older adults need post-acute care, including rehabilitation or home care. However, post-acute care expenses can be as high as the costs for the initial hospitalization. Detailed information on monthly post-acute health care expenditures and the characteristics of patients that make up for a large share of these expenditures is scarce. We aimed to calculate costs in acutely hospitalized older patients and identify patient characteristics that are associated with high post-acute care costs. Prospective multicenter cohort study (between October 2015 and June 2017). 401 acutely hospitalized older persons from internal medicine, cardiology, and geriatric wards. Our primary outcome was mean post-acute care costs within 90 days postdischarge. Post-acute care costs included costs for unplanned readmissions, home care, nursing home care, general practice, and rehabilitation care. Three costs categories were defined: low [0-50th percentile (p0-50)], moderate (p50-75), and high (p75-100). Multinomial logistic regression analyses were conducted to assess the associations between costs and frailty, functional impairment, health-related quality of life, cognitive impairment, and depressive symptoms. Costs were distributed unevenly in the population, with the top 10.0% (n = 40) accounting for 52.1% of total post-acute care costs. Mean post-acute care costs were €4035 [standard deviation (SD) 4346] or $4560 (SD 4911). Frailty [odds ratio (OR) 3.44, 95% confidence interval (CI) 1.78-6.63], functional impairment (OR 1.80, 95% CI 1.03-3.16), and poor health-related quality of life (OR 1.89, 95% CI 1.09-3.28) at admission were associated with classification in the high-cost group, compared with the low-cost group. Post-acute care costs are substantial in a small portion of hospitalized older adults. Frailty, functional impairment, and poor health-related quality of life are associated with higher post-acute care costs and may be used as an indicator of such costs in practice. [ABSTRACT FROM AUTHOR]

Abstract Objectives To establish the prevalence and course of geriatric syndromes from hospital admission up to 3 months postdischarge and to determine the probability to retain geriatric syndromes over the period from discharge until 3 months postdischarge, once they are present at admission. Design Prospective multicenter cohort study conducted between October 2015 and June 2017. Setting and participants Acutely hospitalized patients aged 70 years and older recruited from internal, cardiology, and geriatric wards of 6 Dutch hospitals. Measures Cognitive impairment, depressive symptoms, apathy, pain, malnutrition, incontinence, dizziness, fatigue, mobility impairment, functional impairment, fall risk, and fear of falling were assessed at admission, discharge, and 1, 2, and 3 months postdischarge. Generalized estimating equations analysis were performed to analyze the course of syndromes and to determine the probability to retain syndromes. Results A total of 401 participants [mean age (standard deviation) 79.7 (6.7)] were included. At admission, a median of 5 geriatric syndromes were present. Most prevalent were fatigue (77.2%), functional impairment (62.3%), apathy (57.5%), mobility impairment (54.6%), and fear of falling (40.6%). At 3 months postdischarge, an average of 3 syndromes were present, of which mobility impairment (52.7%), fatigue (48.1%), and functional impairment (42.5%) were most prevalent. Tracking analysis showed that geriatric syndromes that were present at admission were likely to be retained. The following 6 geriatric syndromes were most likely to stay present postdischarge: mobility impairment, incontinence, cognitive impairment, depressive symptoms, functional impairment, and fear of falling. Implications Acutely hospitalized older adults exhibit a broad spectrum of highly prevalent geriatric syndromes. Moreover, patients are likely to retain symptoms that are present at admission postdischarge. Our study underscores the need to address a wide range of syndromes at admission, the importance of communication on syndromes to the next care provider, and the need for adequate follow-up care and syndrome management postdischarge. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: The Grip on Challenging Behavior care program was developed using the current guidelines and models on managing challenging behavior in dementia in nursing homes. It was hypothesized that the use of the care program would lead to a decrease in challenging behavior and in the prescription of psychoactive drugs without increase in use of restraints. Design: A randomized controlled trial was undertaken using a stepped-wedge design to implement the care program and to evaluate the effects. An assessment of challenging behavior and psychoactive medication was undertaken every 4 months on all participating units followed by the introduction of the care program in a group of 3 to 4 units. A total of 6 time assessments took place over 20 months. Setting: Seventeen dementia special care units of different nursing homes. Participants: A total of 659 residents of dementia special care units. All residents with dementia on the unit were included. Units were assigned by random allocation software to 1 of 5 groups with different starting points for the implementation of the care program. Intervention: A care program consisting of various assessment procedures and tools, which ensure a multidisciplinary approach and which structure the process of managing challenging behavior in dementia. Measurements: Challenging behavior was measured using the Cohen-Mansfield Agitation Inventory (CMAI) and the Neuropsychiatric Inventory. Research assistants (blinded for intervention status of the unit) interviewed nurses on the units about challenging behavior. Data on psychoactive drugs and restraints were retrieved from resident charts. Results: A total of 2292 assessments took place involving 659 residents (1126 control measurements, 1166 intervention measurements). The group of residents who remained in the intervention condition compared with the group in the control condition differed significantly in the CMAI change scores between successive assessments [–2.4 CMAI points, 95% confidence interval (CI) –4.3 to –0.6]. No significant effects were found for the control-to-intervention group compared with the group who remained in the control group (0.0 CMAI points, 95% CI –2.3 to 2.4). Significant effects were found on 5 of the 12 Neuropsychiatric Inventory items and on the use of antipsychotics (odds ratio 0.54, 95% CI 0.37– 0.80) and antidepressants (odds ratio 0.65, 95% CI 0.44–0.94). No effect on use of restraints was observed. Conclusions: The Grip on Challenging behavior program was able to diminish some forms of challenging behavior and the use of psychoactive drugs. [Copyright &y& Elsevier]