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INTRODUCTION AND HYPOTHESIS The prevalence of female stress urinary incontinence is high, and young adults are also affected, including athletes, especially those involved in "high-impact" sports. To date there have been almost no studies testing pelvic floor muscle (PFM) activity during dynamic functional whole body movements. The aim of this study was the description and reliability test of PFM activity and time variables during running. METHODS A prospective cross-sectional study including ten healthy female subjects was designed with the focus on the intra-session test-retest reliability of PFM activity and time variables during running derived from electromyography (EMG) and accelerometry. RESULTS Thirteen variables were identified based on ten steps of each subject: Six EMG variables showed good reliability (ICC 0.906-0.942) and seven time variables did not show good reliability (ICC 0.113-0.731). Time variables (e.g. time difference between heel strike and maximal acceleration of vaginal accelerator) showed low reliability. However, relevant PFM EMG variables during running (e.g., pre-activation, minimal and maximal activity) could be identified and showed good reliability. CONCLUSION Further adaptations regarding measurement methods should be tested to gain better control of the kinetics and kinematics of the EMG probe and accelerometers. To our knowledge this is the first study to test the reliability of PFM activity and time variables during dynamic functional whole body movements. More knowledge of PFM activity and time variables may help to provide a deeper insight into physical strain with high force impacts and important functional reflexive contraction patterns of PFM to maintain or to restore continence.

PURPOSE: Electric bicycles (e-bikes) may offer an opportunity to stimulate physical activity among older adults. The current study compared Flemish (Belgian) older e-bike users with those not using an e-bike on sociodemographics, health characteristics, and access to motorized transport. In addition, it examined the association between e-bike use and levels of cycling and the moderating effects of sex, body mass index (BMI), and cycling limitations. METHODS: An online or interview version of the same questionnaire was completed by 1146 participants. Data were analyzed using logistic regression and hurdle models. RESULTS: Women, those with a higher BMI, and those with one (compared with no) motorized vehicle in the household had higher odds of being an e-bike user. E-bike use was related to higher odds of having cycled for transport in the past week, and this relationship was stronger among those with a higher BMI (low BMI: odds ratio, 1.89; 95% confidence interval (CI), 1.24-2.91; high BMI: odds ratio, 3.34; 95% CI, 2.26-5.00). Among those who cycled for transport in the last week, e-bike use was associated with 35% more minutes of cycling for transport (95% CI, 17%-56%). E-bike use was related to 183% higher odds of having biked for recreation (95% CI, 115%-274%). Among women and those with cycling limitations who cycled for recreation in the last week, e-bike use was also related to 57% (95% CI, 18%-109%) and 180% (95% CI, 63%-381%) more minutes of cycling for recreation, respectively. CONCLUSION: E-bikes may provide an opportunity to promote cycling among older adults, particularly among subgroups at risk for physical inactivity.

In 2008, Stodden and colleagues took a unique developmental approach toward addressing the potential role of motor competence in promoting positive or negative trajectories of physical activity, health-related fitness, and weight status. The conceptual model proposed synergistic relationships among physical activity, motor competence, perceived motor competence, health-related physical fit ness, and obesity with associations hypothesized to strengthen over time. At the time the model was proposed, limited evidence was available to support or refute the model hypotheses. Over the past 6 years, the number of investigations exploring these relationships has increased significantly. Thus, it is an appropriate time to examine published data that directly or indirectly relate to specific pathways noted in the conceptual model. Evidence indi cates that motor competence is positively associated with perceived competence and multiple aspects of health (i.e., physical activity, cardiorespiratory fitness, muscular strength, muscular endurance, and a healthy weight status). However, questions related to the increased strength of associations across time and antecedent/consequent mech anisms remain. An individual’s physical and psychological development is a complex and multifaceted process that synergistically evolves across time. Understanding the most salient factors that influence health and well-being and how relationships among these factors change across time is a critical need for future research in this area. This knowledge could aid in addressing the declining levels of physical activity and fitness along with the increasing rates of obesity across childhood and adolescence. 4811-99FE-2ECD | Luis Paulo Rodrigues info:eu-repo/semantics/publishedVersion

BACKGROUND: Efficacy studies concerning robot assisted gait rehabilitation showed limited clinical benefits. A changed kinematic pattern might be responsible for this. Little is known about the kinematics of the trunk and pelvis during robot assisted treadmill walking (RATW). OBJECTIVE: The aim of this studywas to assess the trunk and pelvis kinematics of healthy subjects during RATW, with different amounts of body weight support (BWS) compared to regular treadmill walking (TW). METHOD: Eighteen healthy participants walked on a treadmill, while kinematics were registered by an electromagnetic tracking device. Hereafter, the kinematics of pelvis and trunk were registered during RATW (guidance force 30%) with 0%, 30% and 50% BWS. RESULTS: Compared to TW, RATW showed a decrease in the following trunk movements: axial rotation, anteroposterior flexion, lateral and anteroposterior translation. Besides, a decrease in lateral tilting and all translation of the pelvis was found when comparing RATW with TW. Furthermore, the anteroposterior tilting of the pelvis increased during RATW. CONCLUSION: In general, there was a decrease in trunk and pelvis movement amplitude during RATW compared with regular TW. Though, it is not known if these changes are responsible for the limited efficacy of robot assisted gait rehabilitation. Further research is indicated. Keywords: Kinematics, trunk, robotics, gait, rehabilitation

Background Cardiopulmonary resuscitation (CPR) training at school is recommended. Limited school resources prevent implementation. The learning efficacy of low-cost training strategies is unknown. Objective To evaluate the efficacy of different CPR learning strategies using low-cost didactic tools. Methods Children (n = 593, 15-16 years) were randomized to four training conditions: (1) manikin + teacher instruction (control group), (2) manikin + video instruction, (3) foam dice + plastic bag + peer training + teacher instruction, and (4) foam dice + plastic bag + peer training + video instruction. After a 50 min training, a 3 min CPR test on a manikin was performed using SkillReporting Software (Laerdal, Norway), and repeated after 6 months. The data of children without previous CPR training were analysed. Analysis of variance and the chi(2)-test assessed differences between groups. Results Complete data sets were available for 165 pupils. Initially, group 3 scored lower on the mean ventilation volume (P < 0.05). The control group scored better than the alternative groups (P < 0.05) on the mean compression rate. After 6 months, the differences disappeared. All groups scored equally on ventilation volume (P = 0.12), compression depth (P = 0.11), compression rate (P = 0.10), correct hand position (P = 0.46) and number of correct compressions (P = 0.76). Ventilation volume was sufficient in 32% of the pupils, 18% had a correct compression depth and 59% had a correct compression rate. Conclusion Training efficacy with low-cost equipment was not different from training with a manikin. The outcome for all training strategies was suboptimal. The basics of CPR can be taught with alternative equipment if manikins are not available. (C) 2014 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.

BACKGROUND: Although body weight supported (BWS) treadmill training (TT) leads to some improvements in walking ability, it has not been proven that it is more effective than other walking therapies in persons with multiple sclerosis (PwMS). One possible explanation could be that BWSTT focuses on the cyclic movement of the lower extremities while the trunk is passively suspended in the harness. OBJECTIVE: This study aimed to assess the 3 dimensional trunk and pelvis movements during BWS treadmill walking. METHODS: 14 PwMS and 14 healthy persons (8 male/20 female; age 23 to 59 years) walked with 0%, 10%, 20%, 30%, 50% and 70% BWS. After a familiarization period, kinematic electromagnetic tracking (Polhemus LibertyTM 240/16) of the trunk and pelvis movements was applied. Statistical analysis consisted of a repeated measures ANOVA with simple contrasts (SPSS 20). RESULTS: This study shows that BWS walking leads in general to smaller maximum trunk and pelvis movement amplitudes compared with walking without BWS, this with exception of the pelvis anterior-posterior movement in healthy subjects. CONCLUSION: These data help to identify and isolate the effect of different BWS levels in PwMS and in healthy persons and suggest to use BWS lower than 30% for treadmill training. Keywords: Body weight support, gait, gait analysis, kinematics, multiple sclerosis, pelvis, rehabilitation, treadmill, trunk, walking

PURPOSE: The goal was to assess in healthy participants the three-dimensional kinematics of the pelvis and the trunk during robot-assisted treadmill walking (RATW) at 0%, 30% and 50% body weight support (BWS), compared with treadmill walking (TW). METHODS: 18 healthy participants walked (2 kmph) on a treadmill with and without robot assistance (Lokomat; 60% guidance force; 0%, 30% and 50% BWS). After an acclimatisation period (four minutes), trunk and pelvis kinematics were registered in each condition (Polhemus Liberty™ [240 Hz]). The results were analysed using a repeated measures analysis of variance with Bonferroni correction, with the level of suspension as within-subject factor. RESULTS: During RATW with BWS, there were significantly (1) smaller antero-posterior and lateral translations of the trunk and the pelvis; (2) smaller antero-posterior flexion and axial rotation of the trunk; (3) larger lateral flexion of the trunk; and (4) larger antero-posterior tilting of the pelvis compared with TW. CONCLUSIONS: There are significant differences in trunk and pelvis kinematics in healthy persons during TW with and without robot assistance. These data are relevant in gait rehabilitation, relating to normal balance regulation. Additional research is recommended to further assess the influence of robot assistance on human gait. Implications for Rehabilitation The trunk and pelvis moves in a different way during walking with robot assistance. The data suggest that the change in movement is due to the robot device and the harness of the suspension system more than due to the level of suspension itself.

The aim of our study was to compare Euroqol-5D (EQ-5D) outcomes in coronary heart disease (CHD) patients with those from the general population. We aimed to identify those dimensions which were mostly impaired.EQ-5D results (both the dimensions and the EQ-5D visual analogue scale (EQ-VAS)) from a European sample (11 countries) of coronary patients were compared with published age- and gender-specific normative data.EQ-5D outcomes differed across countries and gender. Overall, the age-adjusted EQ-VAS scores were significantly lower in coronary patients compared with the general population, both in males (mean difference (MD)= -5.24(-7.59 to -2.88)) and in females (MD= -8.32 (-11.69 to -4.95)). Coronary patients had a significantly higher risk to report moderate or severe problems related to anxiety/depression (odds ratio (OR) male=1.84 (1.14-2.95); OR female=3.20 (2.32-4.40)). Furthermore, female coronary patients reported more problems on the mobility (OR=2.00 (1.38-2.90)), usual activity (OR= 2.54 (1.81-3.57)) and pain/discomfort dimension (OR=1.73 (1.23-2.43)) whereas in males, a borderline significant OR was found on the mobility (OR=1.43 (0.97-2.11)) and usual activity dimension (OR=1.44 (0.94-2.20)). The difference between the general population and the CHD patients attenuated as age increased.CHD has a negative influence on patient's self-reported health status, both the EQ-VAS as well as the EQ-5D dimensions (with the exception of self-care in both genders and pain/discomfort in males) were impaired. The relative impairment was the greatest in female patients and the differences in the proportion of reported problems diminished with increasing age. The EQ-5D instrument is appropriate in capturing problems related to anxiety/depression, pain/discomfort, mobility and usual activities. Within clinical practice, particular attention should be given to females and younger CHD patients.

STUDY DESIGN: Systematic literature review. OBJECTIVES: To perform a systematic review of the literature on prognostic factors for successful recovery after arthroscopic rotator cuff repair. BACKGROUND: Rotator cuff lesion is a common shoulder disorder, with a prevalence ranging from 13% in people over 50 years of age to more than 50% in people over 80 years of age. Several factors can affect the extent to which a person will recover after the surgical repair of a rotator cuff tear. More knowledge about these prognostic factors may lead to a better understanding of why the recovery process is successful in some patients but not in others. METHODS: A systematic literature search from 1995 to November 2013 was performed to identify studies reporting prognostic factors for successful recovery after arthroscopic rotator cuff repair. RESULTS: A total of 455 studies were initially identified, 10 of which were included in the review. For all included studies, the percentage of patients with complete tendon healing at final assessment ranged from 60% to 88%. Twelve prognostic factors, which could be divided into 4 categories, were identified as being associated with better recovery: demographic factors (younger age, male gender), clinical factors (higher bone mineral density, absence of diabetes mellitus, higher level of sports activity, greater preoperative range of motion, absence of obesity), factors related to cuff integrity (smaller sagittal size of the cuff lesion, less retraction of the cuff, less fatty infiltration, no multiple tendon involvement), and factors related to the surgical procedure (no concomitant biceps or acromioclavicular joint procedures). CONCLUSION: Knowledge and understanding of prognostic factors should be used in the decision-making process concerning arthroscopic rotator cuff repair to offer better care to patients. LEVEL OF EVIDENCE: Prognosis, level 2a-.

This study evaluated the effect of a 10-week fundamental motor skill programme in pre-schoolers with motor problems. Alongside the general effect of the intervention, we also explored possible gender differences and the role of the environmental context (living community, socio-economic status, and recreational space inside/outside the house). The intervention group (n = 47; 20 boys and 27 girls) received twenty 60-min motor skill sessions (2 per week) in addition to the regular physical education curriculum for pre-schoolers; the control group (n = 46; 21 boys and 25 girls) did not receive additional practice. General motor competence, and locomotor and object control subscales, were assessed before and after the intervention using the Test of Gross Motor Development 2nd edition (TGMD-2). Data regarding environmental factors were gathered through a questionnaire. A Group x Gender x Time ANOVA revealed that the intervention group benefited significantly from the intervention and scored better than the controlgroup at the post-test for general motor competence and both sub-categories (locomotor and object control skill). Moreover, the intervention programme was found to be effective in helping 49% of the intervention group to achieve an average motor skill level, according to the TGMD-2 norms, while a further decline in motor competence was observed in the control group. Interestingly, the effect appeared to be gender-specific, since object control skill improved only in girls of the intervention group. Considering the environmental context, none of the above-mentioned factors was found to have an influence on the effectiveness of the intervention. The present study highlights the need for an early motor skill programme with a gender-specific approach in order to help low skilled boys and girls master a diverse set of motor skills.

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Purpose. Neighborhood built environments are related to obesity and physical activity (PA), but inconsistently to sedentary behaviors. This study investigated the mediating effects of PA and sedentary time on the associations of neighborhood environmental factors and body mass index (BMI) among Nigerian adults. Design. The study design was cross-sectional. Setting. The study setting was metropolitan Maiduguri, Nigeria. Subjects. Nigerian adults (n = 1411) were randomly selected from diverse neighborhoods and had complete data (43.1% women, 33.8% overweight or obese). Measures. PA, sedentary time, and 16 perceived neighborhood environmental factors were measured using Nigerian adaptations of validated international questionnaires. Outcomes were measured BMI and interviewer-led self-reports of moderate to vigorous PA, walking, total PA, and sitting time. Analysis. The product-of-coefficient test using generalized linear models was used to assess the mediating effects of outcomes on the associations between environmental factors and BMI. Results. Walking and total PA significantly mediated the association between BMI and perception of higher residential density (αβ = –.025 and –.037, respectively), absence of garbage (αβ = –.046 and –.076, respectively), and more safety from crime at night (αβ = –.044 and –.083, respectively). In addition, walking, moderate to vigorous PA, and total PA significantly mediated the association between BMI and perception of better aesthetics (αβ = –.035, –.022, and –.071, respectively). Sedentary time was not a significant mediator of any associations between environmental factors and BMI. Conclusion. The association of several neighborhood environmental variables with BMI was partially mediated by PA in Nigerian adults. Including questions on specific types of sedentary behaviors in future prospective studies may improve understanding of the relative influence of sedentary behavior and physical activity on obesity control and prevention among sub-Saharan African adults.

This study aimed to estimate nitrogen balance and protein requirements in adolescent sprint athletes as a function of growth rate and physical development. Sixty adolescent sprint athletes were followed up biannually over a 2-yr period. Individual growth curves and age at peak height velocity were determined. Skeletal muscle mass (SMM) was estimated based on anthropometric measurements and fat mass was estimated by underwater densitometry. Seven-day diet and physical activity diaries were completed to estimate energy balance and protein intake. Nitrogen analysis of 24-hr urine samples collected on 1 weekday and 1 weekend day allowed calculation of nitrogen balance. Body height, weight, and SMM increased throughout the study period in both genders. Mean protein intakes were between 1.4 and 1.6 g kg−1 day−1 in both genders. A protein intake of 1.46 g kg−1 day−1 in girls and 1.35 g kg−1 day−1 in boys was needed to yield a positive nitrogen balance. This did not differ between participants during and after their growth spurt. None of the growth parameters was significantly related to nitrogen balance. It can be concluded that a mean protein intake around 1.5 g kg−1 day−1 was sufficient to stay in a positive nitrogen balance, even during periods of peak growth. Therefore, protein intake should not be enhanced in peak periods of linear or muscular growth.

The study aim was to investigate the health effects of a pedometer-based behavioural modification program in type 2 diabetes patients and to examine the relationship between changes in steps/day (baseline-post and baseline-follow up) and health outcomes. Ninety-two type 2 diabetes patients (69% male, mean age: 62 ± 9 years and mean BMI: 30.0 ± 2.5 kg/m(2)) were recruited and randomly assigned to an intervention or control group. The intervention consisted of one face-to-face session, pedometer use and seven telephone calls. Selection criteria included 35-75 years, 25-35 kg/m(2) and ≤12% HbA1c (108 mmol/mol). Outcome measures were assessed at baseline, post and follow up, and included systolic blood pressure, waist circumference, body mass index, glucose control (HbA1c and fasting glucose), triglycerides, total, HDL and LDL cholesterol and steps/day. The results showed no significant short- or intermediate-term differences in health outcomes between the control and intervention group. However, a threshold was identified, as HbA1c improved significantly in those who increased ≥4000 steps/day between baseline- and post-measurements (n = 18). This threshold was not applicable to any other health outcome. Hence, although the intervention successfully increased steps/day, no direct effect on health outcomes was identified. However, an increase of ≥4000 steps/day seemed a threshold to have a positive impact on HbA1c.

Purpose Chronic hyperinsulinemia may play a role in breast cancer etiology. We performed a meta-analysis examining whether serum concentrations of insulin and C-peptide are associated with increased breast cancer risk. Methods We restricted our analyses to prospective studies. After a systematic literature search, we computed summary relative risks (SRRs) and 95 % confidence intervals (95 % CIs) using random effect models applied to the relative risk associated with the highest versus lowest quantile of serum concentrations. We also graphically examined results in order to identify whether dose–response relationships were present. Results Six articles including 1,890 cases were retrieved for serum insulin levels and five for serum C-peptide levels including 1,759 cases. SRR and 95 % CI were 1.08 (0.66–1.78) for insulin and 1.04 (0.77–1.41) for C-peptide. Heterogeneity of results between studies was high for insulin and inexistent for C-peptide. Restricting the analysis to women diagnosed with breast cancer before or after menopause did not alter results. In insulin studies, SRR computed from relative risks not adjusted for body mass index (and other risk factors) was 1.22 (0.91–1.63). The SRR fell to 1.02 (0.53–1.97) in studies that adjusted for body mass index and other factors. Similar drops occurred in C-peptide studies, from 1.11 (0.87–1.41) to 1.06 (0.70–1.61). No consistent dose–response relationship was apparent in either pre- or post-menopausal cancers. Conclusions Our meta-analysis of observational studies found no evidence of an association between serum insulin or C-peptide concentrations and breast cancer risk. Increased risk found by some studies may have been due to inadequate control for adiposity.

Objectives : This study examined the effect of a 10 and 20% meal price increase when choosing French fries and a 10 and 20% meal price reduction when choosing fruit for dessert on university students' purchasing behaviour in an on-campus restaurant. The moderating effect of gender was also investigated. Secondly, this study aimed at gaining further insight into reasons why these price manipulations did or did not change students' purchasing behaviour. Materials and Methods : This two-phased mixed-methods study was conducted in a Belgian on-campus university restaurant with approximately 1200 to 1300 student visitors per day. In a first phase (French fries experiment), data were collected during a control week (no price manipulation) and two separate intervention weeks (10 and 20% meal price increase when students chose French fries). In a second phase (fruit experiment), following the same protocol but carried out a few weeks later, meal prices were reduced by 10 and 20% when students chose fruit for dessert. French fries and fruit sale counts relative to the total number of items sold were used as outcome measure. Short interviews were conducted in convenient subsamples of student customers to assess influences on food choice. Key findings : Increasing the meal price by 10 and 20% when choosing French fries was associated with respective 10.9 and 21.8% absolute reductions in French fries purchases, while reducing the meal price by 10 and 20% when choosing fruit for dessert was associated with absolute increases in fruit purchases of respectively 25.1 and 42.4% (all p

Objective to describe the demographic, socioeconomic, and nutritional behaviors associated with of sugar-sweetened beverage (SSB) consumption. Design: cross-sectional. Setting: in January 2014, 26,566 military personnel, representing 84.6% of the 31,412 men and women in active service were invited to participate in an online survey. Included questions were about consumption of fruits and vegetables, meat, SSB, number of breakfasts a week, and military rank. Subjects: 7,252 military subjects. Results: mean (standard deviation) age of the participants was 45.4 (7.9) years for 6,529 males and 41.9 (8.9) years for 723 females. Mean (standard deviation) body mass index was 26.6 (3.6) kg/m2 for males and 24.5 (3.9) kg/m2 for females. The probability of consuming daily SSB decreased with age, and with increasing body mass index, being female, and being a noncommissioned officer or officer. Consumption of fruits and vegetables decreased for daily SSB consumption, but meat consumption increased. The odds r...

The aim of the present study was to develop and cross-validate anthropometrical prediction equations for segmental lean tissue mass (SLM). One hundred and seventeen young healthy Caucasians (67 men and 50 women; mean age: 31.9 ± 10.0 years; Body Mass Index: 24.3 ± 3.2 kg · m(-2)) were included. Body mass (BM), stretch stature (SS), 14 circumferences (CC), 13 skinfolds (SF) and 4 bone breadths (BB) were used as anthropometric measurements. Segmental lean mass of both arms, trunk and both legs were measured by dual energy X-ray absorptiometry as the criterion method. Three prediction equations for SLM were developed as follows: arms = 40.394(BM) + 169.836(CCarm-tensed) + 399.162(CCwrist) - 85.414(SFtriceps) - 39.790(SFbiceps) - 7289.190, where Adj.R (2) = 0.97, P

Purpose To review and discuss the literature about the use of trunk muscle electromyography – including the use of surface or fine-wire electrodes, site of application and muscle selection – during gait analysis in healthy subjects. Methods The databases Pubmed, Web of Knowledge and Cochrane Library were searched. Articles were included when EMG activity of at least one trunk muscle was measured in healthy subjects during walking. Results In the 33 selected articles 491 healthy subjects walked with different velocities on a treadmill and/or overground. The activity of the M. erector spinae, M. multifidus, M. obliquus externus and internus, M. rectus abdominus, M. trapezius, M. latissimus dorsi, M. transversus abdominus, M. iliopsoas and M. quadrates lumborum was measured. Twenty-nine studies used surface electrodes, one study fine-wire electrodes, and the other three studies used a combination. There is no consensus on the exact placement site of the electrodes. Conclusion Surface electrodes were used more often than fine-wire electrodes and the descriptions of the electrode locations were mostly vague and not consistent among the different studies. There is need for further research to make specific recommendations about the type of electrodes in combination with the optimal locations of application of these electrodes.

Background: An estimated 17.2% of patients continue to smoke following diagnosis of cardiovascular disease (CVD). To reduce the risk of further morbidity or mortality in cardiovascular patients, smoking cessation has been shown to reduce the risk of mortality by 36% and myocardial infarction by 32%. The objective of this study was to evaluate the long-term health and economic consequences of smoking cessation in patients with CVD. Design and methods: Results of a randomized clinical trial comparing varenicline plus counselling vs. placebo plus counselling were extrapolated using a Markov model to simulate the lifetime costs and health consequences of smoking cessation in patients with stable CVD. For the base case, we considered a payer's perspective including direct costs attributed to the healthcare provider, measuring cumulative life years (LY) and quality adjusted life (QALY) years as outcome measures. Secondary analyses were conducted from a societal perspective, evaluating lost productivity due to premature mortality. Sensitivity and subgroup analyses were also undertaken. Results were analysed for Belgium, Spain, Portugal, and Italy. Results: Varenicline plus counselling was associated with a gain in LY and QALY across all countries; relative to placebo plus counselling. From a payer's perspective, incremental cost effectiveness ratios were €6120 (Belgium), €5151 (Spain), €5357 (Portugal), and €5433 (Italy) per QALY gained. From a societal perspective, varenicline in addition to counselling was less costly than placebo and counselling in all cases. Sensitivity analyses showed little sensitivity in outcomes to model assumptions or uncertainty in model parameters. Conclusions: Varenicline in addition to counselling is cost-effective compared to placebo and counselling in smokers with CVD. © 2011 The European Society of Cardiology.

Recent research in urban planning and public health has drawn attention to the associations between urban form and physical activity in adults. Because little is known on the urban-rural differences in physical activity, the main aims of the present study were to examine differences in physical activity between urban and rural adults and to investigate the moderating effects of the physical environment on the relationship between psychosocial factors and physical activity. In Flanders, Belgium, five rural and five urban neighborhoods were selected. A sample of 350 adults (20-65 years of age; 35 adults per neighborhood) participated in the study. Participants wore a pedometer for 7 days, and self-reported physical activity and psychosocial data were also collected. Results showed that urban adults took more steps/day and reported more walking and cycling for transport in the neighborhood, more recreational walking in the neighborhood, and more walking for transportation outside the neighborhood than rural adults. Rural adults reported more recreational cycling in the neighborhoods. The physical environment was a significant moderator of the associations between several psychosocial factors (modeling from family, self-efficacy, and perceived barriers) and physical activity. In rural participants, adults with psychosocial scores above average were more physically active, whereas there were no differences in physical activity according to psychosocial factors in urban participants. These results are promising and plead for the development of multidimensional interventions, targeting specific population subgroups. In rural environments, where changing the environment would be a very challenging task, interventions focusing on modifiable psychosocial constructs could possibly be effective.

Background Little or no research has been done in the overweight child on the relative contribution of multisensory information to maintain postural stability. Therefore, the purpose of this study was to investigate postural balance control under normal and experimentally altered sensory conditions in normal-weight versus overweight children. Methods Sixty children were stratified into a younger (7–9 yr) and an older age group (10–12 yr). Participants were also classified as normal-weight (n = 22) or overweight (n = 38), according to the international BMI cut-off points for children. Postural stability was assessed during quiet bilateral stance in four sensory conditions (eyes open or closed, normal or reduced plantar sensation), using a Kistler force plate to quantify COP dynamics. Coefficients of variation were calculated as well to describe intra-individual variability. Findings Removal of vision resulted in systematically higher amounts of postural sway, but no significant BMI group differences were demonstrated across sensory conditions. However, under normal conditions lower plantar cutaneous sensation was associated with higher COP velocities and maximal excursion of the COP in the medial-lateral direction for the overweight group. Regardless of condition, higher variability was shown in the overweight children within the 7–9 yr old subgroup for postural sway velocity, and more specifically medial–lateral velocity. Interpretation In spite of these subtle differences, results did not establish any clear underlying sensory organization impairments that may affect standing balance performance in overweight children compared to normal-weight peers. Consequently, it is believed that other factors account for overweight children's functional balance deficiencies.

BACKGROUND Maternal obesity and excessive gestational weight gain (GWG) are major short- and long-term risk factors for maternal and fetal complications. OBJECTIVE The objective was to study whether a lifestyle intervention based on a brochure or on active education can improve dietary habits, increase physical activity (PA), and reduce GWG in obese pregnant women. DESIGN In this randomized controlled trial, 195 white, obese pregnant women [age: 29 + or - 4 y; body mass index (in kg/m(2)); 33.6 + or - 4.2] were randomly assigned into 3 groups: a group that received nutritional advice from a brochure, a group that received the brochure and lifestyle education by a nutritionist, and a control group. Nutritional habits were evaluated every trimester through 7-d food records. PA was evaluated with the Baecke questionnaire. RESULTS Energy intake did not change during pregnancy and was comparable in all groups. Fat intake, specifically saturated fat intake, decreased and protein intake increased from the first to the third trimester in the passive and active groups compared with an opposite change in the control group. Calcium intake and vegetable consumption increased during pregnancy in all groups. PA decreased in all groups, especially in the third trimester. No significant differences in GWG and obstetrical or neonatal outcome could be observed between the groups. CONCLUSIONS Both lifestyle interventions improved the nutritional habits of obese women during pregnancy. Neither PA nor GWG was affected.

Varenicline is a nicotinic acetylcholine receptor partial agonist that is approved for use as an aid to smoking cessation. Randomized clinical trials show that its efficacy is superior to that of other current smoking cessation therapies. This study set out to determine the cost effectiveness of varenicline relative to other smoking cessation interventions (bupropion and nicotine replacement therapy [NRT]) as well as brief counselling alone and unaided cessation in a cohort of Belgian adult smokers making a one-time quit attempt, from the perspective of the healthcare payer (public and private).A Markov model, the Benefits of Smoking Cessation on Outcomes (BENESCO) model, was applied to calculate the long-term health and economic benefits of smoking cessation. Cost effectiveness was expressed as cost per life-year (LY) gained and cost per quality-adjusted life-year (QALY) gained. Clinical and economic model inputs were obtained from the literature and public healthcare databases. Costs were discounted at 3% and health outcomes at 1.5%. A probabilistic sensitivity analysis and a one-way sensitivity analysis were performed to test the robustness of the results.Varenicline is associated with a reduction of smoking-related morbidity and mortality as well as with a decrease in healthcare costs compared with the pharmacological agents bupropion and NRT. Varenicline also leads to additional LYs and QALYs compared with brief counselling alone and unaided cessation over a lifetime period. Varenicline is a dominant strategy compared with bupropion and NRT. Compared with brief counselling alone and unaided cessation, varenicline presents a cost/QALY of euro240 and euro1656, respectively.Varenicline is a cost-effective alternative to brief counselling and unaided cessation, and is a cost-saving treatment in comparison with bupropion and NRT, in a Belgian population of smokers willing to quit.

Study Design. A two group experimental design. Objective. To investigate differences in postural control strategies of pelvis and trunk movement between non-specific chronic low back pain (CLBP) patients and healthy control subjects using three-dimensional motion analysis. Summary of Background Data. Increased postural sway assessed by centre of pressure displacements have been documented in low back pain patients. The three-dimensional movement strategies used by low back pain patients to keep their balance are not well documented. Methods. Nineteen CLBP patients and twenty control subjects were included based on detailed clinical criteria. Every subject was submitted to a postural control test in an unstable sitting position. A three-dimensional motion analysis system, equipped with 7 infra-red M1 camera's, was used to track 9 markers attached to the pelvis and trunk in order to estimate their angular displacement in the 3 cardinal planes. Results. The total angular deviation in all three directionsof pelvis and trunk was higher in the CLBP group compared to the control group. In 4 of the 6 calculated differences, a significant higher deviation was found in the CLBP group (significant p-values between .013 and .047). Subjects of both groups mostly used rotation compared to lateral flexion and flexion-extension displacements of pelvis and trunk to adjust balance disturbance. The CLBP group showed a high correlation (Pearson: .912 - .981) between movement of pelvis and trunk, compared to the control group. Conclusion. A higher postural sway and high correlation between pelvis and trunk displacements was found in the low back pain group compared to healthy controls.

Trastuzumab (Herceptin, Roche) is a recombinant, humanized monoclonal antibody directed against the neu-HER2 protein, since May 2002 reimbursed in Belgium for the treatment of metastatic HER2+ breast cancer and since June 2007 also in adjuvant therapy of HER2+ early stage breast cancer. The purpose of this study was to estimate the cost-effectiveness from the Belgian health care payer perspective of reimbursing trastuzumab in the Latter indication. A Markov state transition model was designed to adequately capture the natural history and course of disease for early stage breast cancer patients, and to simulate cost and disease progression over a life time perspective. The model estimates differences in outcomes for patients treated with adjuvant trastuzumab during 1 year compared to current therapy, and captures cost consequences and health benefits of trastuzumab treatment. Health benefits were expressed in terms of quality-adjusted life years gained, and future benefits were discounted at 1.5%. Costs were calculated from the perspective of the Belgian authorities' health care budget, and future costs were discounted at 3%. Where relevant, the costs per Markov state were obtained from the IMS Hospital Disease database. Additionally, an expert opinion analysis on resource use during the follow-up of treated early breast cancer patients provided the cost estimates for states with minor or without hospital costs. The incremental cost-effectiveness ratio based on a life time simulation was estimated at Euro 10,315 per quality-adjusted life year gained. It can be concluded that trastuzumab treatment of HER2+ early stage breast cancer patients is cost-effective from the perspective of the Belgian health care authorities.

BackgroundBackground The introduction of a quadrivalent human papillomavirus (HPV; types 6, 11, 16, 18) vaccine is expected to significantly reduce the burden of cervical cancer, cervical intraepithelial neoplasia (CIN), genital warts and other HPV-related diseases. Abstract: ObjectiveObjective To determine the cost effectiveness of providing a quadrivalent (6,11,16,18) HPV vaccine programme in adolescent females aged 12 years in addition to the existing cervical cancer screening programme in Belgium. Abstract: MethodsMethods A Markov state-transition model was developed for the Belgian context in order to evaluate the long-term impact of vaccinating a cohort of girls aged 12 years alongside the existing screening programme. Women were followed until the age of 85 years. A vaccine that would prevent 100% of diseases associated with HPV-6, -11, -16 and -18, with lifetime duration of efficacy, 80% coverage, in conjunction with current screening, was compared with screening alone. For this analysis, 35% of cases of CIN-1, 55% of CIN-2/3, 75% of cervical cancer and 90% of genital warts were considered to be attributable to HPV-6, -11, -16 or -18. The model estimated lifetime risks and total lifetime healthcare costs, survival and QALYs for cervical cancer, CIN and genital warts. Outcomes validation was applied. Model outcomes also included incremental costs per life-year gained and incremental costs per QALY gained. The analysis was conducted from the perspective of the Belgian healthcare payer, and costs were in year 2006 values. Abstract: ResultsResults The model estimated a reduction in the lifetime risk of cervical cancer from 0.94% to 0.34%, therefore preventing 362 cases of cervical cancer and 131 related deaths in a cohort of 60 000 girls aged 12 years in Belgium. The base-case scenario suggests quadrivalent HPV vaccination in addition to current cervical screening in Belgium to be cost effective at &U20AC;10 546 per QALY. This is within the accepted range of cost-effective interventions in Europe. This cost effectiveness is maintained for different parameter assumptions in the sensitivity analysis, with the exception of very high discount rates for costs and medical benefits, but, even in the worst case, ratios were still less than &U20AC;50 000 per QALY. Even when a separate scenario modelled the requirement for a booster vaccination to sustain a lifetime duration of protection, the results remained cost effective at &U20AC;17 388 per QALY. Abstract: ConclusionsConclusions Vaccination with a quadrivalent HPV vaccine appears to be a cost-effective public health intervention in conjunction with the existing screening programme in Belgium. The additional costs of introducing vaccination to the established screening programme would be offset by the potential savings from not having to treat the diseases caused by HPV-6, -11, -16 or -18.

ObjectiveThe purpose of the present study was to analyse the lipid profile in men and women differentiated according to energy expenditure during sports participation (EESPORT), energy expenditure during active leisure time (EEALT) and overall energy expenditure (EETOTAL).DesignThe subjects were grouped by sex, age, EESPORT, EEALT and EETOTAL. Group differences were analysed using analyses of covariance with BMI and alcohol consumption as covariates.SettingPhysical activity was assessed using the Flemish Physical Activity Computerised Questionnaire. Fasting blood samples were taken to measure total cholesterol (TC), TAG, HDL-cholesterol (HDL-C), LDL-cholesterol (LDL-C) and the ratio TC:HDL-C.SubjectsThe study sample consisted of 1170 Flemish men and women between 18 and 75 years of age.ResultsDifferences in lipid profile were observed in the younger age group (ALT and EETOTAL, men had a healthier lipid profile for TAG, HDL-C and TC:HDL-C. Differentiation according to EESPORT revealed the same significant results except for TAG. In women significant results for HDL-C, LDL-C and TC:HDL-C were found when differentiated by EESPORT.ConclusionsMen and women

The optimal adjuvant hormonal strategy in post-menopausal women with early breast cancer is a subject of ongoing debate. Aromatase inhibitors (AIs) have been successfully evaluated in clinical trials that have compared them with a standard treatment of 5 years of tamoxifen. However, several options are available in terms of treatment schedule and selected drug. Systematic reviews of clinical trials and health economic evaluations attempt to contribute to the debate. The objective of this paper is to provide a critical review of existing health economic evaluations with a focus on those parameters and assumptions with the largest impact on final outcomes. A wide range of different inputs and assumptions exist, which make a comparison of results difficult, if not impossible. In particular, the modelling of recurrence rates over longer time horizons than those observed in clinical trials, a cornerstone of health economic modelling, is subject to quite different approaches. The practice of indirect comparison of different AIs without sufficiently acknowledging population differences is also bothersome. A list of key features (related to time horizon, clinical data input, patient subtypes, budget impact and model calibration) that an ideal model should have in order to better assist decision makers in this field is proposed.

The daily intake of food flavonoids was determined using a semiquantitative food frequency questionnaire (FFQ) and a four day non consecutive food diary (4DFR) in a group of 45 female Flemish dietitians. The subjects were asked to report their food intake three times: day 1 using the FFQ (FFQ1); between day 2 and 13 using a four day non consecutive food diary (4DFR); and again the FFQ on day 14 (FFQ2). The total flavonoid intake in mg/day as estimated with the different methods were respectively (mean and SD) for FFQ1 166.0 +/- 146.6 mg/day; for 4DFR 203.0 +/- 243.2 mg/day; and for FFQ2 158.3 +/- 151.8 mg/day. There was a significant different estimate for the amount of flavan-3-ols, flavanones and flavones when comparing the two FFQs with the 4DFR. The two research methods classified 88% of the 45 dietitians in the same or in an adjacent quartile for total flavonoid intake. The findings of this study indicate that the developed FFQ seems to be a simple and reliable method to assign subjects in quartiles of flavonoid intake.

To investigate the association of muscular strength and aerobic fitness with a continuous metabolic syndrome risk score in male and female adults.This cross-sectional study included 1019 (571 men) Flemish adults, aged 18-75. Muscular strength was evaluated by measuring isometric knee extension and flexion peak torque, using a Biodex System Pro 3 dynamometer. Aerobic fitness was quantified as VO2peak and was determined during a maximal cycle ergometer exercise test. Both strength and aerobic fitness were scaled for differences in FFM, using allometric analyses. A validated metabolic syndrome risk score that was based on waist circumference, triglycerides, blood pressure, fasting plasma glucose, and HDL cholesterol was used. Metabolic syndrome risk score, strength, and aerobic fitness were analyzed as continuous variables using multiple linear regression.Metabolic syndrome risk was inversely associated with strength, independently of aerobic fitness, and after adjustment for age, height, education level, smoking status, and dietary intake in women (beta = -0.172, P0.001). In men, however, adjustment for aerobic fitness attenuated the inverse association between strength and metabolic syndrome risk (beta = -0.044, P0.05). Independently of strength, aerobic fitness was inversely associated with metabolic syndrome risk (men: beta = -0.309, P0.001; women: beta = -0.208, P0.001). Furthermore, independent associations were found for strength and aerobic fitness with several individual metabolic syndrome risk factors in women, and most of these associations were only partially mediated by central and general adiposity indicators.Although cross-sectional, the present results support inclusion of strength training in addition to aerobic exercise in physical activity recommendations for women, because both types of activity might show additional effects in reducing the risk of the metabolic syndrome.

Assessment of short-term outcome in critically-ill patients who develop acute kidney injury (AKI) may underestimate the true burden of disease. It is important to focus on long-term survival, renal recovery and quality of life beyond hospital discharge. Although the majority of critically-ill patients with AKI die during hospital stay, there is only a minor increase in mortality after hospital discharge among AKI patients treated in the intensive care unit (ICU). Estimates of mortality rates at 1 year following hospital discharge range from 57% to 78% with an absolute difference between hospital mortality and 1-year mortality ranging from 4% to 18%. Renal recovery is another important measure of outcome since chronic renal replacement therapy (RRT) does not only significantly affect health-related quality of life (HRQoL), it is also costly. Fortunately, renal recovery occurs in most AKI survivors leading to independence of RRT at 1 year following hospital discharge. Potential factors associated with reduced recovery of renal function are female sex, high comorbidity, older age, a parenchymal aetiology of AKI, late initiation of RRT, and use of intermittent haemodialysis (IHD). HRQoL in survivors of critical illness and severe AKI is perceived as acceptable and good, despite the fact that HRQoL scores are lower than these of the general population.

Objective: Low-dose aspirin is standard care in patients with a history of cardiovascular disease (CVD). But, the use of low-dose aspirin in primary prevention has not yet been fully established in Japan although meta-analyses and US/European guidelines support its use in persons at increased CVD risk. This study assessed the health economic consequences of the use of low-dose aspirin in the primary prevention of CVD in Japan. Patients and Methods: Based on results reported in two recent meta-analyses of Hayden (2002) and Eidelman (2003), a Markov model was constructed to predict the cost-effectiveness of low-dose aspirin in the primary prevention of CVD. The model consists of 5 health states: 1) no history of CVD, 2) history of stroke, 3) history of myocardial infarction, 4) history of CVD, and 5) death, with a 10-year time horizon and 1-year cycles. Direct costs from the insurers' perspective were used, while health outcome was expressed in Life-Years Gained (LYG). 'Discounting Rate' with 3% was applied on effectiveness and costs. Results: For patients with a 1-year risk of coronary heart disease (CHD) of 1.5% (10-year risk of +/- 15%), the model demonstrated 'dominance' of the 'aspirin' arm versus 'no aspirin' arm; the 10-year costs were Japanese Yen (JPY) 634,000 (Euro 4,857) and JPY 518,000 (Euro 3,968) in the 'no aspirin' arm and 'aspirin' arm, respectively, while LYG was 8.33 and 8.36, respectively. Low-dose aspirin treatment saved on average JPY 116,000 (Euro 889) [95% confidence interval (CI) JPY 57,077-175,151] per patient. Dominance was demonstrated (non-significant) in the first year of treatment and, low-dose aspirin was dominant to 'no aspirin' arm from an annual risk of 0.20%. Other results of sensitivity analysis on gastrointestinal (GI) bleeding rate, stroke rate, cost of each event and discounting showed the robustness of the results. Conclusions: Administering low-dose aspirin to patients with a 1-year risk of CHD of 1.5% and more is significantly costsaving from the insurers' perspective in Japan.

AIMS: A better understanding of pelvic floor muscle (PFM) activation and strength components is a prerequisite to get better insight in PFM contraction mechanisms and develop more specific PFM-training regimens for female stress urinary incontinence (SUI) patients. The aim of this systematic review (2012:CRD42012002547) was to evaluate and summarize existing studies investigating PFM activation and strength components influencing female continence and SUI. METHODS: PubMed, EMBASE, and Cochrane databases were systematically searched for literature from January 1980 to November 2013 for cross-sectional studies comparing female SUI patients with healthy controls and intervention studies with SUI patients reporting on the association between PFM activation and strength components and urine loss. Trial characteristics, evaluated PFM components, their definitions, measurement methods, study outcomes, as well as quality measures, based on the Cochrane risk of bias tool, were independently extracted. The high heterogeneity of the retrieved data made pooling of results impossible and therefore restricted the analysis to a systematic review. RESULTS: Cross-sectional studies showed group differences in favor of the continent women compared to SUI patients for PFM activation or PFM maximal strength, mean strength or sustained contraction. All intervention studies showed an improvement of PFM strength and decrease in urine loss in SUI patients after physical therapy. CONCLUSIONS: Higher PFM activation and strength components influence female continence positively. This systematic review underscored the need for a standardized PFM components' terminology (similar to rehabilitation and training science), standardized test procedures and well matched diagnostic instruments.

Ron Clijsen,1,2 Jean Pierre Baeyens,2 André Odilon Barel,2 Peter Clarys2 1Department of Health Sciences, University of Applied Sciences and Arts of Southern Switzerland, Landquart, Switzerland; 2Faculty ofPhysical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium Aim: There is scarce information concerning the pharmacodynamic behavior of topical substances used in the physiotherapy setting. The aim of the present study was to estimate the formation and emptying of the diclofenac (DF) skin reservoir after passive, semiocclusive, and electrically assisted applications of DF.Subjects and methods: Five different groups of healthy volunteers (ntotal=60, 23 male and 37 female), participated in this study. A 1% DF (Voltaren Emulgel) formulation (12 mg) was applied on the volar forearms on randomized defined circular skin areas of 7 cm2. DF was applied for 20 minutes under three different conditions at the same time. The presence of DF in the skin results in a reduction of the methyl nicotinate (MN) response. To estimate the bioavailability of DF in the skin, MN responses at different times following initial DF application (1.5, 6, 24, 32, 48, 72, 96, and 120 hours) were analyzed.Results: At 1.5 hours after the initial DF application, a significant decrease in MN response was detected for the occluded and iontophoretic delivery. Passive application resulted in a decrease of the MN response from 6 hours post-DF application. The inhibition remained up to 32 hours post-DF application for the iontophoretic delivery, 48 hours for the occluded application, and 72 hours for the passive delivery. At 96 and 120 hours post-DF application none of the MN responses was inhibited.Conclusion: The formation and emptying of a DF skin reservoir was found to be dependent on the DF-application mode. Penetration-enhanced delivery resulted in a faster emptying of the reservoir. Keywords: transdermal drug delivery, passive diffusion, occlusion, iontophoresis, diclofenac

This study investigated moderating effects of psychosocial factors on the association between walkability and physical activity (PA) in 433 Belgian older adults. Furthermore, main effects of psychosocial factors on PA were determined. No moderating effects were observed for the associations between walkability and transport walking, or moderate-to-vigorous PA (MVPA). Walkability was positively associated with recreational walking in those with high self-efficacy. Regarding main effects, benefits and social norm were positively associated with recreational walking. Benefits were positively and barriers were negatively associated with MVPA. There were no significant main effects for transport walking. The overall lack of moderation suggests that environmental interventions might enhance all older adults' transport walking and MVPA. Recreational walking might be enhanced by simultaneously targeting self-efficacy and neighborhood environmental factors.

Background As physical activity levels decrease as children age, sustainable and accessible forms of physical activity are needed from a young age. Transportation cycling is one such physical activity and has been associated with many benefits. The aims of the study were to identify whether manipulating micro-environmental factors (e.g. speed limits, evenness of cycle path) within a photographed street influences the perceived supportiveness for transportation cycling; and whether changing these micro-environmental factors has the same effect across different street settings. Methods We recruited 305 fifth and sixth grade children and their parents from twelve randomly selected primary schools in Flanders, Belgium. They completed a web-based questionnaire including 12 choice-based conjoint tasks, in which they had to choose between two possible routes depicted on manipulated photographs, which the child would cycle along. The routes differed in four attributes: general street setting (enclosed, half open, open), evenness of cycle path (very uneven, moderately uneven, even), speed limit (70 km/h, 50 km/h, 30 km/h) and degree of separation between a cycle path and motorised traffic (no separation, curb, hedge). Hierarchical Bayes analyses revealed the relative importance of each micro-environmental attribute across the three street settings. Results For each attribute, children and their parents chose routes that had the best alternative (i.e. open street setting, even cycle path, 30 km/h, a hedge separating the cycle path from motorised traffic). The evenness of the cycle path and lower speed limit had the largest effect for the children, while the degree of separation and lower speed limit had the largest effect for their parents. Interactions between micro-scale and macro-scale factors revealed differences in the magnitude but not direction of their effects on route choice. The results held across the different kinds of street settings tested. Conclusions Improving micro-scale attributes may increase the supportiveness of a street for children’s transportation cycling. We call for on-site research to test effects of changes in micro-environmental attributes on transportation cycling among children. Electronic supplementary material The online version of this article (doi:10.1186/s12966-015-0216-2) contains supplementary material, which is available to authorized users.

BACKGROUND: Increasing participation in transportation cycling represents a useful strategy for increasing children's physical activity levels. Knowledge on how to design environments to encourage adoption and maintenance of transportation cycling is limited and relies mainly on observational studies. The current study experimentally investigates the relative importance of micro-scale environmental factors for children's transportation cycling, as these micro-scale factors are easier to change within an existing neighborhood compared to macro-scale environmental factors (i.e. connectivity, land-use mix, …). METHODS: Researchers recruited children and their parents (n = 1232) via 45 randomly selected schools across Flanders and completed an online questionnaire which consisted of 1) demographic questions; and 2) a choice-based conjoint (CBC) task. During this task, participants chose between two photographs which we had experimentally manipulated in seven micro-scale environmental factors: type of cycle path; evenness of cycle path; traffic speed; traffic density; presence of speed bumps; environmental maintenance; and vegetation. Participants indicated which route they preferred to (let their child) cycle along. To find the relative importance of these micro-scale environmental factors, we conducted Hierarchical Bayes analyses. RESULTS: Type of cycle path emerged as the most important factor by far among both children and their parents, followed by traffic density and maintenance, and evenness of the cycle path among children. Among parents, speed limits and maintenance emerged as second most important, followed by evenness of the cycle path, and traffic density. CONCLUSION: Findings indicate that improvements in micro-scale environmental factors might be effective for increasing children's transportation cycling, since they increase the perceived supportiveness of the physical environment for transportation cycling. Investments in creating a clearly designated space for the young cyclist, separated from motorized traffic, appears to be the most effective way to increase perceived supportiveness. Future research should confirm our laboratory findings with experimental on-site research. Keywords: SR2S Language: en

Background Pelvic floor muscle training is effective and recommended as first-line therapy for female patients with stress urinary incontinence. However, standard pelvic floor physiotherapy concentrates on voluntary contractions even though the situations provoking stress urinary incontinence (for example, sneezing, coughing, running) require involuntary fast reflexive pelvic floor muscle contractions. Training procedures for involuntary reflexive muscle contractions are widely implemented in rehabilitation and sports but not yet in pelvic floor rehabilitation. Therefore, the research group developed a training protocol including standard physiotherapy and in addition focused on involuntary reflexive pelvic floor muscle contractions. Methods/design The aim of the planned study is to compare this newly developed physiotherapy program (experimental group) and the standard physiotherapy program (control group) regarding their effect on stress urinary incontinence. The working hypothesis is that the experimental group focusing on involuntary reflexive muscle contractions will have a higher improvement of continence measured by the International Consultation on Incontinence Modular Questionnaire Urinary Incontinence (short form), and — regarding secondary and tertiary outcomes — higher pelvic floor muscle activity during stress urinary incontinence provoking activities, better pad-test results, higher quality of life scores (International Consultation on Incontinence Modular Questionnaire) and higher intravaginal muscle strength (digitally tested) from before to after the intervention phase. This study is designed as a prospective, triple-blinded (participant, investigator, outcome assessor), randomized controlled trial with two physiotherapy intervention groups with a 6-month follow-up including 48 stress urinary incontinent women per group. For both groups the intervention will last 16 weeks and will include 9 personal physiotherapy consultations and 78 short home training sessions (weeks 1–5 3x/week, 3x/day; weeks 6–16 3x/week, 1x/day). Thereafter both groups will continue with home training sessions (3x/week, 1x/day) until the 6-month follow-up. To compare the primary outcome, International Consultation on Incontinence Modular Questionnaire (short form) between and within the two groups at ten time points (before intervention, physiotherapy sessions 2–9, after intervention) ANOVA models for longitudinal data will be applied. Discussion This study closes a gap, as involuntary reflexive pelvic floor muscle training has not yet been included in stress urinary incontinence physiotherapy, and if shown successful could be implemented in clinical practice immediately. Trial registration NCT02318251; 4 December 2014 First patient randomized: 11 March 2015 Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-1051-0) contains supplementary material, which is available to authorized users.

Background/aims: In this study, we investigated the bioavailability of iontophoretically delivered diclofenac with the methylnicotinate (MN) test. The inhibition of an erythema provoked by MN is proportional to the bioavailability of diclofenac in the skin. It was our aim to use this procedure in the determination of the contribution of, respectively, passive diffusion, occlusion and electrically assisted delivery during an iontophoretic procedure as used in physiotherapy. Method: A total of six application sites were marked on the volar forearms of each volunteer (n5 12), for the following treatment and/or control modes: A 5cathodal iontophoresis of 12mg/cm2 Voltaren Emulgels (diethylammonii diclofenac 1%) for 20 min; B5 passive diffusion under a contact sponge; C5 passive diffusion without any covering; D 5 current alone; E 5standard MN response; and F 5blanco site. Tristimulus surface colorimetry and Laser Doppler flowmetry were used to measure, respectively, the skin color and the perfusion of the microcirculation. Bioavailability was assessed by quantification of an MN-induced erythema under the different conditions. Results: A significant reduction of the MN-induced erythema was observed with the Chromameter and Laser Doppler measurements for the following treatment modalities: (1) electrically assisted delivery: respectively, 65% and 100%, (2) application under a contact sponge: 66% and 97% and (3) passive diffusion without any covering: 32% and 65%. A significant reduction was equally observed for the site treated with the current alone: 19% and 42%. There was no significant difference between the response after iontophoretic-delivered diclofenac (mode A) and application of diclofenac under a contact sponge (mode B). Conclusion: The procedure used enabled us to evaluate the bioavailability of a non-steroidal anti-inflammatory drug in the skin. Under the conditions used, we did not find an increased bioavailability after electrically assisted delivery of diclofenac compared with the passive percutaneous penetration under the contact sponge.

Background: Obese youth are at increased risk for peer victimization, which may heighten their risk of psychosocial problems and physical activity avoidance, and lower the effectiveness of professional and lifestyle weight-loss initiatives. Little is known about obese adolescents' risk for victimization from cyber-bullying and how this relates to psychosocial functioning and healthy lifestyle barriers. The purpose of the study was to assess traditional and cyber-victimization among adolescents with severe obesity and its relation to psychosocial distress and barriers to healthy lifestyles. Methods: A sample of 102 obese adolescents (mean age = 15.32 +/- 1.71) in residential treatment was matched with 102 normal-weight youngsters from the Health Behavior in School-aged Children (HBSC) study (mean age = 15.30 +/- 1.73). Results: Adolescents with obesity were significantly more often cyber-victimized than normal-weight peers. Obese youth victimized by traditional bullying experienced lower quality of life, lower motivation for physical activity and higher avoidance and emotional coping towards healthy lifestyles than those non-victimized. Obese cyber-victims experienced significantly higher suicidal ideation. Conclusions: Traditional and cyber-victimization may hinder treatment effectiveness and healthy lifestyle change in adolescents with obesity. Health professionals should pro-actively address peer victimization and psychosocial functioning during multidisciplinary obesity treatment. Schools could contribute to a better physical and psychosocial health of obese youth by implementing multi-behavioral health-promotion programs.

The purpose of this study was to describe changes in physical activity and determinants in youngsters treated for obesity. Self-reported physical activity and determinants were assessed at start, during and after an intervention in 24 obese patients (mean age 13.5+/-2.1 years). Participation in activities of moderate to high intensity increased during treatment, but 6-months after treatment this decreased again to pre-treatment levels. Participation in activities of low intensity and television watching decreased during treatment and increased following treatment. Very little change was found in perceived benefits, barriers or self-efficacy scores. Modelling of siblings decreased after treatment, whereas there was no evolution in modelling of parents. Social support by family members increased during treatment, but decreased following treatment. We can conclude that the intervention was successful in activating obese youngsters to move at the desirable exercise intensity and frequency; however, maintenance of the exercise habit after treatment was not successful.

In 4 Simon experiments the authors examined control over 2 routes of sensorimotor processing: response priming in the unconditional route and response selection via the conditional route. The Simon effect diminished as the frequency of noncorresponding trials increased. Location-based response priming was observed only when the stimulus followed a corresponding event but not after a noncorresponding trial. Therefore, the unconditional route appears to be suppressed whenever the task context indicates priming as potentially disadvantageous. Moreover, the task-irrelevant stimulus location was used for response selection as a function of correspondence probability. Although exact repetitions of stimulus-response sequences caused a marked speed-up of responses, this 3rd mechanism is independent of unconditional route suppression and frequency-based adjustments in the conditional route.

Background Little attention has been devoted to the thorax and pelvis movements during gait. The aim of this study is to compare differences in the thorax and pelvis kinematics during unassisted walking on a treadmill and during walking with robot assistance (Lokomat-system (Hocoma, Volketswil, Switzerland)). Methods 18 healthy persons walked on a treadmill with and without the Lokomat system at 2 kmph. Three different conditions of guidance force (30%, 60% and 100%) were used during robot-assisted treadmill walking (30% body weight support). The maximal movement amplitudes of the thorax and pelvis were measured (Polhemus Liberty™ (Polhemus, Colchester, Vermont, USA) (240/16)). A repeated measurement ANOVA was conducted. Findings Robot-assisted treadmill walking with different levels of guidance force showed significantly smaller maximal movement amplitudes for thorax and pelvis, compared to treadmill walking. Only the antero-posterior tilting of the pelvis was significantly increased during robot-assisted treadmill walking compared to treadmill walking. No significant changes of kinematic parameters were found between the different levels of guidance force. Interpretation With regard to the thorax and pelvis movements, robot-assisted treadmill walking is significantly different compared to treadmill walking. It can be concluded that when using robot assistance, the thorax is stimulated in a different way than during walking without robot assistance, influencing the balance training during gait.

Background: Blood lipids are cardiovascular health indicators. High LDL cholesterol values and/or high total cholesterol (TC)/HDL cholesterol ratios are positively related with cardiovascular mortality. Evidence suggests that a Mediterranean diet can reduce the incidence of cardiovascular diseases. Adherence to the Mediterranean diet is often measured by the Mediterranean Diet Score (MDS). However, the association between the Mediterranean diet and blood lipid profiles seems still inconclusive. The aim of this study was to investigate the relationship between the MDS, its different components and blood lipid profiles. Methods: A sample of 506 women and 707 men (aged 18-75 years) was recruited. Three-day diet records were used to calculate the MDS. Blood samples were analyzed for serum TC, LDL and HDL cholesterol. ANOVA was used to analyze blood lipids across the MDS tertiles. A multivariate linear regression analysis was performed to investigate the associations between the MDS, its components and blood lipids, adjusted for several confounders. All analyses were stratified by gender. Results: Few gender-specific associations were found between the MDS, its components and blood lipids. Only in men, the total MDS was negatively related with LDL cholesterol and the ratio TC/HDL cholesterol while positively with HDL cholesterol. In women, respectively two (MUFA/SFA and cereals) and in men three (fruits & nuts, meat and alcohol) of the nine MDS components were related with blood lipids. Conclusions: Analyses investigating the relationship between the MDS, its components and blood lipid profiles indicate only limited influence of the Mediterranean diet on blood lipids. More associations were detected in men compared to women.

Overweight and obesity in children are recognized as a major health problem. The ToyBox-intervention was developed with the aim of preventing obesity in pre-schoolers. Because it is increasingly important to inform policy makers not only on the effects of prevention interventions, but also on their costs and cost-effectiveness, our purpose was to establish a method to estimate the cost-effectiveness of the ToyBox-intervention. In order to estimate the long-term impact of the ToyBox-intervention on health and societal costs, extrapolations of the intervention effect will be conducted to predict children's weight status (based on the body mass index) at adult age. Effects of the adult weight status on the prevalence of obesity-related complications will be modelled through a Markov model, with a total time horizon of 70 years and a cycle length of 1 year. The model will be conducted in six European countries participating in the ToyBox-intervention, based on country-specific economic and epidemiological data. This study describes the methodological rationale and implementation of an analytic model to examine the cost-effectiveness of the ToyBox-intervention for six European countries, in order to inform decision-makers on the value for money of this intervention in the prevention of obesity in pre-schoolers.

Background When students make the transition from high school to college or university, their physical activity (PA) levels decrease strongly. Consequently, it is of crucial importance to identify the determinants of this decline in PA. Purpose The study aims were to (1) examine changes in psychosocial factors in students during the transition from high school to college/university, (2) examine if changes in psychosocial factors and residency can predict changes in PA, and (3) investigate the moderating effects of residency on the relationship between changes in psychosocial factors and changes in PA. Method Between March 2008 and October 2010, 291 Flemish students participated in a longitudinal study, with baseline measurements during the final year of high school and follow-up measurements at the start of second year of college/university. At both time points, participants completed a questionnaire assessing demographics, active transportation, leisure-time sports, psychosocial variables, and residency. Repeated measures MANOVA analyses and multiple moderated hierarchic regression analyses were conducted. Results Modeling, self-efficacy, competition-related benefits, and health-related, external and social barriers decreased, while health-related benefits and time-related barriers increased from baseline to follow-up. Decreases in modeling and time-related barriers were associated with a decrease in active transportation (adjusted R 2 = 3.2 %); residency, decreases in self-efficacy, competition-related benefits, and increases in health- and time-related barriers predicted a decrease in leisure-time sports (adjusted R 2 = 29.3 %). Residency only moderated two associations between psychosocial factors and changes in PA. Conclusion Residency and changes in psychosocial factors were mainly important to explain the decrease in leisure-time sports. Other factors such as distance to college/university are likely more important to explain the decrease in active transportation; these are worth exploring in future studies. Because few interactions were found, similar interventions, focusing on self-efficacy, time management, and increasing perceived benefits may be effective to increase leisure-time sports in all students.

STUDY QUESTION: Does self-operated endovaginal telemonitoring (SOET) of the ovarian stimulation phase in IVF/ICSI produce similar laboratory, clinical, patient reported and health-economic results as traditional monitoring (non-SOET)? SUMMARY ANSWER: SOET is not inferior to traditional monitoring (non-SOET). WHAT IS KNOWN ALREADY: Monitoring the follicular phase is needed to adapt gonadotrophin dose, detect threatening hyperstimulation and plan HCG administration. Currently, patients pay visits to care providers, entailing transportation costs and productivity loss. It stresses patients, partners, care providers and the environment. Patients living at great distance from centres have more difficult access to treatment. The logistics and stress during the follicular phase of assisted reproduction treatment (ART) is often an impediment for treatment. STUDY DESIGNS, SIZE, DURATION: The study was a non-inferiority RCT between SOET and non-SOET performed between February 2012 and October 2013. Sample size calculations of number of metaphase II (MII) oocytes (the primary outcome): 81 patients were needed in each study arm for sufficient statistical power. Block randomization was used with allocation concealment through electronic files. The first sonogram was requested after 5 days of stimulation, after that mostly every 2 days and with a daily sonograms at the end. PARTICIPANTS/MATERIALS, SETTINGS, METHODS: Inclusion criteria were age 15 mm diameter at oocyte retrieval (OR), ova at OR, MII oocytes, log2 MII oocytes, embryos available at transfer, top quality embryos and embryos frozen were obtained in the two groups, indicating non-inferiority of SOET monitoring. Regarding patient-reported outcomes, a significantly higher contentedness of patient and partner (P < 0.01), a higher feeling of empowerment, discretion and more active partner participation (P < 0.001) as well as a trend towards less stress (P = 0.06) were observed in the S versus the NS group. In the economic analysis, the use of SOET led to reduced productivity loss, lower transportation costs, and lower sonogram and consultation costs (all P < 0.001 but higher personnel cost than NS). LIMITATIONS, REASONS FOR CAUTION: The study was stopped (no further funding) before full sample size was reached. There were also a few cases of unexpected poor response, leading to a wider SD than anticipated in the power calculation. However, although the study was underpowered for these reasons, non-inferiority of SOET versus non-SOET was demonstrated. WIDER IMPLICATIONS OF THE FINDINGS: Home monitoring using SOET may provide a patient-centred alternative to the standard methods. ART sonograms can be made, and then sent to the care provider for analysis at any appropriate time and from anywhere if an internet connection is available. This approach offers several advantages for patients as well as care providers, including similar results to the traditional methods with less logistical stress and potentially bringing care to patients in poor resource settings. STUDY FUNDING/COMPETING INTERESTS: Supported by an IOF (industrial research fund) of Ghent University (full protocol available at iBiTech) and as a demonstration project of Flanders Care (Flemish Government). There are no conflicts of interest to declare. TRIAL REGISTRATION NUMBER: EC/2011/669 (Ghent University Hospital), B670201112232 (Belgian registration) and NCT01781143 (clinical trials number).

The aim of this systematic review was to summarize the improvements in balance after robot-assisted gait training (RAGT) in stroke patients. Two databases were searched: PubMed and Web of Knowledge. The most important key words are "stroke," "RAGT," "balance," "Lokomat," and "gait trainer." Studies were included if stroke patients were involved in RAGT protocols, and balance was determined as an outcome measurement. The articles were checked for methodological quality by 2 reviewers (Cohen's κ = 0.72). Nine studies were included (7 true experimental and 2 pre-experimental studies; methodological quality score, 56%-81%). In total, 229 subacute or chronic stroke patients (70.5% male) were involved in RAGT (3 to 5 times per week, 3 to 10 weeks, 12 to 25 sessions). In 5 studies, the gait trainer was used; in 2, the Lokomat was used; in 1 study, a single-joint wearable knee orthosis was used; and in 1 study, the AutoAmbulator was used. Eight studies compared RAGT with other gait rehabilitation methods. Significant improvements (no to large effect sizes, Cohen's d = 0.01 to 3.01) in balance scores measured with the Berg Balance Scale, the Tinetti test, postural sway tests, and the Timed Up and Go test were found after RAGT. No significant differences in balance between the intervention and control groups were reported. RAGT can lead to improvements in balance in stroke patients; however, it is not clear whether the improvements are greater compared with those associated with other gait rehabilitation methods. Because a limited number of studies are available, more specific research (eg, randomized controlled trials with larger, specific populations) is necessary to draw stronger conclusions.

BackgroundEnvironmental factors are found to influence transport-related physical activity, but have rarely been studied in relation with cycling for transport to various destinations in 10-12 yr old children. The current qualitative study used 'bike-along interviews' with children and parents to allow discussion of detailed environmental factors that may influence children's cycling for transport, while cycling in the participant's neighborhood.MethodsPurposeful convenience sampling was used to recruit 35 children and one of their parents residing in (semi-) urban areas. Bike-along interviews were conducted to and from a randomly chosen destination (e.g. library) within a 15 minutes' cycle trip in the participant's neighborhood. Participants wore a GoPro camera to objectively assess environmental elements, which were subsequently discussed with participants. Content analysis and arising themes were derived using a grounded theory approach.ResultsThe discussed environmental factors were categorized under traffic, urban design, cycling facilities, road design, facilities at destination, aesthetics, topography, weather, social control, stranger danger and familiar environment. Across these categories many environmental factors were (in)directly linked to road safety. This was illustrated by detailed discussions of the children's visibility, familiarity with specific traffic situations, and degree of separation, width and legibility of cycle facilities.ConclusionRoad safety is of major concern in this 10-12 yr old study population. Bike-along interviews were able to identify new, detailed and context-specific physical environmental factors which could inform policy makers to promote children's cycling for transport. However, future studies should investigate whether hypothetical changes to such micro environmental features influence perceptions of safety and if this in turn could lead to changes in children's cycling for transport.