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Background: Diabetes is an established risk factor for adverse cardiovascular outcomes including mortality, but the relationship between diabetes and mortality risk in the presence of the extensive or diffuse form of coronary artery disease (CAD) is controversial., Aims: We evaluated the association between diabetes and mortality risk in patients who underwent coronary angiography using a real-life clinical database., Methods: We utilized the KARDIO registry, which comprised data on demographics, prevalent diseases, including diabetes status, cardiovascular risk factors, coronary angiographies, and other interventions in 79,738 patients. Hazard ratios (HRs) (95% confidence intervals [CIs]) for the association between prevalent diabetes and all-cause mortality were estimated., Results: During a median follow-up of 5.5 years, 11,896 all-cause deaths occurred. In analyses adjusted for age, smoking status, hypertension, family history of CAD, dyslipidaemia, urgency of intervention, body mass index, sex, and sex-age interaction, the HR (95% CI) for mortality comparing diabetes with no diabetes was 1.44 (1.38, 1.50). Following additional adjustment for the degree of CAD (1-3 vessels disease) as confirmed by angiography, the HR (95% CI) for mortality remained similar 1.43 (1.36, 1.49). The association did not vary significantly across several relevant clinical characteristics except for a stronger association in those with a family history of CAD than those without (p = 0.034) and former smokers than nonsmokers (p = 0.046)., Conclusion: In patients undergoing coronary angiography, diabetes is associated with an increased mortality risk, independent of several risk factors including the degree of CAD. The association may be modified by family history of CAD and smoking status., (© 2024 The Author(s). Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.)

Objective: The aim of the study was to conduct exploratory analyses on the role of cardiorespiratory fitness (CRF) and body composition in the association between physical activity and menopausal symptoms., Methods: This was a cross-sectional (N = 298) study of women aged 51-59 years including a subsample of 82 women followed for 4 years. The severity of menopausal symptoms was assessed with the Menopause Rating Scale in total symptoms as well as using the somato-vegetative, psychological, and urogenital subscales. Physical activity was assessed with accelerometers and self-reports, body composition with dual-energy x-ray absorptiometry, and CRF with a custom-made prediction model based on the six-minute walking distance and spiroergometry. The associations of interest were studied using unstandardized regression coefficients derived from multiple linear regression models with the severity of menopausal symptoms as the outcome., Results: Higher total body and fat mass (kg) were associated with more severe total symptoms (B = 0.06 [95% CI, 0.01 to 0.12] and 0.07 [0.01 to 0.14], respectively) as well as somato-vegetative (0.03 [0.01 to 0.05]; 0.04 [0.01 to 0.06]) and psychological symptoms (0.03 [0.00 to 0.05]; 0.03 [0.00 to 0.06]) in cross-sectional design. Total and lean body mass interacted with physical activity in total and psychological symptoms with stronger indirect associations being observed in participants with lower total and lean body mass. CRF was not associated with menopausal symptoms and did not interact with physical activity., Conclusions: Maintaining a healthy weight is associated with less severe menopausal symptoms in middle-aged women. The association between physical activity and the severity of menopausal symptoms varied based on the differences in total and lean body mass., Competing Interests: Financial disclosures/conflicts of interest: None reported., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The Menopause Society.)

We address a Bayesian two-stage decision problem in operational forestry where the inner stage considers scheduling the harvesting to fulfill demand targets and the outer stage considers selecting the accuracy of pre-harvest inventories that are used to estimate the timber volumes of the forest tracts. The higher accuracy of the inventory enables better scheduling decisions but also implies higher costs. We focus on the outer stage, which we formulate as a maximization of the posterior value of the inventory decision under a budget constraint. The posterior value depends on the solution to the inner stage problem and its computation is analytically intractable, featuring an NP-hard binary optimization problem within a high-dimensional integral. In particular, the binary optimization problem is a special case of a generalized quadratic assignment problem. We present a practical method that solves the outer stage problem with an approximation which combines Monte Carlo sampling with a greedy, randomized method for the binary optimization problem. We derive inventory decisions for a dataset of 100 Swedish forest tracts across a range of inventory budgets and estimate the value of the information to be obtained., (© The Author(s) 2024. Published by Oxford University Press on behalf of The International Biometric Society.)

Lynch syndrome (LS) is the most common autosomal dominant cancer syndrome and is characterized by high genetic cancer risk modified by lifestyle factors. This study explored whether a circulating miRNA (c-miR) signature predicts LS cancer incidence within a 4-year prospective surveillance period. To gain insight how lifestyle behavior could affect LS cancer risk, we investigated whether the cancer-predicting c-miR signature correlates with known risk-reducing factors such as physical activity, body mass index (BMI), dietary fiber, or NSAID usage. The study included 110 c-miR samples from LS carriers, 18 of whom were diagnosed with cancer during a 4-year prospective surveillance period. Lasso regression was utilized to find c-miRs associated with cancer risk. Individual risk sum derived from the chosen c-miRs was used to develop a model to predict LS cancer incidence. This model was validated using 5-fold cross-validation. Correlation and pathway analyses were applied to inspect biological functions of c-miRs. Pearson correlation was used to examine the associations of c-miR risk sum and lifestyle factors. hsa-miR-10b-5p, hsa-miR-125b-5p, hsa-miR-200a-3p, hsa-miR-3613-5p, and hsa-miR-3615 were identified as cancer predictors by Lasso, and their risk sum score associated with higher likelihood of cancer incidence (HR 2.72, 95% confidence interval: 1.64-4.52, C-index = 0.72). In cross-validation, the model indicated good concordance with the average C-index of 0.75 (0.6-1.0). Coregulated hsa-miR-10b-5p, hsa-miR-125b-5p, and hsa-miR-200a-3p targeted genes involved in cancer-associated biological pathways. The c-miR risk sum score correlated with BMI (r = 0.23, P < 0.01). In summary, BMI-associated c-miRs predict LS cancer incidence within 4 years, although further validation is required., Prevention Relevance: The development of cancer risk prediction models is key to improving the survival of patients with LS. This pilot study describes a serum miRNA signature-based risk prediction model that predicts LS cancer incidence within 4 years, although further validation is required., (©2024 The Authors; Published by the American Association for Cancer Research.)

The aim of this systematic review, meta-analysis, and meta-regression was to examine the effects of virtual reality-based training on global cognition and executive function compared with conventional training or information-based treatment in older adults, regardless of cognitive level. A systematic literature search was conducted using four databases. A total of 31 randomized controlled trials were identified. Pooled effect sizes were calculated, the risk of bias was assessed, and evidence was graded. The primary analyses showed a small but statistically significant effect of virtual reality-based training compared with control on global cognition (Hedges' g 0.42, 95% confidence interval [0.17, 0.68], I2 = 70.1%, n = 876, 20 randomized controlled trials, low evidence) and executive function (Hedges' g 0.35, 95% confidence interval [0.06, 0.65], I2 = 68.4%, n = 810, 16 randomized controlled trials, very low evidence). Meta-regression yielded inconclusive results. Virtual reality-based training may be more effective than control in improving cognition in older adults; however, more high-quality studies are needed.

The evolution of insecticide resistance has been attributed to strong directional selection by lethal concentrations of insecticides, but there is growing evidence that sublethal doses may also modify resistance through the hormetic effects. Hormesis is a beneficial effect caused by exposure to low doses. However, the role of parental (transgenerational) effects on hormesis, and through that on insecticide resistance, is still unclear. We investigated the effects of several sublethal pyrethroid insecticide (Decis) doses on survival, body mass, and reproduction within four generations (F0, F1, F2, and F3) of the Colorado potato beetle (Leptinotarsa decemlineata). We found that insecticide exposure had mostly linear adverse within-generation effects: decreased larva-to-adult survival, adult body mass, and egg hatching. However, transgenerational exposure led to hormetic effects: increased larva-to-adult survival and pre-diapause adult body mass. Moreover, transgenerational effects were even more positive for offspring exposed to insecticides, leading to decreased larva-to-adult survival, increased body mass, and egg hatching. Our results show that despite mostly negative within-generation effects, transgenerational sublethal exposure to insecticide can cause unwanted positive hormetic effects in their offspring, making them to resist or tolerate the insecticides better, even though the underlying mechanisms are still unclear., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier B.V.)

Objective: To study associations of menopausal symptoms with cardiometabolic risk factors., Study Design: A cross-sectional and longitudinal study of a representative population sample of 1393 women aged 47-55 years with a sub-sample of 298 followed for four years. The numbers of vasomotor, psychological, somatic or pain, and urogenital menopausal symptoms were ascertained at baseline through self-report. Their associations with cardiometabolic risk factors were studied using linear regression and linear mixed-effect models. Models were adjusted for age, menopausal status, body mass index, the use of hormonal preparations, education, smoking, and alcohol consumption., Main Outcome Measures: Cardiometabolic risk factors included total cholesterol, low-density and high-density lipoprotein cholesterol, blood pressure, glucose, triglycerides, total and android fat mass, and physical activity., Results: All cholesterol and fat mass measures had modest positive associations with menopausal symptoms. The number of vasomotor symptoms, in particular, was associated with total cholesterol (B = 0.13 mmol/l, 95 % CI [0.07, 0.20]; 0.15 mmol/l [0.02, 0.28]) and low-density lipoprotein cholesterol (0.08 mmol/l [0.03, 0.14]; 0.12 mmol/l [0.01, 0.09]) in cross-sectional and longitudinal analyses, respectively. However, these associations disappeared after adjusting for confounders. The number of symptoms was not associated with blood pressure, glucose, triglycerides, and physical activity. Menopausal symptoms at baseline did not predict the changes in the risk factors during the follow-up., Conclusions: Menopausal symptoms may not be independently associated with cardiometabolic risk, and they do not seem to predict the changes in risk factors during the menopausal transition., Competing Interests: Declaration of competing interest The authors declare that they have no competing interest., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: In patients with some cardiovascular disease conditions, slightly elevated body mass index (BMI) is associated with a lower mortality risk (termed "obesity paradox"). It is uncertain, however, if this obesity paradox exists in patients who have had invasive cardiology procedures. We evaluated the association between BMI and mortality in patients who underwent coronary angiography., Methods: We utilised the KARDIO registry, which comprised data on demographics, prevalent diseases, risk factors, coronary angiographies, and interventions on 42,636 patients. BMI was categorised based on WHO cut-offs or transformed using P-splines. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated for all-cause mortality., Results: During a median follow-up of 4.9 years, 4688 all-cause deaths occurred. BMI was nonlinearly associated with mortality risk: compared to normal weight category (18.5-25 kg/m 2 ), the age-adjusted HRs (95% CIs) for all-cause mortality were 1.90 (1.49, 2.43), 0.96 (0.92, 1.01), 1.04 (0.99, 1.09), 1.08 (0.96, 1.20), and 1.45 (1.22, 1.72) for underweight (<18.5 kg/m 2 ), preobesity (25 to <30 kg/m 2 ), obesity class I (30 to <35 kg/m 2 ), obesity class II (35 to <40 kg/m 2 ), and obesity class III (>40 kg/m 2 ), respectively. The corresponding multivariable adjusted HRs (95% CIs) were 2.00 (1.55, 2.58), 0.92 (0.88, 0.97) 1.01 (0.95, 1.06), 1.10 (0.98, 1.23), and 1.49 (1.26, 1,78), respectively., Conclusions: In patients undergoing coronary angiography, underweight and obesity class III are associated with increased mortality risk, and the lowest mortality was observed in the preobesity class. It appears the obesity paradox may be present in patients who undergo invasive coronary procedures., (© 2022 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.)

Objective: To predict the probability of a benefit from 2 contrasting exercise programs for women with a new diagnosis of mild knee osteoarthritis, and to estimate the short- and long-term effects of aquatic resistance training (ART) and high-impact aerobic land training (HLT) compared with a control., Methods: Original data sets from 2 previously conducted randomized controlled trials were combined and used in a Bayesian meta-analysis. Group differences in multiple response variables were estimated. Variables included cardiorespiratory fitness, dynamic maximum leg muscle power, maximal isometric knee extension and flexion force, pain, other symptoms, and quality of life. The statistical model included a latent commitment variable for each female participant., Results: ART had a 55-71% probability of benefits in the outcome variables, and as the main effect, the intervention outperformed the control in cardiorespiratory fitness, with a probability of 71% immediately after the intervention period. HLT had a 46-63% probability of benefits after intervention with the outcome variables, but differently from ART; the positive effects of physical performance fade away during the follow-up period. Overall, the differences between groups were small, and the variation in the predictions between individuals was high., Conclusion: Both interventions had benefits, but ART has a slightly higher probability of long-term benefits on physical performance. Because of high individual variation and no clear advantage of one training method over the other, personal preferences should be considered in the selection of the exercise program to ensure highest commitment to training., (© 2021 The Authors. Arthritis Care & Research published by Wiley Periodicals LLC on behalf of American College of Rheumatology.)

Background: Health status is a principal determinant of labour market participation. In this study, we examined whether excess weight is associated with withdrawal from the labour market owing to premature retirement., Methods: The analyses were based on nationally representative data from Finland over the period 2001-15 (N ∼ 2500). The longitudinal data included objective measures of body weight (i.e. body mass index and waist circumference) linked to register-based information on actual retirement age. The association between the body weight measures and premature retirement was modelled using cubic b-splines via logistic regression. The models accounted for other possible risk factors and potential confounders, such as smoking and education., Results: Excess weight was associated with an increased risk of premature retirement for both men and women. A closer examination revealed that the probability of retirement varied across the weight distribution and the results differed between sexes and weight measures., Conclusion: Body weight outside a recommended range elevates the risk of premature retirement., (© The Author(s) 2021. Published by Oxford University Press on behalf of the European Public Health Association.)

Objective: The objective of this review was to systematically evaluate the effectiveness of exergaming on walking in older adults. In addition, the aim was to investigate the relationship between the exergaming effect and age, baseline walking performance, exercise traits, technology used, and the risk of bias., Methods: A literature search was carried out in the databases MEDLINE, CINAHL, CENTRAL, EMBASE, WoS, PsycInfo, and PEDro up to January 10, 2020. Studies with a randomized controlled trial design, people ≥60 years of age without neurological disorders, comparison group with other exercise or no exercise, and walking-related outcomes were included. Cochrane RoB2, meta-analysis, meta-regression, and Grading of Recommendations, Assessment, Development and Evaluation were used to estimate quality, treatment effect, covariates' effect, and the certainty of evidence, respectively., Results: In the studies included (n = 66), the overall risk of bias was low (n = 2), unclear (n = 48), or high (n = 16). Compared with comparison groups, exergaming interventions were more effective for walking improvements (standardized mean difference = -0.21; 95% CI = -0.36 to -0.06; 3102 participants, 58 studies; moderate-quality evidence) and more or equally effective (standardized mean difference = -0.32; 95% CI = -0.64 to 0.00; 1028 participants, 13 studies; low-quality evidence) after nonexergaming follow-up. The strongest effect for covariates was observed with the type of comparison group, explaining 18.6% of the variance., Conclusion: For older adults without neurological disorders, exergame-based training improved walking, and improvements were maintained at follow-up. Greater benefits were observed when exergaming groups were compared with inactive comparison groups. To strengthen the evidence, further randomized controlled trials on the effectiveness of gamified exercise intervention are needed., Impact: Exergaming has an effect equivalent to other types of exercising on improving walking in older adults. Physical therapists and other rehabilitation professionals may consider exergaming as a promising form of exercise in this age group., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Physical Therapy Association.)

Objective: To predict the age at natural menopause (ANM)., Methods: Cox models with time-dependent covariates were utilized for ANM prediction using longitudinal data from 47 to 55-year-old women (n = 279) participating in the Estrogenic Regulation of Muscle Apoptosis study. The ANM was assessed retrospectively for 105 women using bleeding diaries. The predictors were chosen from the set of 32 covariates by using the lasso regression (model 1). Another easy-to-access model (model 2) was created by using a subset of 16 self-reported covariates. The predictive performance was quantified with c-indices and by studying the means and standard deviations of absolute errors (MAE ± SD) between the predicted and observed ANM., Results: Both models included alcohol consumption, vasomotor symptoms, self-reported physical activity, and relationship status as predictors. Model 1 also included estradiol and follicle-stimulating hormone levels as well as SD of menstrual cycle length, while model 2 included smoking, education, and the use of hormonal contraception as additional predictors. The mean c-indices of 0.76 (95% CI 0.71-0.81) for model 1 and 0.70 (95% CI 0.65-0.75) for model 2 indicated good concordance between the predicted and observed values. MAEs of 0.56 ± 0.49 and 0.62 ± 0.54 years respectively for model 1 and 2 were clearly smaller than the MAE for predicted sample mean (1.58 ± 1.02)., Conclusions: In addition to sex hormone levels, irregularity of menstrual cycle, and menopausal symptoms, also life habits and socioeconomic factors may provide useful information for ANM prediction. The suggested approach could add value for clinicians' decision making related to the use of contraception and treatments for menopausal symptoms in perimenopausal women., Competing Interests: Financial disclosure/conflicts of interest: J.K. has received funding from Biogen Finland and Tale Ltd. The other authors have nothing to disclose., (Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The North American Menopause Society.)

Introduction: Adolescents have experienced decreased aerobic fitness levels and insufficient physical activity levels over the past decades. While both physical activity and aerobic fitness are related to physical and mental health, little is known concerning how they manifest in the brain during this stage of development, characterized by significant physical and psychosocial changes. The aim of the study is to examine the associations between both physical activity and aerobic fitness with brains' functional connectivity., Methods: Here, we examined how physical activity and aerobic fitness are associated with local and interhemispheric functional connectivity of the adolescent brain (n = 59), as measured with resting-state functional magnetic resonance imaging. Physical activity was measured by hip-worn accelerometers, and aerobic fitness by a maximal 20-m shuttle run test., Results: We found that higher levels of moderate-to-vigorous intensity physical activity, but not aerobic fitness, were linked to increased local functional connectivity as measured by regional homogeneity in 13-16-year-old participants. However, we did not find evidence for significant associations between adolescents' physical activity or aerobic fitness and interhemispheric connectivity, as indicated by homotopic connectivity., Conclusions: These results suggest that physical activity, but not aerobic fitness, is related to local functional connectivity in adolescents. Moreover, physical activity shows an association with a specific brain area involved in motor functions but did not display any widespread associations with other brain regions. These results can advance our understanding of the behavior-brain associations in adolescents., (© 2020 The Authors. Brain and Behavior published by Wiley Periodicals LLC.)

Epidemiologic evidence is based on multiple data sources including clinical trials, cohort studies, surveys, registries, and expert opinions. Merging information from different sources opens up new possibilities for the estimation of causal effects. We show how causal effects can be identified and estimated by combining experiments and observations in real and realistic scenarios. As a new tool, we present do-search, a recently developed algorithmic approach that can determine the identifiability of a causal effect. The approach is based on do-calculus, and it can utilize data with nontrivial missing data and selection bias mechanisms. When the effect is identifiable, do-search outputs an identifying formula on which numerical estimation can be based. When the effect is not identifiable, we can use do-search to recognize additional data sources and assumptions that would make the effect identifiable. Throughout the article, we consider the effect of salt-adding behavior on blood pressure mediated by the salt intake as an example. The identifiability of this effect is resolved in various scenarios with different assumptions on confounding. There are scenarios where the causal effect is identifiable from a chain of experiments but not from survey data, as well as scenarios where the opposite is true. As an illustration, we use survey data from the National Health and Nutrition Examination Survey 2013-2016 and the results from a meta-analysis of randomized controlled trials and estimate the reduction in average systolic blood pressure under an intervention where the use of table salt is discontinued.

Uncertainty in the information obtained through monitoring complicates decision making about aquatic ecosystems management actions. We suggest the value of information (VOI) to assess the profitability of paying for additional monitoring information, when taking into account the costs and benefits of monitoring and management actions, as well as associated uncertainty. Estimating the monetary value of the ecosystem needed for deriving VOI is challenging. Therefore, instead of considering a single value, we evaluate the sensitivity of VOI to varying monetary value. We also extend the VOI analysis to the more realistic context where additional information does not result in perfect, but rather in imperfect information on the true state of the environment. Therefore, we analytically derive the value of perfect information in the case of two alternative decisions and two states of uncertainty. Second, we describe a Monte Carlo type of approach to evaluate the value of imperfect information about a continuous classification variable. Third, we determine confidence intervals for the VOI with a percentile bootstrap method. Results for our case study on 144 Finnish lakes suggest that generally, the value of monitoring exceeds the cost. It is particularly profitable to monitor lakes that meet the quality standards a priori, to ascertain that expensive and unnecessary management can be avoided. The VOI analysis provides a novel tool for lake and other environmental managers to estimate the value of additional monitoring data for a particular, single case, e.g. a lake, when an additional benefit is attainable through remedial management actions., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020. Published by Elsevier B.V.)

Physical activity and exercise beneficially link to brain properties and cognitive functions in older adults, but the findings concerning adolescents remain tentative. During adolescence, the brain undergoes significant changes, which are especially pronounced in white matter. Studies provide contradictory evidence regarding the influence of physical activity or aerobic-exercise on executive functions in youth. Little is also known about the link between both fitness and physical activity with the brain's white matter during puberty. We investigated the connection between aerobic fitness and physical activity with the white matter in 59 adolescents. We further determined whether white matter interacts with the connection of fitness or physical activity with core executive functions. Our results show that only the level of aerobic fitness, but not of physical activity relates to white matter. Furthermore, the white matter of the corpus callosum and the right superior corona radiata moderates the links of aerobic fitness and physical activity with working memory. Our results suggest that aerobic fitness and physical activity have an unequal contribution to the white matter properties in adolescents. We propose that the differences in white matter properties could underlie the variations in the relationship between either physical activity or aerobic fitness with working memory., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to report., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Stress tolerance and adaptation to stress are known to facilitate species invasions. Many invasive species are also pests and insecticides are used to control them, which could shape their overall tolerance to stress. It is well-known that heavy insecticide usage leads to selection of resistant genotypes but less is known about potential effects of mild sublethal insecticide usage. We studied whether stressful, sublethal pyrethroid insecticide exposure has within-generational and/or maternal transgenerational effects on fitness-related traits in the Colorado potato beetle (Leptinotarsa decemlineata) and whether maternal insecticide exposure affects insecticide tolerance of offspring. Sublethal insecticide stress exposure had positive within-and transgenerational effects. Insecticide-stressed larvae had higher adult survival and higher adult body mass than those not exposed to stress. Furthermore, offspring whose mothers were exposed to insecticide stress had higher larval and pupal survival and were heavier as adults (only females) than those descending from control mothers. Maternal insecticide stress did not explain differences in lipid content of the offspring. To conclude, stressful insecticide exposure has positive transgenerational fitness effects in the offspring. Therefore, unsuccessful insecticide control of invasive pest species may lead to undesired side effects since survival and higher body mass are known to facilitate population growth and invasion success.

Objective: To study the effectiveness of technology-based distance physical rehabilitation interventions on physical functioning in stroke., Data Sources: A systematic literature search was conducted in 6 databases from January 2000 to May 2018., Study Selection: Inclusion criteria applied the patient, intervention, comparison, outcome, study design framework as follows: (P) stroke; (I) technology-based distance physical rehabilitation interventions; (C) any comparison without the use of technology; (O) physical functioning; (S) randomized controlled trials (RCTs). The search identified in total 693 studies, and the screening of 162 full-text studies revealed 13 eligible studies., Data Extraction: The studies were screened using the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines and assessed for methodological quality and quality of evidence. Meta-analysis was performed if applicable., Data Synthesis: A total of 13 studies were included, and online video monitoring was the most used technology. Seven outcomes of physical functioning were identified-activities of daily living (ADL), upper extremity functioning, lower extremity functioning, balance, walking, physical activity, and participation. A meta-analysis of 6 RCTs indicated that technology-based distance physical rehabilitation had a similar effect on ADL (standard mean difference 0.06; 95% confidence interval: -0.22 to 0.35, P=.67) compared to the combination of traditional treatments (usual care, similar and other treatment). Similar results were obtained for other outcomes, except inconsistent findings were noted for walking. Methodological quality of the studies and quality of evidence were considered low., Conclusions: The findings suggest that the effectiveness of technology-based distance physical rehabilitation interventions on physical functioning might be similar compared to traditional treatments in stroke. Further research should be performed to confirm the effectiveness of technology-based distance physical rehabilitation interventions for improving physical functioning of persons with stroke., (Copyright © 2018 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Higher levels of aerobic fitness and physical activity are linked to beneficial effects on brain health, especially in older adults. The generalizability of these earlier results to young individuals is not straightforward, because physiological responses (such as cardiovascular responses) to exercise may depend on age. Earlier studies have mostly focused on the effects of either physical activity or aerobic fitness on the brain. Yet, while physical activity indicates the amount of activity, aerobic fitness is an adaptive state or attribute that an individual has or achieves. Here, by measuring both physical activity and aerobic fitness in the same study, we aimed to differentiate the association between these two measures and grey matter volume specifically. Magnetic resonance imaging scans were used to study volumes of 30 regions of interest located in the frontal, motor and subcortical areas of 60 adolescents (12.7-16.2 years old). Moderate-to-vigorous intensity physical activity (MVPA) was measured with hip-worn accelerometers and aerobic fitness was assessed with a 20-m shuttle run. Multiple regression analyses revealed a negative association between aerobic fitness and left superior frontal cortex volume and a positive association between aerobic fitness and the left pallidum volume. No associations were found between MVPA and any brain region of interest. These results demonstrate unequal contribution of physical activity and aerobic fitness on grey matter volumes, with inherent or achieved capacity (aerobic fitness) showing clearer associations than physical activity., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: The decreasing participation rates and selective non-participation peril the representativeness of health examination surveys (HESs)., Methods: Finnish HESs conducted in 1972-2012 are used to demonstrate that survey participation rates can be enhanced with well-planned recruitment procedures and auxiliary information about survey non-participants can be used to reduce selection bias., Results: Experiments incorporated to pilot surveys and experience from previously conducted surveys lead to practical improvements. For example, SMS reminders were taken as a routine procedure to the Finnish HESs after testing their effect on a pilot study and finding them as a cost-effective way to increase participation rate especially among younger age groups. Auxiliary information about survey non-participants can be obtained from many sources: sampling frames, previous measurements in longitudinal setting, re-contacts and non-response questionnaires, and record linkage to administrative data sources. These data can be used in statistical modelling to adjust the population level estimates for the selection bias. Information on the characteristics of non-participants also helps to improve targeting the recruitment in the future., Conclusion: All methods discussed and recommended are relatively easy to incorporate to any national HES in Europe except the record linkage of survey data from administrative data sources. This is not feasible in all European countries because of non-existence of registries, lack of an identifier needed for record linkage, or national data protection legislation which restricts the data use.

Aims: Health examination surveys (HES) provide important information about population health and health-related factors, but declining participation rates threaten the representativeness of collected data. It is hard to conduct national HESs at examination clinics near to every sampled individual. Thus, it is interesting to look into the possible association between the distance from home to the examination clinic and non-participation, and whether there is a certain distance after which the participation activity decreases considerably., Methods: Data from two national HESs conducted in Finland in 2011 and 2012 were used and a logistic regression model was fitted to investigate how distance was related to non-participation., Results: We found out that non-participation modestly increased with distance to the examination clinic. An additional analysis indicated that the option of having an examination at home may decrease the effect of distance to participation., Conclusions: Long distances from home to the examination clinic are one reason for low participation activity. Possible bias caused by these differences in participation could be decreased by providing the option of a home examination.

Aims: A common objective of epidemiological surveys is to provide population-level estimates of health indicators. Survey results tend to be biased under selective non-participation. One approach to bias reduction is to collect information about non-participants by contacting them again and asking them to fill in a questionnaire. This information is called re-contact data, and it allows to adjust the estimates for non-participation., Methods: We analyse data from the FINRISK 2012 survey, where re-contact data were collected. We assume that the respondents of the re-contact survey are similar to the remaining non-participants with respect to the health given their available background information. Validity of this assumption is evaluated based on the hospitalisation data obtained through record linkage of survey data to the administrative registers. Using this assumption and multiple imputation, we estimate the prevalences of daily smoking and heavy alcohol consumption and compare them to estimates obtained with a commonly used assumption that the participants represent the entire target group., Results: When adjusting for non-participation using re-contact data, higher prevalence estimates were observed compared to prevalence estimates based on participants only. Among men, the smoking prevalence estimate was 28.5% (23.2% for participants) and heavy alcohol consumption prevalence was 9.4% (6.8% for participants). Among women, smoking prevalence was 19% (16.5% for participants) and heavy alcohol consumption was 4.8% (3% for participants)., Conclusions: The utilisation of re-contact data is a useful method to adjust for non-participation bias on population estimates in epidemiological surveys.

Aims: We aim to adjust for potential non-participation bias in the prevalence of heavy alcohol consumption., Methods: Population survey data from Finnish health examination surveys conducted in 1987-2007 were linked to the administrative registers for mortality and morbidity follow-up until end of 2014. Utilising these data, available for both participants and non-participants, we model the association between heavy alcohol consumption and alcohol-related disease diagnoses., Results: Our results show that the estimated prevalence of heavy alcohol consumption is on average of 1.5 times higher for men and 1.8 times higher for women than what was obtained from participants only (complete case analysis). The magnitude of the difference in the mean estimates by year varies from 0 to 9 percentage points for men and from 0 to 2 percentage points for women., Conclusion: The proposed approach improves the prevalence estimation but requires follow-up data on non-participants and Bayesian modelling.

Background: Declining participation rates in health examination surveys may impair the representativeness of surveys and introduce bias into the comparison of results between population groups if participation rates differ between them. Changes in the characteristics of non-participants over time may also limit comparability with earlier surveys., Methods: We studied the association of socio-economic position with participation, and its changes over the past 25 years. Occupational class and educational level are used as indicators of socio-economic position. Data from six cross-sectional FINRISK surveys conducted between 1987 and 2012 in Finland were linked to national administrative registers, which allowed investigation of the differences between survey participants and non-participants., Results: Our results show that individuals with low occupational class or low level of education were less likely to participate than individuals with high occupational class or high level of education. Participation rates decreased in all subgroups of the population but the decline was fastest among those with low level of education., Conclusions: The differences in participation rates must be taken into account to avoid biased estimates because socio-economic position has also been shown to be strongly related to health, health behaviour and biological risk factors. Particular attention should be paid to the recruitment of the less-educated population groups.

Objective: To determine the effectiveness of technology-based distance physical rehabilitation interventions in multiple sclerosis (MS) on physical activity and walking., Data Sources: A systematic literature search was conducted in seven databases from January 2000 to September 2016. Randomized controlled trials of technology-based distance physical rehabilitation interventions on physical activity and walking outcome measures were included., Methods: Methodological quality of the studies was determined and a meta-analysis was performed. In addition, a subanalysis of technologies and an additional analysis comparing to no treatment were conducted., Results: The meta-analysis consisted of 11 studies. The methodological quality was good (8/13). The Internet, telephone, exergaming, and pedometers were the technologies enabling distance physical rehabilitation. Technology-based distance physical rehabilitation had a large effect on physical activity (standard mean difference (SMD) 0.59; 95% confidence interval (95% CI) 0.38 to 0.79; p < 0.00001) compared to control group with usual care, minimal treatment, and no treatment. A large effect was also observed on physical activity (SMD 0.59; 95% CI 0.34 to 0.83; p < 0.00001) when compared to no treatment alone. There were no differences in walking and the subanalysis of technologies., Conclusions: Technology-based distance physical rehabilitation increased physical activity among persons with MS, but further research on walking in MS is needed. Implications for Rehabilitation Technology-based distance physical rehabilitation interventions increase physical activity among persons with MS. This study was unable to identify if the technologies (Internet, telephone, or combinations) lead to differing effects on physical activity or walking in the distance physical rehabilitation interventions in MS. Further research on the effectiveness of technology-based distance physical rehabilitation interventions on walking in MS is needed.

Introduction: Technology has been thought to have strong potential for promoting physical activity, but the evidence has remained unclear. The aim of this study was to examine whether a technology-based distance intervention promoting physical activity is more effective than a physical activity intervention without the use of technology. This systematic review is registered in Prospero (CRD42016035831)., Evidence Acquisition: A systematic literature search of studies published between January 2000 to December 2015 was conducted in CENTRAL, EMBASE, Ovid MEDLINE, CINAHL, PsycINFO, OT-Seeker, WOS and PEDro. Studies were selected by two independent authors applying the following PICOS criteria P) adults, I) technology-based distance intervention promoting physical activity, C) distance intervention promoting physical activity without technology, O) physical activity, S) RCT. Quality was assessed following the guidelines of Cochrane Back Review Group. Meta-analysis and meta-regression were performed using R., Evidence Synthesis: From 3 031 studies, 23 randomized controlled trials with a total of 4 645 participants were included in the meta-analysis. The quality of the studies was moderate (mean 6 out of the maximum 12, with range of 4-9). Technology-based interventions were 12% more effective than similar or minimal control interventions in increasing physical activity (RR: 1.12; 95% CI: 1.01 to 1.25, P=0.03). Compared to minimal control interventions, technology-based interventions were 19% more effective (RR: 1.19; 95% CI 1.05 to 1.35, P=0.0096). In the interventions targeting patients, use of technology was 25% more effective than non-use (P=0.027). No differences were observed in physical activity between the effectiveness of interactive, non-interactive and self-monitoring technologies. Study quality, intervention duration and whether the measures used were subjective or objective were not significantly related to the amount of physical activity engaged in., Conclusions: Technology-based delivery of interventions seems to be more effective than usual care in promoting physical activity, particularly in the interventions targeting patients. Future research should investigate the cost-effectiveness of the use of distance technology for this purpose. Technology benefits rehabilitation, and can be considered for use in clinical practice, may adequately replace face-to-face meetings and stimulate more intensive rehabilitation in daily life.

Science can be seen as a sequential process where each new study augments evidence to the existing knowledge. To have the best prospects to make an impact in this process, a new study should be designed optimally taking into account the previous studies and other prior information. We propose a formal approach for the covariate prioritization, that is the decision about the covariates to be measured in a new study. The decision criteria can be based on conditional power, change of the p-value, change in lower confidence limit, Kullback-Leibler divergence, Bayes factors, Bayesian false discovery rate or difference between prior and posterior expectation. The criteria can be also used for decisions on the sample size. As an illustration, we consider covariate prioritization based on genome-wide association studies for C-reactive protein levels and make suggestions on the genes to be studied further., (© 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Repeated covariate measurements bring important information on the time-varying risk factors in long epidemiological follow-up studies. However, due to budget limitations, it may be possible to carry out the repeated measurements only for a subset of the cohort. We study cost-efficient alternatives for the simple random sampling in the selection of the individuals to be remeasured. The proposed selection criteria are based on forms of the D-optimality. The selection methods are compared with the simulation studies and illustrated with the data from the East-West study carried out in Finland from 1959 to 1999. The results indicate that cost savings can be achieved if the selection is focused on the individuals with high expected risk of the event and, on the other hand, on those with extreme covariate values in the previous measurements., (© The Author(s) 2014.)

Objective: One of the main goals of health examination surveys is to provide unbiased estimates of health indicators at the population level. We demonstrate how multiple imputation methods may help to reduce the selection bias if partial data on some nonparticipants are collected., Study Design and Setting: In the FINRISK 2007 study, a population-based health study conducted in Finland, a random sample of 10,000 men and women aged 25-74 years were invited to participate. The study included a questionnaire data collection and a health examination. A total of 6,255 individuals participated in the study. Out of 3,745 nonparticipants, 473 returned a simplified questionnaire after a recontact. Both the participants and the nonparticipants were followed up for death and hospitalizations. The follow-up data allowed to check the assumptions on the missing data mechanism, and tailored multiple imputation methods were used to handle the missing data., Results: Nonparticipation is a strong predictor for mortality in the five-year follow-up. However, the recontact response does not predict mortality or morbidity among the nonparticipants when adjusted for age and sex. The result suggests that the recontact respondents can be used as proxy for all nonparticipants. A comparison of raw estimates and estimates adjusted for selection bias reveals clear differences in the estimated population prevalences of smoking and heavy alcohol usage., Conclusion: All efforts to collect data on nonparticipants are likely to be useful even if the response rate for the recontact remains low. Statistical analysis of the recontact respondents provides an indication of the extent of the selection bias, even in studies where follow-up data are not available to check the assumptions., (Copyright © 2016 Elsevier Inc. All rights reserved.)