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Objectives: Longitudinal mediation effects can be estimated with mixed effects models. Mixed effects models are versatile, as they accommodate the estimation of contemporaneous, lagged, time-independent, and time-dependent effects. However, the inclusion of time lags and time interactions in mixed effects models for longitudinal mediation analysis has received little attention. This article demonstrates how time lags and time interactions in mixed effects models affect the interpretation of longitudinal mediation effect estimates. Study Design and Setting: We used a data example from the Amsterdam Growth and Health Longitudinal Study to illustrate how the inclusion of time lags and time interactions in mixed effects models may affect the size and interpretation of longitudinal mediation effect estimates. Results: The chosen time lags between the determinant, mediator, and outcome influenced the size and interpretation of the mediation effect estimates. Furthermore, time interactions can be used to model linear or nonlinear development of the mediation effects over time. Conclusion: The inclusion of time lags and time interactions should be considered when estimating longitudinal mediation effects based on mixed effects models, as this enables the estimation of lagged and time-dependent effects.

Error in Table In the original publication, there was a mistake in Table 1 as published [1]. The number of patients with death was swapped between the one-hour administration group and the push administration group. The corrected Table 1 appears below. The authors state that the scientific conclusions are unaffected. This correction was approved by the Academic Editor. The original publication has also been updated.

In the original publication, study group author name “on behalf of Netherlands Brain Bank” was mistakenly included in the author name and it should be omitted. The original article has been corrected.

Background Confounding is a common issue in epidemiological research. Commonly used confounder-adjustment methods include multivariable regression analysis and propensity score methods. Although it is common practice to assess the linearity assumption for the exposure-outcome effect, most researchers do not assess linearity of the relationship between the confounder and the exposure and between the confounder and the outcome before adjusting for the confounder in the analysis. Failing to take the true non-linear functional form of the confounder-exposure and confounder-outcome associations into account may result in an under- or overestimation of the true exposure effect. Therefore, this paper aims to demonstrate the importance of assessing the linearity assumption for confounder-exposure and confounder-outcome associations and the importance of correctly specifying these associations when the linearity assumption is violated. Methods A Monte Carlo simulation study was used to assess and compare the performance of confounder-adjustment methods when the functional form of the confounder-exposure and confounder-outcome associations were misspecified (i.e., linearity was wrongly assumed) and correctly specified (i.e., linearity was rightly assumed) under multiple sample sizes. An empirical data example was used to illustrate that the misspecification of confounder-exposure and confounder-outcome associations leads to bias. Results The simulation study illustrated that the exposure effect estimate will be biased when for propensity score (PS) methods the confounder-exposure association is misspecified. For methods in which the outcome is regressed on the confounder or the PS, the exposure effect estimate will be biased if the confounder-outcome association is misspecified. In the empirical data example, correct specification of the confounder-exposure and confounder-outcome associations resulted in smaller exposure effect estimates. Conclusion When attempting to remove bias by adjusting for confounding, misspecification of the confounder-exposure and confounder-outcome associations might actually introduce bias. It is therefore important that researchers not only assess the linearity of the exposure-outcome effect, but also of the confounder-exposure or confounder-outcome associations depending on the confounder-adjustment method used.

Additional file 1.

Additional file 6. Observer OPTIONMCC scores with and without use of patient preparatory tool (intervention group).

Additional file 4. Baseline characteristics informal caregivers.

Additional file 4.

Background: White matter (WM) lesions and brain atrophy are present early in multiple sclerosis (MS). However, their spatio-temporal relationship remains unclear. Methods: Yearly magnetic resonance images were analysed in 387 patients with a first clinical demyelinating event (FCDE) from the 5-year REFLEXION study. Patients received early (from baseline; N = 258; ET) or delayed treatment (from month-24; N = 129; DT) with subcutaneous interferon beta-1a. FSL-SIENA/VIENA were used to provide yearly percentage volume change of brain (PBVC) and ventricles (PVVC). Yearly total lesion volume change (TLVC) was determined by a semi-automated method. Using linear mixed models and voxel-wise analyses, we firstly investigated the overall relationship between TLVC and PBVC and between TLVC and PVVC in the same follow-up period. Analyses were then separately performed for: the untreated period of DT patients (first two years), the first year of treatment (year 1 for ET and year 3 for DT), and a period where patients had received at least 1 year of treatment (stable treatment; ET: years 2, 3, 4, and 5; DT: years 4 and 5). Results: Whole brain: across the whole study period, lower TLVC was related to faster atrophy (PBVC: B = 0.046, SE = 0.013, p < 0.001; PVVC: B = −0.466, SE = 0.118, p < 0.001). Within the untreated period of DT patients, lower TLVC was related to faster atrophy (PBVC: B = 0.072, SE = 0.029, p = 0.013; PVVC: B = −0.917, SE = 0.306, p = 0.003). A similar relationship was found within the first year of treatment of ET patients (PBVC: B = 0.081, SE = 0.027, p = 0.003; PVVC: B = −1.08, SE = 0.284, p < 0.001), consistent with resolving oedema and pseudo-atrophy. Voxel-wise: overall, higher TLVC was related to faster ventricular enlargement. Lower TLVC was related to faster widespread atrophy in year 1 in both ET (first year of treatment) and DT (untreated) patients. In the second untreated year of DT patients and within the stable treatment period of ET patients (year 4), faster periventricular and occipital lobe atrophy was associated with higher TLVC. Conclusions: WM lesion changes and atrophy occurred simultaneously in early MS. Spatio-temporal correspondence of these two processes involved mostly the periventricular area. Within the first year of the study, in both treatment groups, faster atrophy was linked to lower lesion volume changes, consistent with higher shrinking and disappearing lesion activity. This might reflect the pseudo-atrophy phenomenon that is probably related to the therapy driven (only in ET patients, as they received treatment from baseline) and “natural” (both ET and DT patients entered the study after a FCDE) resolution of oedema. In an untreated period and later on during stable treatment, (real) atrophy was related to higher lesion volume changes, consistent with increased new and enlarging lesion activity.

Additional file 7. Observer OPTIONMCC scores for geriatricians, patients and informal caregivers (subgroup analysis of eight geriatricians).

Additional file 3. Adapted control preference scale.

Additional file 1. Patient preparatory tool.

Additional file 5. Evaluation of use of the patient preparatory tool in the intervention group (n = 108).

Additional file 3.

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

Additional file 5.

Additional file 2.

Because missing data are present in almost every study, it is important to handle missing data properly. First of all, the missing data mechanism should be considered. Missing data can be either completely at random (MCAR), at random (MAR), or not at random (MNAR). When missing data are MCAR, a complete case analysis can be valid. Also when missing data are MAR, in some situations a complete case analysis leads to valid results. However, in most situations, missing data imputation should be used. Regarding imputation methods, it is highly advised to use multiple imputations because multiple imputations lead to valid estimates including the uncertainty about the imputed values. When missing data are MNAR, also multiple imputations do not lead to valid results. A complication hereby is that it not possible to distinguish whether missing data are MAR or MNAR. Finally, it should be realized that preventing to have missing data is always better than the treatment of missing data.

OBJECTIVE: Depression among older adults predicts mortality after acute hospitalization. Depression is highly heterogeneous in its presentation of symptoms, whereas individual symptoms may differ in predictive value. This study aimed to investigate the prevalence of individual cognitive-affective depressive symptoms during acute hospitalization and investigate the predictive value of both overall and individual cognitive-affective depressive symptoms for mortality between admission up to 3-month postdischarge among older patients.METHODS: A prospective multicenter cohort study enrolled 401 acutely hospitalized patients 70 years and older (Hospitalization-Associated Disability and impact on daily Life Study). The predictive value of depressive symptoms, assessed using the Geriatric Depression Scale 15, during acute hospitalization on mortality was analyzed with multiple logistic regression.RESULTS: The analytic sample included 398 patients (M (SD) = 79.6 (6.6) years; 51% men). Results showed that 9.3% of participants died within 3 months, with symptoms of apathy being most frequently reported. The depression total score during hospitalization was associated with increased mortality risk (admission: odds ratio [OR] = 1.2, 95% confidence interval [CI] = 1.2-1.3; discharge: OR = 1.2, 95% CI = 1.2-1.4). Stepwise multiple logistic regression analyses yielded the finding that feelings of hopelessness during acute hospitalization were a strong unique predictor of mortality (admission: OR = 3.6, 95% CI = 1.8-7.4; discharge: OR = 5.7, 95% CI = 2.5-13.1). These associations were robust to adjustment for demographic factors, somatic symptoms, and medical comorbidities.CONCLUSIONS: Symptoms of apathy were most frequently reported in response to acute hospitalization. However, feelings of hopelessness about their situation were the strongest cognitive-affective predictor of mortality. These results imply that this item is important in identifying patients who are in the last phase of their lives and for whom palliative care may be important.

Objective: Intrathecal baclofen treatment is used for the treatment of dystonia in patients with severe dyskinetic cerebral palsy; however, the current level of evidence for the effect is low. The primary aim of this study was to provide evidence for the effect of intrathecal baclofen treatment on individual goals in patients with severe dyskinetic cerebral palsy. Methods: This multicenter, randomized, double-blind, placebo-controlled trial was performed at 2 university medical centers in the Netherlands. Patients with severe dyskinetic cerebral palsy (Gross Motor Functioning Classification System level IV–V) aged 4 to 24 years who were eligible for intrathecal baclofen were included. Patients were assigned by block randomization (2:2) for treatment with intrathecal baclofen or placebo for 3 months via an implanted microinfusion pump. The primary outcome was goal attainment scaling of individual treatment goals (GAS T score). A linear regression model was used for statistical analysis with study site as a covariate. Safety analyses were done for number and type of (serious) adverse events. Results: Thirty-six patients were recruited from January 1, 2013, to March 31, 2018. Data for final analysis were available for 17 patients in the intrathecal baclofen group and 16 in the placebo group. Mean (standard deviation) GAS T score at 3 months was 38.9 (13.2) for intrathecal baclofen and 21.0 (4.6) for placebo (regression coefficient = 17.8, 95% confidence interval = 10.4-25.0, p < 0.001). Number and types of (serious) adverse events were similar between groups. Interpretation: Intrathecal baclofen treatment is superior to placebo in achieving treatment goals in patients with severe dyskinetic cerebral palsy. ANN NEUROL 2019.

Supplemental material, sj-docx-4-heb-10.1177_10901981211046533 for How to Evaluate the Effectiveness of Health Promotion Actions Developed Through Youth-Centered Participatory Action Research by Manou Anselma, Teatske M. Altenburg, Jos W. R. Twisk, dr. Xinhui Wang and Mai J. M. Chinapaw in Health Education & Behavior

Additional file 1. Hypothetical data example to illustrate the noncollapsibility effect.

Supplemental material, sj-docx-1-heb-10.1177_10901981211046533 for How to Evaluate the Effectiveness of Health Promotion Actions Developed Through Youth-Centered Participatory Action Research by Manou Anselma, Teatske M. Altenburg, Jos W. R. Twisk, dr. Xinhui Wang and Mai J. M. Chinapaw in Health Education & Behavior

Supplemental material, sj-docx-1-heb-10.1177_10901981211046533 for How to Evaluate the Effectiveness of Health Promotion Actions Developed Through Youth-Centered Participatory Action Research by Manou Anselma, Teatske M. Altenburg, Jos W. R. Twisk, dr. Xinhui Wang and Mai J. M. Chinapaw in Health Education & Behavior

Supplemental material, sj-docx-3-heb-10.1177_10901981211046533 for How to Evaluate the Effectiveness of Health Promotion Actions Developed Through Youth-Centered Participatory Action Research by Manou Anselma, Teatske M. Altenburg, Jos W. R. Twisk, dr. Xinhui Wang and Mai J. M. Chinapaw in Health Education & Behavior

Additional file 3: Supplementary appendix 3. List of papers included in the scoping review.

Supplemental material, sj-docx-3-heb-10.1177_10901981211046533 for How to Evaluate the Effectiveness of Health Promotion Actions Developed Through Youth-Centered Participatory Action Research by Manou Anselma, Teatske M. Altenburg, Jos W. R. Twisk, dr. Xinhui Wang and Mai J. M. Chinapaw in Health Education & Behavior

Supplemental material, sj-docx-2-heb-10.1177_10901981211046533 for How to Evaluate the Effectiveness of Health Promotion Actions Developed Through Youth-Centered Participatory Action Research by Manou Anselma, Teatske M. Altenburg, Jos W. R. Twisk, dr. Xinhui Wang and Mai J. M. Chinapaw in Health Education & Behavior

Supplemental material, sj-docx-4-heb-10.1177_10901981211046533 for How to Evaluate the Effectiveness of Health Promotion Actions Developed Through Youth-Centered Participatory Action Research by Manou Anselma, Teatske M. Altenburg, Jos W. R. Twisk, dr. Xinhui Wang and Mai J. M. Chinapaw in Health Education & Behavior

Additional file 1: Supplementary appendix 1. PRISMA-ScR checklist.

Supplemental material, sj-docx-2-heb-10.1177_10901981211046533 for How to Evaluate the Effectiveness of Health Promotion Actions Developed Through Youth-Centered Participatory Action Research by Manou Anselma, Teatske M. Altenburg, Jos W. R. Twisk, dr. Xinhui Wang and Mai J. M. Chinapaw in Health Education & Behavior

Supplemental material, Supplementary_Material for Is Resting-State EEG Longitudinally Associated With Recovery of Clinical Neurological Impairments Early Poststroke? A Prospective Cohort Study by Mique Saes, Sarah B. Zandvliet, Aukje S. Andringa, Andreas Daffertshofer, Jos W. R. Twisk, Carel G. M. Meskers, Erwin E. H. van Wegen and Gert Kwakkel in Neurorehabilitation and Neural Repair

Additional file 1. Cognitive Failure Questionnaire (CFQ).

OBJECTIVE. We investigated whether demographic, disease-related, or personal baseline determinants can predict a positive response to energy conservation management (ECM). METHOD. We conducted a secondary analysis of a single-blind, two-parallel-arms randomized controlled trial that included ambulatory adults with severe MS-related fatigue. Therapy responders and nonresponders were categorized by Checklist Individual Strength fatigue change scores between baseline and end of treatment. Logistic regression analyses were used to assess the determinants of response. RESULTS. Sixty-nine participants were included (ECM group, n = 34; control group, n = 35). In the ECM group, fatigue severity, perception of fatigue, illness cognitions about MS, and social support discrepancies were related to the probability of being a responder. CONCLUSION. The results suggest that people with MS-related fatigue who had a less negative perception of fatigue and who perceived fewer disease benefits and a higher discrepancy in social support had the best response to ECM treatment.

OBJECTIVES: To investigate the accuracy and reliability of 3-dimensional (3D) transvaginal sonography in classifying submucous fibroids using the International Federation of Gynecology and Obstetrics PALM-COEIN (polyp, adenomyosis, leiomyoma, malignancy and hyperplasia, coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, and not yet classified) classification and protrusion (percent) compared to 2-dimensional (2D) transvaginal sonography, 2D saline infusion sonography, and 3D saline infusion sonography, using hysteroscopy as a reference test.METHODS: A prospective cohort pilot study was performed among 14 consecutive patients undergoing hysteroscopic surgery, preceded by routine sonography (2D transvaginal sonography, 2D saline infusion sonography, 3D transvaginal sonography, and 3D saline infusion sonography).RESULTS: The intraclass correlation coefficient (ICC) for 2D transvaginal sonography versus hysteroscopy was 0.69 (95% confidence interval [CI], 0.06, 0.90) compared to 0.94 (95% CI, 0.83, 0.98) for 2D saline infusion sonography. The ICCs for 3D transvaginal sonography versus hysteroscopy were 0.69 (95% CI, 0.03, 0.90 [investigator A]) and 0.55 (95% CI, -0.48, 0.86 [investigator B]). The ICCs for 3D saline infusion sonography versus hysteroscopy were 0.94 (95% CI, 0.81, 0.98 [investigator A]) and 0.87 (95% CI, 0.60, 0.96 [investigator B]). Interobserver agreement of 3D transvaginal sonography was 0.81 (95% CI, 0.43, 0.94) compared to 0.86 (95% CI, 0.56, 0.96) for 3D saline infusion sonography.CONCLUSIONS: In these preliminary data, 3D transvaginal sonography was not as accurate as 2D or 3D saline infusion sonography and was not more accurate than 2D transvaginal sonography. There was moderate interobserver agreement for 3D transvaginal sonography. There might be room for improvement, as 3D transvaginal sonography is more accurate when endometrial thickness increases. Further study is warranted to evaluate in which patients saline infusion sonography eventually can be obviated.

Grey matter (GM) atrophy is a prominent aspect of multiple sclerosis pathology and an important outcome in studies. GM atrophy measurement requires accurate GM segmentation. Several methods are used in vivo for measuring GM volumes in MS, but assessing their validity in vivo remains challenging. In this postmortem study, we evaluated the correlation between postmortem MRI cortical volume or thickness and the cortical thickness measured on histological sections. Sixteen MS brains were scanned in situ using 3DT1-weighted MRI and these images were used to measure regional cortical volume using FSL-SIENAX, FreeSurfer, and SPM, and regional cortical thickness using FreeSurfer. Subsequently, cortical thickness was measured histologically in 5 systematically sampled cortical areas. Linear regression analyses were used to evaluate the relation between MRI regional cortical volume or thickness and histological cortical thickness to determine which postprocessing technique was most valid. After correction for multiple comparisons, we observed a significant correlation with the histological cortical thickness for FSL-SIENAX cortical volume with manual editing (std. β = 0.345, adjusted R(2) = 0.105, P = 0.005), and FreeSurfer cortical volume with manual editing (std. β = 0.379, adjusted R(2) = 0.129, P = 0.003). In addition, there was a significant correlation between FreeSurfer cortical thickness with manual editing and histological cortical thickness (std. β = 0.381, adjusted R(2) = 0.130, P = 0.003). The results support the use of FSL-SIENAX and FreeSurfer in cases of severe MS pathology. Interestingly none of the methods were significant in automated mode, which supports the use of manual editing to improve the automated segmentation. Hum Brain Mapp 37:2223-2233, 2016. © 2016 Wiley Periodicals, Inc.

Aim: This study aimed to determine the developmental trajectories of social participation, by level of gross motor function and intellectual disability, in a Dutch population of individuals with cerebral palsy (CP) aged 1 to 24 years. Method: As part of the Pediatric Rehabilitation Research in the Netherlands (PERRIN+), 424 individuals with CP (261 males, 163 females; mean age [SD] 9y 6mo [6y 2mo]; Gross Motor Function Classification [GMFCS] levels I-V [50% level I]; 87% with spastic CP; 26% with intellectual disability) were longitudinally followed for up to 4 years between 2002 and 2007. Social participation was assessed with the Vineland Adaptive Behavior Scales survey. Effects of age, GMFCS level and intellectual disability were analysed using multilevel modelling. Results: The developmental trajectories for individuals in GMFCS levels I to IV did not significantly differ from each other. For individuals without intellectual disability, the degree of social participation increased with age and stabilized at about 18 years. These individuals reached social participation levels similar to typically developing individuals. The trajectories were significantly less favourable for individuals in GMFCS level V and individuals with intellectual disability. Interpretation: Intellectual disability is more distinctive for the development of social participation than GMFCS level. The developmental trajectories will support individuals with CP and their families in setting realistic goals and professionals in optimizing the choice of interventions at an early age.

Aim This study aimed to determine the developmental trajectories of social participation, by level of gross motor function and intellectual disability, in a Dutch population of individuals with cerebral palsy (CP) aged 1 to 24 years. Method As part of the Pediatric Rehabilitation Research in the Netherlands (PERRIN+), 424 individuals with CP (261 males, 163 females; mean age [SD] 9y 6mo [6y 2mo]; Gross Motor Function Classification [GMFCS] levels I–V [50% level I]; 87% with spastic CP; 26% with intellectual disability) were longitudinally followed for up to 4 years between 2002 and 2007. Social participation was assessed with the Vineland Adaptive Behavior Scales survey. Effects of age, GMFCS level and intellectual disability were analysed using multilevel modelling. Results The developmental trajectories for individuals in GMFCS levels I to IV did not significantly differ from each other. For individuals without intellectual disability, the degree of social participation increased with age and stabilized at about 18 years. These individuals reached social participation levels similar to typically developing individuals. The trajectories were significantly less favourable for individuals in GMFCS level V and individuals with intellectual disability. Interpretation Intellectual disability is more distinctive for the development of social participation than GMFCS level. The developmental trajectories will support individuals with CP and their families in setting realistic goals and professionals in optimizing the choice of interventions at an early age.

The Amsterdam Growth and Health Longitudinal Study (AGHLS) is a unique, multidisciplinary cohortstudy that was initially set up to examine growth and health among teenagers. Throughout the years, the AGHLS has aimed to answer research questions dealing with the relationships between the (natural) development of anthropometry, lifestyle and health from adolescence into adulthood. The AGHLS specifically focuses on anthropometrics, physical activity and fitness, cardiovascular disease risk, lifestyle, musculoskeletal health, psychological health and well-being. Besides this, many methodological issues related to the analysis of longitudinal data were also explored within the framework of the AGHLS. In 1976, students from two secondary schools from the greater Amsterdam area were included in the study. Between 1976 and 2006, 10 rounds of measurement were performed covering an age range between 13 and 43 years. The huge database collected so far has been primarily used to answer relevant research questions regarding the longitudinal relationship between lifestyle and health. Further informationabout the study can be obtained from the principal investigator Jos Twisk (jwr.twisk@vumc.nl), and up-to-date information on AGHLS can be found by visiting the website www.aggo.nl. © The Author 2012; all rights reserved.

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

Musculoskeletal complaints (MSC) are common among children, often persist into adolescence, and increase the risk of MSC in adulthood. Knowledge regarding determinants of MSC among children is limited. The aim of this study was to determine the prevalence of MSC at age 11 years and to examine associations with sociodemographic factors, growth and development factors, mental health, tiredness, and lifestyle. Data from a Netherlands birth cohort study, the Prevention and Incidence of Asthma and Mite Allergy (PIAMA) Study (n = 2,638), were used (1996-2009). MSC were defined as complaints about the back, an upper extremity, a lower extremity, or any of these sites. Logistic regression analyses using a forward stepwise procedure were performed on multiply imputed data. The 1-year period prevalences of back, upper extremity, and lower extremity complaints that lasted at least 1 month were 2.8%, 4.8%, and 10.9%, respectively. Only poorer mental health was consistently associated with all 3 types of complaints. Poorer mental health, daytime tiredness, early pubertal development, being physically active at age 11 years, and weight-for-height z score were associated with having any MSC. This study showed that MSC, especially lower extremity complaints, are common among 11-year old-children and that only poorer mental health status is associated with MSC at all anatomic sites.

Carotid-femoral pulse wave velocity (PWV), a direct measure of aortic stiffness, has become increasingly important for total cardiovascular (CV) risk estimation. Its application as a routine tool for clinical patient evaluation has been hampered by the absence of reference values. The aim of the present study is to establish reference and normal values for PWV based on a large European population. We gathered data from 16 867 subjects and patients from 13 different centres across eight European countries, in which PWV and basic clinical parameters were measured. Of these, 11 092 individuals were free from overt CV disease, non-diabetic and untreated by either anti-hypertensive or lipid-lowering drugs and constituted the reference value population, of which the subset with optimal/normal blood pressures (BPs) (n = 1455) is the normal value population. Prior to data pooling, PWV values were converted to a common standard using established conversion formulae. Subjects were categorized by age decade and further subdivided according to BP categories. Pulse wave velocity increased with age and BP category; the increase with age being more pronounced for higher BP categories and the increase with BP being more important for older subjects. The distribution of PWV with age and BP category is described and reference values for PWV are established. Normal values are proposed based on the PWV values observed in the non-hypertensive subpopulation who had no additional CV risk factors. The present study is the first to establish reference and normal values for PWV, combining a sizeable European population after standardizing results for different methods of PWV measurement.

Objectives Recently, a rule was developed to predict sick leave related to shoulder pain during a period of 6 months after patients have consulted a general practitioner for a new episode of shoulder pain. The objective was to evaluate the generalizability of this prediction rule by testing it in two other populations of workers who had gone for a consultation in primary care for a new episode of shoulder pain. Methods The prediction rule was derived in a prognostic cohort study (N=350). The outcome was sick leave related to shoulder pain during 6 months following the first consultation. The rule was tested on merged control groups from three trials on shoulder pain (N=128). In addition to this population, a recently conducted study on musculoskeletal disorders (N=224) was used to validate the prediction rule. The generalizability of the prediction rule was tested by studying calibration and discrimination in the validation cohorts. Results The prediction rule showed reasonable calibration in both validation cohorts. The discriminative ability, with an area under the receiver operating characteristic (ROC) curve (AUC) of 0.70 in the derivation cohort was stable in the cohort of the musculoskeletal disorder study (AUC 0.71). In the control groups of the three randomized controlled trials of a Dutch shoulder study, the discriminative ability decreased to an AUC of 0.66. Conclusions The prediction rule for sick leave related to shoulder pain in a 6-month period following the first consultation in primary care showed adequate generalizability to another population of workers with shoulder pain participating in an observational cohort study. In the control groups of the three randomized controlled trials the prediction rule performed less well.

OBJECTIVE: To evaluate the effectiveness of three different training protocols on physical function of older adults living in long-term care facilities. Emphasis was placed on feasibility in real-life situations.METHODS: Subjects (N=224) were randomised to 6 months of twice weekly (1) resistance training; (2) all-round functional-skills training; (3) a combination of both; or (4) a control program. Fitness and performance measures and self-reported disability were measured at baseline and after 24 weeks intervention.RESULTS: Attendance to the strength training was 76%, to the functional-skills training 70% and to the combined training 73%. In those who attended at least 75% of all classes (n=97) the functional-skills and combined training program improved several fitness and performance measures compared to the control group.CONCLUSION: Twice weekly functional-skills training, or a combination of resistance and functional-skills training can improve several fitness and performance measures of institutionalised older people.PRACTICE IMPLICATIONS: An important finding from our study was that less than twice a week exercise training is not enough for functional improvement, while it proved difficult for the elderly subjects to exercise twice weekly. Education on the health benefits of regular exercise, and a larger availability of classes in long-term care facilities may improve attendance.