Search

Objective: This study evaluated the nationwide trends in care and accompanied postoperative outcomes for patients with distal esophageal and gastro-esophageal junction cancer., Summary of Background Data: The introduction of transthoracic esophagectomy, minimally invasive surgery, and neo-adjuvant chemo(radio)therapy changed care for patients with esophageal cancer., Methods: Patients after elective transthoracic and transhiatal esophagectomy for distal esophageal or gastroesophageal junction carcinoma in the Netherlands between 2007-2016 were included. The primary aim was to evaluate trends in both care and postoperative outcomes for the included patients. Additionally, postoperative outcomes after transthoracic and tran-shiatal esophagectomy were compared, stratified by time periods., Results: Among 4712 patients included, 74% had distal esophageal tumors and 87% had adenocarcinomas. Between 2007 and 2016, the proportion of transthoracic esophagectomy increased from 41% to 81%, and neo-adjuvant treatment and minimally invasive esophagectomy increased from 31% to 96%, and from 7% to 80%, respectively. Over this 10-year period, postoperative outcomes improved: postoperative morbidity decreased from 66.6% to 61.8% ( P = 0.001), R0 resection rate increased from 90.0% to 96.5% (P <0.001), median lymph node harvest increased from 15 to 19 ( P <0.001), and median survival increased from 35 to 41 months ( P = 0.027)., Conclusion: In this nationwide cohort, a transition towards more neo-adju-vant treatment, transthoracic esophagectomy and minimally invasive surgery was observed over a 10-year period, accompanied by decreased postoperative morbidity, improved surgical radicality and lymph node harvest, and improved survival., Competing Interests: Luyer received research grants from Galvani and Medtronic. Nieuwenhuijzen reports consulting fees and research grants from Medtronic. Rosman has received research grants from Johnson&Johnson and Medtronic. van Berge Henegouwen reports research grants from Olympus and Stryker, in addition to consulting fees from Medtronic, Alesi Surgical, Johnson&Johnson and Mylan. van Oijen has received unrestricted research grants from Bayer, Lilly, Merck Serono, Nordic, Servier, and Roche. The remaining authors have no conflict of interest to report. No funding was received for this study., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: This study investigated the patterns, predictors, and survival of recurrent disease following esophageal cancer surgery., Background: Survival of recurrent esophageal cancer is usually poor, with limited prospects of remission., Methods: This nationwide cohort study included patients with distal esophageal and gastroesophageal junction adenocarcinoma and squamous cell carcinoma after curatively intended esophagectomy in 2007 to 2016 (follow-up until January 2020). Patients with distant metastases detected during surgery were excluded. Univariable and multivariable logistic regression were used to identify predictors of recurrent disease. Multivariable Cox regression was used to determine the association of recurrence site and treatment intent with postrecurrence survival., Results: Among 4626 patients, 45.1% developed recurrent disease a median of 11 months postoperative, of whom most had solely distant metastases (59.8%). Disease recurrences were most frequently hepatic (26.2%) or pulmonary (25.1%). Factors significantly associated with disease recurrence included young age (≤65 y), male sex, adenocarcinoma, open surgery, transthoracic esophagectomy, nonradical resection, higher T-stage, and tumor positive lymph nodes. Overall, median postrecurrence survival was 4 months [95% confidence interval (95% CI): 3.6-4.4]. After curatively intended recurrence treatment, median survival was 20 months (95% CI: 16.4-23.7). Survival was more favorable after locoregional compared with distant recurrence (hazard ratio: 0.74, 95% CI: 0.65-0.84)., Conclusions: This study provides important prognostic information assisting in the surveillance and counseling of patients after curatively intended esophageal cancer surgery. Nearly half the patients developed recurrent disease, with limited prospects of survival. The risk of recurrence was higher in patients with a higher tumor stage, nonradical resection and positive lymph node harvest., Competing Interests: M.D.P.L. received research grants from Galvani and Medtronic. G.A.P.N. reports consulting fees and research grants from Medtronic. C.R. has received research grants from Johnson&Johnson and Medtronic. M.I.v.B.H. reports research grants from Olympus and Stryker, in addition to consulting fees from Medtronic, Alesi Surgical, Johnson&Johnson, and Mylan. M.G.H.v.O. has received unrestricted research grants from Bayer, Lilly, Merck Serono, Nordic, Servier, and Roche. The remaining authors report no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: To explore employees' intentions to improve lifestyle habits, investigate the health and lifestyle-related predictors of these intentions, and how it translated into behavioral improvement., Methods: Employees participating in the Activate Your Health WHPP completed a questionnaire of their demographics, health-related variables, as well as six lifestyle habits and intention to improve them., Results: At baseline (n = 2729), most employees wanted to focus on physical activity and eating habits. Many predictors were identified for each intention. Majority of intentions were associated with behavioral improvement post-program (n = 525), especially in High., Conclusions: In the context of WHPPs, intention to improve may lead to actual behavioral improvement. Exploring employees' intentions to improve various lifestyle habits at the start of the program could improve the effectiveness of these programs., Competing Interests: All the authors (TAK, FL, SL, JT, and MEM) declare a potential conflict of interest as the program is cofinanced by the Public Health Agency of Canada and Capsana. However, none of the authors work for the Public Health Agency of Canada or Capsana., (Copyright © 2021 American College of Occupational and Environmental Medicine.)

Aims: Determining prognosis following poor response to neoadjuvant chemoradiotherapy (nCRT) in oesophageal adenocarcinoma (OAC) remains challenging. An immunosuppressive tumour microenvironment (TME) as well as immune infiltrate density and composition are considered to play a critical role in the immune interaction between host and tumour and can predict therapy response and survival in many cancers, including gastrointestinal malignancies. The aim of this study was to establish the TME characteristics associated with survival following a poor response to nCRT., Methods and Results: The prognostic significance of OAC-associated CD3 + , CD4 + , CD8 + , forkhead box protein 3 (FoxP3 + ) and programmed cell death ligand 1 (PD-L1) expression was studied by immunohistochemistry and quantified by automated image analysis in 123 patients who underwent nCRT and curative resection. Results from good and poor responders were contrasted and immune infiltration was related to disease course in both groups. Subsequently a cohort of 57 patients with a moderate response to nCRT was analysed in a similar fashion. Tumour cell percentage positively correlated to immune infiltration markers. In good and moderate responders, none of the immune infiltrate parameters was associated with survival; in poor responders CD8 + was an independent negative predictor of OS in univariate analysis (P = 0.03) and high CD8 + infiltration was associated with worse OS (15 versus 32 months, P = 0.042)., Conclusion: A high CD8 + density is an independent biomarker of poor OS in poor responders to nCRT, but not in good and moderate responders. Our results suggest that patients with a poor response to nCRT but concomitant high CD8 + counts in the resection specimen require adjuvant therapy., (© 2021 John Wiley & Sons Ltd.)

Background: Workplace Health Promotion Programs (WHPP) have been shown to be an efficient way of improving workers' health. These programs can be incorporated in the worker's daily schedule and improve their productivity at work. Improving employees' health also benefits the employers by increasing their return on investment and lowering healthcare costs. The Activate Your Health program, created by Capsana in 2015, is a WHPP targeting multiple lifestyle habits for a three-year period. This WHPP includes tailored web-based interventions and the support of different health professionals throughout the years. We hypothesize that this approach will yield long-term lifestyle changes. The objective of the current paper is to describe the Activate Your Health program's design., Methods/design: Eleven companies are taking part in this WHPP and had to choose among five different options of this program and all their employees were encouraged to participate. Each option differs by the number and type of interventions included. The limited option, which is considered the control group, only consists in completing a questionnaire regarding their health status, lifestyle habits and behaviors. On the other end, the extensive option receives a combination of multiple interventions: online menus, health challenges, support in creating a healthy work environment, coaching by health professionals (nurse, nutritionist, and kinesiologist), health screening and flexibility assessment, online resources, social health platform, and activity tracking. The remaining options are in between these options and vary by the amount of intervention. Baseline data are already gathered; two other data collection periods will take place after one and 2 years into the program. The primary outcomes of the current program are physical activity and fitness measures, nutritional data, smoking habits, stress and intention to change., Discussion: The Activate Your Health program will allow us to compare which combinations of interventions are the most effective. It is expected that the extensive option will be the most advantageous to improve lifestyle habits. The results will indicate the strength and weakness of each intervention and how it could be improved., Trial Registration: Clinicaltrails.gov, registration number: NCT02933385 (updated on the 26th of March 2019, initially registered on the 5th of October 2016).

In order to reduce sedentary behaviour at work, research has examined the effectiveness of active workstations. However, despite their relevance in replacing conventional desks, the comparison between types of active workstations and their respective benefits remains unclear. The purpose of this review article is thus to compare the benefits between standing, treadmill and cycling workstations. Search criteria explored Embase, PubMed and Web of Science databases. The review included studies concerning adults using at least two types of active workstations, evaluating biomechanical, physiological work performance and/or psychobiological outcomes. Twelve original articles were included. Treadmill workstations induced greater movement/activity and greater muscular activity in the upper limbs compared with standing workstations. Treadmill and cycling workstations resulted in elevated heart rate, decreased ambulatory blood pressure and increased energy expenditure during the workday compared with standing workstations. Treadmill workstations reduced fine motor skill function (ie, typing, mouse pointing and combined keyboard/mouse tasks) compared with cycling and standing workstations. Cycling workstations resulted in improved simple processing task speeds compared with standing and treadmill workstations. Treadmill and cycling workstations increased arousal and decreased boredom compared with standing workstations. The benefits associated with each type of active workstation (eg, standing, treadmill, cycling) may not be equivalent. Overall, cycling and treadmill workstations appear to provide greater short-term physiological changes than standing workstations that could potentially lead to better health. Cycling, treadmill and standing workstations appear to show short-term productivity benefits; however, treadmill workstations can reduce the performance of computer tasks., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

The purpose of this study was to evaluate the validity of maximal velocity (Vmax) estimated from three-parameter systems models, and to compare the predictive value of two- and three-parameter models for the 800 m. Seventeen trained male subjects (VO2max=66.54+/-7.29 ml min(-1) kg(-1)) performed five randomly ordered constant velocity tests (CVT), a maximal velocity test (mean velocity over the last 10 m portion of a 40 m sprint) and a 800 m time trial (V 800 m). Five systems models (two three-parameter and three two-parameter) were used to compute V max (three-parameter models), critical velocity (CV), anaerobic running capacity (ARC) and V800m from times to exhaustion during CVT. Vmax estimates were significantly lower than (0.19