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Objective: We investigated methotrexate safety and the influence of dose on efficacy outcomes in combination with three different biologic treatments and with active conventional treatment (ACT) in early rheumatoid arthritis (RA). Methods: This post hoc analysis included 812 treatment‐naïve patients with early RA who were randomized (1:1:1:1) in the NORD‐STAR trial to receive methotrexate in combination with ACT, certolizumab‐pegol, abatacept, or tocilizumab. Methotrexate safety, doses, and dose effects on Clinical Disease Activity Index (CDAI) remission were assessed after 24 weeks of treatment. Results: Compared with ACT, the prevalence of methotrexate‐associated side effects was higher when methotrexate was combined with tocilizumab (hazard ratio [HR] 1.48, 95% confidence interval [CI] 1.20–1.84) but not with certolizumab‐pegol (HR 0.99, 95% CI 0.79–1.23) or with abatacept (HR 0.93, 95% CI 0.75–1.16). With ACT as the reference, the methotrexate dose was significantly lower when used in combination with tocilizumab (β −4.65, 95% CI −5.83 to −3.46; P < 0.001) or abatacept (β −1.15, 95% CI −2.27 to −0.03; P = 0.04), and it was numerically lower in combination with certolizumab‐pegol (β −1.07, 95% CI −2.21 to 0.07; P = 0.07). Methotrexate dose reductions were not associated with decreased CDAI remission rates within any of the treatment combinations. Conclusion: Methotrexate was generally well tolerated in combination therapies, but adverse events were a limiting factor in receiving the target dose of 25 mg/wk, and these were more frequent in combination with tocilizumab versus ACT. On the other hand, methotrexate dose reductions were not associated with decreased CDAI remission rates within any of the four treatment combinations at 24 weeks. [ABSTRACT FROM AUTHOR]

Methylphenidate (MPH) is highly efficacious in reducing symptoms of attention-deficit/hyperactivity disorder (ADHD) in children. Generally increased doses are found to result in better symptom control; however, it remains unclear whether this pattern can be observed at the individual level, given the large heterogeneity in individual dose–response relationships and observed placebo responses. A double-blind, randomized, placebo-controlled cross-over trial was used to compare weekly treatment with placebo and 5, 10, 15 and 20 mg of MPH twice daily on parent and teacher ratings of child ADHD symptoms and side effects. Participants were 5–13-year-old children with a DSM-5 diagnosis of ADHD (N = 45). MPH response was assessed at group and individual levels and predictors of individual dose–response curves were examined. Mixed model analysis showed positive linear dose–response curves at group level for parent and teacher rated ADHD symptoms and parent rated side effects, but not for teacher rated side effects. Teachers reported all dosages to improve ADHD symptoms compared to placebo, while parents only reported > 5 mg/dose as effective. At the individual level, most (73–88%) children, but not all, showed positive linear dose–response curves. Higher severity of hyperactive-impulsive symptoms and lower internalizing problems, lower weight, younger age and more positive opinions towards diagnosis and medication partly predicted steeper linear individual dose–response curves. Our study confirms that increased doses of MPH yield greater symptom control at a group level. However, large interindividual variation in the dose–response relationship was found and increased doses did not lead to greater symptom improvement for all children. This trial was registered in the Netherlands trial register (# NL8121). [ABSTRACT FROM AUTHOR]

Worrisome sexual behavior (WSB) is often described as an outcome specific to child sexual abuse (CSA). Therefore, it is highly relevant to study WSB in relation to sexual abuse, especially in very young children, as it is hard to recognize sexual abuse in children who have limited verbal capacities of disclosing. Over time, literature describing WSB following CSA has gradually broadened. However, a gap remains regarding the long-term development of WSB in children who were sexually abused during infancy or very early childhood. To our knowledge, our study is the first to examine developmentally-related sexual behavior versus sexual abuse-specific behavior longitudinally in children who were sexually abused at a very young age. In total, we examined the sexual behavior, as reported by parents of 45 children who experienced early-age sexual abuse for a period of more than five years. Overall, we found that WSB is likely to be a CSA-specific and potentially long-term outcome for children who were sexually abused at a very young age. Despite the decrease in sexual abuse-specific behavior over time, the level of this behavior was still significantly high 8 years after the sexual abuse. This finding supports long-term monitoring and assessment and intervention for WSB over time. Despite these findings, it is important to note that WSB does not serve as proof of sexual abuse in children; likewise, when a child does not present with WSB, it does not indicate the absence of a substantiated history of sexual abuse. [ABSTRACT FROM AUTHOR]

Selection for higher education (HE) programs may hinder equal opportunities for applicants and thereby reduce student diversity and representativeness. However, variables which could play a role in inequality of opportunity are often studied separately from each other. Therefore, this retrospective cohort study conducts an innovative intersectional analysis of the inequality of opportunity in admissions to selective HE programs. Using a combination of multivariable logistic regression analyses and descriptive statistics, we aimed to investigate 1) the representativeness of student populations of selective HE programs, as compared to both the applicant pool and the demographics of the age cohort; 2) the demographic background variables which are associated with an applicant's odds of admission; and 3) the intersectional acceptance rates of applicants with all, some or none of the background characteristics positively associated with odds of admission. The study focused on all selective HE programs (n = 96) in The Netherlands in 2019 and 2020, using Studielink applicant data (N = 85,839) and Statistics Netherlands microdata of ten background characteristics. The results show that student diversity in selective HE programs is limited, partly due to the widespread inequality of opportunity in the selection procedures, and partly due to self-selection. Out of all ten variables, migration background was most often (negatively) associated with the odds of receiving an offer of admission. The intersectional analyses provide detailed insight into how (dis)advantage has different effects for different groups. We therefore recommend the implementation of equitable admissions procedures which take intersectionality into account. [ABSTRACT FROM AUTHOR]

Parenting programs are effective for children with externalizing problems, but not always easily accessible for parents. In order to facilitate accessibility, we developed a self-help parenting program, consisting of a manual and online part. The efficacy of the program in reducing children's externalizing problems was compared to waitlist in a randomized controlled trial. In addition, two versions of the program were exploratively compared, one with and one without biweekly telephonic support. Candidate moderators (child and parent factors) and parental satisfaction were also examined. We randomly assigned 110 families to one of the following three conditions: the support condition, the no support condition, or the waitlist condition. Intervention duration was 15 weeks. Outcomes were collected at baseline (T0), 8 weeks (T1), 15 weeks (T2), and 28 weeks (T3) and included daily telephonic measurements of parent-rated externalizing behavior and the Intensity scale of the parent-rated Eyberg Child Behavior Inventory (ECBI). Main analyses compared outcomes at T2, using longitudinal regressions with T0 as fixed factor. Results showed that children improved significantly more on both outcomes in the intervention condition compared to waitlist, with small to medium effect sizes. Parental satisfaction was high. Neither differences in efficacy nor in parental satisfaction were found between the support and no support condition. No moderators were detected. The newly developed self-help parenting program is effective in reducing children's externalizing behavior problems and may help improve access to evidence-based care. [ABSTRACT FROM AUTHOR]

Concerns exist about the role of selection in the lack of diversity in health professions education (HPE). In The Netherlands, the gradual transition from weighted lottery to selection allowed for investigating the variables associated with HPE admission, and whether the representativeness of HPE students has changed. We designed a retrospective multi-cohort study using Statistics Netherlands microdata of all 16-year-olds on 1 October 2008, 2012, and 2015 (age cohorts, N > 600,000) and investigated whether they were eligible students for HPE programs (n > 62,000), had applied (n > 14,000), and were HPE students at age 19 (n > 7500). We used multivariable logistic regression to investigate which background variables were associated with becoming an HPE student. HPE students with ≥1 healthcare professional (HP) parent, ≥1 top-10% income/wealth parent, and women are overrepresented compared to all age cohorts. During hybrid lottery/selection (cohort-2008), applicants with ≥1 top-10% wealth parent and women had higher odds of admission. During 100% selection (cohort-2015) this remained the case. Additionally, applicants with ≥1 HP parent had higher odds, those with a migration background had lower odds. Odds of admission are increasingly influenced by applicants' backgrounds. Targeted recruitment and equitable admissions procedures are required to increase matriculation of underrepresented students. [ABSTRACT FROM AUTHOR]

Objectives To examine whether (a) as people age, accumulation of negative events increases ("sensitizing") or decreases ("steeling") the detrimental effects of subsequent events on depressive symptoms, and (b) how particular psychosocial factors are associated with the strength of these steeling or sensitizing effects. Method We used data from 6 measurement waves from 2,069 adults aged 55–84 (M = 68.0) at baseline in the Longitudinal Aging Study Amsterdam, the Netherlands. We included 18 different life events across the life course. Using hybrid multilevel models, we tested whether the effects of proximate life events (<3 years) on depressive symptoms (measured by the Center for Epidemiologic Studies Depression scale) were moderated by previous cumulative events (childhood until previous measurement wave). Additionally, we tested whether education, mastery, emotional support, neuroticism, having strong faith, and loneliness were associated with the strength of steeling/sensitizing effects. Results Cumulative and proximate life events were independently associated with more depressive symptoms. Interaction effects indicated that the more cumulative life events, the weaker the effects of recent life events, suggesting a "steeling" effect. Unexpectedly, 3-way interaction effects showed that higher mastery and lower neuroticism were associated with weaker steeling effects. These effects were predominantly attributable to within-person changes rather than to fixed between-person differences. Results from analyses with event severity scores were similar. Conclusions As a population, older adults appear to become more resilient against new stressors as they accumulate experience in dealing with negative life events. Findings on mastery tentatively suggest that accepting limits to one's own control over life circumstances may foster a steeling effect. [ABSTRACT FROM AUTHOR]

Purpose This study investigated the effects of psychosocial working conditions on mental health-related long-term sickness absence and whether distress, work satisfaction, burnout, engagement, and work ability mediated the associations between psychosocial working conditions and mental health-related long-term sickness absence. Methods This cohort study included 53,833 non-sick listed workers who participated in occupational health surveys between 2010 and 2013. The effects of the individual psychosocial working conditions on mental long-term sickness absence were analyzed using univariable and multivariable logistic regression analyses. Mediation analyses were performed to examine the mediating role of distress, burnout, work satisfaction, engagement, and work ability between psychosocial working conditions and mental long-term sickness absence. The mediation analyses were performed using structural equation modeling. Results Role clarity, cognitive demands, emotional demands, work variety, learning opportunities, and co-worker support were related to mental health-related long-term sickness absence after adjustment for other working conditions. The relationship between emotional demands and mental health-related long-term sickness absence was the strongest, OR 1.304 (p < 0.001, 95% CI 1.135 to 1.498). The relation between psychosocial working conditions and mental health-related long-term sickness absence was mediated by distress, burnout, work satisfaction, engagement, and work ability. Distress was the most important mediator between psychosocial working conditions and mental health-related long-term sickness absence. Conclusions Psychosocial working conditions are related to mental health-related long-term sickness absence. After correction for other working conditions, the association between emotional demands and mental health-related long-term sickness absence was the strongest. Psychosocial working conditions are indirectly related to mental health-related long-term sickness absence through mediation by distress, work satisfaction, and work ability. [ABSTRACT FROM AUTHOR]

Background: Psychosocial work characteristics are associated with all-cause long-term sickness absence (LTSA). Aims: This study investigated whether psychosocial work characteristics such as higher workload, faster pace of work, less variety in work, lack of performance feedback, and lack of supervisor support are prospectively associated with higher LTSA due to mental disorders. Methods: Cohort study including 4877 workers employed in the distribution and transport sector in The Netherlands. Psychosocial work characteristics were included in a logistic regression model estimating the odds ratios (OR) and 95% confidence intervals (CI) of mental LTSA during 2-year follow-up. The ability of the regression model to discriminate between workers with and without mental LTSA was investigated with the area under the receiver operating characteristic curve (AUC). Results: Tow thousand seven hundred and eighty-two (57%) workers were included in the analysis; 73 (3%) had mental LTSA. Feedback about one's performance (OR = 0.82; 95% CI 0.70–0.96) was associated with mental LTSA. A prediction model including psychosocial work characteristics poorly discriminated (AUC = 0.65; 95% CI 0.56–0.74) between workers with and without mental LTSA. Conclusions: Feedback about one's performance is associated with lower rates of mental LTSA, but it is not useful to measure psychosocial work characteristics to identify workers at risk of mental LTSA. [ABSTRACT FROM AUTHOR]

Purpose: To determine childhood predictors of participation in domestic life and interpersonal relationships of young adults with cerebral palsy (CP). Materials and methods: This 13-year follow-up of an existing cohort (baseline age 9–13 years) included 67 young adults with CP (age 21–27 years). The Vineland adaptive behavior scales (VABS) and Life Habits questionnaire were used to assess attendance and difficulty in participation in domestic life and interpersonal relationships. Baseline factors were categorised according to the international classification of functioning, disability, and health. Stepwise multiple linear regression analyses determined significant predictors (p < 0.05). Results: Lower manual ability, intellectual disability (ID), epilepsy and lower motor capacity predicted decreased future participation in domestic life, and/or interpersonal relationships (explained variance R2 = 67–87%), whereas no association was found with environmental and personal factors. Extending models with baseline fine motor skills, communication, and interpersonal relationships increased R2 to 79–90%. Conclusions: Childhood factors account for 79–90% of the variation in young adult participation in domestic life and interpersonal relationships of individuals with CP. Children with limited motor capacity, low manual ability, ID, or epilepsy are at risk for restrictions in participation in young adulthood. Addressing fine motor, communication, and social skills in paediatric rehabilitation might promote young adult participation. Childhood risk factors for limited participation in domestic life and interpersonal relationships as a young adult with CP are ID, epilepsy, low manual ability, low motor capacity, and low activity & participation levels. In line with current practice, this study confirms the importance of addressing gross and fine motor skills in children with CP for their future participation in domestic life. In addition, results suggest that addressing communication and social skills during paediatric rehabilitation may optimise future participation in interpersonal relationships. [ABSTRACT FROM AUTHOR]

Objectives To study (i) the association of general self-efficacy (GSE) on the course of subjective (i.e. basic and instrumental activities of daily living (ADLs and IADLs) and objective physical performance outcomes (short physical performance battery (SPPB)) among older persons from discharge up to 3 months post-discharge and (ii) the extent to whether motivational factors such as depressive symptoms, apathy and fatigue mediate this association. Methods Prospective multi-centre cohort of acutely hospitalised patients aged ≥70 (Hospital-ADL study). Structural equation modelling was used to analyse the structural relationships. Results The analytic sample included 236 acutely hospitalised patients. GSE had a significant total effect on the course of subjective and objective performance outcomes (ADLs: β  = −0.21, P  < 0.001, IADLs: β  = −0.24, P  < 0.001 and SPPB: β  = 0.17, P  < 0.001). However, when motivational factors as mediator were included into the same model, motivational factors (IADLs: β  = 0.51, P  < 0.001; SPPB: β  = 0.49, P  < 0.001) but not GSE remained significantly associated with IADLs (β  = −0.06, P  = 0.16) and SPPB (β  = 0.002, P  = 0.97). Motivational factors partially mediated the relationship between GSE and ADLs (β  = −0.09, P  = 0.04). The percentage of mediation was 55, 74 and 99% for ADLs, IADLs and SPPB, respectively. Conclusions Motivational factors and GSE are both associated with subjective and objective performance outcomes. However, the relationship between GSE and subjective and objective performance outcomes was highly mediated by motivational factors. Taken together, this suggests that GSE is important to being physically active but not sufficient to becoming more physical active in acutely hospitalised older patients; motivation is important to improving both subjective and objective performance. [ABSTRACT FROM AUTHOR]

Purpose This study investigated if and how occupational health survey variables can be used to identify workers at risk of long-term sickness absence (LTSA) due to mental disorders. Methods Cohort study including 53,833 non-sicklisted participants in occupational health surveys between 2010 and 2013. Twenty-seven survey variables were included in a backward stepwise logistic regression analysis with mental LTSA at 1-year follow-up as outcome variable. The same variables were also used for decision tree analysis. Discrimination between participants with and without mental LTSA during follow-up was investigated by using the area under the receiver operating characteristic curve (AUC); the AUC was internally validated in 100 bootstrap samples. Results 30,857 (57%) participants had complete data for analysis; 450 (1.5%) participants had mental LTSA during follow-up. Discrimination by an 11-predictor logistic regression model (gender, marital status, economic sector, years employed at the company, role clarity, cognitive demands, learning opportunities, co-worker support, social support from family/friends, work satisfaction, and distress) was AUC = 0.713 (95% CI 0.692–0.732). A 3-node decision tree (distress, gender, work satisfaction, and work pace) also discriminated between participants with and without mental LTSA at follow-up (AUC = 0.709; 95% CI 0.615–0.804). Conclusions An 11-predictor regression model and a 3-node decision tree equally well identified workers at risk of mental LTSA. The decision tree provides better insight into the mental LTSA risk groups and is easier to use in occupational health care practice. [ABSTRACT FROM AUTHOR]

Objective This study determined if partial sick leave was associated with a shorter duration of sick leave due to musculoskeletal disorders (MSD) based on routinely collected health data in Dutch sick-listed employees. Furthermore, the effect of timing of partial sick leave on sick leave duration was determined. Methods This cohort study consisted of 771 employees with partial sick leave and 198 employees with full-time sick leave who participated in an occupational health check, and had sick leave due to MSD for minimally 4 weeks and were diagnosed by an occupational physician. Multivariable linear regression models were performed to determine the effects of partial sick leave (unadjusted and adjusted for confounders and MSD diagnosis) and Kaplan–Meier curves were presented for visualization of return to work for different timings of starting partial sick leave. Furthermore, linear regression analysis were done in subsets of employees with different minimal durations of sick leave to estimate the effects of timing of partial sick leave. Results Initial results suggest that partial sick leave was associated with longer sick leave duration, also when adjusted for confounders and sick leave diagnosis. Secondary results which accounted for the timing of partial sick leave suggest that partial sick leave had no effect on the duration of sick leave. Conclusion Partial sick leave does not influence MSD sick leave duration in this study when accounting for the timing of partial sick leave. [ABSTRACT FROM AUTHOR]

Background A high protein intake in early life is associated with a risk of obesity later in life. The essential amino acid requirements of formula-fed infants have been reassessed recently, enabling a reduction in total protein content and thus in protein intake. Objectives We aimed to assess the safety of an infant formula with a modified amino acid profile and a modified low-protein (mLP) content in healthy term-born infants. Outcomes were compared with a specifically designed control (CTRL) infant formula. Methods In this double-blind, randomized controlled equivalence trial, infants received either mLP (1.7 g protein/100 kcal; n  = 90) or CTRL formula (2.1 g protein/100 kcal; n  = 88) from enrollment (age ≤ 45 d) to 6 mo of age. A breastfed group served as a reference (n  = 67). Anthropometry and body composition were determined at baseline, 17 wk (including safety blood parameters), and 6 mo of age. The primary outcome was daily weight gain from enrollment up until the age of 17 wk (at an equivalence margin of ±3.0 g/d). Results Weight gain from baseline (mean ± SD age: 31 ± 9 d) up to the age of 17 wk was equivalent between the mLP and CTRL formula groups (27.9 and 28.8 g/d, respectively; difference: −0.86 g/d; 90% CI: −2.36, 0.63 g/d). No differences in other growth parameters, body composition, or in adverse events were observed. Urea was significantly lower in the mLP formula group than in the CTRL formula group (−0.74 mmol/L; 95% CI: −0.97, −0.51 mmol/L; P  < 0.001). Growth rates, fat mass, fat-free mass, and several essential amino acids were significantly higher in both formula groups than in the breastfed reference group. Conclusions Feeding an infant formula with a modified amino acid profile and a lower protein content from an average age of 1 mo until the age of 6 mo is safe and supports an adequate growth, similar to that of infants consuming CTRL formula. This trial was registered at www.trialregister.nl as Trial NL4677. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effectiveness of the WhiteTeeth mobile app, a theory‐based mobile health (mHealth) program for promoting oral hygiene in adolescent orthodontic patients. Methods: In this parallel randomized controlled trial, the data of 132 adolescents were collected during three orthodontic check‐ups: at baseline (T0), at 6‐week follow‐up (T1) and at 12‐week follow‐up (T2). The intervention group was given access to the WhiteTeeth app in addition to usual care (n = 67). The control group received usual care only (n = 65). The oral hygiene outcomes were the presence and the amount of dental plaque (Al‐Anezi and Harradine plaque index), and the total number of sites with gingival bleeding (Bleeding on Marginal Probing Index). Oral health behaviour and its psychosocial factors were measured through a digital questionnaire. We performed linear mixed‐model analyses to determine the intervention effects. Results: At 6‐week follow‐up, the intervention led to a significant decrease in gingival bleeding (B = −3.74; 95% CI −6.84 to −0.65) and an increase in the use of fluoride mouth rinse (B = 1.93; 95% CI 0.36 to 3.50). At 12‐week follow‐up, dental plaque accumulation (B = −11.32; 95% CI −20.57 to −2.07) and the number of sites covered with plaque (B = −6.77; 95% CI −11.67 to −1.87) had been reduced significantly more in the intervention group than in the control group. Conclusions: The results show that adolescents with fixed orthodontic appliances can be helped to improve their oral hygiene when usual care is combined with a mobile app that provides oral health education and automatic coaching. Netherlands Trial Registry Identifier: NTR6206: 20 February 2017. [ABSTRACT FROM AUTHOR]

Purpose The aim of this study was to develop prediction models to determine the risk of sick leave due to musculoskeletal disorders (MSD) in non-sick listed employees and to compare models for short-term (i.e., 3 months) and long-term (i.e., 12 months) predictions. Methods Cohort study including 49,158 Dutch employees who participated in occupational health checks between 2009 and 2015 and sick leave data recorded during 12 months follow-up. Prediction models for MSD sick leave within 3 and 12 months after the health check were developed with logistic regression analysis using routinely assessed health check variables. The performance of the prediction models was evaluated with explained variance (Nagelkerke's R-square), calibration (Hosmer–Lemeshow test) and discrimination (area under the receiver operating characteristic curve, AUC) measures. Results A total of 376 (0.8%) and 1193 (2.4%) employees had MSD sick leave within 3 and 12 months after the health check. The prediction models included similar predictor variables (educational level, musculoskeletal complaints, distress, supervisor social support, work-home interference, intrinsic motivation, development opportunities, and work pace). The explained variances were 7.6% and 8.8% for the model with 3 and 12 months follow-up, respectively. Both prediction models showed adequate calibration and discriminated between employees with and without MSD sick leave 3 months (AUC = 0.761; Interquartile range [IQR] 0.759–0.763) and 12 months (AUC = 0.740; IQR 0.738–0.741) after the health check. Conclusion The prediction models could be used to determine the risk of MSD sick leave in non-sick listed employees and invite them to preventive consultations with occupational health providers. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

This study intended to investigate the capability of the 4 test items “sprint”, “agility”, “speed while dribbling” and “throwing a ball” of the Dutch perceptuo-motor skills assessment used at the age of 7–10 years to predict table tennis performance (U13, U15 and U18) in an observational study. Data of 1191 young table tennis players, collected from 1998 to 2013, were analysed in univariable and multivariable logistic and linear regression models. The test items “sprint” and “throwing a ball” showed to be significant predictors for table tennis performance outcomes in boys (P < 0.05). For girls, besides these test items also “speed while dribbling” had a significant contribution (P < 0.05). Since the accuracies of the models were low, it is advised to include other determinants to enhance the predictive value of a model for table tennis performance. Nevertheless, it can be concluded that a perceptuo-motor skills assessment might improve the effectiveness of talent programmes in table tennis as an additional method to objectively estimate a youth players’ potential. Future research focusing on the inclusion of test items specifically assessing eye hand coordination and other domains, for example, the psychological and the environmental domain, related to table tennis performance are recommended. [ABSTRACT FROM AUTHOR]

Background: Medically unexplained physical symptoms (MUPS) are highly prevalent and may affect work functioning. In this study we aimed to assess the longitudinal association between MUPS and work functioning over 2 years and the influence of job characteristics and depressive and anxiety disorders on this association. Methods: We assessed the longitudinal association between MUPS and work functioning, operationalized in terms of absenteeism and disability at work, in 1887 working participants from the Netherlands Study of Depression and Anxiety (NESDA). The NESDA study population included participants with a current depressive and/or anxiety disorder, participants with a lifetime risk and/or subthreshold symptoms and healthy controls. Absenteeism was assessed with the Health and Labour Questionnaire Short Form and disability with the World Health Organization Disability Assessment Schedule II. MUPS were measured with the Four Dimensional Symptom Questionnaire. Measurements were taken at baseline and at 2 years follow-up. We used mixed model analyses to correct for the dependency of observations within participants. Results: MUPS were positively associated with disability (regression coefficient 0.304; 95 % O 0.281-0.327) and with short and long-term absenteeism over 2 years (OR 1.030, 95 % CI 1.016-1.045; OR 1.099, 95 % CI 1.085-1.114). After adjusting for depressive disorders, anxiety disorders and job characteristics, associations weakened but remained significant. Conclusion: Our results show that MUPS were positively associated with disability and absenteeism over 2 years, even after adjusting for depressive and anxiety disorders and job characteristics. This suggests that early identification of MUPS and adequate management is important. [ABSTRACT FROM AUTHOR]

Background Sitting is associated with health risks. Factors that influence sitting are however not well understood. The aim was to examine the biological, socio-demographic, work-related and lifestyle determinants of sitting time (including during transport, work and leisure) in young adult Australian women. Methods Self-reported data from 11,676 participants (aged 22-27 years in 2000) in the Australian Longitudinal Study on Women's Health were collected over 9 years in 2000, 2003, 2006 and 2009. Generalised Estimating Equations were used to examine univariable and multivariable associations of body mass index (BMI), country of birth, area of residence, education, marital status, number of children, occupational status, working hours, physical activity, smoking, alcohol intake and stress with week- and weekend-day sitting time. Results Compared with women in the respective referent categories, (1) women with higher BMI, those born in Asia, those with less than University level education, doing white collar work, working 41-48 hours a week, current smokers, non, rare or risky/ high risk drinkers and those being somewhat stressed had significantly higher sitting time; and (2) women living in rural and remote areas, partnered women, those with children, those without a paid job and blue collar workers, those working less than 34 hours a week, and active women had significantly lower sitting time. Conclusions Among young adult Australian women, those with higher BMI, those born in Asia, those with higher level occupations and long working hours, were most at risk of higher sitting time. These results can be used to identify at-risk groups and inform intervention development. [ABSTRACT FROM AUTHOR]

Background Rotation thromboelastometry ( ROTEM) is an easy, fast and complete method of measuring coagulation. Aims Our goal was to obtain longitudinal values on ROTEM in uncomplicated pregnancies and in the puerperium. Materials and Methods Healthy women, who visited our outpatient clinic for antenatal checks and who accomplished an uncomplicated pregnancy were tested three times during pregnancy and one time postpartum. Intrinsic and extrinsic pathway tests were carried out. Results In total, 62 women were analysed, and 298 measurements were taken. With increasing gestational age, there are significant changes towards hypercoagulability. Conclusion This study provides a better knowledge about physiological changes in ROTEM measurements during pregnancy. These normative data may serve as assistance for future studies and interventions. [ABSTRACT FROM AUTHOR]

Background: Studies determining the development of a wide variety of different comorbid disorders in inflammatory arthritis (IA) patients are scarce, however, this knowledge could be helpful in optimising preventive care in IA patients. The aim of this study is to establish the risk that new chronic comorbid disorders in newly diagnosed patients with IA in a primary care setting are developed. Methods: This is a nested-case-control study from 2001-2010 using data from electronic medical patient records in general practice. In total, 3,354 patients with newly diagnosed IA were selected. Each patient was matched with two control patients of the same age and sex in the same general practice. The development of 121 chronic comorbid disorders of index and control patients was compared using Cox regression. Results: After a median follow-up period of 2.8 years, 56% of the IA-patients had developed at least one chronic comorbid disorder after the onset of IA, compared to 46% of the control patients (p < 0.05). The most frequent developed comorbid disorders after the onset of IA were of cardiovascular (23%), and musculoskeletal (17%) origin. The highest hazard ratios (HRs) were found for anaemia (HR 2.0 [95%CI:1.4-2.7]) osteoporosis (HR 1.9 [1.4-2.4]), and COPD (HR 1.8 [1.4-2.3]). Conclusion: Patients with IA developed more chronic comorbid disorders after the onset of IA than one might expect based on age and sex. Since comorbidity has a large impact on the disease course, quality of life, and possibly on treatment itself, prevention of comorbidity should be one of the main targets in the treatment of IA patients. [ABSTRACT FROM AUTHOR]

Background: The essential amino acid methionine can be used for protein synthesis but also serves as a precursor for homocysteine and cysteine. Objective: The objective of this study was to determine the minimal obligatory methionine requirement of infants in the presence of excess cysteine (91 mg · kg-1 · d -1) by using the indicator amino acid oxidation (IAAO) method with L-[1 -13C]phenylalanine as the indicator. Design: Fully enterally fed term infants < 1 mo of age were randomly assigned to methionine intakes that ranged from 3 to 59 mg • kg-1 · d-1 as part of an elemental formula. After 1 d of adaptation to the test diet, [l3C]bicarbonate and L-[1-13C]phenylalanine tracers were given enterally. Breath samples were collected at baseline and during isotopic plateaus. The mean methionine requirement was determined by using biphasic linear regression crossover analysis on the fraction of 13CO2 recovery from L-[1-13C]phenylalanine oxidation (F13CO2). Data are presented as means ± SDs. Results: Thirty-three neonates (gestational age: 39 ± 1 wk) were studied at 13 ± 6 d. With increasing methionine intakes, F13CO2 decreased until a methionine intake of 38 mg • kg~' · d-1; additional increases in methionine intake did not affect FI3CO2. The mean methionine requirement was determined at 38 mg • kg-1 • d-1, and the upper and lower CIs were 48 and 27 mg • kg-1 • d-1, respectively (P < 0.0001, r = 0.59). Conclusions: Although the current recommended methionine intake of 28 mg • kg-1 • d-1 is within the CIs of our study, the estimated mean requirement is substantially higher. However, most of the infant formulas provide a methionine intake of 49-80 mg · kg-1 • d-1, which is above the upper CI of our study. This trial was registered at www.trialregister.nl as NTR1610. [ABSTRACT FROM AUTHOR]

Background: Recently, a three-item screener, derived from the 16-item distress scale of the Four-Dimensional Symptom Checklist (4DSQ), was used to measure psychological distress in sicklisted employees. The aim of the present study was to investigate the ability of the 16-item distress scale and three-item distress screener to identify non-sicklisted employees at risk of sickness absence (SA) due to mental disorders. Methods: Prospective cohort study including 4877 employees working in distribution and transport. The 4DSQ distress scale was distributed at baseline in November 2010. SA diagnosed within the International Classification of Diseases -10 chapter F was defined as mental SA and retrieved from an occupational health register during 2-year follow-up. The area under the receiver operating characteristic curve (AUC) was used to discriminate between workers with ('cases') and without ('non-cases') mental SA during follow-up. Results: A total of 2782 employees (57%) were included in complete cases analysis; 73 employees had mental SA during 2-year follow-up. Discrimination between cases and non-cases was similar for the 16-item distress scale (AUC =0.721; 95% CI, 0.622-0.823) and the three-item screener (AUC = 0.715; 95% CI, 0.615-0.815). Conclusion: Healthcare providers could use the three-item distress screener to identify non-sicklisted employees at risk of future mental SA. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVES: The effects of endocrinological treatment on cardiovascular risk profile in transgender adolescents are unknown. In this retrospective cohort study, we aim to investigate these effects and assess obesity and dyslipidemia prevalence in transgender adolescents at 22 years compared with peers. METHODS: Changes in BMI, systolic blood pressure (SBP), diastolic blood pressure (DBP), glucose, homeostatic model assessment for insulin resistance (HOMA-IR), and lipid values during treatment, along with the prevalence of obesity and dyslipidemia at 22 years, were recorded in 71 transwomen and 121 transmen who started gonadotropin-releasing hormone agonists in their adolescence (15 years), with a subsequent addition of sex hormones (17 years). RESULTS: In transwomen, changes in BMI (+3.0; 95% confidence interval [CI] 1.6 to 4.4), SBP (-2 mm Hg; 95% CI -7 to 3), DBP (+10 mm Hg; 95% CI 7 to 14), glucose (0.0 mmol/L; 95% CI -0.2 to 0.2), HOMA-IR (+0.6; 95% CI -0.6 to 1.9), and lipid values were similar or more favorable compared with peers. The same was true for transmen regarding changes in BMI (+2.3; 95% CI 1.7 to 2.9), SBP (+7 mm Hg; 95% CI 3 to 10), DBP (+7 mm Hg; 95% CI 5 to 10), glucose (+0.1 mmol/L; 95% CI -0.1 to 0.3), HOMA-IR (-0.2; 95% CI -0.8 to 0.3), and lipid values. At age 22, obesity prevalence was 9.9% in transwomen, 6.6% in transmen, 2.2% in ciswomen, and 3.0% in cismen. CONCLUSIONS: Generally, endocrinological treatment in transgender adolescents is safe regarding cardiovascular risk. Because obesity is more prevalent in transgender adolescents compared with peers, body weight management should be important during the medical trajectory. [ABSTRACT FROM AUTHOR]

Purpose: Accelerometer-based wearables can provide the user with real-time feedback through the device's interface and the mobile platforms. Few studies have focused on the minute-by-minute validity of wearables, which is essential for high-quality real-time feedback. This study aims to assess the validity of the Fitbit One compared with the ActiGraph GT3x + for assessing physical activity (i.e., steps, time spent in moderate, vigorous, and moderate--vigorous physical activity) in young adults using traditional time intervals (i.e., days) and smaller time intervals (i.e., minutes and hours). Methods: Healthy young adults (N = 34) wore the ActiGraph GT3x+ and a Fitbit One for 1 wk. Three aggregation levels were used: minute, hour, and day. Mixed models analyses, intraclass correlation coefficients, Bland--Altman analyses, and absolute error percentage for steps per day were conducted to analyze the validity for steps and minutes spent in moderate, vigorous, and moderate--vigorous physical activity. Results: As compared with ActiGraph (mean = 9 steps per minute, 509 steps per hour and 7636 steps per day), the Fitbit One systematically overestimated physical activity for all aggregation levels: on average 0.82 steps per minute, 45 steps per hour, and 677 steps per day. Strong and significant associations were found between ActiGraph and Fitbit results for steps taken (B = 0.72-0.89). Weaker but statistically significant associations were found for minutes spent in moderate, vigorous, and moderate--vigorous physical activity for all time intervals (B = 0.39-0.57). Conclusions: Although the Fitbit One overestimates the step activity compared with the ActiGraph, it can be considered a valid device to assess step activity, including for real-time minute-by-minute self-monitoring. However, agreement and correlation between ActiGraph and Fitbit One regarding time spent in moderate, vigorous, and moderate--vigorous physical activity were lower. [ABSTRACT FROM AUTHOR]

Introduction: Lung function, nutritional status, and parameters of exercise capacity are known predictors of mortality in patients with cystic fibrosis (CF). The aim of the current study was to use these important parameters to develop a multivariate model to predict mortality in adolescent patients with CF. Methods: A total of 127 adolescents with CF (57 girls) with a mean age of 12.7 ± 0.9 yr and a mean percentage of predicted forced expired volume in 1 s (FEV1%predicted) of 77.7% + 15.6% were included. Cardiopulmonary exercise testing-derived parameters, nutritional status, and resting lung functions were dichotomized according to the criterion value determined using receiver operating characteristic curves. Body mass index (BMI), FEV1%predicted, predicted peak oxygen uptake corrected for body weight (VO2peak/kg%predicted), peak minute ventilation (VEpeak), peak VE/VO2, peak VE/VCO2, and breathing reserve were included in a multivariate model. The Cox proportional hazards model was used to determine the combination of parameters that best predicted mortality and/or lung transplantation. Results: The mean duration of follow-up was 7.5 ± 2.7 yr, during which, nine of the 127 patients (7.1%) died and six (4.7%) underwent lung transplantation. Mortality in this population was best predicted by the model that included FEV1%predicted (hazard ratio, 17.13; 95% confidence interval (Cl), 3.76-78.06), peak VE/VO2 (hazard ratio, 5.92; 95% Cl, 1.27—27.63), and BMI (hazard ratio, 5.54; 95% Cl, 1.82-16.83). Conclusions: The currently developed model consisting of BMI, FEV1%predicted, and VE/VO2 is a strong predictor of mortality rate in adolescents with CF. This prediction equation may be useful in clinical practice to detect patients with a high risk of mortality and to provide them with additional therapy earlier. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effectiveness of a combined social and physical environmental intervention as well as the effectiveness of both separate interventions. Methods: In a 2 x 2 factorial design, 412 office employees were allocated to the combined social and physical environmental intervention, to the social environmental intervention only, to the physical environmental intervention only, or were part of the control group. Data on presenteeism, absenteeism, work performance, and work engagement were obtained with questionnaires at baseline, 6, and 12 months. Multilevel analyses were performed. Results: The combined intervention showed a decrease in contextual performance and dedication. The social environmental intervention showed an improvement in task performance. The physical environmental intervention revealed an improvement in absorption. Conclusion: Although the study showed some promising results, it is not recommended to implement the current interventions. [ABSTRACT FROM AUTHOR]