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BACKGROUND: Healthy eating behavior throughout pregnancy and postpartum is important. This study aimed to investigate the perceived sex-specific importance of determinants of changes in eating behavior during pregnancy and postpartum. METHODS: Fifty-four determinants were rated by first-time parents (n = 179) on their impact. Experts (n = 31) rated the determinants in terms of their modifiability, relationship strength, and population-level effect from which a "priority for research"-score was calculated. RESULTS: During pregnancy, the three highest rated determinants by women were "health concerns", "physiological changes", and "fatigue". Men perceived "health concerns", "health consciousness", and "influence of the pregnant partner" as important. Postpartum, the three highest rated determinants by women were "adaptation to rhythm of baby", "baby becomes priority", and "practical constraints because of the baby". Men perceived "adaptation to rhythm of baby", "fatigue". and "(lack of) anticipation" as important. According to the experts, "professional influence", "food knowledge", and "home food availability" received high priority scores for both sexes and during both periods. CONCLUSIONS: Priority for research and interventions should go towards tailored family-based approaches focusing on food education in a broad sense taking into account aspects such as health consciousness, self-efficacy skills, and the social and home food environment while being supported by healthcare professionals. ispartof: NUTRIENTS vol:13 issue:7 ispartof: location:Switzerland status: published

Background Although diet is an essential aspect of human health, the link between diet and pain is still not well understood. Preclinical animal research provides information to understand underlying mechanisms that allow identifying the needs for human research. Objectives This study aims to give a systematic overview of the current evidence from preclinical studies regarding the analgesic and pronociceptive effects of various diets in non-neuropathic, non-cancer, or non-visceral acute and chronic pain models. Study design A systematic Review. Setting This study examined studies that investigate the analgesic and pronociceptive effects of various diets in non-neuropathic, non-cancer, or non-visceral acute and chronic pain models. Methods This review was conducted following the PRISMA guidelines and was registered in PROSPERO with the registration number CRD42019133473. The certainty of evidence was examined by a modified GRADE approach. Results After the screening process twenty-four eligible papers were included in this review. Nineteen studies examined acute pain, nine studies chronic inflammatory pain, and four studies assessed both acute and chronic pain models. Limitations Due to the heterogeneity of the included studies, a meta-analysis was not included in this study. Conclusions In animal models, excessive saturated, monounsaturated or omega-6 polyunsaturated fat ingestion and diets rich in fats and carbohydrates can decrease pain sensitivity in acute nociceptive pain, whereas it can induce mechanical allodynia and heat hyperalgesia in chronic inflammatory pain. Additionally, diets rich in anti-inflammatory ingredients, as well as a calorie-restricted diet can promote recovery from primary mechanical allodynia and heat hyperalgesia in chronic inflammatory pain.

Background:\ud Asymmetries have been reported to negatively impact sport performance. This study examined the magnitude and direction of whole-body functional asymmetry in international versus national female tennis players.\ud Methods:\ud Ten internationally and twelve nationally ranked tennis players participated. Upper extremity functional asymmetries (or side-to-side performance differences) were evaluated using handgrip strength, seated shot-put throw and plate tapping. Lower extremity functional asymmetries were determined using the single leg countermovement jump, single leg forward hop test, 6 m single leg hop test, 505 changes of direction (time and deficit), and Y-balance test (anterior, posteromedial, posterolateral). ANOVAs were used to compare the dominant (overall best or fastest result of a specific test) versus non-dominant performance values (best or fastest result of the corresponding extremity) within the internationally versus nationally ranked players. Functional asymmetry magnitudes differences (expressed as a %) were examined using Mann-Whitney U tests. Kappa coefficients examined the consistency as to which extremity performed dominantly across tests.\ud Results:\ud Significant asymmetries for every upper and lower extremity test were found. The functional asymmetry magnitude was significantly (p=0.020) higher on the single leg forward hop test for the nationally (6.3%) versus internationally ranked players (2.9%). Kappa coefficients showed perfect levels of consistency regarding all upper extremity tests (k=1.00), indicating true limb dominance whereas more variance was found as to which lower extremity performed dominantly across tests (k range=-0.067-0.174).\ud Conclusions:\ud The included female tennis players displayed significant whole-body functional asymmetries. Poor consistency as to which lower extremity performed dominantly across tests warrants individual asymmetry monitoring.

Amongst adults with chronic pain, overweight and obesity are highly prevalent. The association between chronic pain and overweight is driven by several explanations, including increased biomechanical load, changes in the gut microbiome, and low-grade (neuro)inflammation. Moreover, the link between overweight, obesity and chronic pain can best be considered from a lifestyle perspective. Since conservative treatment for chronic pain is often limited to short-term and small effects, addressing important comorbidities within a lifestyle approach could be the next step towards precision medicine for these patients. Indeed, evidence shows that combining weight reduction with conservative pain management is more effective to reduce pain and disability, compared to either intervention alone. This perspective article aims to update the reader with the current understanding of the possible explanatory mechanisms behind the interaction between overweight/obesity and chronic pain in an adult population. Second, this paper applies this knowledge to clinical practice, including assessment and conservative treatment of overweight/obesity in adults with chronic pain. Henceforth, clinical recommendations and guidelines are provided based on available scientific evidence and the authors’ clinical expertise. Impact This paper will guide clinicians in the implementation of weight reduction programs within pain management.

Numerous studies have reported that athletes’ pre-training/-game hydration status is of concern. Up to now, only two cohort studies have examined the effect of an intervention aimed at improving pretraining/-game hydration status; however, without including a control group. Therefore, the aim of this quasi-experimental study was to examine whether and to what extent an individually tailored intervention focused on the benefits of being optimally hydrated before training or game would alter the hydration status of female soccer players. Two teams of young adult female soccer players were allocated to an intervention (n = 22; 19.8 ± 3.0 years) or a control group (n = 15; 22.8 ± 4.0 years). Players in the intervention group received an individually tailored intervention, based on Urine Specific Gravity (USG) measurements, which took place in between two training weeks. Before each training and match play, a urine sample was collected to determine players’ hydration status. Mixed modelling was applied to assess within and between differences in hydration status over time. The pre-training/-game hydration status of the intervention group improved significantly, with players’ mean USG-value decreasing from 1.013 ± 0.001 g/mL to 1.008 ± 0.002 g/mL (p = 0.005). In contrast, the mean USG-value in the control group increased significantly from 1.012 ± 0.002 g/mL to 1.016 ± 0.002 g/mL (p = 0.023), indicating a deterioration of their pre-training/-game hydration status. The individually tailored intervention did show a positive effect even though female soccer players in the present study were already reasonably well hydrated before the start of the intervention.

This study examined the influence of both anthropometric and physical performance determinants on the likelihood to be selected to progress through a talent identification and development programme in young tennis. Data were collected in 538 young tennis players (323 males and 215 females) from 6 age categories (U8–U13). A principal component analysis was used to generate one anthropometric determinant (based on body height, body weight and maturity offset) and four physical performance determinants: speed and agility (based on 5 m sprint, 20 m sprint and 505 change of direction test); jumping power (based on standing broad jump and standing broad jump in series); motor coordination (based on balancing backwards and jumping sideways) and tennis ball control (based on a throw and catch test and hold tennis ball up test). For all determinants, tertiles were generated for every age category and both sexes separately. Univariate binary logistic regressions were performed to examine the influence of each determinant on the chances to be selected to progress in the talent identification and development programme. Significant odds ratios were found for all included anthropometric and physical performance determinants ( p

Greenlandic traditional nutrition was unique in the arctic environment. The aim of the present study was to reanalyse the Høygaard et al. data, focusing on two micronutrients object of discussion, i.e. Ca and vitamin C. Høygaard et al. left Copenhagen in August 1936 and stayed in East-Greenland until August 1937. The members of the expedition recorded nutritional intake whilst residing in families. However, the nutritional intake was analysed on a household level. In total, thirty-five adults and fourty-one children participated. Median total energy expenditure in kcal per d was estimated at 2978 and 2627 for male and female adults, respectively, and 1997 for children and adolescents. Median (IQR) energy consumption in kcal per d was 3881 (1568) for male and 2910 (882) for female adults. This was 2442 (857) and 2023 (1122) for male and female children and adolescents. Median (IQR) Ca intake in mg.d–1 was 555 (1110) for male and 484 (883) for female adults. This was 458 (747) and 358 (838) for male and female children and adolescents. Median (IQR) vitamin C intake in mg.d–1 was 79 (77) for male and 59 (56) for female adults. This was 44 (47) and 60 (52) for male and female children and adolescents. In this study, the importance of traditional foods in reaching an acceptable energy balance was emphasised, together with the confirmation of a low Ca intake in East-Greenland traditional dietary pattern, and the important role of algae consumption in Inuit traditional dietary pattern to avoid scurvy.

Greenlandic traditional nutrition was unique in the arctic environment because it was an almost exclusive meat dietary pattern. Høygaard et al. left Copenhagen in August 1936, and stayed in East Greenland until August 1937. The four members of the expedition resided in Tasisaq and visited eight settlements around where nutritional intake was recorded by residing in families. However, the nutritional intake was analysed on a household level. The aim of the present study is to reanalyse the Høygaard et al. data according to modern scientific standards. In total, 21 males and 14 females participated. Median (IQR) energy consumption was 3881 (1568) kcal.day−1 for males and 2910 (882) kcal.day−1 for females. Without the five participants living near trading centres, this was 3268 (219) kcal.day−1 and 2634 (723) kcal.day−1, respectively. Expressed in energy-percent, the macronutrient consumptions were 34% for protein, 37% for fat and 29% for carbohydrates. Without imported food, this was 41%, 49% and 10%, respectively. The main findings of the present study are, as expected, that the food consumed came mainly from traditional hunting, was low in plant foods and extremely low in carbohydrates. The Inuit succeeded to stay in apparently healthy conditions with a traditional meat-based dietary pattern.

Although the beneficial health effects of plant-based dietary patterns are evident, it is not clear if population-wide dietary patterns are shifting in a more plant-based direction. This study evaluated trends in dietary patterns among Flemish adults over a 10-year period. Furthermore, differences in socio-demographic characteristics between different dietary pattern groups were explored. Findings show that the vast majority of participants were omnivorous as measured at the different time points. The proportion of flexitarians increased over time, while the opposite was true for omnivores. The proportion of vegetarians and vegans, on the other hand, remained stable. Eating more plant-based diet was associated with female sex, younger age, higher education and living in urban areas. Findings show that the vast majority of participants were omnivorous as measured at the different time points. The proportion of flexitarians increased over time, while the opposite was true for omnivores. The proportion of vegetarians and vegans, on the other hand, remained stable. Eating more plant-based diet was associated with female sex, younger age, higher education and living in urban areas. In contrast to the stricter plant-based dietary patterns, a modest shift from the omnivorous towards the flexitarian dietary pattern was observed over the past decennium in the Flemish adult population. Campaigns might benefit from targeting older and lower educated male living in rural areas.

Introduction: Few treatment programs for chronic pain nowadays take a dietary pattern or adipose status into account. Areas covered: An important role of neuroinflammation in chronic pain is now well established, at least in part due to increased central nervous system glial activation. Based on preclinical studies, it is postulated that the interaction between nutrition and central sensitization is mediated via bidirectional gut–brain interactions. This model of diet-induced neuroinflammation and consequent central sensitization generates a rationale for developing innovative treatments for patients with chronic pain. Methods: An umbrella approach to cover the authors’ expert opinion within an evidence-based viewpoint. Expert opinion: A low-saturated fat and low-added sugar dietary pattern potentially decreases oxidative stress, preventing Toll-like receptor activation and subsequent glial activation. A low-saturated fat and low-added sugar diet might also prevent afferent vagal nerve fibers sensing the pro-inflammatory mediators that come along with a high-(saturated) fat or energy-dense dietary pattern, thereby preventing them to signal peripheral inflammatory status to the brain. In addition, the gut microbiota produces polyamines, which hold the capacity to excite N-methyl-D-aspartate receptors, an essential component of the central nervous system sensitization. Hence, a diet reducing polyamine production by the gut microbiota requires exploration as a therapeutic target for cancer-related and non-cancer chronic pain.

Objective To evaluate the cost-effectiveness of an influenza vaccination program (IVP) among employees. Methods This health economic evaluation was embedded in a prospective cohort study of a voluntary IVP. Data on incidence, direct, and indirect costs were collected via questionnaires. Bootstrapping and modeling techniques were used to assess uncertainty of the results. Results In the base-scenario, the IVP was less effective, more expensive and thus, neither cost-effective nor cost-beneficial. When applying a sensitivity analysis using published estimates of IVP effectiveness on the data, the IVP became cost-effective and cost-beneficial. Conclusions Like in many evaluations of real-world settings, lack of randomization may have caused selection bias which may explain the surprising results of the main analysis. This indicates the importance of sensitivity analyses and modeling approaches for future studies assessing the cost-effectiveness of IVP in a real-world setting.

Background The aim of this study was to assess the evidence regarding economic evaluations of worksite health promotion programs in Europe. Methods Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the literature search, study selection, data extraction and quality appraisal were performed independently by two researchers. Full economic evaluations of worksite health promotion programs carried out in a European workplace were included. Results From 1728 search results, 39 articles describing 37 studies were included. Regarding methodological quality, 9 studies were rated as strong, 15 as moderate and 15 as weak. Six of the studies fulfilled the minimum standard for health economic evaluations. Worksite health promotion was applied in many different forms for a wide range of settings. Cost-effectiveness, cost-benefit and cost-utility analyses were performed from different perspectives. Effects on health outcomes tended to be small and uncertain. Only 9 out of 21 cost-benefit analyses reported a financial benefit and 10 out of 23 cost-effectiveness analyses concluded that the intervention was cost-effective. Two out of eight cost-utility analyses were found to be cost-effective. Productivity loss accounted for more than 85% of the total costs and thus, was the main cost driver in the analyses. Conclusions Due to considerable heterogeneity, no specific type of intervention could be identified to be particularly effective and the economic value of worksite health promotion remains uncertain. Further studies, investigating comprehensive worksite health promotion programs are needed to provide evidence on their efficiency. Guidelines to perform economic evaluations in the field of worksite health promotion, especially for valuation of productivity loss, are required.

Objectives: The aim of this systematic review and meta-analysis was to evaluate the effectiveness of local heat applications (LHAs) in individuals with acute or chronic musculoskeletal disorders.Data sources: An electronic search was conducted on MEDLINE, Cochrane Controlled Register of Trials, Current Nursing and Allied Health Literature, and the Physiotherapy Evidence databases up to December 2019.Study selection: Studies incorporating adults with any kind of musculoskeletal issues treated by LHA compared with any treatment other than heat were included.Data extraction: Two authors independently performed the methodological quality assessment using the Cochrane Risk of Bias tool.Data synthesis: LHA showed beneficial immediate effects to reduce pain vs no treatment (P

Dietary patterns may play an important role in musculoskeletal well-being. However, the link between dietary patterns, the components of patients’ diet, and chronic musculoskeletal pain remains unclear. Therefore, the purpose of this review was to systematically review the literature on the link between dietary patterns, the components of patients’ diet and chronic musculoskeletal pain. This review was conducted following the “Preferred Reporting Items for Systematic reviews and Meta-Analyses” (PRISMA) guidelines and was registered in PROSPERO with the registration number CRD42018110782. PubMed, Web of Science, and Embase online databases were searched. After screening titles and abstracts of 20,316 articles and full texts of 347 articles, 12 eligible articles were included in this review, consisting of nine experimental and three observational studies. Seven out of nine experimental studies reported a pain-relieving effect of dietary changes. Additionally, protein, fat, and sugar intake were found to be associated with pain intensity and pain threshold. In conclusion, plant-based diets might have pain relieving effects on chronic musculoskeletal pain. Patients with chronic rheumatoid arthritis pain can show inadequate intake of calcium, folate, zinc, magnesium, and vitamin B6, whilst patients with fibromyalgia can show a lower intake of carbohydrates, proteins, lipids, vitamin A-E-K, folate, selenium, and zinc. Chronic pain severity also shows a positive relation with fat and sugar intake in osteoarthritis, and pain threshold shows a positive association with protein intake in fibromyalgia.

Purpose: Military personnel are exposed to variable and sometimes very high noise in their professional environment. The aim of this study is to evaluate through a longitudinal study if our hearing conservation program has to be adapted to consider specific interventions for subgroups of our military population still subject to a higher risk of hearing loss. Methods: We conducted a retrospective longitudinal study in 2015–2016 to describe the evolution of hearing threshold levels of military personnel as measured during periodic audiometric screening over a period of 6 years (2009–2014) after the implementation of our hearing conservation program. A linear mixed model explored the relationship of pure-tone average (PTA) on 3, 4 and 6 KHz with probability of noise exposure, gender, age at baseline, time since baseline, hearing loss at baseline and ear. Results: For 18,672 military individuals, our results show a small but statistically significant increase of 0.08 dB per year in PTA on 3, 4 and 6 KHz over the 6-year period that is consistently decelerating as a function of time. An additional annual increase of hearing thresholds due to higher age and moderate and high probability of exposure to noise was also found. Conclusions: No major adaptation of our hearing conservation program is required but efforts should be strengthened to better evaluate and counsel older individuals and subjects exposed to noise regarding avoidance of noise and correct use of personal hearing protection.

Acute Effects on TH4 Thoracic Spine Mobilisation Techniques on the Sympathetic Nervous System - a Cross-Over Feasibility Study Abstract. Up to date, empiric evidence about effects of thoracic spine mobilisation (TH4) on the sympathetic nervous system is lacking. The primary goal of this feasibility study was to determine adherence rate, side effects and the protocol as well as the implementation of the study design. The secondary goal was to analyse and interpret acute effects on the sympathetic nervous system after thoracic mobilisation in anterior thrust and posterior thrust on six healthy participants on two following days. The feasibility of this study was adequate. The spine mobilisations did not produce any adverse effects. The anterior thrust spine mobilisations showed a tendency in reducing the heart rate activity.

The promotion of sustainable and healthy mobility among older adults (≥ 65 years) is an important challenge. E-bikes may be part of the solution, but research about e-bike use among older adults is scarce. The current study aims to examine e-bikes’ purchase reasons, benefits and disadvantages, purposes and amount of use, substitution effects and crash characteristics among older e-bike users. Additionally, it examines differences between men and women. In Flanders (Belgium), 357 older e-bike users completed an online- or interview-version of the same questionnaire. Among men and women, the most prevalent reason for e-bike purchase was to bike with less effort (24.1%). The most important benefit of e-bike use was to be able to bike longer distances (35.0%). E-bikes’ heavy weight was the most frequently reported disadvantage (33.3%). Men more frequently reported battery issues, but also that they do not experience any disadvantage. Women more frequently reported fear of falling/injuries. Participants used their e-bikes for various purposes. Men more frequently reported to cycle for recreation alone while women used the e-bike more for social reasons. E-bikes predominantly replaced trips by conventional bike (72.0%) and car (50.7%). About one quarter (27.5%) had experienced an e-bike crash, most frequently caused by an uneven or slippery surface (26.5%). To promote active ageing, policy initiatives could include strategies aimed at stimulating e-bike use. These strategies should focus on emphasizing the identified benefits, reducing the disadvantages and increasing e-bike safety. Research in countries with less favorable cycling cultures is necessary to confirm current findings.

In order to be able to tailor environmental interventions to adolescents at risk for low levels of physical activity, the aim of the present study is to identify subgroups of adolescents with different physical and social environmental preferences towards cycling for transport and to determine differences in individual characteristics between these subgroups. In this experimental study, 882 adolescents (12–16 years) completed 15 choice tasks with manipulated photographs. Participants chose between two possible routes to cycle to a friend's house which differed in seven physical micro-environmental factors, cycling distance and co-participation in cycling (i.e. cycling alone or with a friend). Latent class analysis was performed. Data were collected from March till October 2016 across Flanders (Belgium). Three subgroups could be identified. Subgroup 1 attached most importance to separation of the cycle path and safety-related aspects. Subgroup 2 attached most importance to being able to cycle together with a friend and had the highest percentage of regular cyclists. In subgroup 3, the importance of cycling distance clearly stood out. This subgroup included the lowest percentage of regular cyclists. Results showed that in order to stimulate the least regular cyclists, and thus also the subgroup most at risk for low levels of active transport, cycling distances should be as short as possible. In general, results showed that providing well-separated cycle paths which enable adolescents to cycle side by side and introducing shortcuts for cyclists may encourage different subgroups of adolescents to cycle for transport without discouraging other subgroups.

When relating glycaemic index (GI) and glycaemic load (GL) to health outcomes, many prospective cohort studies assess the nutritional exposure only once in time, that is, at the start of the study, presuming a stability in nutritional consumption during the course of the study. The aim of this study is to investigate the reproducibility of GI and GL. This is a prospective cohort study in which 562 middle-aged Belgian adults noted all foods and drinks consumed during 3 d in 2002 and 2012. GI and GL were calculated after reference tables. The Pearson correlation coefficients between 2002 and 2012 were 0·27 for GI and 0·41 for GL. For GI, 33 % of the participants remained in the same quintile between 2002 and 2012, whereas 31 % moved to a non-adjacent quintile. For GL, this was 34 and 28 %, respectively. The lowest and the highest quintiles of GI were the most stable, with 40 and 44 % of the participants staying in the same quintile. This was only 22 % for the fourth quintile. The same tendency was present for GL – that is, the most extreme quintiles were the most stable. This study shows 10-year correlation coefficients for GI and GL below 0·50. Multiple nutritional assessments and limiting the analysis to the extreme quintiles of GI and GL will limit a possible misclassification in the prospective cohort studies owing to the low reproducibility.

BACKGROUND: Becoming a parent may cohere with drastic changes in physical activity (PA) and sedentary behavior (SB). A clear understanding of determinants of changes in PA and SB during pregnancy and postpartum is needed to facilitate the development of tailored family-based interventions. METHODS: Thirteen focus group discussions targeting determinants of changes in PA and SB behavior were conducted, involving a total of 74 expecting and first-time parents. A semi-structured question guide was used to facilitate the discussions. RESULTS: Four main levels of determinants were identified: the individual (including psychological, situational and biological determinants), interpersonal, environmental and policy level. Some determinants were mentioned to be a barrier (e.g., "barriers to self-care") while others were a facilitator (e.g., "weight control"). Determinants were related to both PA and SB and applicable during pregnancy as well as postpartum (e.g., "self-regulation"), or only related to one behavior and/or one period (e.g., "feeding baby"). Some were described by both parents (e.g., "parenthood perceptions"), whereas others were mentioned by women (e.g., "PA knowledge") or men (e.g., "time opportunities") only. CONCLUSIONS: Focus should be given to interventions aimed at improving parents' self-regulation skills and support on how to cope with interpersonal and situational constraints as well as parenthood perceptions. ispartof: INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH vol:19 issue:4 ispartof: location:Switzerland status: published

Hintergrund: Manualtherapeutische Behandlungen werden oftmals auf der Hohe der thorakalen Wirbelsaule durchgefuhrt. Die segmentale Reaktion des sympathischen Nervensystems nach einer BWS-Mobilisation ist bislang unklar. Ziel: Ziele dieser Pilotstudie sind (1) die Darstellung der Durchfuhrbarkeit sowie (2) die Untersuchung der akuten Effekte einer thorakalen manuellen Mobilisationstechnik auf das SNS in Bauchlage mit in anteriorer bzw. im Sitz mit in posteriorer Schubrichtung mobilisiertem Brustwirbel. Methode: Fur diese Cross-Over-Pilotstudie sollen mindestens 10 gesunde Erwachsene rekrutiert und eingeschlossen werden. Cross-Over-Effekte werden mittels non-parametrischer L-Puri-Sen-Statistik berechnet. Um Unterschiede innerhalb bzw. der Gruppen untereinander zu ermitteln, werden der Friedman-Test bzw. der Mann-Whitney-U-Test angewendet. Schlussfolgerung: Aufgrund der Wechselwirkung des Spinalnervs und des SNS kann durch manualtherapeutische Techniken im Bereich der BWS eine Veranderung von Herzratenvariabilitat, Blutdruck, Puls sowie Hautdurchblutung und Hautrotung im entsprechenden Segment angenommen werden.

Evaluating and testing hydration status is increasingly requested by rehabilitation, sport, military and performance-related activities. Besides commonly used biochemical hydration assessment markers within blood and urine, which have their advantages and limitations in collection and evaluating hydration status, there are other potential markers present within saliva, sweat or tear. This literature review focuses on body fluids saliva, sweat and tear compared to blood and urine regarding practicality and hydration status influenced by fluid restriction and/or physical activity. The selected articles included healthy subjects, biochemical hydration assessment markers and a well-described (de)hydration procedure. The included studies (n=16) revealed that the setting and the method of collecting respectively accessing body fluids are particularly important aspects to choose the optimal hydration marker. To obtain a sample of saliva is one of the simplest ways to collect body fluids. During exercise and heat exposures, saliva composition might be an effective index but seems to be highly variable. The collection of sweat is a more extensive and time-consuming technique making it more difficult to evaluate dehydration and to make a statement about the hydration status at a particular time. The collection procedure of tear fluid is easy to access and causes very little discomfort to the subject. Tear osmolarity increases with dehydration in parallel to alterations in plasma osmolality and urine-specific gravity. But at the individual level, its sensitivity has to be further determined.

The central- and peripheral mechanisms by which heat strain limits physical performance are not fully elucidated. Nevertheless, pre-cooling is often used in an attempt to improve subsequent performance. This study compared the effects of pre-cooling vs. a pre-thermoneutral application on central- and peripheral fatigue during 60% of isometric maximum voluntary contraction (MVC) of the right quadriceps femoris muscle. Furthermore, the effects between a pre-cooling and a pre-thermoneutral application on isometric MVC of the right quadriceps femoris muscle and subjective ratings of perceived exertion (RPE) were investigated. In this randomized controlled trial, 18 healthy adults voluntarily participated. The participants received either a cold (experimental) application (+8 °C) or a thermoneutral (control) application (+32 °C) for 20 min on their right thigh (one cuff). After the application, central (fractal dimension – FD) and peripheral (muscle fiber conduction velocity – CV) fatigue was estimated using sEMG parameters during 60% of isometric MVC. Surface EMG signals were detected from the vastus medialis and lateralis using bidimensional arrays. Immediately after the submaximal contraction, isometric MVC and RPE were assessed. Participants receiving the cold application were able to maintain a 60% isometric MVC significantly longer when compared to the thermoneutral group (mean time: 78 vs. 46 s; p=0.04). The thermoneutral application had no significant impact on central fatigue (p>0.05) compared to the cold application (p=0.03). However, signs of peripheral fatigue were significantly higher in the cold group compared to the thermoneutral group (p=0.008). Pre-cooling had no effect on isometric MVC of the right quadriceps muscle and ratings of perceived exertion. Pre-cooling attenuated central fatigue and led to significantly longer submaximal contraction times compared to the pre-thermoneutral application. These findings support the use of pre-cooling procedures prior to submaximal exercises of the quadriceps muscle compared to pre-thermoneutral applications.

AimThe potential renal acid load (PRAL) has been described in relation to different health outcomes. Outcomes over time and conclusions made are often based on baseline dietary intake values. However, to study reliable long-term associations, parameters calculated based on dietary intake data, such as PRAL, must be stable over time. Therefore, the aim of the present study was to assess the stability of PRAL and its components over a 10-year time period. MethodsPRAL values of three-day dietary intake data from 197 women and 373 men on two assessment moments (2002-2004 and 2012-2014) were calculated. Pearson correlation and intra-class correlation coefficients were used for assessing the stability of PRAL and its components. Level of agreement between the two assessment moments was estimated after splitting up subjects in quintiles of PRAL, calculating kappa values and changes of quintiles over time. ResultsNo significant differences in mean PRAL over time were found. Stability of PRAL and its components was low. Poor agreement between the first and second assessment was shown by low kappa values and change of most of the subjects to an adjacent and non-adjacent quintile after 10 years. ConclusionsBased on nutrition assessments carried out using three-day dietary records, stability of PRAL over a 10-year time period could not be confirmed, even though no significant difference between mean PRAL and its components over time was found. Therefore, interpretation of longitudinal outcomes based on PRAL and its component calculated at baseline should be interpreted with caution.

Objective The workplace is an ideal setting to implement public health strategies, but economic justification for such interventions is needed. Therefore, we performed a critical appraisal and synthesis of health economic evaluations (HEE) of workplace interventions aiming to increase physical activity (PA) and/or decrease sedentary behavior (SB). Methods A comprehensive search filter was developed using appropriate guidelines, such as the Peer Review of Electronic Search Strategies (PRESS) checklist, and published search algorithms. Six databases and hand searches were used to identify eligible studies. Full HEE of workplace interventions targeting PA/SB were included. Methodological quality was assessed using the Consensus Health Economic Criteria (CHEC) list. Two researchers independently performed all procedures. Hedges' g was calculated to compare intervention effects. Outcomes from HEE were recalculated in 2017 euros and benefit-standardized. Results Eighteen HEE were identified that fulfilled on average 68% of the CHEC list criteria. Most studies showed improvements in PA/SB, but effects were small and thus, their relevance is questionable. Interventions were heterogeneous, no particular intervention type was found to be more effective. HEE were heterogeneous regarding methodological approaches and the selection of cost categories was inconsistent. Indirect costs were the main cost driver. In all studies, effects on costs were subject to substantial uncertainty. Conclusions Due to small effects and uncertain impact on costs, the economic evidence of worksite PA/SB-interventions remains unclear. Future studies are needed to determine effective strategies. The HEE of such interventions should be developed using guidelines and validated measures for productivity costs. Additionally, studies should model the long-term costs and effects because of the long pay-back time of PA/SB interventions. ispartof: SCANDINAVIAN JOURNAL OF WORK ENVIRONMENT & HEALTH vol:46 issue:2 pages:127-142 ispartof: location:Finland status: published

IntroductionThe Special Forces (SF) are an elite military group usually engaged in physically demanding field operations, resulting among others in high daily energy requirements. Optimising energy supply and nutritional requirements is therefore mandatory for success. The aim of this study was to estimate energy availability and nutrition during a Qualification Course (Q-Course) for Belgian SF.Methods21 participants recorded all foods and beverages consumed during four days in a structured food diary. Energy expenditure was measured with an accelerometer and fat mass measured with quadripolar impedance. Energy availability was calculated by the following formula: (energy intake by foods and beverages − energy expenditure for physical activity)/kg FFM/day (FFM, fat-free mass).ResultsThe mean (SD) total energy expenditure was 4926 kcal/day (238), with a minimum of 4645 kcal/day and a maximum of 5472 kcal/day. The mean (SD) total energy consumption was 4186 kcal/day (842), giving an energy balance ranging from −2005 kcal/day to 1113 kcal/day. The mean (SD) energy availability was 17 kcal/kg FFM/day, with a minimum of 1 kcal/kg FFM/day and a maximum of 44 kcal/kg FFM/day. The mean (SD) intake of carbohydrates was 6.8 g/kg body weight/day (1.5).ConclusionsDuring this studied Q-Course, energy intake was not optimal as demonstrated by an overall negative energy balance and low energy availability. High interindividual variations in energy intake were found, highlighting the importance of providing SF members nutritional education.

Summary Background To date, the accuracy of bio-impedance (BIA) to assess body composition & sarcopenia in persons aged 80 and over remains unclear. Objective We aimed to evaluate the agreement between dual energy X-ray absorptiometry (DXA) and BIA equations to determine lean mass, as well as their suitability to identify sarcopenia. Design 174 community dwelling well-functioning persons (83 women, 91 men) aged 80 and over were included. Appendicular lean mass (ALM) was predicted using BIA-based equations available in literature, and compared to DXA outcomes. Through cross-validation and stepwise multiple linear regression, a new ALM-formula was generated suitable for this population. Results Literature-based BIA equations systematically overestimated ALM. The new prediction formula that we propose for the 80+ is: ALM = 0,827+(0,19*Impedance Index)+(2,101*Sex)+(0,079*Weight); R2 = 0,888; SEE = 1,450 kg. Sarcopenia classification based on our new BIA equation for ALM showed better agreement with DXA (k ≥ 0,454) compared to literature-based BIA equations (k Conclusions Despite the high correlation between both methods, literature-based BIA equations consistently overestimate ALM compared to DXA in persons aged 80 and over. We proposed a new equation for ALM, reaching higher agreement with DXA and thus improving the accuracy of BIA for this specific age group.

Purpose To identify the different fatigue items in existing frailty scales. Methods PubMed, Web of Knowledge and PsycINFO were systematically screened for frailty scales. 133 articles were included, describing 158 frailty scales. Fatigue items were extracted and categorized in 4 fatigue constructs: “mood state related tiredness”, “general feeling of tiredness”, “activity based feeling of tiredness” and “resistance to physical tiredness”. Results 120 fatigue items were identified, of which 100 belonged to the construct “general feeling of tiredness” and only 9 to the construct “resistance to physical tiredness”. 49,4% of the frailty scales included at least 1 fatigue item, representing 15 ± 9,3% of all items in these scales. Fatigue items have a significantly higher weight in single domain (dominantly physical frailty scales) versus multi domain frailty scales (21 ± 3.2 versus 10.6 ± 9.8%, p= Conclusion Fatigue is prominently represented in frailty scales, covering a great diversity in fatigue constructs and underlying pathophysiological mechanisms by which fatigue relates to frailty. Although fatigue items were more prevalent and had a higher weight in physical frailty scales, the operationalization of fatigue leaned more towards psychological constructs. This review can be used as a reference for choosing a suitable frailty scale depending on the type of fatigue of interest.

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The aim of this study was to examine the magnitude of upper extremity bone mineral content (BMC) asymmetries in tennis players. Furthermore, the influence of sex (male versus female versus mixed), chronological age (juniors: < 18 years; adults: 18–39 years and seniors: ≥ 40 years) and starting age (early starters: < 14 years and late starters: > 18 years) on these asymmetries were examined. Two databases were searched for scientific articles that examined upper extremity BMC in tennis players. Pooling of the individual study effect sizes was conducted using the random-effects model. Three subgroup analyses were performed based on sex, chronological age and starting age. Out of the 15 included studies 24 effect sizes were extracted resulting in a significant difference in BMC value between the dominant and nondominant upper extremity of the tennis players (Standardised Mean Difference: 0.85 [95% CI: 0.67–1.03]). The three subgroup analyses all showed medium to strong effect sizes and significant intergroup differences. To conclude, BMC was significantly higher in the dominant upper extremity compared to the nondominant upper extremity in tennis players. Nevertheless, the influence of training volume and playing experience on these asymmetries are yet to be examined.

Chronic pain has a tremendous personal and socioeconomic impact and remains difficult to treat. Therefore, it is important to provide an update on the current understanding regarding lifestyle factors in people with chronic pain across the lifespan. Lifestyle factors such as physical (in)activity, sedentary behavior, stress, poor sleep, unhealthy diet, and smoking are associated with chronic pain severity and sustainment. This applies to all age categories, that is, chronic pain across the lifespan. Yet current treatment options often do not or only partly address the many lifestyle factors associated with chronic pain or attempt to address them in a standard format rather than providing an individually tailored multimodal lifestyle intervention. The evidence regarding lifestyle factors is available in adults, but limited in children and older adults having chronic pain, providing important avenues for future research. In conclusion, it is proposed that treatment approaches for people with chronic pain should address all relevant lifestyle factors concomitantly in an individually-tailored multimodal intervention. Ultimately, this should lead to improved outcomes and decrease the psychological and socioeconomic burden of chronic pain. Level of Evidence: IV. ispartof: PM&R vol:12 issue:4 pages:410-419 ispartof: location:United States status: published

Background:Longitudinal evidence concerning the association between cardiorespiratory fitness (CRF) and blood lipids and between anthropometric parameters (ANTP) and blood lipids is limited. This study aimed to investigate the association between changes in CRF and ANTP and changes in blood lipids.Methods:In 2002–2004 and 2012–2014, 652 participants were tested. CRF was measured as VO2peak using a maximal ergometer test. Waist circumference (WC) and Body Mass Index (BMI) were used as ANTP. Blood samples were analyzed for total cholesterol (TC), HDL cholesterol, LDL cholesterol and triglycerides. A linear regression analysis was performed to investigate associations between changes in CRF and ANTP and changes in blood lipids.Results:After adjustment a decrease in CRF was associated with an increase in triglycerides and a decrease in HDL cholesterol in men. An increase in WC was associated with an increase in TC, LDL cholesterol and ratio total/HDL cholesterol and a decrease in HDL cholesterol, while an increase in BMI was associated with an increase in ratio total/HDL cholesterol and a decrease in HDL cholesterol.Conclusions:WC and BMI were more longitudinally associated with blood lipids compared with CRF. Improving ANTP can enhance the blood lipid profile, while CRF had only limited influence.

Objective This study examined the effect of nudges, inspired by the recently renewed Flemish Food Triangle, on fruit sales in a Belgian on-campus university restaurant. Methods In this mixed-method real-life experiment, nudges were added weekly over a period of four consecutive weeks: placement of (1) Food Triangle posters in the restaurant, (2) ‘green heart’ icons above the fruit stands, and (3) substitution and (4) social norm messages at the fruit stands. During baseline (no intervention) and all intervention weeks, dessert sales were registered. Short interviews were used to ask customers about their perceptions regarding the intervention. Follow-up measurements (7 and 30 weeks later) evaluated the longer-term effectiveness, while all nudges remained in place. Dessert sales were analyzed separately for both sexes, students and staff categories (based on academic degree). Results Compared to baseline, the combination of the Food Triangle and the green heart intervention materials in week 2 resulted in significant increases in fruit consumption across almost all subgroups. The other intervention materials used in the current study had rather limited effects in the short term. After 7 weeks of follow-up, significant fruit sale increases were established for all subgroups compared to baseline. At 30 weeks follow-up, the effect for staff B (Bachelor's degree) disappeared. The majority of the respondents (66.4%) had noticed at least one of the nudges, while only 3.4% indicated to have adjusted their dessert choice as a result of the nudges. Conclusions The combination of nudges was effective in the long term and increased fruit purchase in nearly all subgroups. Short interviews show that a more active approach may be needed to increase effect sizes.

Aim Plant-based diets are recommended in the context of environmental sustainability and health. Since not all plant foods can be considered beneficial, a distinction needs to be made between healthful and unhealthful plant foods. The aim of this study was to investigate longitudinal associations between changes in an overall plant-based diet index, a healthful plant-based diet index and an unhealthful plant-based diet index, with changes in anthropometrics and blood lipids as indicators of morphological and metabolic fitness, respectively. Methods A 3-day dietary record was completed by 650 Flemish adults (420 men, 230 women) in 2002-2004 and 2012-2014. Three plant-based diet indices were calculated based on quintile scores regarding the intake of animal- or plant-based food items. Associations between 10-year changes in diet indices and changes in anthropometrics and blood lipids were tested using multivariate linear regression. Results Plant-based diet indices did not differ over time. Using the unadjusted model, few significant associations were found between changes in diet indices and changes in anthropometrics and blood lipids. However, these relationships disappeared after adjusting for confounding. In women, a positive association was found between changes in overall plant-based diet index and changes in body mass index in the adjusted model. Conclusions Index values did not differ over time and few longitudinal associations were found.

Introduction Cycling is a non-polluting and healthy transportation mode for older adults. However, there is limited knowledge about the infrastructural changes necessary to stimulate cycling among older adults (≥65 years). This is particularly true for electric cycling (e-biking), an increasingly popular form of cycling. The current experiment with manipulated photographs examined the environmental preferences for transportation cycling among older adults. Additionally, it examined whether subgroups with different environmental preferences exist and whether these subgroups differ on socio-demographics, health characteristics, transport behaviour, e-bike use and cycling levels. Methods A structured questionnaire and choice-based conjoint exercise was completed by 895 Flemish older adults. The conjoint exercise included 13 choice tasks each presenting two street situations, which were manipulated on nine environmental attributes. Hierarchical Bayes and latent class analyses were applied to obtain environmental preferences and identify subgroups. Results In the total sample, type of cycle path was the most important environmental attribute (importance = 40.0, 95% CI = 39.0–41.0) determining older adults’ preference for transportation cycling. The second most important attribute was traffic density (16.7, 95% CI = 15.9–17.4), followed by cycle path evenness (11.8, 95% CI = 11.4–12.1) and distance (10.6, 95% CI = 10.1–11.0). Six subgroups with different environmental preferences were identified. These subgroups could be characterized based on differences in cycling limitations, driving status, e-bike use and cycling levels. Conclusions The provision of well-separated cycle paths should be considered a priority in urban planning initiatives aiming to stimulate transportation cycling among older adults. Such initiatives should be evaluated to validate the current findings and optimize future initiatives.

Objectives The transition from high school to college or university has been shown to be a critical period for weight and fat gain. To date, no European data on weight and fat gain over the full trajectory of college or university are available. Therefore, the purpose of the present study was to investigate weight and fat gain among Belgian university students from freshman through senior year of university. Methods In this prospective observational study, a total of 340 university students were measured six times, i.e. at baseline (start of the first academic year) and at the start of the second semester of the first, second, third, fourth and fifth academic year. Objective measurements included body weight, height, body mass index (BMI), fat%, fat mass, fat free mass and waist circumference. Multilevel modelling was used to assess anthropometric changes over time according to sex. Results From freshman through senior year of university, individual weight changes ranged from -5.2 to +15.7kg, and respectively 77.4% and 69.3% of students showed increases in BMI and fat%. Stronger increases in weight and BMI were found for males (5.7kg; 1.6kg/m2; both p

Acute Effects on TH4 Thoracic Spine Mobilisation Techniques on the Sympathetic Nervous System - a Cross-Over Feasibility Study Abstract. Up to date, empiric evidence about effects of thoracic spine mobilisation (TH4) on the sympathetic nervous system is lacking. The primary goal of this feasibility study was to determine adherence rate, side effects and the protocol as well as the implementation of the study design. The secondary goal was to analyse and interpret acute effects on the sympathetic nervous system after thoracic mobilisation in anterior thrust and posterior thrust on six healthy participants on two following days. The feasibility of this study was adequate. The spine mobilisations did not produce any adverse effects. The anterior thrust spine mobilisations showed a tendency in reducing the heart rate activity.Zusammenfassung. Empirische Erkenntnisse über Effekte auf das sympathische Nervensystem bei Brustwirbelsäulenmobilisationen auf Höhe TH4 sind bis heute kaum vorhanden. Das primäre Ziel dieser Machbarkeitsstudie war, Adhärenzrate, Sicherheit und Untersuchungsverfahren und -durchführung zu evaluieren. Sekundär wurde der akute Effekt auf das sympathische Nervensystem der Mobilisationen nach anterior bzw. posterior an sechs gesunden Probanden an zwei aufeinanderfolgenden Tagen analysiert und interpretiert. Die Machbarkeit dieser Studie konnte gezeigt werden. Die Mobilisationen verursachten keine Beschwerden. Eine Tendenz zur Reduzierung der Herzfrequenz konnte für eine Brustwirbelsäulenmobilisation mit Schub nach anterior nachgewiesen werden.

BackgroundMobile technologies have great potential to promote an active lifestyle in lower educated working young adults, an underresearched target group at a high risk of low activity levels. ObjectiveThe objective of our study was to examine the effect and process evaluation of the newly developed evidence- and theory-based smartphone app “Active Coach” on the objectively measured total daily physical activity; self-reported, context-specific physical activity; and self-reported psychosocial variables among lower educated working young adults. MethodsWe recruited 130 lower educated working young adults in this 2-group cluster randomized controlled trial and assessed outcomes at baseline, posttest (baseline+9 weeks), and follow-up (posttest+3 months). Intervention participants (n=60) used the Active Coach app (for 9 weeks) combined with a Fitbit activity tracker. Personal goals, practical tips, and educational facts were provided to encourage physical activity. The control group received print-based generic physical activity information. Both groups wore accelerometers for objective measurement of physical activity, and individual interviews were conducted to assess the psychosocial variables and context-specific physical activity. Furthermore, intervention participants were asked process evaluation questions and generalized linear mixed models and descriptive statistics were applied. ResultsNo significant intervention effects were found for objectively measured physical activity, self-reported physical activity, and self-reported psychosocial variables (all P>.05). Intervention participants evaluated the Active Coach app and the combined use with the Fitbit wearable as self-explanatory (36/51, 70.6%), user friendly (40/51, 78.4%), and interesting (34/51, 66.7%). Throughout the intervention, we observed a decrease in the frequency of viewing graphical displays in the app (P

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

BACKGROUND Mobile technologies have great potential to promote an active lifestyle in lower educated working young adults, an underresearched target group at a high risk of low activity levels. OBJECTIVE The objective of our study was to examine the effect and process evaluation of the newly developed evidence- and theory-based smartphone app “Active Coach” on the objectively measured total daily physical activity; self-reported, context-specific physical activity; and self-reported psychosocial variables among lower educated working young adults. METHODS We recruited 130 lower educated working young adults in this 2-group cluster randomized controlled trial and assessed outcomes at baseline, posttest (baseline+9 weeks), and follow-up (posttest+3 months). Intervention participants (n=60) used the Active Coach app (for 9 weeks) combined with a Fitbit activity tracker. Personal goals, practical tips, and educational facts were provided to encourage physical activity. The control group received print-based generic physical activity information. Both groups wore accelerometers for objective measurement of physical activity, and individual interviews were conducted to assess the psychosocial variables and context-specific physical activity. Furthermore, intervention participants were asked process evaluation questions and generalized linear mixed models and descriptive statistics were applied. RESULTS No significant intervention effects were found for objectively measured physical activity, self-reported physical activity, and self-reported psychosocial variables (all P>.05). Intervention participants evaluated the Active Coach app and the combined use with the Fitbit wearable as self-explanatory (36/51, 70.6%), user friendly (40/51, 78.4%), and interesting (34/51, 66.7%). Throughout the intervention, we observed a decrease in the frequency of viewing graphical displays in the app (P CONCLUSIONS The lack of significant intervention effects might be due to low continuous user engagement. Advice or feedback that was not perceived as adequately tailored and the difficulty to compete with many popular commercial apps on young people’s smartphones may be responsible for a decrease in the engagement. A stand-alone app does not seem sufficient to promote an active lifestyle among lower educated working young adults; therefore, multicomponent interventions (using both technological and human support), as well as context-specific sensing to provide tailored advice, might be needed in this population. CLINICALTRIAL ClinicalTrials.gov NCT02948803; https://clinicaltrials.gov/ct2/show/results/NCT02948803 (Archived by WebCite at http://www.webcitation.org/71OPFwaoA)

Installing cycling infrastructure well-separated from motorized traffic is hypothesized to increase children's transportation cycling. However, in some streets it may not be possible to install such cycling paths (e.g. due to financial or space constraints). The current paper investigates which physical factors could increase parents' perceptions of environmental supportiveness for children's transportation cycling, across six different types of cycling infrastructure. Parents completed a choice-based conjoint task by indicating which photographed street they preferred to let their child cycle along. The streets were experimentally manipulated on 7 physical factors (e.g. traffic speed, vegetation). Interactions between type of cycle path and the other environmental factors were identified. When no or limited separation from motorized traffic is present, street characteristics increasing parents' safety perceptions (traffic density and speed) should be prioritized when aiming to improve the supportiveness of streets for children's transportation cycling. Comfort and aesthetics can further improve streets' environmental supportiveness when cycling paths are more separated from traffic.

Adolescents should engage in 60 min of physical activity daily in order to obtain health benefits. Creating environments supportive for physical activity, could be a valuable strategy to increase physical activity at the population level. The purpose of this study was to understand the relative importance of park characteristics for park visitation and park-based physical activity among adolescents, using manipulated photographs of parks. Participants (n = 1197) were asked to perform two sets of ten choice tasks. For each choice task, a choice had to be made between two photographs of a park where ten characteristics were manipulated: naturalness, upkeep, walking paths, outdoor fitness equipment/playground, sport field, benches, drinking fountain, peers, mother with children and homeless person. In the first set of choice tasks participants had to select the park most inviting for visitation, in the second, they had to select the park most inviting for physical activity. Hierarchical Bayes Estimations were used to calculate (1) average utilities that represent the desirability of each level within a characteristic and (2) importance scores which reflect the effect each park characteristic had on the choice. The results indicate that park upkeep was the most important characteristic for park visitation and physical activity followed by the presence of playground/outdoor fitness equipment and sport fields. Policymakers could ensure that parks are well maintained, have sport fields and outdoor fitness equipment in order to meet adolescents’ needs. Evaluation of such initiatives can confirm whether these park characteristics will influence actual adolescent park visitation and park-based physical activity.

Cycling for transport offers an opportunity to promote active and sustainable mobility among the growing population of older adults. However, only a few studies examined how environmental factors may promote cycling for transport among older adults. Purposeful convenience sampling was used to recruit 40 older adults in Flanders, Belgium. Researchers and participants made a cycle trip, during which bike-along interviews were used to obtain in-depth and context-sensitive information about the environmental factors influencing their perceptions and experiences, which were analysed using inductive content analysis. A model including seven environmental themes emerged; traffic safety, cycling infrastructure, road design & maintenance, connectivity, aesthetics, hilliness and weather. Traffic safety appeared to be the most important concern. Participants felt safer where cycling tracks were well-separated from motorized traffic and where clearly demarcated crossings were present. They expressed preferences for cycling tracks being wide, obstacle-free, even and well-separated from the sidewalk; and, for a well-connected street network that provided alternative routes to reach destinations. Our findings suggest that traffic safety may have a major influence on older adults’ transportation cycling experiences and that the provision of a well-separated cycling space may be crucial in that context. Further research studies with larger, more-representative, samples and using quantitative methods are needed to examine the mechanisms proposed in our inductively-derived model.

Pooled analysis of secondary data increases the power of research and enables scientific discovery in nutritional epidemiology. Information on study characteristics that determine data quality is needed to enable correct reuse and interpretation of data. This study aims to define essential quality characteristics for data from observational studies in nutrition. First, a literature review was performed to get an insight on existing instruments that assess the quality of cohort, case-control, and cross-sectional studies and dietary measurement. Second, 2 face-to-face workshops were organized to determine the study characteristics that affect data quality. Third, consensus on the data descriptors and controlled vocabulary was obtained. From 4884 papers retrieved, 26 relevant instruments, containing 164 characteristics for study design and 93 characteristics for measurements, were selected. The workshop and consensus process resulted in 10 descriptors allocated to "study design" and 22 to "measurement" domains. Data descriptors were organized as an ordinal scale of items to facilitate the identification, storage, and querying of nutrition data. Further integration of an Ontology for Nutrition Studies will facilitate interoperability of data repositories. © 2017 American Society for Nutrition.

INTRODUCTION: This meta-analysis investigated the effectiveness of low-level laser therapy (LLLT) on pain in adult patients with musculoskeletal disorders. EVIDENCE ACQUISITION: A systematic literature search was conducted in the Medline and PEDro databases. Two researchers independently screened titles and abstracts of the retrieved studies for eligibility. Quality assessment of the eligible studies was conducted using the PEDro rating scale. Studies that scored ≥ 4 were included. A random-effects model was used for this meta-analysis. Subgroup meta-analyses were conducted to evaluate the influence of the adherence of the applied LLLT to the World Association of Laser Therapy (WALT) guidelines, the anatomical site under investigation and the study design on the overall weighted mean effect size. Meta regression was used to assess the possible influence of the study quality on the individual study effect sizes. EVIDENCE SYNTHESIS: Eighteen studies allowing for 21 head-to-head comparisons (totaling n=1462 participants) were included. The pooled raw mean difference (D) in pain between LLLT and the control groups was -0.85 [95%CI: -1.22 to -0.48]. There was high (I² = 85.6%) and significant between study heterogeneity (Cochran’s Q = 139.2; df = 20; p < 0.001). The subgroup meta-analysis of the comparisons not following the WALT guidelines revealed a D = -0.68 [95%CI: -1.09 to -0.27]. In this group, heterogeneity decreased to I² = 72.6% (Q = 51.2; df = 14; p < 0.001). In the WALT subgroup D equaled -1.52 [95%CI: -2.34 to -0.70]. This between groups difference was clinically relevant although statistically not significant (Q = 3.24; df = 1; p = 0.072). CONCLUSION: This meta-analysis presents evidence that LLLT is an effective treatment modality to reduce pain in adult patients with musculoskeletal disorders. Adherence to WALT dosage recommendations seems to enhance treatment effectiveness. Key words: Low-level light therapy - Meta-analysis - Musculoskeletal diseases - Systematic review

The objective of this systematic review was to provide insight into the specific characteristics of public open spaces (POS) associated with adolescents' POS visitation and physical activity (PA). Qualitative research suggests many characteristics to be associated with POS visitation and PA. Quantitative evidence confirmed a positive association between presence of trails, playgrounds and specific types of sports fields (e.g. basketball) with POS visitation and PA, whereas safety and aesthetics seemed subordinate. Suggestions for future research, as well as some methodological recommendations are provided.

In a comment on several articles on the vegan dietary pattern, Antoniazzi & Acosta-Navarro (2017) mentioned the paradox of the presence of dietary cholesterol as a nutritional component in the analysis of the vegan dietary pattern [1]. [...]