Motivation and active travel in adolescent girls and boys in Germany – Findings from the ARRIVE study

Active travel (using an active mode of transport such as walking or cycling) contributes to the accumulation of daily physical activity and thus holds potential for promoting health. To promote active travel among adolescents an in-depth understanding of determinants from a sex/gender perspective is needed. Within Self-Determination Theory (SDT), it is proposed that the quality of an individuals’ motivation (i.e., the degree to which it is autonomous) determines the extent to which they engage in particular behaviors and perform them effectively. As part of the ARRIVE study, the aim of this research was to investigate the relationship between motivation and active travel in adolescent boys (N = 263, Mage = 12.92) and girls (N = 254, Mage = 13.21) from a nationwide German sample. Results showed significant group differences between male and female adolescents in the proportion of trips traveled actively, intrinsic motivation and amotivation. Logistic regression analyses demonstrated different relationships of the different types of motivation proposed within SDT on active travel behavior depending on sex/gender. In the total sample, integrated and identified regulation increased the odds of active travel (by 15.8 %, and 20.3 % respectively), whereas amotivation decreased the odds by 23.0 %. Intrinsic motivation and controlled forms of extrinsic motivation (i.e. introjected and external regulation) did not significantly change the odds of active travel. Separate sex/gender-specific analyses were conducted. For boys, only identified regulation significantly increased the odds of active travel (by 40.2 %) and amotivation significantly decreased the odds (by 18.8 %). In girls, integrated (by 25.3 %) and external (by 20.3 %) regulation significantly increased the odds of active travel, while amotivation (26.6 %) significantly decreased the odds. We conclude that disparities exist in the relationship among different regulation types with active travel behavior between adolescent boys and girls, and that findings contradictory to SDT might result from the specific context of traveling to a destination. Considering the regression analyses findings, future interventions to promote active travel among adolescents should incorporate sex/gender-sensitive development, because some behavioral regulations might not be equally effective among girls and boys

Parental perspectives on the decision-making process on transport mode choice in adolescents: a qualitative study with mothers and fathers

ObjectiveThe present study aims to understand the familial decision-making process on transport mode choice in adolescents with a focus on the parental perspective within this process.BackgroundActive travel contributes to adolescents’ overall physical activity and its positive health effects. Based on the social-learning theory, especially parents are assigned a central role for adolescents’ travel behavior. The aim of the present study was to examine how parents are involved in the decision-making process on transport mode choice in adolescents.MethodThe study is part of the cross-sectional mixed-methods ARRIVE study which includes semi-structured interviews with mothers (n = 12) and fathers (n = 7) of 11- to 14-year-old German adolescents. The interviews focused on travel behavior in adolescents and the decision-making process on transport mode choice from the parental perspective. All interviews were analyzed inductively using Thematic Analysis.ResultsOur study revealed that parents do not primarily decide for or against active travel in adolescents, but are mostly involved in the decision-making process, especially in case of a deviation from the main transport mode. Different forms of parental involvement in the decision-making process were identified. Some parents acted as main decision makers which is the highest form of involvement while others gave their children complete freedom of choose a transport mode for themselves. These parents accepted their child’s choice fully which shows a low involvement in the decision-making process.ConclusionThe results provide a deeper understanding of the familial decision-making process on travel behavior in adolescents. The results indicate an occasionally parental involvement in the decision-making process on the mainly used transport mode by adolescents, and that mothers and fathers are always involved when deviating from the main mode.ImplicationsFurther research should investigate changes in travel behavior from childhood to young adulthood to understand long-term travel decisions in families. Due to the findings that parents are often involved in the decision-making process on transport mode choice and that they mainly reported safety concerns as barriers to their children’s active travel, further research should focus especially on the social and physical environment of adolescents

Outcomes following small bowel obstruction due to malignancy in the national audit of small bowel obstruction

Introduction Patients with cancer who develop small bowel obstruction are at high risk of malnutrition and morbidity following compromise of gastrointestinal tract continuity. This study aimed to characterise current management and outcomes following malignant small bowel obstruction. Methods A prospective, multicentre cohort study of patients with small bowel obstruction who presented to UK hospitals between 16th January and 13th March 2017. Patients who presented with small bowel obstruction due to primary tumours of the intestine (excluding left-sided colonic tumours) or disseminated intra-abdominal malignancy were included. Outcomes included 30-day mortality and in-hospital complications. Cox-proportional hazards models were used to generate adjusted effects estimates, which are presented as hazard ratios (HR) alongside the corresponding 95% confidence interval (95% CI). The threshold for statistical significance was set at the level of P ≤ 0.05 a-priori. Results 205 patients with malignant small bowel obstruction presented to emergency surgery services during the study period. Of these patients, 50 had obstruction due to right sided colon cancer, 143 due to disseminated intraabdominal malignancy, 10 had primary tumours of the small bowel and 2 patients had gastrointestinal stromal tumours. In total 100 out of 205 patients underwent a surgical intervention for obstruction. 30-day in-hospital mortality rate was 11.3% for those with primary tumours and 19.6% for those with disseminated malignancy. Severe risk of malnutrition was an independent predictor for poor mortality in this cohort (adjusted HR 16.18, 95% CI 1.86 to 140.84, p = 0.012). Patients with right-sided colon cancer had high rates of morbidity. Conclusions Mortality rates were high in patients with disseminated malignancy and in those with right sided colon cancer. Further research should identify optimal management strategy to reduce morbidity for these patient groups

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Tῆς πάσης ναυτιλίης φύλαξ: Aphrodite and the Sea

Cet article présente une série d’épigrammes hellénistiques généralement peu étudiées et quelques témoignages littéraires et épigraphiques attestant le culte d’Aphrodite en tant que protectrice de la navigation. Les temples de la déesse occupaient souvent une position littorale, non parce qu’ils étaient des lieux où la « prostitution sacrée » était pratiquée, mais plutôt en raison de l’association d’Aphrodite avec la mer et de son rôle de patronne des marins. La protection qu’elle accordait était destinée à tous les navigateurs, y compris la marine et les commerçants, et est attestée dans toute la Méditerranée, depuis la période archaïque jusqu’à la période hellénistique. De plus, les textes examinés révèlent un lien métaphorique entre les rôles d’Aphrodite comme protectrice de la navigation d’une part et comme déesse de la sexualité d’autre part.This paper offers a collection of generally neglected Hellenistic epigrams and some literary and epigraphic evidence that attest to the worship of Aphrodite as a patron deity of navigation.The goddess’ temples were often coastal not because they were places where “sacred prostitution” was practiced, but rather because of Aphrodite’s association with the sea and her role as a patron of seafaring.The protection she offered was to anyone who sailed, including the navy and traders, and is attested throughout the Mediterranean, from the Archaic to the Hellenistic periods.Further, the texts examined here reveal a metaphorical link between Aphrodite’s role as patron of navigation and her role as a goddess of sexuality

Pistiros and a North Aegean Trade Network

Demetriou Denise. Pistiros and a North Aegean Trade Network . In: L'antiquité classique, Tome 79, 2010. pp. 77-93