Independent and combined effects of physical activity and body mass index on the development of Type 2 Diabetes - a meta-analysis of 9 prospective cohort studies.

BACKGROUND: The aim of this harmonized meta-analysis was to examine the independent and combined effects of physical activity and BMI on the incidence of type 2 diabetes. METHODS: Our systematic literature review in 2011 identified 127 potentially relevant prospective studies of which 9 fulfilled the inclusion criteria (total N = 117,878, 56.2 % female, mean age = 50.0 years, range = 25-65 years). Measures of baseline physical activity (low, intermediate, high), BMI-category [BMI < 18.4 (underweight), 18.5-24.9 (normal weight), 25.0-29.9 (overweight), 30+ (obese)] and incident type 2 diabetes were harmonized across studies. The associations between physical activity, BMI and incident type 2 diabetes were analyzed using Cox regression with a standardized analysis protocol including adjustments for age, gender, educational level, and smoking. Hazard ratios from individual studies were combined in a random-effects meta-analysis. RESULTS: Mean follow-up time was 9.1 years. A total of 11,237 incident type 2 diabetes cases were recorded. In mutually adjusted models, being overweight or obese (compared with normal weight) and having low physical activity (compared with high physical activity) were associated with an increased risk of incident type 2 diabetes (hazard ratios 2.33, 95 % CI 1.95-2.78; 6.10, 95 % CI: 4.63-8.04, and 1.23, 95 % CI: 1.09-1.39, respectively). Individuals who were both obese and had low physical activity had 7.4-fold (95 % CI 3.47-15.89) increased risk of type 2 diabetes compared with normal weight, high physically active participants. CONCLUSIONS: This harmonized meta-analysis shows the importance of maintaining a healthy weight and being physically active in diabetes prevention

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine

[This corrects the article DOI: 10.1186/s13054-016-1208-6.]

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

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Barriers and facilitators to extended working lives in Europe : a gender focus

Background: There is a global imperative to respond to the challenge of a growing ‘old-age dependency ratio’ by ensuring the workforce is healthy enough to remain in work for longer. Currently more than half of older workers leave before the default retirement age, and in some countries (e.g. the United Kingdom) the time spent in retirement is increasing. At the same time across Europe there is a gender employment gap, with 14.5% fewer female workers between 55-64 years old, and a large variation in the participation of older women in the workforce (ranging from 30%-75%). As older women are under-represented in the workforce, increasing employment in this group has the propensity to go some way towards reducing the old-age dependency ratio to ensure continued economic growth. Objectives: This review explores the barriers and facilitators to extended working lives in Europe, particularly those than impact on women. Methods: A systematic mapping review process was undertaken using four electronic databases, Medline, PsychoInfo, Psych Extra via Ovid and Age Line via EBSCO, using the terms, ‘work’, ‘ageing’, ‘retirement’, ‘pension’, ‘old’, ‘barrier’, ‘extended working life’, ‘gender’, ‘health and wellbeing’. Hand searching was also carried out in the Journal of Aging and Human Development and the Journal of Ageing and Society. Results: The search resulted in 15 English language studies published from 1st January 2005 to the current date that met the inclusion criteria. Key findings: The key factors that influenced decisions to retire or extend working lives in Europe, were health; social factors; workplace factors; and financial security and pension arrangements. Conclusions and implications of key findings: Health was found to be the most commonly cited barrier to extended working lives in Europe, and a number of social inequalities to work exist by gender. Structural factors exist, such as the gender pay gap, which disadvantage women, while the nature of work itself differs by gender and can have a negative impact on health. Currently women tend to exit the labour market earlier than men, however, changes in the state pension age are resulting in women being required to work for as long as men, in most countries. For women to remain healthy at work, workplaces need to consider a range of interventions, including flexible arrangements to both work and retirement to enable women to balance the demands of work with domestic and caring responsibilities that particularly impact on them

Physical environmental and financial determinants of sports, physical activity and sedentary behaviour

Ruimtelijke factoren (determinanten) die samenhangen met sporten en bewegen bij volwassenen en ouderen zijn o.a. de aanwezigheid van parken en/of recreatieve voorzieningen in de buurt, goede voetgangersinfrastructuur en een aantrekkelijke buurt. Bij kinderen en adolescenten lijken, naast de aanwezigheid van formele en informele speelvoorzieningen, ook de aanwezigheid van groen of water, de verkeersveiligheid en verscheidenheid in routes van belang. Er is nog niet veel bekend over financiële determinanten van sporten en bewegen. Bij volwassenen en ouderen hangt een lage sociaaleconomische status samen met minder lichamelijke activiteit, sporten en recreatief wandelen. Voor sedentair gedrag (alle laag intensieve activiteiten die zittend of liggend worden uitgevoerd, zoals computeren en tv kijken) zijn deze determinanten nog weinig onderzocht. Dit blijkt uit een verkenning van de internationale literatuur door het RIVM. Deze kennis kan worden gebruikt voor het vormgeven van beleid om bewegen te stimuleren. Financiële factoren vaker een belemmering dan ruimtelijke factorenIn samenwerking met het W.J.H. Mulier Instituut en het Nederlands Instituut voor Sport en Bewegen (NISB) is in twee Nederlandse studies (SportersMonitor 2011 en NL de maat 2009/2010) bekeken hoe vaak een aantal omgevingskenmerken en kosten als belemmering om te sporten en bewegen worden ervaren. Kosten vormen vaker een belemmering dan omgevingskenmerken. Dit is het geval in alle leeftijdsgroepen. Kosten zijn een belemmering voor 11% van de kinderen, 17% van de adolescenten, 13-17% van de volwassenen en 7-8% van de ouderen. Ruimtelijke factoren zijn minder vaak een belemmering (maximaal 8%). Hierbij dient echter in ogenschouw te worden gehouden dat slechts een beperkt aantal potentiële belemmeringen is geïnventariseerd. Er waren geen grote verschillen in belemmeringen tussen sporters en niet-sporters en mensen met en zonder chronische aandoening(en).Based on international literature reviews, RIVM has provided an overview of potential physical environmental determinants of sports and physical activity. For adults and elderly persons these are, among others, availability of parks and recreational facilities in the vicinity, a pedestrian infrastructure, and the attractiveness of the neighbourhood. For children and adolescents, the presence of formal and informal playing areas, parks, water, road safety, and diversity in cycling and walking routes are of importance. These international reviews provided little information on the influence of the financial environment on sports and physical activity. However, in several studies it was shown that a low socioeconomic status is correlated with a lower level of physical activity, sports and recreational walking. Little research is available on potential physical environmental and financial determinants of sedentary behaviour (activities with a low activity level that are performed while in a sitting or reclining posture), e.g. screen-related activities such as computer work, playing video games or watching television. This research was commissioned by the ministry of Health, Welfare, and Sports. The results can be used to develop policies to stimulate physical activity. Financial factors more often a barrier than physical environmental factorsDutch research using questionnaires shows that costs more often are perceived as a barrier than physical environmental factors. In each age category, less than 8% of respondents indicated that physical environmental factors were a barrier to become physically active. Whereas costs were a barrier for 11% of children, 17% of adolescents, 13 to 17 % of adults, and 7 to 8 % of elderly. However, for the interpretation of these figures, it should be considered that only a limited number of all potential barriers were listed, such as lack of facilities in the vicinity, and safety of facilities. There were no substantial differences in barriers between people who do or do not practise sports on a regular basis, or between people with or without physical limitations.<br