The environment and physical activity: The influence of psychosocial, perceived and built environmental factors

This study sought to integrate perceived and built environmental and individual factors into the Theory of Planned Behavior (TPB) model to better understand adolescents' physical activity

Biochemical Effects of Carbohydrate Supplementation in a Simulated Competition of Short Terrestrial Duathlon

The purpose of the present study was to investigate the biochemical effects of carbohydrate supplementation in a simulated competition of short terrestrial duathlon. Ten duathletes participated in a simulated competition of short terrestrial duathlon 30 minutes after the ingestion of a 6% (30 g/500 ml) maltodextrin solution (MALT) or a placebo (PLA). This solution was also ingested every 15 minutes during the competition (12 g/200 ml); and immediately after the competition (18 g/300 ml). Samples of blood were collected at 3 time points: 1) at rest 1 hour before the beginning of the competition; 2) during the competition (approximately 1 hour and 45 minutes after the 1st collection); 3) immediately after the competition. Blood was analyzed for blood glucose, lactate, insulin and cortisol. Significant differences were observed in relation to blood glucose levels between MALT and PLA in the post-competition phase. There was also a significant difference in the lactate levels observed between MALT and PLA during the competition phase. Similarly, a significant difference in the cortisol concentrations during and after the competition phases (MALT and PLA) were observed. We conclude that maltodextrin supplementation appears to be beneficial during short terrestrial duathlon competition as evidenced by biochemical markers

Social inequalities in changes in health-related behaviour among Slovak adolescents aged between 15 and 19: A longitudinal study

<p>Abstract</p> <p>Background</p> <p>Lower socioeconomic position is generally associated with higher rates of smoking and alcohol consumption and lower levels of physical activity. Health-related behaviour is usually established during late childhood and adolescence. The aim of this study is to explore changes in health-related behaviour in a cohort of adolescents aged between 15 and 19, overall and by socioeconomic position.</p> <p>Methods</p> <p>The sample consisted of 844 first-year students (42.8% males, baseline in 1998 – mean age 14.9, follow-up in 2002 – mean age 18.8) from 31 secondary schools located in Kosice, Slovakia. This study focuses on changes in adolescents' smoking, alcohol use, experience with marijuana and lack of physical exercise with regard to their socioeconomic position. Four indicators of socioeconomic position were used – adolescents' current education level and employment status, and the highest education level and highest occupational status of their parents. We first made cross tabulations of HRB with these four indicators, using McNemar's test to assess differences. Next, we used logistic regression to assess adjusted associations, using likelihood ratio tests to assess statistical significance.</p> <p>Results</p> <p>Statistically significant increases were found in all health-related behaviours. Among males, the most obvious socioeconomic gradient was found in smoking, both at age 15 and at 19. Variations in socioeconomic differences in health-related behaviour were more apparent among females. Although at age 15, almost no socioeconomic differences in health-related behaviour were found, at age 19 differences were found for almost all socioeconomic indicators. Among males, only traditional socioeconomic gradients were found (the lower the socioeconomic position, the higher the prevalence of potentially harmful health-related behaviour), while among females reverse socioeconomic gradients were also found.</p> <p>Conclusion</p> <p>We confirmed an increase in unhealthy health-related behaviour during adolescence. This increase was related to socioeconomic position, and was more apparent in females.</p

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1⋅6 per cent at 24 h (high 1⋅1 per cent, middle 1⋅9 per cent, low 3⋅4 per cent; P < 0⋅001), increasing to 5⋅4 per cent by 30 days (high 4⋅5 per cent, middle 6⋅0 per cent, low 8⋅6 per cent; P < 0⋅001). Of the 578 patients who died, 404 (69⋅9 per cent) did so between 24 h and 30 days following surgery (high 74⋅2 per cent, middle 68⋅8 per cent, low 60⋅5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2⋅78, 95 per cent c.i. 1⋅84 to 4⋅20) and low-income (OR 2⋅97, 1⋅84 to 4⋅81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)

Understanding University Fee Litigation: A Few Lessons About The Perils of Imprudence for Higher Ed Plan Sponsors

Beginning in August 2016, a series of class action lawsuits were filed on behalf of participants and beneficiaries of 403(b) employee retirement plans sponsored by major American colleges and universities. These plans are regulated by the 1974 Employee Retirement Income Security Act (“ERISA”), which sets minimum standards to protect the participants and beneficiaries of voluntarily established retirement and health plans. The allegations in the several lawsuits have centered primarily around breaches of fiduciary duties by those charged with administering the plan. These cases are all class action lawsuits brought on behalf of the participants and beneficiaries of the plans in question. Generally, the class sizes are between 15,000 and 25,000, and the plaintiffs have not had difficulty getting their classes certified by the courts. The defendants are 403(b) plan fiduciaries at prominent colleges and universities with large pools of assets held in ERISA covered plans. Each plan ranges in aggregate value from $1.25 billion to$4.7 billion.1 The fiduciaries charged with breach of duty are those explicitly designated as such in plan documents, as well as functional fiduciaries, i.e., those whose ERISA duties arise because they (1) exercise discretionary authority/control over management of a plan, (2) exercise authority/control over management/disposition of plan’s assets, (3) render investment advice for a fee (or has authority to do so), or (4) have any discretionary authority/responsibility in the of administration of plan.2 Most defendants are functional fiduciaries, as plan creation documents usually only explicitly name one person or organizational role. Apart from the case against MIT, each plan sponsor maintained between two and five recordkeepers. Some recordkeepers in this industry provide only recordkeeping and administrative services, while others provide both recordkeeping services and investment products. This latter type is the kind employed by the defendant institutions subject to these suits. The primary companies whose services/products are at issue in these cases are TIAA-CREF, Vanguard, and Fidelity. Having multiple recordkeepers raises the costs associated with administering the plans and has been alleged by plaintiffs to be de-facto imprudent. The MIT case is unique among these suits in that Fidelity was the sole recordkeeper and provider of investment options. In this case, the plaintiffs have also brought “prohibited transaction” claims based on the theory that Fidelity and MIT were both “parties in interest.” Plaintiffs assert that the philanthropic generosity showed to MIT by Fidelity, coupled with the presence on the MIT board of multiple Fidelity CEOs, created conflicts of interest and fell under the umbrella of prohibited transactions which create fiduciary conflicts, and which ERISA Section 406 was specifically designed to protect against. The fiduciary breaches most cited are the “duty of prudence” and “duty of loyalty,” as well as allegations of various prohibited transactions. In almost every instance, the only claims which have survived 12(b)(6) motions to dismiss have been those relating to prudence

Understanding University Fee Litigation: A Few Lessons About The Perils of Imprudence for Higher Ed Plan Sponsors

Beginning in August 2016, a series of class action lawsuits were filed on behalf of participants and beneficiaries of 403(b) employee retirement plans sponsored by major American colleges and universities. These plans are regulated by the 1974 Employee Retirement Income Security Act (“ERISA”), which sets minimum standards to protect the participants and beneficiaries of voluntarily established retirement and health plans. The allegations in the several lawsuits have centered primarily around breaches of fiduciary duties by those charged with administering the plan. These cases are all class action lawsuits brought on behalf of the participants and beneficiaries of the plans in question. Generally, the class sizes are between 15,000 and 25,000, and the plaintiffs have not had difficulty getting their classes certified by the courts. The defendants are 403(b) plan fiduciaries at prominent colleges and universities with large pools of assets held in ERISA covered plans. Each plan ranges in aggregate value from $1.25 billion to$4.7 billion.1 The fiduciaries charged with breach of duty are those explicitly designated as such in plan documents, as well as functional fiduciaries, i.e., those whose ERISA duties arise because they (1) exercise discretionary authority/control over management of a plan, (2) exercise authority/control over management/disposition of plan’s assets, (3) render investment advice for a fee (or has authority to do so), or (4) have any discretionary authority/responsibility in the of administration of plan.2 Most defendants are functional fiduciaries, as plan creation documents usually only explicitly name one person or organizational role. Apart from the case against MIT, each plan sponsor maintained between two and five recordkeepers. Some recordkeepers in this industry provide only recordkeeping and administrative services, while others provide both recordkeeping services and investment products. This latter type is the kind employed by the defendant institutions subject to these suits. The primary companies whose services/products are at issue in these cases are TIAA-CREF, Vanguard, and Fidelity. Having multiple recordkeepers raises the costs associated with administering the plans and has been alleged by plaintiffs to be de-facto imprudent. The MIT case is unique among these suits in that Fidelity was the sole recordkeeper and provider of investment options. In this case, the plaintiffs have also brought “prohibited transaction” claims based on the theory that Fidelity and MIT were both “parties in interest.” Plaintiffs assert that the philanthropic generosity showed to MIT by Fidelity, coupled with the presence on the MIT board of multiple Fidelity CEOs, created conflicts of interest and fell under the umbrella of prohibited transactions which create fiduciary conflicts, and which ERISA Section 406 was specifically designed to protect against. The fiduciary breaches most cited are the “duty of prudence” and “duty of loyalty,” as well as allegations of various prohibited transactions. In almost every instance, the only claims which have survived 12(b)(6) motions to dismiss have been those relating to prudence