Eating for science:The effect of lifestyle on prevention of non-communicable diseases

Although the average life expectancy is increasing, general health is deteriorating. An important cause of disease is an unhealthy lifestyle. In this thesis is therefore looked at the different aspects of lifestyle on the prevention of non-communicable disease. It appeared that both a low-carbohydrate as well as a low-fat diet led to improvement in health. However, a lower carbohydrate and higher fat and protein intake are more beneficial for health, independent of diet and caloric intake. A self-chosen dietary intervention can reduce mental and physical complaints and lead to body weight loss, more specifically reducing processed food intake and increase fruit and vegetable intake. There also seems to be a role in this relation for the gut microbiota, since there was a relation with both food intake and mental complaints. To investigate several aspects of lifestyle at once, the characteristics of the blue zone lifestyle was applied in Bakkeveen. After four week of eating a plant-based Mediterranean diet, increased social contacts and more physical activity, health and fitness improved in the inhabitants of Bakkeveen. Another aspects of lifestyle that was investigated, was that of working in irregular shift work. This was associated with reduced resting metabolic rate and thus energy expenditure, which is difficult to increase with physical activity, compared to day shift workers. Without altering food intake this can lead to body weight gain

A trial-based cost-utility analysis of metastasis-directed therapy for oligorecurrent prostate cancer

The optimal management of patients with oligorecurrent prostate cancer (PCa) is unknown. There is growing interest in metastasis-directed therapy (MDT) for this population. The objective was to assess cost-utility from a Belgian healthcare payer's perspective of MDT and delayed androgen deprivation therapy (ADT) in comparison with surveillance and delayed ADT, and with immediate ADT. A Markov decision-analytic trial-based model was developed, projecting the results over a 5-year time horizon with one-month cycles. Clinical data were derived from the STOMP trial and literature. Treatment costs were derived from official government documents. Probabilistic sensitivity analyses showed that MDT is cost-effective compared to surveillance (ICER: Euro8393/quality adjusted life year (QALY)) and immediate ADT (dominant strategy). The ICER is most sensitive to utilities in the different health states and the first month MDT cost. At a willingness-to-pay threshold of Euro40,000 per QALY, the cost of the first month MDT should not exceed Euro8136 to be cost-effective compared to surveillance. The Markov-model suggests that MDT for oligorecurrent PCa is potentially cost-effective in comparison with surveillance and delayed ADT, and in comparison with immediate ADT

Finger creases lend a hand in Kabuki syndrome.

International audienceKabuki syndrome (KS) is a rare syndrome associating malformations with intellectual deficiency and numerous visceral, orthopedic, endocrinological, immune and autoimmune complications. The early establishment of a diagnostic of KS leads to better care of the patients and therefore prevents complications such as perception deafness, severe complications of auto-immune diseases or obesity. However, the diagnosis of KS remains difficult because based on the appreciation of facial features combined with other highly variable features. We describe a novel sign, namely the attenuation and/or congenital absence of the IPD crease of the third and fourth fingers associated with limitation of flexion of the corresponding joints, which seems to be specific of KS and could help the clinician to diagnose KS

Multi-ancestry sleep-by-SNP interaction analysis in 126,926 individuals reveals lipid loci stratified by sleep duration.

Both short and long sleep are associated with an adverse lipid profile, likely through different biological pathways. To elucidate the biology of sleep-associated adverse lipid profile, we conduct multi-ancestry genome-wide sleep-SNP interaction analyses on three lipid traits (HDL-c, LDL-c and triglycerides). In the total study sample (discovery + replication) of 126,926 individuals from 5 different ancestry groups, when considering either long or short total sleep time interactions in joint analyses, we identify 49 previously unreported lipid loci, and 10 additional previously unreported lipid loci in a restricted sample of European-ancestry cohorts. In addition, we identify new gene-sleep interactions for known lipid loci such as LPL and PCSK9. The previously unreported lipid loci have a modest explained variance in lipid levels: most notable, gene-short-sleep interactions explain 4.25% of the variance in triglyceride level. Collectively, these findings contribute to our understanding of the biological mechanisms involved in sleep-associated adverse lipid profiles

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

Doing it #LikeACorporation: feminist organisations navigating the corporate feminism dilemma

While the involvement of corporations in feminist campaigns has recently been in the limelight of feminist research, with studies exploring its impact on consumers as well as its utility for various corporations, little research has been carried out regarding the impact of corporate involvement on feminist organisations, such as organisations fighting against menstrual poverty, sexual harassment, or for better sexual education. The project thus aims at bridging this gap through a series of semistructured interviews with participants who work for, or volunteer with, a range of feminist organisations in the UK, followed by a thematic analysis of these interviews to examine the perceived relationship between corporate feminism and feminist activists. After reviewing theories of the history of the relationship between feminist theories and capitalism to highlight the tension between ideologies, the thesis explores how feminist organisations navigate corporate partnerships and how and why they consider forming one, the activists’ perception of the social impact of corporate feminism, and whether they believe it makes a real difference. Drawing from theories such as popular feminism and neoliberal feminism, and using a feminist framework to give a voice to significant actors, the thesis explores how capitalism has shaped new strands of feminism, and how it has redirected the feminist focus to once again charge women with their own happiness and emancipation. Through the interviews, the thesis reveals the struggle of organisations in terms of money and platform, and their fear that their values might clash with that of corporations, and how this difference, coupled with corporate influence and platform, impacts society’s perception of feminism, and, in turn, the work of activists. The thesis thus explores the concept of constrained feminism, which argues that organisations are affected by the involvement of corporate feminism whether they enter partnerships or not, as they have to compromise.</p

Does multidisciplinary therapy improve pain , functionality and return to work in employed (sub)acute low back pain sufferers ? A systematic review

Introduction Low back pain (LBP) is characterized with enormous costs originating from e.g. work absenteeism (1). This study examined the effectiveness of a multidisciplinary intervention, with or without additional workplace intervention (WPI), in improving pain, functionality and return to work in employed (sub)acute LBP sufferers. Methods A comprehensive search in six electronic databases was performed. The risk of bias (RoB) was assessed using the Cochrane RoB 2-tool and the ROBIS-tool. A level of evidence (LoE) and conclusion was determined according to the Dutch EBRO checklist. Results Twelve studies were included (one A1, seven A2, four B LoE studies). A multidisciplinary intervention has beneficial effects on pain intensity and functionality compared to usual care. Contradictory results exist when compared with another intervention or an additional WPI. Regarding work-related outcomes conflicting results were found when a multidisciplinary intervention was compared to usual care, and no superior effects were found in comparison to other types of interventions. Adding a WPI to usual care might result in earlier work resumption. Discussion A multidisciplinary intervention has favorable effects compared with usual care on pain and functionality. An additional WPI on top of usual care might be beneficial for RTW

A multidisciplinary treatment program in (sub)acute low back pain patients has favorable effects on pain intensity and functional status but not on return to work . A systematic review

Background and aims Low back pain (LBP) is one of the most common causes of disability worldwide and is accompanied by enormous costs for society originating from e.g. healthcare use and work absenteeism. In the (sub)acute phase, early multidisciplinary treatment programs are recommended. Thereby integrating health and workplace management seems essential to reduce sick leave. Nevertheless, there are some uncertainties regarding recommendations for (sub)acute LBP and this may be due to the absence of multiple direct comparisons of the available multidisciplinary interventions (MDI). The Cochrane review on this topic was published by Marin et al. in 2017 [1] in which multidisciplinary biopsychosocial rehabilitation interventions were compared with usual care or other interventions in adults with subacute LBP. Given the increase in the use of multidisciplinary programs in recent years and the lack of the inclusion of a workplace intervention (WPI) in previous reviews, an extension of the literature on this topic is required to further evaluate the effectiveness of those interventions. Therefore the objective of this study was to examine the effectiveness of a MDI, with or without additional WPI, for (sub)acute LBP among adults on pain, functional status, return to work (RTW), and sick leave. Methods A comprehensive search of the existing literature up to June 2021 was performed in six electronic databases. The studied population were working adults (18 – 65 years) with acute or subacute low back pain. Study selection was performed independently as a two-step method based upon predefined eligibility criteria. Risk of bias was assessed using the RoB 2-tool for RCT studies and the ROBIS-tool for systematic reviews was used for the systematic review of Marin et al. [1] which was also included. The risk of bias was evaluated at study level, by one researcher and checked by the other. Relevant information concerning the studied population, MDI, outcome measures (i.e. pain, functional status, RTW, sick leave) and results was extracted from each included article and presented in an evidence table by one of the two researchers and checked by the other. The results were synthesized in 4 clusters: (1) MDI versus ‘usual care’; (2) MDI versus ‘other interventions’; (3) ‘additional WPI’ versus usual care; (4) subgrouping patients in favor of an earlier RTW. Usual care was defined as the current clinical practice. In the second cluster, the category ‘other interventions’ entailed another type of multidisciplinary therapy, whereas the category ‘MDI’ contained a more extensive MDI compared to the other intervention. A level of conclusion was determined for each cluster. Results A total of 12 studies were included of which 11 RCT studies and one systematic review. The results of the latter review were included in the current review and extended with results from more recent literature. High quality of evidence was found supporting greater beneficial effects of MDI compared to usual care on pain intensity scores and functional outcomes. Conflicting evidence was found when a more extensive MDI was compared with another MDI. Adding a WPI to usual care did not result in additional beneficial effects on pain and functional status. In regard to work related outcomes, there were conflicting results when a MDI was compared to usual care. High quality of evidence was found for the comparable effects between a more extensive MDI and another MDI, while moderate quality of evidence showed that adding WPI to usual care results in earlier RTW. Subgrouping patients regarding their risk at protracted work disability, work satisfaction, influence on work planning, and risk of losing their job at baseline seems useful to promote earlier RTW. Conclusions A MDI has favorable effects compared to usual care on pain intensity and functional status. Furthermore, there is moderate evidence that adding a WPI to usual care, as well as subdividing patients based on work-related characteristics, can be beneficial for RTW. The evidential value of the conclusions made in this systematic review was often not strong enough due to conflicting results in the included studies and the limited studies available in the topic. Future studies should focus more on investigating the effects of a MDI in combination with interventions at work in patients with (sub)acute LBP as too few studies examining a MDI with an additional WPI were found

Disability and return to work after a multidisciplinary intervention for (sub)acute low back pain: A systematic review

Objective This systematic review aimed to examine pain, functional status and return to work after a multidisciplinary intervention, with or without additional workplace intervention, for (sub)acute low back pain among adults. Data sources A comprehensive search was completed (November 2022) in six electronic databases (Embase, MEDLINE, Web of Science, Cochrane, CENTRAL and Scopus) and in the reference list of all identified studies. Review methods The search results were screened against predefined eligibility criteria by two independent researchers. Included articles were systematic reviews or randomized controlled trials examining the effect of a multidisciplinary intervention, with or without workplace intervention, in working adults with (sub)acute low back pain. Relevant information was summarized and clustered, and the methodological quality and certainty of evidence were assessed respectively using the RoB 2-tool, the ROBIS tool and the GRADE criteria. Results The search resulted in a total of 3020 articles. After the screening process, 12 studies remained (11 randomized controlled trials and 1 systematic review), which studied overall 2751 patients, with a follow-up period of at least 12 months. Conclusions A multidisciplinary intervention is favorable compared to usual care for pain intensity and functional status but this is less clear for return to work. Comparable work-related effects were found when comparing a multidisciplinary intervention with a less extensive intervention, whereas uncertainties exist regarding outcomes of pain intensity and functional status. Furthermore, adding a workplace intervention to usual care and subdividing patients based on work-related characteristics seems beneficial for return to work. </jats:sec

Does a multidisciplinary intervention, with or without workplace intervention, have an impact on pain, functional status or return to work in employees suffering from (sub)acute low back pain? A systematic review

Background: Low back pain (LBP) is highlighted globally as the leading cause of disability and is characterised by enormous costs for society originating from e.g. healthcare use and work absenteeism. Early interventions with a multidisciplinary approach are recommended in the (sub)acute stage and integrating health and workplace management seems essential in reducing sick leave. Nevertheless, there are some uncertainties regarding recommendations for (sub)acute LBP and this may be due to the absence of multiple direct comparisons of the available multidisciplinary interventions. Purpose: The objective was to examine the effectiveness of a multidisciplinary intervention, with or without additional workplace intervention (WPI), for (sub)acute LBP among adults, with a focus on pain, functional status, return to work (RTW), or sick leave. Study design: Systematic Review. Methods: A comprehensive search in six electronic databases was completed (last search in June 2021). The methodological quality was assessed by using the RoB 2-tool for RCT studies and the ROBIS-tool for a systematic review. Relevant information was extracted from each included article and presented in an evidence table and a narrative synthesis of results was conducted. Results: A total of 12 studies were included of which 11 RCT studies and one systematic review. A multidisciplinary intervention has beneficial effects with regard to pain scores and functional status when compared to usual care. When compared with another intervention or an additional work intervention, the results were contradictory. Conflicting results were found with respect to work-related outcomes when compared to usual care. When compared with another intervention, the results do not appear to be more favourable but when an additional work intervention is considered, it might result in earlier work resumption compared to usual care. Lastly, subdividing patients at baseline is beneficial to assign them to the most effective therapy in order to favour early RTW. Discussion: Most important limitations of this study include: 3 articles with coherent samples, the lack of articles containing an additional WPI upon a multidisciplinary intervention and the difficulty to compare results due to high clinical heterogeneity in population and/or intervention. Conclusions: A multidisciplinary intervention has favourable effects compared with usual care regarding pain scores and functional status. Furthermore, adding a WPI to usual care as well as subdividing patients based on work-related characteristics might be beneficial for RTW. The evidential value of the conclusions is often not strong enough due to low evidence or too few studies. Future studies should focus more on investigating the effects of a multidisciplinary intervention in patients with (sub)acute LBP in combination with interventions at work