Does environment influence childhood BMI? A longitudinal analysis of children aged 3 to 11

Background: Childhood overweight/obesity has been associated with environmental context, such as green space, gardens, crime and deprivation. This paper assesses the longitudinal association between environment and body mass index (BMI) for children across the ages of 3-11 years. It also investigates the relationship between environment and child overweight/obesity Methods: 6001 Children from the UK Millennium Cohort Study living in England were analysed. We estimated fixed effects linear and logistic regression models of the association between environment (levels of green space, gardens, crime and deprivation) and BMI/overweight of children at four time points between the ages of 3 and 11. Models were adjusted for age-related changes in weight, child sex, and education level of the main carer. Results: Statistically significant associations were found between environmental measures of both more gardens and lower levels of crime and lower BMI (effect size [95% confidence interval (CI)] respectively: -0.02 [-0.04–0.00], -0.04 [-0.07– -0.02]). Areas with less crime were associated with a slightly lower odds of overweight among children with a higher educated parent (odds ratio [OR] 0,93 [0,87 – 0,99]) Conclusions: By exploiting longitudinal measures of environment and BMI this study is able to establish a more causal association between environment and BMI. Environments with more gardens and lower crime tend to result in slightly lower BMI. However, the effect sizes are small and non-significant odds of changing weight status do not support environmental factors as a key determinant of cohort changes in childhood overweight/obesity

The impact of greenspace and condition of the neighbourhood on child overweight

Background: Childhood overweight/obesity has been associated with environmental, parenting and socioeconomic status (SES) factors. This paper assesses the influence of the amount of green space, accessibility to a garden and neighbourhood condition on being overweight/obese. It investigates whether parental behaviours moderate or mediate this influence and evaluates the interaction of SES with environmental context. Methods: 6467 children from the UK Millennium Cohort Study living in England were analysed. We estimated logistic regressions to examine the initial association between environment and overweight. Subsequently, parenting determinants comprising: food consumption, physical activity, rules and regularity were evaluated as moderators or mediators. Lastly SES related variables were tested as moderators or mediators of the associations. Results: Statistically significant associations were found between low levels of green space, no access to a garden, run down area and childhood overweight/obesity [odds ratio (OR) [95% confidence interval (CI)] respectively: 1.14 (1.02–1.27), 1.35 (1.16–1.58), 1.22 (1.05–1.42)]. None of the parental constructs mediated or moderated the relationships between environment and childhood overweight/obesity. Including SES, parental education moderated the effect of environmental context. Specifically, among lower educated households lack of garden access and less green space was associated with overweight/obesity; and among higher educated households poor neighbourhood condition influenced the probability of overweight/obesity respectively: 1.38 (1.12–1.70) OR 1.38, 95% CI (1.21–1.70). Conclusions: This study suggests that limits on access to outdoor space are associated with future childhood overweight/obesity although the ways in which this occurs are moderated by parental education leve

Does environment influence childhood BMI? A longitudinal analysis of children aged 3 to 11

Background: Childhood overweight/obesity has been associated with environmental context, such as green space, gardens, crime and deprivation. This paper assesses the longitudinal association between environment and body mass index (BMI) for children across the ages of 3-11 years. It also investigates the relationship between environment and child overweight/obesity Methods: 6001 Children from the UK Millennium Cohort Study living in England were analysed. We estimated fixed effects linear and logistic regression models of the association between environment (levels of green space, gardens, crime and deprivation) and BMI/overweight of children at four time points between the ages of 3 and 11. Models were adjusted for age-related changes in weight, child sex, and education level of the main carer. Results: Statistically significant associations were found between environmental measures of both more gardens and lower levels of crime and lower BMI (effect size [95% confidence interval (CI)] respectively: -0.02 [-0.04–0.00], -0.04 [-0.07– -0.02]). Areas with less crime were associated with a slightly lower odds of overweight among children with a higher educated parent (odds ratio [OR] 0,93 [0,87 – 0,99]) Conclusions: By exploiting longitudinal measures of environment and BMI this study is able to establish a more causal association between environment and BMI. Environments with more gardens and lower crime tend to result in slightly lower BMI. However, the effect sizes are small and non-significant odds of changing weight status do not support environmental factors as a key determinant of cohort changes in childhood overweight/obesity

Routine versus on demand removal of the syndesmotic screw; a protocol for an international randomised controlled trial (RODEO-trial) (vol 19, 35, 2018)

Peer reviewe

Routine versus on demand removal of the syndesmotic screw; a protocol for an international randomised controlled trial (RODEO-trial)

Background: Syndesmotic injuries are common and their incidence is rising. In case of surgical fixation of the syndesmosis a metal syndesmotic screw is used most often. It is however unclear whether this screw needs to be removed routinely after the syndesmosis has healed. Traditionally the screw is removed after six to 12 weeks as it is thought to hamper ankle functional and to be a source of pain. Some studies however suggest this is only the case in a minority of patients. We therefore aim to investigate the effect of retaining the syndesmotic screw on functional outcome. Design: This is a pragmatic international multicentre randomised controlled trial in patients with an acute syndesmotic injury for which a metallic syndesmotic screw was placed. Patients will be randomised to either routine removal of the syndesmotic screw or removal on demand. Primary outcome is functional recovery at 12 months measured with the Olerud-Molander Score. Secondary outcomes are quality of life, pain and costs. In total 194 patients will be needed to demonstrate non-inferiority between the two interventions at 80% power and a significance level of 0.025 including 15% loss to follow-up. Discussion: If removal on demand of the syndesmotic screw is non-inferior to routine removal in terms of functional outcome, this will offer a strong argument to adopt this as standard practice of care. This means that patients will not have to undergo a secondary procedure, leading to less complications and subsequent lower costs.Peer reviewe

Routine versus on demand removal of the syndesmotic screw; A protocol for an international randomised controlled trial (RODEO-trial)

Background: Syndesmotic injuries are common and their incidence is rising. In case of surgical fixation of the syndesmosis a metal syndesmotic screw is used most often. It is however unclear whether this screw needs to be removed routinely after the syndesmosis has healed. Traditionally the screw is removed after six to 12 weeks as it is thought to hamper ankle functional and to be a source of pain. Some studies however suggest this is only the case in a minority of patients. We therefore aim to investigate the effect of retaining the syndesmotic screw on functional outcome. Design: This is a pragmatic international multicentre randomised controlled trial in patients with an acute syndesmotic injury for which a metallic syndesmotic screw was placed. Patients will be randomised to either routine removal of the syndesmotic screw or removal on demand. Primary outcome is functional recovery at 12 months measured with the Olerud-Molander Score. Secondary outcomes are quality of life, pain and costs. In total 194 patients will be needed to demonstrate non-inferiority between the two interventions at 80% power and a significance level of 0.025 including 15% loss to follow-up. Discussion: If removal on demand of the syndesmotic screw is non-inferior to routine removal in terms of functional outcome, this will offer a strong argument to adopt this as standard practice of care. This means that patients will not have to undergo a secondary procedure, leading to less complications and subsequent lower costs. Trial registration: This study was registered at the Netherlands Trial Register (NTR5965), Clinicaltrials.gov (NCT02896998) on July 15th 2016

Foot pain and foot health in an educated population of adults: results from the Glasgow Caledonian University Alumni Foot Health Survey

Abstract Background Foot pain is common amongst the general population and impacts negatively on physical function and quality of life. Associations between personal health characteristics, lifestyle/behaviour factors and foot pain have been studied; however, the role of wider determinants of health on foot pain have received relatively little attention. Objectives of this study are i) to describe foot pain and foot health characteristics in an educated population of adults; ii) to explore associations between moderate-to-severe foot pain and a variety of factors including gender, age, medical conditions/co-morbidity/multi-morbidity, key indicators of general health, foot pathologies, and social determinants of health; and iii) to evaluate associations between moderate-to-severe foot pain and foot function, foot health and health-related quality-of-life. Methods Between February and March 2018, Glasgow Caledonian University Alumni with a working email address were invited to participate in the cross-sectional electronic survey (anonymously) by email via the Glasgow Caledonian University Alumni Office. The survey was constructed using the REDCap secure web online survey application and sought information on presence/absence of moderate-to-severe foot pain, patient characteristics (age, body mass index, socioeconomic status, occupation class, comorbidities, and foot pathologies). Prevalence data were expressed as absolute frequencies and percentages. Multivariate logistic and linear regressions were undertaken to identify associations 1) between independent variables and moderate-to-severe foot pain, and 2) between moderate-to-severe foot pain and foot function, foot health and health-related quality of life. Results Of 50,228 invitations distributed, there were 7707 unique views and 593 valid completions (median age [inter-quartile range] 42 [31–52], 67.3% female) of the survey (7.7% response rate). The sample was comprised predominantly of white Scottish/British (89.4%) working age adults (95%), the majority of whom were overweight or obese (57.9%), and in either full-time or part-time employment (82.5%) as professionals (72.5%). Over two-thirds (68.5%) of the sample were classified in the highest 6 deciles (most affluent) of social deprivation. Moderate-to-severe foot pain affected 236/593 respondents (39.8%). High body mass index, presence of bunions, back pain, rheumatoid arthritis, hip pain and lower occupation class were included in the final multivariate model and all were significantly and independently associated with moderate-to-severe foot pain (p < 0.05), except for rheumatoid arthritis (p = 0.057). Moderate-to-severe foot pain was significantly and independently associated lower foot function, foot health and health-related quality of life scores following adjustment for age, gender and body mass index (p < 0.05). Conclusions Moderate-to-severe foot pain was highly prevalent in a university-educated population and was independently associated with female gender, high body mass index, bunions, back pain, hip pain and lower occupational class. Presence of moderate-to-severe foot pain was associated with worse scores for foot function, foot health and health-related quality-of-life. Education attainment does not appear to be protective against moderate-to-severe foot pain

Small business economics: A perspective from The Netherlands

In the analysis of economic phenomena either within or across industries there is room for integrating the role of small business. This contribution can be made by aggregation or generalization of the findings at the meso level, which again are partly based upon analyses at the micro level. The Netherlands has a long history in macro model building. A recent discussion among Dutch macro-economists considered the future of econometric model building at the macro level, and considered how best to improve this model building. The explicit integration of scale effects, however, was not mentioned. I am convinced that improvements in this respect are possible. In particular, I have in mind the role which small businesses play in certain areas such as wage structure, employment or investments. The dissection of macro prognoses into a small business component and a remaining component is a traditional practice in The Netherlands.1 Finally, there is much concern in The Netherlands for the calculation of regulatory effects, decomposed into effects for small and large businesses. If anywhere in the world there is a solid foundation for studying scale effects in both macro and sectoral models, it most certainly has been in The Netherlands. There is a strong tradition of macro-econometric model building; groups of econometricians specialized in small business research exist; Dutch policymakers show concern and the required research apparatus is available