Abstract A low level of physical activity and poor physical fitness are important risk factors of chronic non-communicable diseases and all-cause mortality. Much of the risk of these diseases originates in fetal life. The associations of early-life determinants with physical activity and fitness later in life are as yet not well studied. The aim of this work was to investigate early-life factors as predictors of physical activity and fitness in adolescence and young adulthood. We assessed a wide range of parental and pregnancy-related factors in 16-year-old adolescent participants of the Northern Finland Birth Cohort 1986 (n=7,344), and focused on the long-term consequences of preterm birth in the 23-year-old adult participants of the ESTER study (n=1,161). Prenatal and parental predictors of low physical activity and cardiorespiratory fitness in adolescence included high gestational age-related birth weight as well as parental overweight or obesity. Also, both short and long gestational lengths were associated with lower physical activity, and maternal gestational diabetes mellitus and smoking during pregnancy were associated with lower cardiorespiratory fitness. Young adults born before 34 weeks of gestation reported substantially less leisure-time physical activity than those born at term, although this was not detected by accelerometer measurement. Those born preterm had lower muscular fitness, as individuals born before 37 weeks were able to perform fewer modified push-ups, and those born before 34 weeks had lower handgrip strength, but no difference was observed in cardiorespiratory fitness. Based on questionnaire data, young adults born before 34 weeks perceived themselves to be less fit than their term-born peers. Most individuals exposed to preterm birth or maternal gestational disorders are relatively healthy when reaching adulthood. However, their lower levels of physical activity and physical fitness compared with their peers born at term may contribute to a higher risk of chronic non-communicable diseases in later life. Finding physical activities that are suitable for each individual is essential to promote well-being and health and diminish the increased disease risk later in life. / Tiivistelmä Vähäinen fyysinen aktiivisuus ja heikko fyysinen kunto ovat merkittäviä kroonisten sairauksien ja ennenaikaisen kuoleman riskitekijöitä. Jo sikiökautisten tekijöiden tiedetään vaikuttavan syntyvän lapsen kroonisten sairauksien riskiin myöhemmin elämässä, mutta elämän varhaisvaiheen tekijöiden yhteyttä myöhempään fyysiseen aktiivisuuteen ja kuntoon on tutkittu verrattain vähän. Väitöstutkimuksen tavoitteena oli selvittää elämän varhaisvaiheen tekijöiden yhteyttä fyysiseen aktiivisuuteen ja kuntoon nuoruusiässä ja nuorena aikuisena. Tarkastelimme useiden vanhempiin ja raskausaikaan liittyvien tekijöiden vaikutuksia Pohjois-Suomen syntymäkohortti 1986 16-vuotistutkimuksessa (n=7344) ja keskityimme ennenaikaisen syntymän pitkäaikaisvaikutuksiin ESTER-tutkimuksen 23-vuotiaiden nuorten aikuisten aineistossa (n=1161). Tutkimustulostemme mukaan raskauden kestoon suhteutettu suuri syntymäpaino sekä vanhempien ylipaino tai lihavuus ennustivat vähäisempää liikunta-aktiivisuutta ja heikompaa kestävyyskuntoa nuoruusiässä. Sekä keskimääräistä lyhyempi että pidempi raskaudenkesto olivat yhteydessä vähäisempään liikunta-aktiivisuuteen ja äidin raskausdiabetes ja tupakointi raskauden aikana puolestaan heikompaan kestävyyskuntoon. Alle 34-viikkoisena syntyneet raportoivat liikkuvansa nuorena aikuisena vapaa-aikanaan huomattavasti vähemmän kuin täysiaikaisena syntyneet, vaikka eroa ei kiihtyvyysantureilla mitattuna fyysisessä aktiivisuudessa havaittukaan. Verrattuna täysiaikaisena syntyneisiin, ennenaikaisesti syntyneillä aikuisilla oli heikompi lihaskunto etunojapunnerrustestillä mitattuna ja hyvin ennenaikaisesti syntyneillä käden puristusvoima oli heikompi. Kestävyyskunnossa ei havaittu eroja. Hyvin ennenaikaisesti syntyneet myös arvioivat fyysisen kuntonsa huonommaksi kuin täysiaikaisena syntyneet ikätoverinsa. Vaikka valtaosa ennenaikaisena syntyneistä ja äidin raskaudenaikaisille sairauksille altistuneista on aikuisena varsin terveitä, liikunnan vähäisyys ja heikko fyysinen kunto voivat lisätä kroonisten sairauksien riskiä myöhemmin elämässä. Siksi tähän ryhmään kuuluvia tulisi erityisesti auttaa löytämään itselleen sopivia liikuntamuotoja hyvinvoinnin ja terveyden edistämiseksi ja siten myöhempien sairauksien ennaltaehkäisemiseksi.

La Communauté française décide en concertation avec la Région bruxelloise et la Région wallonne, de financer un Centre d’Epidémiologie Périnatale (CEpiP). Les Communautés et Régions chargent le CEpiP de les assister dans la vérification, le remplissage et la correction des certificats concernant les naissances à partir du 1er janvier 2008. Le CEpiP est également chargé d’encoder les certificats bruxellois, les certificats wallons étant toujours encodés par un sous-traitant.<p>Un problème souvent rencontré dans l’analyse des certificats de naissance est la présence de données manquantes. Des informations manquaient sur 64.0% des certificats bruxellois de janvier 2008 (situation de base). Le renforcement de l’enregistrement par le CEpiP durant l’année 2008 est lié à une diminution des informations manquantes sur les certificats initiaux (à la sortie des maternités et services d’état civil) après la première et la deuxième année d’enregistrement :20,8% et 19,5% des naissances en décembre 2008 et 2009 respectivement. Le taux résiduel de données manquantes après correction grâce aux listes envoyées aux maternités et services d’Etat civil est faible. En particulier, la nationalité d’origine des parents était souvent manquante, jusqu’à 35% à Bruxelles (données non publiées), et ce taux est passé à 2.6% en 2008 et 0.1% en 2009. Certaines données manquantes ne sont pas distribuées de façon équivalente selon la nationalité de la mère, même après correction. Les mères d’origine sub-saharienne ont les taux de remplissage les moins élevés. Enfin, le taux de mort-nés a augmenté par rapport aux données de 2007, au profit des mort-nés avant l’âge de 28 semaines, et suggère une amélioration de l’enregistrement suite au renforcement de l’information.<p>Les données concernant l’indice de masse corporelle des patientes sont donc relevées depuis 2009 pour l’ensemble des mères qui accouchent en Belgique. L’obésité maternelle et l’immigration sont en augmentation en Belgique, et ont été rarement étudiées au travers d’études de population sur les certificats de naissance. Des études ont pourtant montré que ces mères étaient à risque de complications périnatales, comme la césarienne ou la mortalité périnatale. L’obésité et l’immigration ont en commun le fait qu’elles recouvrent des réalités médicales, sociales et relationnelles face au personnel soignant, qui les mettent à risque de complications périnatales.<p>Des différences en termes de complications obstétricales et néonatales entre populations immigrantes et autochtones ont été observées en Belgique et dans d’autres pays, mais elles sont encore mal comprises. <p>Dans un premier travail d’analyse, nous avons évalué les taux de mortalité périnatale chez les mères immigrantes, en fonction du fait qu’elles étaient naturalisées ou non.<p>Le taux de mortalité périnatale est globalement plus élevé chez les mères immigrantes (8.6‰) que non-immigrantes (6.4‰).<p>Le taux de mortalité périnatale est globalement plus élevé chez les mères non naturalisées (10.3‰) que chez les mères naturalisées (6.1‰).<p>Le taux de mortalité périnatale varie selon l’origine des mères, mais dans chaque sous-groupe étudié, les mères non naturalisées ont un taux plus élevé de mortalité périnatale.<p><p>Des études ont successivement montré davantage, ou moins de césariennes chez les mères immigrantes. Peu de facteurs confondants étaient généralement pris en compte. Dans un second travail d’analyse, nous avons comparé les taux de césarienne dans plusieurs sous-groupes de nationalités.<p>Les taux de césarienne varient selon les sous-groupes de nationalités. Les mères originaires d’Afrique sub-saharienne ont un odds ratio ajusté pour la césarienne de 2.06 (1.62-2.63) en comparaison aux mères belges. L’odds ratio ajusté n’est plus statistiquement significatif après introduction des variables anthropométriques dans le modèle multivariable pour les mères d’Europe de l’Est, et après introduction des interventions médicales pour les mères du Maghreb.<p><p>Peu d’études ont analysé la relation entre l’obésité maternelle et les complications néonatales, et la plupart de ces études n’ont pas ajusté leurs résultats pour plusieurs variables confondantes. Nous avons eu pour but dans un troisième travail d’analyse d’étudier la relation entre l’obésité maternelle et les paramètres néonatals, en tenant compte du type de travail (induit ou spontané) et du type d’accouchement (césarienne ou voie basse). Les enfants de mères obèses ont un excès de 38% d’admission en centre néonatal après ajustement pour toutes les caractéristiques du modèle multivariable (intervalle de confiance à 95% :1.22-1.56) ;les enfants de mères obèses en travail spontané et induit ont également un excès de risque de 45% (1.21-1.73) et 34% (1.10-1.63) respectivement, alors qu’après une césarienne programmée l’excès de risque est de 18% (0.86-1.63) et non statistiquement significatif.<p>Les enfants de mères obèses ont un excès de 31% de taux d’Apgar à 1 minute inférieur à 7, après ajustement pour toutes les caractéristiques du modèle mutivariable (1.15-1.49) ;les enfants de mères obèses en travail spontané et induit ont également un excès de risque de 26% (1.04-1.52) et 38% (1.12-1.69) respectivement, alors qu’après une césarienne programmée l’excès de risque est de 50% (0.96-2.36) et non statistiquement significatif.<p><p>In 2008, a Centre for Perinatal Epidemiology was created inter alia to assist the Health Departments of Brussels-Capital City Region and the French Community to check birth certificates. A problem repeatedly reported in birth certificate data is the presence of missing data. The purpose of this study is to assess the changes brought by the Centre in terms of completeness of data registration for the entire population and according to immigration status. Reinforcement of data collection was associated with a decrease of missing information. The residual missing data rate was very low. Education level and employment status were missing more often in immigrant mothers compared to Belgian natives both in 2008 and 2009. Mothers from Sub-Saharan Africa had the highest missing rate of socio-economic data. The stillbirth rate increased from 4.6‰ in 2007 to 8.2‰ in 2009. All twin pairs were identified, but early loss of a co-twin before 22 weeks was rarely reported.<p>Differences in neonatal mortality among immigrants have been documented in Belgium and elsewhere, and these disparities are poorly understood. Our objective was to compare perinatal mortality rates in immigrant mothers according to citizenship status. Perinatal mortality rate varied according to the origin of the mother and her naturalization status: among immigrants, non-naturalized immigrants had a higher incidence of perinatal mortality (10.3‰) than their naturalized counterparts (6.1‰). In a country with a high frequency of naturalization, and universal access to health care, naturalized immigrant mothers experience less perinatal mortality than their not naturalized counterparts. <p>Our second objective was to provide insight into the differential effect of immigration on cesarean section rates, using Robson classification. Cesarean section rates currently vary between Robson categories in immigrant subgroups. Immigrant mothers from Sub-Saharan Africa with a term, singleton infant in cephalic position, without previous cesarean section, appear to carry the highest burden.<p>If it is well known that obesity increases morbidity for both mother and fetus and is associated with a variety of adverse reproductive outcomes, few studies have assessed the relation between obesity and neonatal outcomes. This is the aim of the last study, after taking into account type of labor and delivery, as well as social, medical and hospital characteristics in a population-based analysis. Neonatal admission to intensive care and low Apgar scores were more likely to occur in infants from obese mothers, both after spontaneous and <p> / Doctorat en Sciences médicales / info:eu-repo/semantics/nonPublished

The thesis focuses on body image - defines the main characteristics of this area, describes cultural influences and body image history and explains basic quantitative values (Body Mass Index, Waist Hip Ratio, Bioelectrical Impedance Analysis). Furthemore the thesis deals with media influence on body ideal formation process, especially in gay subculture. The research part explores recent situation of body image in gay subculture compared with heterosexual males. This section includes the content analysis of mainstream gay movies which compares media presentation of gays and the real situation and examines media influence on gay body image formation.

Obesity is a serious health concern in modern society. One way to reduce caloric intake is with nonnutritive sweeteners (NNS). However, recent research suggests they may be compounding the obesity problem. Nonnutritive sweeteners have been linked to increased body mass in a few studies and may be a barrier to effective weight management for some individuals. Under the framework of the health belief model, the research question was: Does this pattern of NNS-BMI covariance exist in young adults at the University of North Florida and, if so, are there other dietary or activity differences that might partially explain this relationship? A sample of 113 students completed an online survey based on the Youth Risk Behavior Surveillance Survey to answer this question. Their responses quantified BMI, activity level estimates, NNS intake, and produce consumption. There was a no trend of covariance between BMI and NNS intake overall. However, there was a significant relationship between length of NNS usage and both BMI (p<0.01) and NNS intake (p<0.05). A positive correlation also existed between NNS usage and fruit and vegetable intake (p<.005). Weight variability was positively related to NNS due to the maintenance of previous weight loss (p<0.005). There was no correlation between NNS and activity. There is a tendency to have a higher BMI the longer NNS is consumed. This pattern does not appear to be explained by nutrient intake or activity. However, it may be due to increased tolerance towards sweets over time. Nurse practitioners can make recommendations that facilitate healthy behaviors amongst their patients. Therefore, this is an important issue for advanced practice nursing.

INTRODUÇÃO: A alta prevalência da obesidade infantil em diferentes partes do planeta a posiciona como um dos principais focos de atenção da saúde pública, conhecida a associação dos seus agravos às doenças cardiovasculares e à morte prematura. O objetivo do presente trabalho foi avaliar as intervenções escolares que se utilizam das práticas em atividade física e educação nutricional na antropometria e na pressão arterial de crianças e adolescentes. MÉTODOS: Os artigos foram recuperados por buscas sistemáticas em quatorze bases de dados eletrônicas e por busca manual em listas de referências, com atualização até 30 de setembro de 2012. Dois revisores independentes avaliaram os trabalhos e extraíram os dados. Os trabalhos deveriam atender adequadamente aos seguintes critérios de elegibilidade: população dos 6 aos 18 anos de idade; intervenções comunitárias randomizadas no ambiente escolar, fundamentadas nas práticas em atividade física ou educação nutricional, ou nas duas formas combinadas; presença de grupo controle em paralelo, com seguimento concomitante; descrição de pelo menos um dos desfechos: índice de massa corporal, peso corporal e pressão arterial. A meta-análise foi desenvolvida pelo modelo de efeito randômico, com diferença padronizada entre médias pelo método de Hedges. Também foi realizada a meta-análise de regressão para identificação das fontes de heterogeneidade entre os ensaios, envolvendo as variáveis tempo e tipo de intervenção, faixa etária e qualidade. O grau de heterogeneidade entre os estudos foi verificado pelas estatísticas Q de Cochran e I2, e o viés de publicação foi avaliado subjetivamente por meio da distribuição no gráfico funnel plot. RESULTADOS: Dos 5.899 trabalhos inicialmente recuperados, 140 tiveram seus dados extraídos e 60 remanesceram para a composição das sínteses, assim subdivididas: 12 em atividade física, 8 em educação nutricional e 40 com intervenção combinada. A análise das intervenções combinadas apresentou significância estatística a favor do grupo de intervenção no índice de massa corporal, com a magnitude e variabilidade na medida do efeito em diferença padronizada de -0,14 (IC95%: -0,24 a -0,03; p=0,01; n=29471; I2= 94,4%), ao contrário dos resultados obtidos nas duas intervenções em separado, que não foram conclusivos. No desfecho peso corporal, os resultados foram significantes nas intervenções em atividade física (-0,14; IC95%: -0,27 a -0,02; I2= 7,84%) e nas combinadas (-0,65; IC95%: -1,17 a -0,13; I2= 99,3%). As análises da pressão arterial não obtiveram resultados com significância estatística. O conjunto de todas as intervenções com dados em índice de massa corporal, incluindo 55 estudos, mostrou o resultado de -0,02 (IC95%: -0,03 a 0,00; I2= 94,5%), e nenhuma das covariáveis incluídas na meta-regressão, tempo de intervenção, qualidade metodológica do estudo e faixa etária da população mostrou significância para explicar a heterogeneidade observada. A análise de subgrupos mostrou redução do efeito no estrato por tempo de intervenção curto, de até quatro meses, com estimativa de -0,04 (IC95%: -0,06 a -0,03; I2= 96,6%), e na faixa etária dos seis aos dez anos, com estimativa de -0,23 (IC95%: -0,27 a -0,19; I2= 97,9%). CONCLUSÕES: As intervenções escolares que combinaram atividade física e educação nutricional mostraram redução do índice de massa corporal, ao contrário das intervenções que se utilizaram destes elementos em separado. Os efeitos positivos estão associados aos estudos com menor tempo entre as avaliações iniciais e finais e com as faixas populacionais mais jovens. A alta heterogeneidade observada compromete a validade externa dos resultados e sugere cautela quanto à capacidade de generalização para outras populações. / INTRODUCTION: Because of its high prevalence of in different parts of the planet childhood obesity is one of the main public health issues, with obesity worsening known to be associated with cardiovascular diseases and premature death. The aim of this study was to evaluate school interventions that use physical activity and nutrition education practices in anthropometric measurements and blood pressure in children and teenagers. METHODS: The articles were retrieved via a systematic search of fourteen electronic databases and manual search through reference lists updated until September 30, 2012. Two independent reviewers assessed studies and extracted data. The papers should meet the following eligibility criteria: population aged 6 to 18 years old; randomized community interventions targeting the school environment based on physical activity or nutrition education practices, or a combination of the two approaches; placebo- controlled parallel group and concomitant monitoring; description of at least one of the outcomes: body mass index, body weight and blood pressure. Random-effects meta-analysis was used, with Hedges\'g standardized mean differences. Also, meta-analysis was performed to identify sources of heterogeneity between trials, involving the variables such as duration and type of intervention, age group and quality. The degree of heterogeneity between studies was assessed using Cochran\'s Q statistics and I2 tests, and publication bias was subjectively assessed by a funnel plot. RESULTS: Of the 5,899 papers initially retrieved, 140 were data-extracted and 60 were used in synthesis, as follows: 12 in physical activity, 8 in nutrition education and 40 in combined intervention. Analysis of the combined interventions showed that BMI was statistically more significant in the combined intervention group, with magnitude and variability in the measure of the effect size in standardized difference of (-0.14; CI95%: -0.24 to -0.03; p=0.01; n=29471; I2= 94.4%), unlike the results obtained in the two separate interventions, which were not conclusive. Regarding the body weight outcome, the results were significant for physical activity (-0.14; CI95%: -0.27 to -0.02; I2= 7.84%) and in the combined interventions (-0.65; CI95%: -1.17 to -0.13; I2= 99.3%). Blood pressure analyses did not obtain statistically significant results. The set of all interventions with BMI data (55 studies), showed the result of -0.02 (CI95%: -0.03 to 0.00; I2= 94.5%), and none of the covariates included in meta-analysis, intervention duration, methodological quality of the study and population age could explain the heterogeneity observed. Subgroup analysis showed a reduced effect in the short intervention duration stratum (up to four months), with an estimate of -0.04 (CI95%: -0.06 to -0.03; I2= 96.6%), and in the age group of 6-10 years old, with an estimate of -0.23 (CI95%: -0.27 to -0.19; I2= 97.9%). CONCLUSIONS: The school interventions that combined physical activity and nutrition education led to reduced body mass index, unlike the interventions that used these approaches separately. The positive effects are associated with studies with shorter periods of time between the initial and final evaluations and younger populations. The high heterogeneity observed jeopardizes the external validity of the results and suggests caution in generalizing these findings to other populations.

<p>Dijabetes melitus je metaboliĉki poremećaj koji karakteri&scaron;e hroniĉna hiperglikemija i predstavlja veoma ozbiljan javno-zdravstveni problem u celom svetu. Najveći potencijal za pobolj&scaron;anje zdravlja obolelih leţi u postizanju i odrţavanju optimalne glikoregulacije. Podaci iz literature pokazuju da se sprovođenjem strukturiranih edukativnih programa o tipu 2 dijabetesa postiţu pozitivni efekti na zdravstveno pona&scaron;anje i glikoregulaciju kod obolelih koji su pohađali edukaciju. Cilj ovog istraţivanja bio je da se proceni efekat strukturirane edukacije o tipu 2 dijabetesa u primarnoj zdravstvenoj za&scaron;titi na promenu nivoa znanja, zdravstveno pona&scaron;anje, antropometrijske i biohemijske parametre glikoregulacije pacijenata. Istraživanje je sprovedeno u vidu prospektivne studije od februara do avgusta 2018. godine u Savetovali&scaron;tu za dijabetes Doma zdravlja Subotica. Ispitivanje je obuhvatilo 91 pacijenta sa dijagnostikovanim tipom 2 dijabetesa. Ispitanici su pohađali strukturirani &scaron;estonedeljni grupni edukativni program, kreiran za potrebe ovog istraţivanja. U cilju procene efekata edukativnog programa, na poĉetku i ĉetiri meseca nakon edukacije, prikupljeni su podaci o: zdravstvenom pona&scaron;anju, nivou znanja o dijabetesu (Diabetes Knowledge Test), o aktivnostima samonege u prethodnih sedam dana (The Summary of Diabetes Self-Care Activities) i o aktivnostima samonege prethodnih osam nedelja (The Diabetes Self-Management Questionnaire), određeni su antropometrijski (telesna teţina, indeks telesne mase, obim struka i nivo arterijskog krvnog pritiska) i biohemijski parametri glikoregulacije (nivo &scaron;ećera u krvi na&scaron;te, dva sata nakon jela, nivo HbA1c) i lipidni status pacijenata. Na početku strukturirane edukacije 79% pacijenata imalo je nizak nivo znanja o dijabetesu, prosečna vrednost na DKT bila je 46,4%. Nivo samonege pacijenatna bio je nizak i prethodnih 7 dana (SDSCA 45,8%) i prethodnih 8 nedelja (DSMQ 6,75). Trećina (35%) pacijenata imala je prekomernu telesnu masu, a njih 45% bilo je gojazno (BMI 29,85&plusmn;5,47). Povi&scaron;ene vrednosti sistolnog krvnog pritiska imalo je 43%, a dijastolnog 54% pacijenata. Polovina (54,9%) pacijenata imala je idealnu glikoregulaciju (HbA1c 6,56&plusmn;0,96%). Trećina (35%) pacijenata imala je visokorizičan nivo holesterola, a 26% visokoriziĉan nivo triglicerida u krvi. Ispitivanja sprovedena ĉetiri meseca nakon strukturirane edukacije pokazuju značajno povi&scaron;en nivo znanja pacijenata o dijabetesu, tj. visok nivo sa prosečnom vredno&scaron;ću DKT 81,5%. Nivo aktivnosti samonege prethodnih 7 dana i prethodnih 8 nedelja dostigao je umeren nivo (SDSCA 57,7%; DSMQ 7,9). Utvrđeno je značajno smanjenje telesne mase pacijenata za 1,5 kg i indeksa telesne mase, BMI, za 0,58 kg/m2. Procenat gojaznih pacijenata smanjen je na 40%. Povi&scaron;ene vrednosti sistolnog krvnog pritiska imalo je 26,4% (uz proseĉno smanjenje od 4 mmHg), a dijastolnog krvnog pritiska kod 44% pacijenata (uz prosečno smanjenje od 3 mmHg). Utvrđeno je znaĉajno smanjenje nivoa HbA1c za 0,36%, idealnu glikoregulaciju postiglo je 68% pacijenata. Zabeleţeno je smanjenje nivoa ukupnog holesterola za 0,3 mmol/L i nivoa triglicerida u krvi pacijenata za 0,23 mmol/L. Broj pacijenata sa visokorizičnim nivoom holesterola smanjen je za 19,6%, a u visokoriziĉnoj kategoriji triglicerida za 12%. Rezultati studije ukazuju da su efekti strukturiranog edukativnog programa o tipu 2 dijabetesa u primarnoj zdravstvenoj za&scaron;titi značajni, povećani su nivoi znanja i aktivnosti samonege, znaĉajno je smanjena telesna masa, vrednosti arterijskog krvnog pritiska su smanjene a pobolj&scaron;ane su vrednosti pokazatelja glikoregulacije i lipidnog statusa pacijenata.</p> / <p>Diabetes Mellitus is a metabolic disorder characterised by chronic hyperglycaemia and is a very serious public health issue worldwide. Achieving and maintaining optimal glucoregulation represents major potential for the improvement of affected persons&rsquo; health. According to information available in relative literature, the implementation of restructured Type 2 diabetes education programmes, positive results on health behaviour and glucoregulation in persons who took part in the education. The objective of the research was to assess the effect of structured education on Type 2 diabetes in primary health care, on changes in the level of knowledge, health behaviour and the anthropometric and biochemical parameters of patients&rsquo; glucoregulation. The research was conducted in the form of a prospective study between February and August 2018 in the Diabetes Support Group of the Subotica Health Centre. The research included 91 patients who were diagnosed with Type 2 diabetes. Research subjects attended a structured six-week group educational programme, which was specifically developed for the purpose of this research. In order to assess the effects of this educational programme from its outset and four months following the education, data concerning the following were gathered: health behaviour, level of knowledge on diabetes (Diabetes Knowledge Test - DKT), self care activities in the past seven days (The Summary of Diabetes Self-Care Activities - SDSCA) and self care activities in the past eight weeks (The Diabetes Self-Management Questionnaire - DSMQ). These data were anthropomorphic measurements (weight, height, waist circumference and the level of arterial blood pressure) and biochemical glucoregulation parameters (blood sugar levels on an empty stomach, two hours after a meal, HbA1c levels) and patient lipid status. When the structured education first started, 79% patients had a low level of knowledge on diabetes, and the average score at the DKT was 46.4%. The level of patient self care was also low in the past seven days (SDSCA 45.8%) and past eight weeks (DSMQ 6.75%). One third (35%) of patients had excess body mass, of whom 45% were obese (Body Mass Index &ndash; BMI 29.85&plusmn;5.47). 43% of patients had higher systolic blood pressure values while 54% had higher diastolic blood pressure values. In one half of patients (54.9%), glucoregulation was ideal (HbA1c 6.56&plusmn;0.96%). One third of patients (35%) had highly elevated cholesterol levels, with 26% who had highly elevated triglyceride blood levels. Research conducted during the four-month structured education show a significantly higher level of patient knowledge of diabetes, i.e. high level with the average DKT score of 81.5%. The level of self care activities in the past seven days and eight weeks reached a moderate level (SDCA 57.7%; DSMQ 7.9). A significant reduction in body mass by 1.5 kg as well as Body Mass Index, BMI by 0.58 kg/m2 was determined. The percentage of obese patients was reduced to 40%. 26.4% of patients had increased values of systolic blood pressure (with an average reduction of 4 mmHg), diastolic blood pressure 44% of patients (with an average reduction of 3 mmHg). A significant reduction in HbA1c level by 36% was determined, while 68% of patients achieved ideal glucoregulation. The reduction of total cholesterol level by 0.3% mmol/L as well as triglycerides level by 0.23% mmol/L was recorded. The number of patients with a high-risk cholesterol level was reduced by 19.6%, and the number of patients in high-risk category of triglycerides by 12%. The results of the study indicate that the effects of a structured educational programme on Type 2 diabetes in primary health care are significant. Knowledge levels were increased along with self care activities, body mass was significantly reduced, arterial blood pressure values were reduced and glucoregulation and lipid status values improved.</p>

<p>Ispitivanu grupu činilo je 1247 ispitanika sa povredama prednje ukr&scaron;tene veze kolena koji su operativno lečeni u periodu 2012.-2017. godina na Klinici za ortopedsku hirurgiju i traumatologiju Kliničkog centra Vojvodine. Ciljevi istraživanja bili su utvrđivanje uticaja nivoa sportske aktivnosti i mehanizama povređivanja na nastanak povreda prednje ukr&scaron;tene veze kolena, zatim uticaj spolja&scaron;njih faktora rizika (vrsta sporta, rang takmičenja, vrsta podloge, trening ili utakmica, period treninga) na nastanak povreda prednje ukr&scaron;tene veze kolena, odnosno uticaj unutra&scaron;njih faktora rizika (pol, starost, BMI) na nastanak povreda ove strukture kolena. Od ukupnog broja ispitanika njih 517 (41,5%) su činili aktivni sportisti, a 730 (58,5%) rekreativci. Značajnu većinu u posmatranom uzorku su činili mu&scaron;karci (82,6%), osobe starosti od 16 do 25 godina (62,6%) i normalno uhranjenje osobe (62%). Do povrede prednje ukr&scaron;tene veze do&scaron;lo je kod njih 504 (40,5%) prilikom aktivnog bavljenja sportom, dok su se povrede prilikom rekreativnog bavljenja sportom dogodile kod 741 ispitanika (59,5%). Među aktivnim sportistima, vi&scaron;e od dve trećine se takmičilo na internacionalnom ili republičkom nivou, odnosno u najvi&scaron;im rangovima takmičenja. Kontaktnim kolektivnim sportovima (fudbal, ko&scaron;arka i rukomet) bavilo se 77,9% ispitanika. Nekontaktnim sportovima kao &scaron;to su odbojka, borilački sportovi i skijanje bavilo se 22,1% ispitanika, pri čemu je najveći broj povreda nastao prilikom igranja fudbala (51,3%). Statistički značajno vi&scaron;e povreda (i prilikom aktivnog i prilikom rekreativnog bavljenja sportom) je nastalo bez direktnog kontakta (nekontaktne povrede koje su činile 78,7% povreda), pri čemu je najveći broj povreda nastao usled promene pravca i ritma kretanja. Kod aktivnih sportista najvi&scaron;e povreda dogodilo se na utakmicama (73,8%), slede povrede na treningu (24,1%), dok se na rekreaciji povredilo svega 2,1% ispitanika. Značajno vi&scaron;e povreda dogodilo se na sredini bavljenja sportskom aktivno&scaron;ću (47,4%) u odnosu na povrede na zagrevanju, početku, odnosno kraju sportske aktivnosti. Povrede su značajno če&scaron;će nastajale na travi (42%) i parketu (28%), nego na drugim vrstama podloge. Najveći broj ispitanika povredio se noseći patike prilikom bavljenja sportskom aktivno&scaron;ću. Postoje značajne razlike u kontekstu povređivanja u zavisnosti od pola ispitanika. Žene su u značajno većem procentu povređivane prikom aktivnog bavljenja sportom, dok su se mu&scaron;karci če&scaron;će povređivali na rekreaciji. Žene su se najče&scaron;će povređivale na rukometu, mu&scaron;karci na fudbalu. U odnosu na mu&scaron;karce, kod žena su povrede znatno ređe nastajale prilikom direktnog kontakta, a kad je u pitanju mesto povređivanja, žene su se če&scaron;će nego mu&scaron;karci povređivale na treningu. Preko 50% žena je povređeno na parketu, dok se najveći broj mu&scaron;karaca povredio na travi. Ispitanici sa prekomernom telesnom masom značajno če&scaron;će su se povređivali prilikom rekreacije, dok su se normalno uhranjeni če&scaron;će povređivali prilikom aktivnog bavljenja sportom. Faktori rizika za nastanak povreda prednje ukr&scaron;tene veze su brojni i specifični, odnosno da za svaku populacionu kategoriju postoje rizici, ali se uočava da su u svim sportovima, na svim podlogama i kod svih ispitanika povrede najče&scaron;će nastajale nekontaknim mehanizmom povređivanja. Formiranjem registra povređenih omogućilo bi se bolje razumevanje faktora rizika i njihovog međusobnog uticaja, kao i definisanje profila osoba pod najvećim rizikom za nastanak povrede prednje ukr&scaron;ene veze kolena. Na taj način obezbedile bi se potrebne informacije za planiranje preventivnih programa usmerenih na smanjenje rizika od povređivanja i omogućilo bi se sprovođenje odgovarajućih mera selektivne prevencije.</p> / <p>The study group consisted of 1247 respondents with anterior cruciate ligament injuries who were surgically treated in the period 2012-2017. at the Clinic for Orthopedic Surgery and Traumatology of the Clinical Center of Vojvodina. The objectives of the study were to determine the impact of sports activity levels and injury mechanisms on the occurrence of anterior cruciate ligament injuries, then the impact of external risk factors (type of sport, competition rank, type of surface, training or match, training period) on the occurrence of anterior cruciate ligament injuries and the influence of internal risk factors (gender, age, BMI) on the occurrence of injuries of this knee structure. Out of the total number of respondents 517 (41.5%) were active athletes, and 730 (58.5%) were recreational athletes. A significant majority in the observed group were men (82.6%), persons aged 16 to 25 years (62.6%) and normal BMI respondents (62%). Anterior cruciate ligament injury occurred in 504 of them (40.5%) during active sports, while injuries during recreational sports occurred in 741 respondents (59.5%). Among active athletes, more than two thirds competed at the international or national level- in the highest ranks of the competition. Contact collective sports (football, basketball and handball) were practiced by 77.9% of respondents. 22.1% of respondents practiced non-contact sports such as volleyball, martial arts sports and skiing. The largest number of injuries occurring while playing football (51.3%). Statistically significantly more injuries (both during active and recreational sports) occurred without direct contact (noncontact injuries-78,7% of total injuries number), with the largest number of injuries caused by changes in the direction and rhythm of movement. Among active athletes, most injuries occurred in matches (73.8%), followed by injuries in training (24.1%), while only 2.1% of respondents were injured in recreation. Significantly more injuries occurred in the middle of engaging in sports activity (47.4%) compared to injuries during the warm-up, beginning and end of sports activity. Injuries occurred significantly more often on grass (42%) and floor (28%) than on other types of surfaces. Most of the respondents were injured wearing sneakers while doing sports. There are significant differences in the context of injury depending on the gender of the respondents. A significantly higher percentage of women were injured during active sports, while men were more often injured during recreational sport activities. Women were most often injured in handball, men in football. Compared to men, injuries were much less common in women during direct contact, and when it comes to the place of injury, women were injured more often than men during training acitivities. Over 50% of women were injured on the floor, while the largest number of men were injured on the grass. Subjects with overweight were significantly more likely to be injured during recreational sport acitivites, while those with normal BMI were more likely to be injured during active sports. Risk factors for anterior cruciate ligament injuries are numerous and specific and there are risks for each population category, but it is noticed that in all sports, on all surfaces and in all subjects, injuries were most often caused by a noncontact injury mechanism. The formation of a Register of injuries would enable a better understanding of risk factors and their mutual influence, as well as the definition of the profile of persons at greatest risk for the occurrence of an anterior cruciate ligament injury. This would provide the necessary information for planning prevention programs aimed at reducing the risk of injury and would enable the implementation of appropriate selective prevention measures.</p>

Indiana University-Purdue University Indianapolis (IUPUI) / This paper describes the influence of body satisfaction, weight satisfaction, and BMI on sexual behaviors among female college students.

Background: Knee osteoarthritis is a degenerative disease characterized by damaged joint tissues (e.g., cartilage) that leads to joint pain, and reduced mobility and quality of life. Various factors are involved in disease progression, including biomechanical, patient-reported outcome and mobility measures. This thesis provides important longitudinal data on the role of these factors in disease progression, and the trajectory of biomechanical factors in persons with knee osteoarthritis. Objectives: (1) Determine the extent to which changes over 2.5 years in knee cartilage thickness and volume in persons with knee osteoarthritis were predicted by the knee adduction and flexion moment peaks, and knee adduction moment impulse and loading frequency. (2) Determine the extent to which changes over 2 years in walking and stair-climbing mobility in women with knee osteoarthritis were predicted by quadriceps strength and power, pain and self-efficacy. (3) Estimate the relative and absolute test-retest reliabilities of biomechanical risk factors for knee osteoarthritis progression. Methods: Data were collected at 3-month intervals during a longitudinal (3-year), observational study of persons with clinical knee osteoarthritis (n=64). Magnetic resonance imaging of the study knee was acquired at the first and last assessments, and used to determine cartilage thickness and volume. Accelerometry and dynamometry data were acquired every 3 months, and used to determine knee loading frequency and knee muscle strength and power, respectively. Walking and stair-climbing mobility, as well as pain and self-efficacy data, were also collected every 3 months. Gait analyses were performed every 6 months, and used to calculate lower-extremity kinematics and kinetics. Results: (1) The knee adduction moment peak and impulse each interacted with body mass index to predict loss of medial tibial cartilage volume over 2.5 years. These interactions suggested that larger joint loads in those with a higher body mass index were associated with greater loss of cartilage volume. (2) In women, lower baseline self-efficacy predicted decreased walking and stair ascent performances over 2 years. Higher baseline pain intensity/frequency also predicted decreased walking performance. Quadriceps strength and power each interacted with self-efficacy to predict worsening stair ascent times. These interactions suggested that the impact of lesser quadriceps strength and power on worsening stair ascent performance was more important among women with lower self-efficacy. (3) Relative reliabilities were high for the knee adduction moment peak and impulse, quadriceps strength and power, and body mass index (i.e., intraclass correlation coefficients >0.80). Absolute reliabilities were high for quadriceps strength and body mass index (standard errors of measurement <15% of the mean). Data supported the use of interventions effective in reducing the knee adduction moment and body mass index, and increasing quadriceps strength, in persons with knee osteoarthritis. Conclusion: Findings from this thesis suggest that biomechanical factors play a modest independent role in the progression of knee osteoarthritis. However, in the presence of other circumstances (e.g., obesity, low self-efficacy, high pain intensity/frequency), biomechanical factors can vastly worsen the disease. Strategies aiming to curb structural progression and improve clinical outcomes in knee osteoarthritis should target biomechanical and clinical outcomes simultaneously. / Thesis / Doctor of Philosophy (PhD) / Knee osteoarthritis is a multifactorial disease whose progression involves worsening joint structure, symptoms, and mobility. Various factors are linked to the progression of this disease, including biomechanical, patient-reported outcome and mobility measures. This thesis provides important information on how these factors, separately and collectively, are involved in worsening disease over time, as well as benchmarks that are useful to clinicians and researchers in interpreting results from interventional or longitudinal research. First, we examined how different elements of knee loading were associated with changes in knee cartilage quantity over time in persons with knee osteoarthritis. Second, we examined how different elements of knee muscle capacity and patient-reported outcomes were related to changes in mobility over time in persons with knee osteoarthritis. Third, we examined the stability over time of various biomechanical risk factors for the progression of knee osteoarthritis. Novel results from this thesis showed that: (1) larger knee loads predicted cartilage loss over 2.5 years in obese individuals with knee osteoarthritis but not in persons of normal weight or overweight; (2) among women with knee osteoarthritis with lower self-efficacy (or confidence), lesser knee muscle capacity (strength, power) was an important predictor of declining stair-climbing performance over 2 years; and (3) clinical interventions that can positively alter knee biomechanics include weight loss, knee muscle strengthening, as well as specific knee surgery and alterations during walking to reduce knee loads. Interventions for knee osteoarthritis should target biomechanical and clinical outcomes simultaneously.

The thesis examines the relationship of birthweight to risk factors and markers, such as proteinuria and glomerular filtration rate, for chronic disease in postnatal life. It made use of the Australian Diabetes, Obesity and Lifestyle Study (AusDiab). The AusDiab study is a cross sectional study where baseline data on 11,247 participants were collected in 1999-2000. Participants were recruited from a stratified sample of Australians aged ≥ 25 years, residing in 42 randomly selected urban and non-urban areas (Census Collector Districts) of the six states of Australia and the Northern Territory. The AusDiab study collected an enormous amount of clinical and laboratory data. During the 2004-05 follow-up AusDiab survey, questions about birthweight were included. Participants were asked to state their birthweight, the likely accuracy of the stated birthweight and the source of their stated birthweight. Four hundred and twelve chronic kidney disease (CKD) patients were approached, and 339 agreed to participate in the study. The patients completed the same questionnaire. Medical records were reviewed to check the diagnoses, causes of kidney trouble and SCr levels. Two control subjects, matched for gender and age, were selected for each CKD patient from participants in the AusDiab study who reported their birthweight. Among 7,157 AusDiab participants who responded to the questionnaire, 4,502 reported their birthweights, with a mean (standard deviation) of 3.4 (0.7) kg. The benefit and disadvantages of these data are discussed in chapter three. The data were analysed for the relationship between birthweight and adult body size and composition, disorders of glucose regulation, blood pressure, lipid abnormalities, cardiovascular diseases and glomerular filtration rate. Low birthweight was associated with smaller body build and lower lean mass and total body water in both females and males. In addition low birthweight was associated with central obesity and higher body fat percentage in females, even after taking into account current physical activity and socioeconomic status. Fasting plasma glucose, post load glucose and glycosylated haemoglobin were strongly and inversely correlated with birthweight. In those with low birthweight (< 2.5 kg), the risks for having impaired fasting glucose, impaired glucose tolerance, diabetes and all abnormalities combined were increased by 1.75, 2.22, 2.76 and 2.28 for females and by 1.40, 1.32, 1.98 and 1.49 for males compared to those with normal birthweight (≥ 2.5 kg), respectively. Low birthweight individuals were at higher risk for having high blood pressure ≥ 140/90 mmHg and ≥ 130/85 mmHg compared to those with normal birthweight. People with low birthweight showed a trend towards increased risk for high cholesterol (≥ 5.5 mmol/l) compared to those of normal birthweight. Females with low birthweight had increased risk for high low density lipoprotein cholesterol (≥ 3.5 mmol/l) and triglyceride levels (≥ 1.7 mmol/l) when compared to those with normal birthweight. Males with low birthweight exhibited increased risk for low levels of high density lipoprotein cholesterol (<0.9 mmol/l) than those with normal birthweight. Females with low birthweight were at least 1.39, 1.40, 2.30 and 1.47 times more likely to have angina, coronary artery disease, stroke and overall cardiovascular diseases respectively, compared to those ≥ 2.5 kg. Similarly, males with low birthweight were 1.76, 1.48, 3.34 and 1.70 times more likely to have angina, coronary artery disease, stroke and overall cardiovascular diseases compared to those ≥ 2.5 kg, respectively. The estimated glomerular filtration rate was strongly and positively associated with birthweight, with a predicted increase of 2.6 ml/min (CI 2.1, 3.2) and 3.8 (3.0, 4.5) for each kg of birthweight for females and males, respectively. The odd ratio (95% confidence interval) for low glomerular filtration rate (<61.0 ml/min for female and < 87.4 male) in people of low birthweight compared with those of normal birthweight was 2.04 (1.45, 2.88) for female and 3.4 (2.11, 5.36) for male. One hundred and eighty-nineCKD patients reported their birthweight; 106 were male. Their age was 60.3(15) years. Their birthweight was 3.27 (0.62) kg, vs 3.46 (0.6) kg for their AusDiab controls, p<0.001 and the proportions with birthweight<2.5 kg were 12.17% and 4.44%, p<0.001. Among CKD patients, 22.8%, 21.7%, 18% and 37.6% were in CKD stages 2, 3, 4 and 5 respectively. Birthweights by CKD stage and their AusDiab controls were as follows: 3.38 (0.52) vs 3.49 (0.52), p=0.251 for CKD2; 3.28 (0.54) vs 3.44 (0.54), p=0.121 for CKD3; 3.19 (0.72) vs 3.43 (0.56), p= 0.112 for CKD4 and 3.09 (0.65) vs 3.47 (0.67), p<0.001 for CKD5. The results demonstrate that in an affluent Western country with a good adult health profile, low birthweight people were predisposed to higher rates of glycaemic dysregulation, high blood pressure, dyslipidaemia, cardiovascular diseases and lower glomerular filtration rate in adult life. In all instances it would be prudent to adopt policies of intensified whole of life surveillance of lower birthweight people, anticipating this risk. The general public awareness of the effect of low birthweight on development of chronic diseases in later life is of vital importance. The general public, in addition to the awareness of people in medical practice of the role of low birthweight, will lead to a better management of this group of our population that is increasingly surviving into adulthood.