Showing papers by "Maastricht University published in 2007"

2007 Guidelines for the Management of Arterial Hypertension : The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).

Abstract: 2007 Guidelines for the Management of Arterial Hypertension : The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).

How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology

Abstract: Diastolic heart failure (DHF) currently accounts for more than 50% of all heart failure patients. DHF is also referred to as heart failure with normal left ventricular (LV) ejection fraction (HFNEF) to indicate that HFNEF could be a precursor of heart failure with reduced LVEF. Because of improved cardiac imaging and because of widespread clinical use of plasma levels of natriuretic peptides, diagnostic criteria for HFNEF needed to be updated. The diagnosis of HFNEF requires the following conditions to be satisfied: (i) signs or symptoms of heart failure; (ii) normal or mildly abnormal systolic LV function; (iii) evidence of diastolic LV dysfunction. Normal or mildly abnormal systolic LV function implies both an LVEF > 50% and an LV end-diastolic volume index (LVEDVI) 16 mmHg or mean pulmonary capillary wedge pressure >12 mmHg) or non-invasively by tissue Doppler (TD) (E/E' > 15). If TD yields an E/E' ratio suggestive of diastolic LV dysfunction (15 > E/E' > 8), additional non-invasive investigations are required for diagnostic evidence of diastolic LV dysfunction. These can consist of blood flow Doppler of mitral valve or pulmonary veins, echo measures of LV mass index or left atrial volume index, electrocardiographic evidence of atrial fibrillation, or plasma levels of natriuretic peptides. If plasma levels of natriuretic peptides are elevated, diagnostic evidence of diastolic LV dysfunction also requires additional non-invasive investigations such as TD, blood flow Doppler of mitral valve or pulmonary veins, echo measures of LV mass index or left atrial volume index, or electrocardiographic evidence of atrial fibrillation. A similar strategy with focus on a high negative predictive value of successive investigations is proposed for the exclusion of HFNEF in patients with breathlessness and no signs of congestion. The updated strategies for the diagnosis and exclusion of HFNEF are useful not only for individual patient management but also for patient recruitment in future clinical trials exploring therapies for HFNEF.

The Biopsychosocial Approach to Chronic Pain: Scientific Advances and Future Directions

Abstract: The prevalence and cost of chronic pain is a major physical and mental health care problem in the United States today. As a result, there has been a recent explosion of research on chronic pain, with significant advances in better understanding its etiology, assessment, and treatment. The purpose of the present article is to provide a review of the most noteworthy developments in the field. The biopsychosocial model is now widely accepted as the most heuristic approach to chronic pain. With this model in mind, a review of the basic neuroscience processes of pain (the bio part of biopsychosocial), as well as the psychosocial factors, is presented. This spans research on how psychological and social factors can interact with brain processes to influence health and illness as well as on the development of new technologies, such as brain imaging, that provide new insights into brain-pain mechanisms.

Review article: the role of butyrate on colonic function

Abstract: BACKGROUND: Butyrate, a short-chain fatty acid, is a main end-product of intestinal microbial fermentation of mainly dietary fibre. Butyrate is an important energy source for intestinal epithelial cells and plays a role in the maintenance of colonic homeostasis. AIM: To provide an overview on the present knowledge of the bioactivity of butyrate, emphasizing effects and possible mechanisms of action in relation to human colonic function. METHODS: A PubMed search was performed to select relevant publications using the search terms: 'butyrate, short-chain fatty acid, fibre, colon, inflammation, carcinogenesis, barrier, oxidative stress, permeability and satiety'. RESULTS: Butyrate exerts potent effects on a variety of colonic mucosal functions such as inhibition of inflammation and carcinogenesis, reinforcing various components of the colonic defence barrier and decreasing oxidative stress. In addition, butyrate may promote satiety. Two important mechanisms include the inhibition of nuclear factor kappa B activation and histone deacetylation. However, the observed effects of butyrate largely depend on concentrations and models used and human data are still limited. CONCLUSION: Although most studies point towards beneficial effects of butyrate, more human in vivo studies are needed to contribute to our current understanding of butyrate-mediated effects on colonic function in health and disease.

2007 ESH-ESC Practice Guidelines for the Management of Arterial Hypertension: ESH-ESC Task Force on the Management of Arterial Hypertension.

Abstract: Authors/Task Force Members: Giuseppe Mancia, Co-Chairperson (Italy), Guy De Backer, Co-Chairperson (Belgium), Anna Dominiczak (UK), Renata Cifkova (Czech Republic), Robert Fagard (Belgium), Giuseppe Germano (Italy), Guido Grassi (Italy), Anthony M. Heagerty (UK), Sverre E. Kjeldsen (Norway), Stephane Laurent (France), Krzysztof Narkiewicz (Poland), Luis Ruilope (Spain), Andrzej Rynkiewicz (Poland), Roland E. Schmieder (Germany), Harry A.J. Struijker Boudier (Netherlands), Alberto Zanchetti (Italy)

The fear-avoidance model of musculoskeletal pain: current state of scientific evidence.

Abstract: Research studies focusing on the fear-avoidance model have expanded considerably since the review by Vlaeyen and Linton (Vlaeyen J. W. S. & Linton, S. J. (2000). Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain, 85(3), 317--332). The fear-avoidance model is a cognitive-behavioral account that explains why a minority of acute low back pain sufferers develop a chronic pain problem. This paper reviews the current state of scientific evidence for the individual components of the model: pain severity, pain catastrophizing, attention to pain, escape/avoidance behavior, disability, disuse, and vulnerabilities. Furthermore, support for the contribution of pain-related fear in the inception of low back pain, the development of chronic low back pain from an acute episode, and the maintenance of enduring pain, will be highlighted. Finally, available evidence on recent clinical applications is provided, and unresolved issues that need further exploration are discussed.

2007 Guidelines for the management of arterial hypertension

Abstract: For several years the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC) decided not to produce their own guidelines on the diagnosis and treatment of hypertension but to endorse the guidelines on hypertension issued by the World Health Organization (WHO) and International Society of Hypertension (ISH)1,2 with some adaptation to reflect the situation in Europe. However, in 2003 the decision was taken to publish ESH/ESC specific guidelines3 based on the fact that, because the WHO/ISH Guidelines address countries widely varying in the extent of their health care and availability of economic resource, they contain diagnostic and therapeutic recommendations that may be not totally appropriate for European countries. In Europe care provisions may often allow a more in-depth diagnostic assessment of cardiovascular risk and organ damage of hypertensive individuals as well as a wider choice of antihypertensive treatment. The 2003 ESH/ESC Guidelines3 were well received by the clinical world and have been the most widely quoted paper in the medical literature in the last two years.4 However, since 2003 considerable additional evidence on important issues related to diagnostic and treatment approaches to hypertension has become available and therefore updating of the previous guidelines has been found advisable. In preparing the new guidelines the Committee established by the ESH and ESC has agreed to adhere to the principles informing the 2003 Guidelines, namely 1) to try to offer the best available and most balanced recommendation to all health care providers involved in the management of hypertension, 2) to address this aim again by an extensive and critical review of the data accompanied by a series of boxes where specific recommendations are given, as well as by a concise set of practice recommendations to be published soon thereafter as already done in 2003; …

The endothelial glycocalyx: composition, functions, and visualization

Abstract: This review aims at presenting state-of-the-art knowledge on the composition and functions of the endothelial glycocalyx. The endothelial glycocalyx is a network of membrane-bound proteoglycans and glycoproteins, covering the endothelium luminally. Both endothelium- and plasma-derived soluble molecules integrate into this mesh. Over the past decade, insight has been gained into the role of the glycocalyx in vascular physiology and pathology, including mechanotransduction, hemostasis, signaling, and blood cell–vessel wall interactions. The contribution of the glycocalyx to diabetes, ischemia/reperfusion, and atherosclerosis is also reviewed. Experimental data from the micro- and macrocirculation alludes at a vasculoprotective role for the glycocalyx. Assessing this possible role of the endothelial glycocalyx requires reliable visualization of this delicate layer, which is a great challenge. An overview is given of the various ways in which the endothelial glycocalyx has been visualized up to now, including first data from two-photon microscopic imaging.

A variant in CDKAL1 influences insulin response and risk of type 2 diabetes.

Abstract: We conducted a genome-wide association study for type 2 diabetes (T2D) in Icelandic cases and controls, and we found that a previously described variant in the transcription factor 7-like 2 gene (TCF7L2) gene conferred the most significant risk. In addition to confirming two recently identified risk variants, we identified a variant in the CDKAL1 gene that was associated with T2D in individuals of European ancestry (allele-specific odds ratio (OR) = 1.20 (95% confidence interval, 1.13-1.27), P = 7.7 x 10(-9)) and individuals from Hong Kong of Han Chinese ancestry (OR = 1.25 (1.11-1.40), P = 0.00018). The genotype OR of this variant suggested that the effect was substantially stronger in homozygous carriers than in heterozygous carriers. The ORs for homozygotes were 1.50 (1.31-1.72) and 1.55 (1.23-1.95) in the European and Hong Kong groups, respectively. The insulin response for homozygotes was approximately 20% lower than for heterozygotes or noncarriers, suggesting that this variant confers risk of T2D through reduced insulin secretion.

Environmental correlates of physical activity in youth - a review and update.

Abstract: Obesogenic environments are thought to underlie the increased obesity prevalence observed in youth during the past decades. Understanding the environmental factors that are associated with physical activity (PA) in youth is needed to better inform the development of effective intervention strategies attempting to halt the obesity epidemic. We conducted a systematic semi-quantitative review of 150 studies on environmental correlates of youth PA published in the past 25 years. The ANalysis Grid for Environments Linked to Obesity (ANGELO) framework was used to classify the environmental correlates studied. Most studies retrieved used cross-sectional designs and subjective measures of environmental factors and PA. Variables of the home and school environments were especially associated with children's PA. Most consistent positive correlates of PA were father's PA, time spent outdoors and school PA-related policies (in children), and support from significant others, mother's education level, family income, and non-vocational school attendance (in adolescents). Low crime incidence (in adolescents) was characteristic of the neighbourhood environment associated with higher PA. Convincing evidence of an important role for many other environmental factors was, however, not found. Further research should aim at longitudinal and intervention studies, and use more objective measures of PA and its potential (environmental) determinants.

Assurance on Sustainability Reports: An International Comparison

Abstract: Globally, companies increasingly publish separate general purpose, non-financial (sustainability) reports. Some of these are independently assured and assurers may or may not be from the auditing profession. We seek to understand this emerging voluntary assurance market. Using a sample of 2,113 companies (from 31 countries) that produced sustainability reports between 2002-2004, we use sequential logit analysis to identify the factors associated with the decision to voluntarily purchase assurance and the choice of assurance provider. We hypothesize that a company's need to enhance credibility through assurance and choice of assurance provider will be a function of company, industry and country-related factors. Our results support the argument that companies seeking to enhance the credibility of their reports and build their corporate reputation are more likely to have their sustainability reports assured, although it does not matter whether the assurance provider comes from the auditing profession. We also find that companies operating in stakeholder orientated countries are more likely to choose the auditing profession as an assurer.

Anti-Inflammatory Activity of Human IgG4 Antibodies by Dynamic Fab Arm Exchange

Abstract: Antibodies play a central role in immunity by forming an interface with the innate immune system and, typically, mediate proinflammatory activity. We describe a novel posttranslational modification that leads to anti-inflammatory activity of antibodies of immunoglobulin G, isotype 4 (IgG4). IgG4 antibodies are dynamic molecules that exchange Fab arms by swapping a heavy chain and attached light chain (half-molecule) with a heavy-light chain pair from another molecule, which results in bispecific antibodies. Mutagenesis studies revealed that the third constant domain is critical for this activity. The impact of IgG4 Fab arm exchange was confirmed in vivo in a rhesus monkey model with experimental autoimmune myasthenia gravis. IgG4 Fab arm exchange is suggested to be an important biological mechanism that provides the basis for the anti-inflammatory activity attributed to IgG4 antibodies.

Publication bias in meta-analysis: Prevention, assessment and adjustments

Abstract: Each study that is published about the effect of an independent variable on a dependent one, or the strength of the relationship between two variables, constitutes only a single piece in a constantly growing body of evidence. For example, over one hundred studies have been carried out to determine the relationship between employment interview performance and job performance (McDaniel, Whetzel, Schmidt, & Maurer, 1994). Each study yields a measure of the strength and direction of the association, typically in the form of a correlation coefficient. In some studies, the correlation coefficient is statistically significant, while others do not find a statistically significant association. To make sense of the often-conflicting results found in the literature, one can conduct a meta-analysis (e.g., Cooper, 1998; Cooper & Hedges, 1994; Hedges & Olkin, 1985; Hunter & Schmidt, 2004; Lipsey & Wilson, 2001; Rosenthal, 1991). In essence, the correlation coefficients that we extract from the various studies then become the data for further analysis. For example, if we assume that the observed correlation coefficients only differ from each other due to sampling variability, then the average of the correlation coefficients provides an estimate of the overall validity of employment interviews. However, if the correlation coefficients of published studies differ systematically from those of unpublished studies, then the estimate may be biased (e.g., when studies with statistically significant results are more likely to be published, then the true correlation may be overestimated). In fact, regardless of whether we use meta-analysis, or simply conduct a narrative review to synthesize the relevant literature, the conclusions that we draw may be wrong if the accessible studies (and these typically coincide to a great deal with the ones we find in the published literature) differ systematically from the population of completed studies. This is known as the publication bias problem and constitutes the topic of the book Publication bias in meta-analysis: Prevention, assessment and adjustments, edited by Rothstein, Sutton, and Borenstein (2005). This is the first book to address this issue in such detail and is likely to become a standard reference for those who carry out systematic literature reviews. The chapters, which were written by leading experts in the field of research synthesis, summarize a substantial amount of research that has been conducted on the issue of publication bias. The following topics are addressed in the chapters: various forms of publication bias, evidence of its existence, the extent of its influence, and potential causes and consequences of publication bias; statistical techniques for detecting publication bias, for assessing the sensitivity of conclusions to the possible presence of publication bias, and for adjusting meta-analytic estimates for publication bias; capabilities of various software packages with respect to these techniques; strategies for eliminating or at least minimizing the influence of publication bias; other forms of missing data or data suppression mechanisms besides publication bias that may bias the conclusions from systematic literature reviews; and other factors that may mimic the appearance of publication bias, but should not be confused with it. Many of the chapters (especially those dealing with statistical techniques) assume some basic familiarity with meta-analytic methodology. As prior readings, I would therefore suggest The handbook of research synthesis (Cooper & Hedges, 1994), Statistical methods for meta-analysis (Hedges & Olkin, 1985), or Practical meta-analysis (Lipsey & Wilson, 2001). Unfortunately, the meta-analytic approach proposed by Hunter and Schmidt (2004) is not directly addressed in the book. Nevertheless, it needs to be stressed that researchers using any method for research synthesis need to be aware of the potential influence of publication bias on their conclusions and therefore would benefit greatly from reading this book. The chapters dealing with the statistical methods are generally accessible to those with an undergraduate level training in statistics. Technical details are largely skipped, so those interested in the more technical aspects of particular methods will have to turn to the original sources (ample references are provided). Most notable for those with a methodological interest is probably the chapter on selection models (written by Larry Hedges and Jack Vevea, who have conducted a substantial amount of research in this area), which may be considered the most sophisticated approach for detecting and adjusting for publication bias. The use of a standardized notation across the chapters greatly facilitates their readability. Another noteworthy feature is the use of three common examples throughout the book to illustrate the various methods (the examples deal with the effects of teacher expectancy on student intelligence, the relationship between second-hand tobacco smoke and lung cancer, and the validity of employment interviews for predicting job performance). Since the datasets for these examples are provided in the appendix along with some background information, readers can replicate many of the results presented in the chapters. Besides datasets, the appendix also includes an annotated bibliography regarding key articles on the research of publication bias. The bibliography is given in chronological order, allowing readers to trace methodological developments and the emergence of empirical evidence of publication bias over time. Finally, recognizing that the intended audience comes from various disciplines, a short glossary was included at the end of the appendix, which provides definitions for some frequently used terms and concepts in the book. Although publication bias is a concern in all disciplines, most of the empirical evidence regarding its existence and influence comes from the medical literature. The emphasis on this discipline is therefore also notable throughout the book. For example, some proposed strategies to minimize the influence of publication bias, like the registration of clinical trials at their inception, may not be easily transferred to other disciplines. Nevertheless, it is apparent that an effort has been made to address various disciplines. A website has been created to supplement the book, but the address given in the book is incorrect (the actual address is http://www.meta-analysis.com/pages/pub_bias.html). Chapter 1 (which provides a short introduction to the publication bias problem and the contents of the book) and Chapter 11 (on software) are freely available for download at this website. Unfortunately, the website appears to be still under construction, as several links are not working at this point. In conclusion, the book definitely succeeds in raising the awareness of the reader to an issue that unfortunately still remains underappreciated by those who conduct systematic literature reviews and by researchers in general. Although the book does not delve into issues of epistemology or the philosophy of science, one should easily recognize how publication bias, in its various forms, may seriously threaten the entire scientific method, which involves the acquisition of knowledge through the accumulation of research findings. Sir Isaac Newton once wrote: “If I have seen further, it is by standing on the shoulders of giants.” However, only an unobstructed view will allow us to benefit from the work of those who came before us. Hopefully, the book will be an impetous for all researchers to ensure that the view is as unobstructed as possible.

For whom the mind wanders, and when: an experience-sampling study of working memory and executive control in daily life.

Abstract: An experience-sampling study of 124 undergraduates, pretested on complex memory-span tasks, examined the relation between working memory capacity (WMC) and the experience of mind wandering in daily life. Over 7 days, personal digital assistants signaled subjects eight times daily to report immediately whether their thoughts had wandered from their current activity, and to describe their psychological and physical context. WMC moderated the relation between mind wandering and activities' cognitive demand. During challenging activities requiring concentration and effort, higher-WMC subjects maintained on-task thoughts better, and mind-wandered less, than did lower-WMC subjects. The results were therefore consistent with theories of WMC emphasizing the role of executive attention and control processes in determining individual differences and their cognitive consequences.

Regulation and characteristics of vascular smooth muscle cell phenotypic diversity

Abstract: Vascular smooth muscle cells can perform both contractile and synthetic functions, which are associated with and characterised by changes in morphology, proliferation and migration rates, and the expression of different marker proteins The resulting phenotypic diversity of smooth muscle cells appears to be a function of innate genetic programmes and environmental cues, which include biochemical factors, extracellular matrix components, and physical factors such as stretch and shear stress Because of the diversity among smooth muscle cells, blood vessels attain the flexibility that is necessary to perform efficiently under different physiological and pathological conditions In this review, we discuss recent literature demonstrating the extent and nature of smooth muscle cell diversity in the vascular wall and address the factors that affect smooth muscle cell phenotype (Neth Heart J 2007;15:100-8)

Two variants on chromosome 17 confer prostate cancer risk, and the one in TCF2 protects against type 2 diabetes

Abstract: We performed a genome-wide association scan to search for sequence variants conferring risk of prostate cancer using 1,501 Icelandic men with prostate cancer and 11,290 controls. Follow-up studies involving three additional case-control groups replicated an association of two variants on chromosome 17 with the disease. These two variants, 33 Mb apart, fall within a region previously implicated by family-based linkage studies on prostate cancer. The risks conferred by these variants are moderate individually (allele odds ratio of about 1.20), but because they are common, their joint population attributable risk is substantial. One of the variants is in TCF2 (HNF1beta), a gene known to be mutated in individuals with maturity-onset diabetes of the young type 5. Results from eight case-control groups, including one West African and one Chinese, demonstrate that this variant confers protection against type 2 diabetes.

High prevalence of ischaemia, infection and serious comorbidity in patients with diabetic foot disease in Europe. Baseline results from the Eurodiale study

Abstract: Large clinical studies describing the typical clinical presentation of diabetic foot ulcers are limited and most studies were performed in single centres with the possibility of selection of specific subgroups. The aim of this study was to investigate the characteristics of diabetic patients with a foot ulcer in 14 European hospitals in ten countries. The study population included 1,229 consecutive patients presenting with a new foot ulcer between 1 September 2003 and 1 October 2004. Standardised data on patient characteristics, as well as foot and ulcer characteristics, were obtained. Foot disease was categorised into four stages according to the presence or absence of peripheral arterial disease (PAD) and infection: A: PAD -, infection -; B: PAD -, infection +; C: PAD +, infection -; D: PAD +, infection +. PAD was diagnosed in 49% of the subjects, infection in 58%. The majority of ulcers (52%) were located on the non-plantar surface of the foot. With regard to severity, 24% had stage A, 27% had stage B, 18% had stage C and 31% had stage D foot disease. Patients in the latter group had a distinct profile: they were older, had more non-plantar ulcers, greater tissue loss and more serious comorbidity. According to our results in this European cohort, the severity of diabetic foot ulcers at presentation is greater than previously reported, as one-third had both PAD and infection. Non-plantar foot ulcers were more common than plantar ulcers, especially in patients with severe disease, and serious comorbidity increased significantly with increasing severity of foot disease. Further research is needed to obtain insight into the clinical outcome of these patients.

A novel algorithm for reliable detection of human papillomavirus in paraffin embedded head and neck cancer specimen.

Abstract: Human papillomavirus type 16 (HPV16) plays a role in the development of a subgroup of head and neck squamous cell carcinomas (HNSCC). However, uncertainty exists about the true impact of HPV in this tumor type as conflicting reports have been published with prevalence rates from 0 to 100%. We aimed to find a detection algorithm of a biologically and thus clinically meaningful infection, applicable for high-throughput screening of frozen and formalin-fixed paraffin embedded (FFPE) specimens. By considering detection of HPV E6 oncogene expression in frozen biopsies as gold standard for a meaningful HPV infection, the value of several assays was evaluated on FFPE tumor specimens and sera of 48 HNSCC patients. The following assays were evaluated on FFPE tissue samples: HPV DNA general primer (GP)5+/6+ PCR, viral load analysis, HPV16 DNA FISH detection, HPV16 E6 mRNA RT-PCR, p16 immunostaining, and on corresponding serum samples detection of antibodies against the HPV16 proteins L1, E6 and E7. Comparing single assays on FFPE tissue samples detection of E6 expression by RT-PCR was superior, but application remains at present limited to HPV16 detection. Most suitable algorithm with 100% sensitivity and specificity appeared p16 immunostaining followed by GP5+/6+ PCR on the p16-positive cases. We show that clinically meaningful viral HPV infections can be more reliably measured in FFPE HNSCC samples in a standard and high throughput manner, paving the way for prognostic and experimental vaccination studies, regarding not only HNSCC, but possibly also cancer types with HPV involvement in subgroups such as penile and anal cancer.

Study of active controlled monotherapy used for rheumatoid arthritis, an IL-6 inhibitor (SAMURAI): evidence of clinical and radiographic benefit from an x ray reader-blinded randomised controlled trial of tocilizumab

Abstract: Objective To evaluate the ability of tocilizumab (a humanised anti-IL-6 receptor antibody) monotherapy to inhibit progression of structural joint damage in patients with RA. Methods In a multi-centre, x ray reader-blinded, randomised, controlled trial, 306 patients with active RA of Results Patients had a mean disease duration of 2.3 years and a disease activity score in 28 joints of 6.5 at baseline. Mean total modified Sharp score (TSS) was 29.4, which was very high despite the relatively short disease duration. At week 52, the tocilizumab group showed statistically significantly less radiographic change in TSS (mean 2.3; 95% CI 1.5 to 3.2) than the DMARD group (mean 6.1; 95% CI 4.2 to 8.0; p Conclusion Tocilizumab monotherapy was generally well tolerated and provided radiographic benefit in patients with RA.

Gut microbiota composition and development of atopic manifestations in infancy: the KOALA Birth Cohort Study

Abstract: Background and aims: Perturbations in intestinal microbiota composition due to lifestyle changes may be involved in the development of atopic diseases. We examined gut microbiota composition in early infancy and the subsequent development of atopic manifestations and sensitisation. Methods: The faeces of 957 infants aged 1 month and participating in the KOALA Birth Cohort Study were analysed using quantitative real-time PCR. Information on atopic symptoms (eczema, wheeze) and potential confounders was acquired through repeated questionnaires. Total and specific IgE were measured in venous blood samples collected during home visits when the infant was 2 years old. During these home visits a clinical diagnosis of atopic dermatitis was made according to the UK-Working Party criteria. Results: The presence of Escherichia coli was associated with a higher risk of developing eczema (OR adj = 1.87; 95% CI 1.15 to 3.04), this risk being increased with increasing numbers of E coli (p for trend = 0.016). Infants colonised with Clostridium difficile were at higher risk of developing eczema (OR adj = 1.40; 95% CI 1.02 to 1.91), recurrent wheeze (OR adj = 1.75; 95% CI 1.09 to 2.80) and allergic sensitisation (OR adj = 1.54; 95% CI 1.02 to 2.31). Furthermore, the presence of C difficile was also associated with a higher risk of a diagnosis of atopic dermatitis during the home visit (OR adj = 1.73; 95% CI 1.08 to 2.78). Conclusion: This study demonstrates that differences in gut microbiota composition precede the development of atopy. Since E coli was only associated with eczema and C difficile was associated with all atopic outcomes, the underlying mechanisms explaining these association may be different.

EBPG on Vascular Access

Abstract: Department of Surgery, University Hospital Maastricht, The Netherlands, Nephrology, Dialysis and Intensive Care Unit; Lapeyronie University Hospital, Montpellier, France, Department of Diagnostic and Interventional Radiology, Helios Klinikum Wuppertal, University Hospital Witten/Herdecke, Germany, Medical Faculty University of Cologne, Medicine Clinic I, Hospital Merheim, Germany (retired), Department of Medicine, Division of Nephrology, Ege University Medical Faculty, Izmir, Turkey, Departement de Nephrologie JE 2411–Denutrition des Maladies Chroniques, Hopital E Herriot, France, Department of Internal Medicine, Division of Nephrology, University Hospital Maastricht, The Netherlands, Nephrology Department, Reina Sofia University Hospital, Cordoba, Spain, Division of Nephrology and Dialysis, Bolognini Hospital, Seriate, Italy, Nephrology Unit, SM Annunziata Hospital, Florence, Italy, Department of Renal Medicine, St James’s University Hospital, Leeds, UK, Department of Nephrology, Nutrition and Dietetics, Guy’s and St Thomas’ NHS Foundation Trust, London, UK (retired), Department of Medicine, Division of Nephrology, University Hospital, Wurzburg, Germany, Department of Nephrology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands and Nephrology Section, Department of Internal Medicine, University Hospital, Ghent, Belgium

Physical activity assessment with accelerometers: an evaluation against doubly labeled water

Abstract: This review focuses on the ability of different accelerometers to assess daily physical activity as compared with the doubly labeled water (DLW) technique, which is considered the gold standard for measuring energy expenditure under free-living conditions. The PubMed Central database (U.S. NIH free digital archive of biomedical and life sciences journal literature) was searched using the following key words: doubly or double labeled or labeled water in combination with accelerometer, accelerometry, motion sensor, or activity monitor. In total, 41 articles were identified, and screening the articles' references resulted in one extra article. Of these, 28 contained sufficient and new data. Eight different accelerometers were identified: 3 uniaxial (the Lifecorder, the Caltrac, and the CSA/MTI/Actigraph), one biaxial (the Actiwatch AW16), 2 triaxial (the Tritrac-R3D and the Tracmor), one device based on two position sensors and two motion sensors (ActiReg), and the foot-ground contact pedometer. Many studies showed poor results. Only a few mentioned partial correlations for accelerometer counts or the increase in R(2) caused by the accelerometer. The correlation between the two methods was often driven by subject characteristics such as body weight. In addition, standard errors or limits of agreement were often large or not presented. The CSA/MTI/Actigraph and the Tracmor were the two most extensively validated accelerometers. The best results were found for the Tracmor; however, this accelerometer is not yet commercially available. Of those commercially available, only the CSA/MTI/Actigraph has been proven to correlate reasonably with DLW-derived energy expenditure.

Potential environmental determinants of physical activity in adults: a systematic review

Abstract: The objective of this systematic review of observational studies was to gain insight into potential determinants of various types and intensities of physical activity among adult men and women. Studies were retrieved from Medline, PsycInfo, Embase and Social scisearch. The ANGELO framework was used to classify environmental factors. In total, 47 publications were identified. Social support and having a companion for physical activity were found to be convincingly associated with different types of physical activity [(neighbourhood) walking, bicycling, vigorous physical activity/sports, active commuting, leisure-time physical activity in general, sedentary lifestyle, moderately intense physical activity and a combination of moderately intense and vigorous activity]. Availability of physical activity equipment was convincingly associated with vigorous physical activity/sports and connectivity of trails with active commuting. Other possible, but less consistent correlates of physical activity were availability, accessibility and convenience of recreational facilities. No evidence was found for differences between men and women. In conclusion, supportive evidence was found for only very few presumed environmental determinants. However, most studies used cross-sectional designs and non-validated measures of environments and/or behaviour. Therefore, no strong conclusions can be drawn and more research of better quality is clearly needed.