Bone mineral density in vocational and professional ballet dancers

Summary: According to existing literature, bone health in ballet dancers is controversial. We have verified that, compared to controls, young female and male vocational ballet dancers have lower bone mineral density (BMD) at both impact and non-impact sites, whereas female professional ballet dancers have lower BMD only at non-impact sites. Introduction: The aims of this study were to (a) assess bone mineral density (BMD) in vocational (VBD) and professional (PBD) ballet dancers and (b) investigate its association with body mass (BM), fat mass (FM), lean mass (LM), maturation and menarche. Methods: The total of 152 VBD (13 ± 2.3 years; 112 girls, 40 boys) and 96 controls (14 ± 2.1 years; 56 girls, 40 boys) and 184 PBD (28 ± 8.5 years; 129 females, 55 males) and 160 controls (27 ± 9.5 years; 110 female, 50 males) were assessed at the lumbar spine (LS), femoral neck (FN), forearm and total body by dual-energy X-ray absorptiometry. Maturation and menarche were assessed via questionnaires. Results: VBD revealed lower unadjusted BMD at all anatomical sites compared to controls (p < 0.001); following adjustments for Tanner stage and gynaecological age, female VBD showed similar BMD values at impact sites. However, no factors were found to explain the lower adjusted BMD values in VBD (female and male) at the forearm (non-impact site), nor for the lower adjusted BMD values in male VBD at the FN. Compared to controls, female PBD showed higher unadjusted and adjusted BMD for potential associated factors at the FN (impact site) (p < 0.001) and lower adjusted at the forearm (p < 0.001). Male PBD did not reveal lower BMD than controls at any site. Conclusions: both females and males VBD have lower BMD at impact and non-impact sites compared to control, whereas this is only the case at non-impact site in female PBD. Maturation seems to explain the lower BMD at impact sites in female VBD

Tuning fresh: radiation through rewiring of central metabolism in streamlined bacteria

Most free-living planktonic cells are streamlined and in spite of their limitations in functional flexibility, their vast populations have radiated into a wide range of aquatic habitats. Here we compared the metabolic potential of subgroups in the Alphaproteobacteria lineage SAR11 adapted to marine and freshwater habitats. Our results suggest that the successful leap from marine to freshwaters in SAR11 was accompanied by a loss of several carbon degradation pathways and a rewiring of the central metabolism. Examples for these are C1 and methylated compounds degradation pathways, the Entner–Doudouroff pathway, the glyoxylate shunt and anapleuretic carbon fixation being absent from the freshwater genomes. Evolutionary reconstructions further suggest that the metabolic modules making up these important freshwater metabolic traits were already present in the gene pool of ancestral marine SAR11 populations. The loss of the glyoxylate shunt had already occurred in the common ancestor of the freshwater subgroup and its closest marine relatives, suggesting that the adaptation to freshwater was a gradual process. Furthermore, our results indicate rapid evolution of TRAP transporters in the freshwater clade involved in the uptake of low molecular weight carboxylic acids. We propose that such gradual tuning of metabolic pathways and transporters toward locally available organic substrates is linked to the formation of subgroups within the SAR11 clade and that this process was critical for the freshwater clade to find and fix an adaptive phenotype.This work was supported by the Swedish Research Council (Grant Numbers 2012-4592 to AE and 2012-3892 to SB) and the Communiy Sequencing Programme of the US Department of Energy Joint Genome Institute. The work conducted by the US Department of Energy Joint Genome Institute, a DOE Office of Science User Facility, is supported under Contract No. DE-AC02-05CH11231

Implementing Individually Tailored Prescription of Physical Activity in Routine Clinical Care:Protocol of the Physicians Implement Exercise = Medicine (PIE=M) Development and Implementation Project

BACKGROUND: The prescription of physical activity (PA) in clinical care has been advocated worldwide. This "exercise is medicine" (E=M) concept can be used to prevent, manage, and cure various lifestyle-related chronic diseases. Due to several challenges, E=M is not yet routinely implemented in clinical care. OBJECTIVE: This paper describes the rationale and design of the Physicians Implement Exercise = Medicine (PIE=M) study, which aims to facilitate the implementation of E=M in hospital care. METHODS: PIE=M consists of 3 interrelated work packages. First, levels and determinants of PA in different patient and healthy populations will be investigated using existing cohort data. The current implementation status, facilitators, and barriers of E=M will also be investigated using a mixed-methods approach among clinicians of participating departments from 2 diverse university medical centers (both located in a city, but one serving an urban population and one serving a more rural population). Implementation strategies will be connected to these barriers and facilitators using a systematic implementation mapping approach. Second, a generic E=M tool will be developed that will provide tailored PA prescription and referral. Requirements for this tool will be investigated among clinicians and department managers. The tool will be developed using an iterative design process in which all stakeholders reflect on the design of the E=M tool. Third, we will pilot-implement the set of implementation strategies, including the E=M tool, to test its feasibility in routine care of clinicians in these 2 university medical centers. An extensive learning process evaluation will be performed among clinicians, department managers, lifestyle coaches, and patients using a mixed-methods design based on the RE-AIM framework. RESULTS: This project was approved and funded by the Dutch grant provider ZonMW in April 2018. The project started in September 2018 and continues until December 2020 (depending on the course of the COVID-19 crisis). All data from the first work package have been collected and analyzed and are expected to be published in 2021. Results of the second work package are described. The manuscript is expected to be published in 2021. The third work package is currently being conducted in clinical practice in 4 departments of 2 university medical hospitals among clinicians, lifestyle coaches, hospital managers, and patients. Results are expected to be published in 2021. CONCLUSIONS: The PIE=M project addresses the potential of providing patients with PA advice to prevent and manage chronic disease, improve recovery, and enable healthy ageing by developing E=M implementation strategies, including an E=M tool, in routine clinical care. The PIE=M project will result in a blueprint of implementation strategies, including an E=M screening and referral tool, which aims to improve E=M referral by clinicians to improve patients' health, while minimizing the burden on clinicians

The Mediterranean diet for Polish infants: a losing struggle or a battle still worth fighting?

The Mediterranean diet is well known for its health-promoting effects. Among its key ingredients, olive oil is the most characteristic. Processing industries have been successfully manufacturing and marketing jarred baby foods with the use of vegetable oils, including olive oil, as well as other sources of visible fat. We aimed to survey manufacturer claims concerning added fat in jarred infant foods supplied to the Polish market. A total of 124 kinds of infant foods from six suppliers were analyzed. Corn, canola, and soybean oil occupied the first three positions, respectively, in rank order of vegetable oils used in jarred baby foods. In our sample, only one type of ready-to-eat jars with vegetables contained olive oil. 11% of products contained cow milk butter or cream. 61% of jarred “dinners” contained poultry or fish, which are typical sources of animal protein in the Mediterranean diet. Given that commercial baby foods currently available in the Polish market contain no olive oil, we advocate considering home preparation of infant foods with the use of visible fat. Medical professionals should encourage food manufacturers to return to the concepts of the Mediterranean diet for young consumers, aimed at long-term health

Brief oral health promotion intervention among parents of young children to reduce early childhood dental decay

Background: Severe untreated dental decay affects a child’s growth, body weight, quality of life as well as cognitive development, and the effects extend beyond the child to the family, the community and the health care system. Early health behavioural factors, including dietary practices and eating patterns, can play a major role in the initiation and development of oral diseases, particularly dental caries. The parent/caregiver, usually the mother, has a critical role in the adoption of protective health care behaviours and parental feeding practices strongly influence children’s eating behaviours. This study will test if an early oral health promotion intervention through the use of brief motivational interviewing (MI) and anticipatory guidance (AG) approaches can reduce the incidence of early childhood dental decay and obesity. Methods: The study will be a randomised controlled study with parents and their new-born child/ren who are seen at 6–12 weeks of age by a child/community health nurse. Consenting parents will complete a questionnaire on oral health knowledge, behaviours, self-efficacy, oral health fatalism, parenting stress, prenatal and peri-natal health and socio-demographic factors at study commencement and at 12 and 36 months. Each child–parent pair will be allocated to an intervention or a standard care group, using a computer-generated random blocks. The standard group will be managed through the standard early oral health screening program; “lift the lip”. The intervention group will be provided with tailored oral health counselling by oral health consultants trained in MI and AG. Participating children will be examined at 24, and 36 months for the occurrence of dental decay and have their height and weight recorded. Dietary information obtained from a food frequency chart will be used to determine food and dietary patterns. Data analysis will use intention to treat and per protocol analysis and will use tests of independent proportions and means. Multivariate statistical tests will also be used to take account of socio-economic and demographic factors in addition to parental knowledge, behaviour, self-efficacy, and parent/child stress. Discussion: The study will test the effects of an oral health promotion intervention to affect oral health and general health and have the potential to demonstrate the "common risk factor" approach to health promotion.Peter Arrow, Joseph Raheb and Margaret Mille

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

För en ekonomiskt och ekologiskt hållbar ekonomi : En studie av grön finansiering inom bygg- och anläggningsbranschen, idag och i framtiden

BAKGRUND: Ökade växthusgasutsläpp och större klimatpåverkan speglar dagens samhälle allt mer. Bygg-och anläggningssektorn står idag för en femtedel av Sveriges totala klimatpåverkan och är en bransch som behöver ta steg framåt för att minimera den. Ett instrument som har använts för att motivera och skapa finansiella samt klimatmässiga fördelar för projekt som kan visa på en lägre klimatpåverkan är grön finansiering. Grön finansiering bygger på att projekt kan påvisa en mindre klimatpåverkan för att kunna ta del av de finansiella fördelar det skulle innebära. Dock har tidigare forskning runt ämnet visat att detta bortses av investerare och beslutsfattare av olika orsaker trots att klimatdebatten blir allt mer tydlig. Avsaknad av tydliga regelverk, standarder eller policyer lyfts av tidigare forskning samtidigt som hot kan anas i form av för hårda åtstramningar. En analys av bygg-och anläggningssektorns syn på grön finansiering och gröna projekt och vad marknaden behöver för att i framtiden kunna vara finansiellt hållbar är någonting som behövs för att marknaden ska kunna ta steg framåt. SYFTE: Syftet med studien är att analysera de finansiella fördelarna och riskerna som grön finansiering medför. Utifrån en analys av grön finansiering inom ramen för bygg-och anläggningssektorn kommer sedan förslag till sätt marknaden kan utvecklas på att föreslås utifrån ett finansiellt perspektiv. GENOMFÖRANDE: Studien har genomförts genom kvalitativa, semi-strukturerade intervjuer med respondenter kopplade till bygg-och anläggningsbranschen samt grön finansiering. Som tillägg har en kartläggning av erbjudande inom grön finansiering sammanställts från två respondenter. Utifrån tidigare forskning samt rapporter ställdes frågor runt grön finansiering och dess finansiella påverkan på marknaden. Utifrån svaren från aktörerna kunde en analys göras av var de aktiva aktörerna såg marknaden idag samt dess viktigaste aspekter för framtiden. SLUTSATS: Studiens slutsats är att den gröna finansieringsmarknaden behöver införa ett graderingssystem för att på så sätt skilja projekt åt. Ett sådant system skulle fungera som ett incitament för projekt att gå mot att bli gröna då det inkluderar en prissättning av sådant som inte lever upp till kraven för att bli gröna och fördelar för de som tar allra störst klimatansvar. Det skulle också möjliggöra för investerare som vill ta högre risk att investera i projekt som i dagsläget inte är gröna men som har som ambition att bli det. Utöver graderingssystemet behöver det också kompletteras av mer obligatoriska regelverk för att öka utbudet av grön finansiering på marknaden.BACKGROUND: Increased greenhouse gas emissions and greater climatic impact reflect today's society more and more. Today, the construction and civil engineering industry accounts for one fifth of Sweden's total climate impact and is an industry that needs to take steps to minimize it. An instrument that has been used to motivate and create financial and climatic benefits for projects that can show a lower climate impact is green financing. Green financing is based on the fact that projects can show a minor impact on the climate in order to be able to take advantage of the financial benefits it would entail. However, previous research on the subject has shown that this is ignored by investors and decision-makers for various reasons, although the climate debate is becoming increasingly clear. The lack of clear regulations, standards or policies is highlighted by previous research, while at the same time one can perceive a threat in the form of too tight austerities. An analysis of the construction industry’s view today of green financing and green projects and what the market needs in order to be financially sustainable in the future is something that is necessary for the market to be able to take steps forward. AIM: The purpose of the study is to analyze the financial benefits and risks that green financing entails. On the basis of an analysis of green financing within the framework of the construction and civil engineering sector, then proposals for ways in which the market can be developed are proposed from a financial perspective. COMPLETION: The study was conducted through qualitative, semi-structured interviews with respondents linked to the construction and civil engineering sectors and green financing. In addition, a survey of green financing offers has been compiled from two respondents. Based on previous research and reports, questions were asked about green financing and its financial impact on the market. Based on the responses from the players, an analysis could be made of where the active players saw the market today and its most important aspects for the future. CONCLUSION: The study concludes that the green financing market needs to introduce a grading system in order to separate projects. Such a system would serve as an incentive for projects to go green as it includes pricing of things that do not meet the requirements to become green and benefits those who take the greatest climate responsibility. It would also make it possible for investors who want to take a higher risk of investing in projects that are not green at the moment, but which have the ambition to become so. In addition to the grading system, it also needs to be supplemented by more mandatory regulations to increase the supply of green financing in the market

För en ekonomiskt och ekologiskt hållbar ekonomi : En studie av grön finansiering inom bygg- och anläggningsbranschen, idag och i framtiden

BAKGRUND: Ökade växthusgasutsläpp och större klimatpåverkan speglar dagens samhälle allt mer. Bygg-och anläggningssektorn står idag för en femtedel av Sveriges totala klimatpåverkan och är en bransch som behöver ta steg framåt för att minimera den. Ett instrument som har använts för att motivera och skapa finansiella samt klimatmässiga fördelar för projekt som kan visa på en lägre klimatpåverkan är grön finansiering. Grön finansiering bygger på att projekt kan påvisa en mindre klimatpåverkan för att kunna ta del av de finansiella fördelar det skulle innebära. Dock har tidigare forskning runt ämnet visat att detta bortses av investerare och beslutsfattare av olika orsaker trots att klimatdebatten blir allt mer tydlig. Avsaknad av tydliga regelverk, standarder eller policyer lyfts av tidigare forskning samtidigt som hot kan anas i form av för hårda åtstramningar. En analys av bygg-och anläggningssektorns syn på grön finansiering och gröna projekt och vad marknaden behöver för att i framtiden kunna vara finansiellt hållbar är någonting som behövs för att marknaden ska kunna ta steg framåt. SYFTE: Syftet med studien är att analysera de finansiella fördelarna och riskerna som grön finansiering medför. Utifrån en analys av grön finansiering inom ramen för bygg-och anläggningssektorn kommer sedan förslag till sätt marknaden kan utvecklas på att föreslås utifrån ett finansiellt perspektiv. GENOMFÖRANDE: Studien har genomförts genom kvalitativa, semi-strukturerade intervjuer med respondenter kopplade till bygg-och anläggningsbranschen samt grön finansiering. Som tillägg har en kartläggning av erbjudande inom grön finansiering sammanställts från två respondenter. Utifrån tidigare forskning samt rapporter ställdes frågor runt grön finansiering och dess finansiella påverkan på marknaden. Utifrån svaren från aktörerna kunde en analys göras av var de aktiva aktörerna såg marknaden idag samt dess viktigaste aspekter för framtiden. SLUTSATS: Studiens slutsats är att den gröna finansieringsmarknaden behöver införa ett graderingssystem för att på så sätt skilja projekt åt. Ett sådant system skulle fungera som ett incitament för projekt att gå mot att bli gröna då det inkluderar en prissättning av sådant som inte lever upp till kraven för att bli gröna och fördelar för de som tar allra störst klimatansvar. Det skulle också möjliggöra för investerare som vill ta högre risk att investera i projekt som i dagsläget inte är gröna men som har som ambition att bli det. Utöver graderingssystemet behöver det också kompletteras av mer obligatoriska regelverk för att öka utbudet av grön finansiering på marknaden.BACKGROUND: Increased greenhouse gas emissions and greater climatic impact reflect today's society more and more. Today, the construction and civil engineering industry accounts for one fifth of Sweden's total climate impact and is an industry that needs to take steps to minimize it. An instrument that has been used to motivate and create financial and climatic benefits for projects that can show a lower climate impact is green financing. Green financing is based on the fact that projects can show a minor impact on the climate in order to be able to take advantage of the financial benefits it would entail. However, previous research on the subject has shown that this is ignored by investors and decision-makers for various reasons, although the climate debate is becoming increasingly clear. The lack of clear regulations, standards or policies is highlighted by previous research, while at the same time one can perceive a threat in the form of too tight austerities. An analysis of the construction industry’s view today of green financing and green projects and what the market needs in order to be financially sustainable in the future is something that is necessary for the market to be able to take steps forward. AIM: The purpose of the study is to analyze the financial benefits and risks that green financing entails. On the basis of an analysis of green financing within the framework of the construction and civil engineering sector, then proposals for ways in which the market can be developed are proposed from a financial perspective. COMPLETION: The study was conducted through qualitative, semi-structured interviews with respondents linked to the construction and civil engineering sectors and green financing. In addition, a survey of green financing offers has been compiled from two respondents. Based on previous research and reports, questions were asked about green financing and its financial impact on the market. Based on the responses from the players, an analysis could be made of where the active players saw the market today and its most important aspects for the future. CONCLUSION: The study concludes that the green financing market needs to introduce a grading system in order to separate projects. Such a system would serve as an incentive for projects to go green as it includes pricing of things that do not meet the requirements to become green and benefits those who take the greatest climate responsibility. It would also make it possible for investors who want to take a higher risk of investing in projects that are not green at the moment, but which have the ambition to become so. In addition to the grading system, it also needs to be supplemented by more mandatory regulations to increase the supply of green financing in the market