Community networks of sport and physical activity promotion: an analysis of structural properties and conditions of cooperation.

BACKGROUND: The importance of intersectoral cooperation networks among community organizations located in people's immediate environments in addressing population health problems such as physical inactivity has come into focus in recent years. To date, there is limited evidence on how and why such networks emerge. Therefore, the aims of this study were (a) to analyze the structural properties and (b) to identify the conditions of cooperation in interorganizational community networks of sport and physical activity promotion. METHODS: Survey data on cooperative relationships and organizational attributes of sports and physical activity providers as well as sports administrating organizations in two community networks located in urban districts in southern Germany were collected (Network I: n = 133 organizations; Network II: n = 50 organizations). Two quantitative descriptive procedures - network analysis and stochastic analyses of network modeling (exponential random graphs) - were applied. RESULTS: Similar structures and conditions of cooperation were found in the networks (e.g. low density, centralization). The community sports administrations had the most central positions in both networks. Exponential random graph modeling showed that cooperation took place more frequently in triangular structures (closure effect) and revolved around a few central actors (preferential attachment effect). Organizations from different sectors cooperated more often than organizations from the same sector (heterophily effect). CONCLUSION: The study provided valid and robust findings on significant mechanisms and conditions of interorganizational cooperation in community networks focused on sport and physical activity promotion. Based on the results, implications for the development and most efficient governance of these networks can be derived.

The Use of Compression Stockings to Reduce Water Retention in the Legs During Gaming and Esports: Randomized Controlled Field Study.

BACKGROUND: With the increasing digitalization of daily life, internet-based entertainment such as gaming and streaming has advanced to one of the megatrends of the 21st century. Besides offering a multitude of controversially discussed opportunities for entertainment and social interaction, there is reasonable concern about health issues caused by the absence of physical activity among activities linked to gaming and streaming. OBJECTIVE: The aim of this study is to compare the water balance of recreational gamers with and those without compression stockings during a gaming event. METHODS: We measured body composition and water balance with 8-electrode bioelectrical impedance analysis among 46 recreational gamers with an average age of 27.1 (SD 6.5) years (5/46, 11% women and 41/46, 89% men) before and after 24 hours at a gaming event. Of the 46 gamers, 23 (50%) gamers wore compression stockings for the duration of the study. RESULTS: Our study shows that prolonged gaming and associated behaviors during a 24-hour time frame lead to an increase in total body water (+0.76 L; P<.001) and a decrease of phase angle in the lower extremities (-0.47°; P<.001) but not in the upper extremities (+0.09°; P=.80), when no compression is used. Gamers using compression socks did not show any significant negative effects on their body composition. CONCLUSIONS: Prolonged gaming and streaming are serious risk factors for diseases associated with water retention in the legs, and these risks can be measured by bioelectrical impedance and reduced by wearing compression stockings. We conclude that these findings should be discussed and replicated in larger studies and that there is a considerably large market for compression stockings among gamers and live streamers.

Relationship between Birth Weight, Early Growth Rate, and Body Composition in 5- to 7-Year-Old Children.

BACKGROUND: Programing of body composition during intrauterine growth may contribute to the higher risk for cardio-metabolic disease in individuals born small or large for gestational age (SGA, LGA). Compensations of intrauterine growth by catch-up or catch-down postnatal growth may lead to adverse consequences like a thin-fat phenotype. METHODS: The impact of (i) birth weight as well as (ii) the interaction between birth weight and catch-up or catch-down growth during the first 2 years of life on fat-free mass index (FFMI) and fat mass index (FMI) in 3,204 5-7-year-old children were investigated using Hattori's body composition chart. Body composition results were compared to appropriate for gestational age (AGA) birth weight with the same body mass index (BMI). RESULTS: In total, 299 children at age 5-7 years were categorized as SGA, 2,583 as AGA, and 322 as LGA. When compared to AGA-children, BMI at 5-7 years of age was higher in LGA-children (15.5 vs. 16.2 kg/m2; p < 0.001) but not different in SGA-children. Compared to AGA with the same BMI, LGA was associated with higher FMI and a lower FFMI in 5-7-year-old girls. This phenotype was also seen for both sexes with catch-down growth during the first 2 years of life whereas catch-up growth prevented the higher FMI and lower FFMI per BMI. By contrast, SGA was associated with a higher FFMI and lower FMI in 5-7-year-old boys compared to AGA boys with the same BMI. This phenotype was also seen with catch-down growth in both genders whereas catch-up growth in girls led to more gain in FMI per BMI. CONCLUSION: LGA with a compensatory catch-down postnatal growth may be a risk factor for the development of disproportionate gain in fat over lean mass whereas SGA with a catch-down postnatal growth seems to favor the subsequent accretion of lean over fat mass. A higher propensity of lean mass accretion during postnatal growth in boys compared to girls explains sex differences in these phenotypes.

Body Composition Characteristics of a Load-Capacity Model: Age-Dependent and Sex-Specific Percentiles in 5- to 17-Year-Old Children.

INTRODUCTION: Body composition assessment is superior to the use of body mass index (BMI) to characterize the nutritional status in pediatric populations. For data interpretation, suitable reference data are needed; hence, we aimed to generate age-dependent and sex-specific body composition reference data in a larger population of children and adolescents in Germany. METHODS: This is a cross-sectional study on a representative group of 15,392 5- to 17-year-old children and adolescents. Body composition was assessed by bioelectrical impedance analysis using a population-specific algorithm validated against air displacement plethysmography. Age- and sex-specific percentiles for BMI, fat mass index (FMI), fat-free mass index (FFMI), and a "load-capacity model" (characterized by the ratios of fat mass [FM]/ fatt-free mass [FFM] and FM/FFM2) were modeled using the LMS method. RESULTS: BMI, FMI, FFMI, FM/FFM, and FM/FFM2 curves showed similar shapes between boys and girls with steady increases in BMI, FMI, and FFMI, while FM/FFM2-centiles decreased during early childhood and adolescence. Sex differences were observed in FMI and FM/FFM percentiles with increases in FMI up to age 9 years followed by a steady decrease in FM/FFM during and after puberty with a fast-growing FFMI up to age 17 in boys. The prevalence of low FFM relative to FM reached more than 60% in overweight children and adolescents. CONCLUSION: These pediatric body composition reference data enable physicians and public health scientists to monitor body composition during growth and development and to interpret individual data. The data point out to an early risk of sarcopenia in overweight children and adolescents.

How to disseminate national recommendations for physical activity: a qualitative analysis of critical change agents in Germany.

BACKGROUND: Physical activity recommendations are reached by only a small part of the population. A common problem is that research findings on public health-related topics such as physical activity promotion are oftentimes not translated into practice. The involvement of relevant stakeholders, such as change agents (role models, decision-makers, and/or knowledge mediators), is a common strategy to implement physical activity recommendations in specific settings, as they have the necessary knowledge of contextual factors. However, dissemination and implementation of physical activity recommendations are often prevented by focusing exclusively on the health sector and by underestimating the individual perceptions and needs of change agents. Therefore, the purpose of this study was to address the problem of how physical activity recommendations can be translated into practice through comprehensive consideration of the situation and context of change agents from various sectors of society at different administrative levels. This allows for deriving recommendations for action on how a national dissemination strategy of physical activity recommendations should be designed. METHODS: Qualitative expert interviews were conducted with change agents from different sectors of society and administrative levels in Germany (N = 21). Case selection took place via a sampling plan. The interviews were recorded, transcribed verbatim, and analysed by two trained researchers using qualitative content analysis. RESULTS: The change agents' perceived relevance of physical activity and physical activity promotion and their knowledge of physical activity recommendations varied across different sectors. Nine themes were identified covering the change agents' needs for the implementation of physical activity recommendations: strengthening of political will and cooperation, availability of public space for physical activity, change in awareness and health education, professional qualification, financial incentives, development of physical activity-promoting programmes and structures, provision of resources, bridging the theory-practice gap, and knowledge of physical activity recommendations. CONCLUSIONS: This exploratory study contributes to the development of an evidence-based dissemination strategy of physical activity recommendations involving change agents from various sectors. Cross-sectoral needs and obstacles were identified indicating gaps that have to be addressed. Future research should choose practice-oriented approaches to develop dissemination strategies that are adapted to the needs of local contexts.

Spontaneous intracardiac microcavitations in a patient with a colonic carcinoma.

Intracardiac microcavitations consist of airy microbubbles. They are typically found in patients with an intravascular line or device, mechanical heart valves or in decompression sickness. We report a case of a patient in mid-70s who was admitted due to weakness in both legs, left-thoracic pain and fever. Despite the lack of any of the risk factors mentioned above, spontaneous microcavitations were detected in the right sided cardiac cavities. After the detection of liver lesions suspicious for a metastatic disease, a colonoscopy was performed. An ulcerated colonic carcinoma at the ileocoecal valve was diagnosed and highly suspicious for being the entry port of the microcavitations. This unusual presentation of microcavitations together with a colonic neoplasia leads to hypotheses about the journey of the microbubbles from the ascending colon into the right heart. Gastrointestinal tumours are described as being the causes of microbubbles. Translocation of microbubbles through hepatopulmonary shunting are described in the context of locally applied particles of similar size during radioembolisation. A thorough aetiological workup is of importance since the underlying cause is potentially dangerous due to its own nature of disease and due the complications of the microcavitations such as paradoxical emboli or pulmonary sequelae.

[Red yeast rice: An unsafe food supplement?] / Rotschimmelreis: Ein bedenkliches Nahrungsergänzungsmittel?

Red yeast rice is the fermentation product of the mould Monascus ruber and is traditionally used in East Asia to dye and conserve food. Its main pharmacologically active compound, monakolin K, was isolated from red yeast rice and is used as an inhibitor of cholesterol synthesis under the INN lovastatin. Lovastatin and several other statins are marketed as drugs whereas red yeast rice is offered as a food supplement. As statins can cause severe side effects, such as muscle damage and kidney failure, the dosing and information about interactions with drugs and food is essential for the use of these products. Furthermore, red yeast rice can contain the mycotoxin citrinin and several other substances that are not yet toxicologically evaluated.

The influence of chronic L-carnitine supplementation on the formation of preneoplastic and atherosclerotic lesions in the colon and aorta of male F344 rats.

L-Carnitine, a key component of fatty acid oxidation, is nowadays being extensively used as a nutritional supplement with allegedly "fat burning" and performance-enhancing properties, although to date there are no conclusive data supporting these claims. Furthermore, there is an inverse relationship between exogenous supplementation and bioavailability, i.e., fairly high oral doses are not fully absorbed and thus a significant amount of carnitine remains in the gut. Human and rat enterobacteria can degrade unabsorbed L-carnitine to trimethylamine or trimethylamine-N-oxide, which, under certain conditions, may be transformed to the known carcinogen N-nitrosodimethylamine. Recent findings indicate that trimethylamine-N-oxide might also be involved in the development of atherosclerotic lesions. We therefore investigated whether a 1-year administration of different L-carnitine concentrations (0, 1, 2 and 5 g/l) via drinking water leads to an increased incidence of preneoplastic lesions (so-called aberrant crypt foci) in the colon of Fischer 344 rats as well as to the appearance of atherosclerotic lesions in the aorta of these animals. No significant difference between the test groups regarding the formation of lesions in the colon and aorta of the rats was observed, suggesting that, under the given experimental conditions, L-carnitine up to a concentration of 5 g/l in the drinking water does not have adverse effects on the gastrointestinal and vascular system of Fischer 344 rats.

What is a food and what is a medicinal product in the European Union? Use of the benchmark dose (BMD) methodology to define a threshold for "pharmacological action".

The decision criterion for the demarcation between foods and medicinal products in the EU is the significant "pharmacological action". Based on six examples of substances with ambivalent status, the benchmark dose (BMD) method is evaluated to provide a threshold for pharmacological action. Using significant dose-response models from literature clinical trial data or epidemiology, the BMD values were 63mg/day for caffeine, 5g/day for alcohol, 6mg/day for lovastatin, 769mg/day for glucosamine sulfate, 151mg/day for Ginkgo biloba extract, and 0.4mg/day for melatonin. The examples for caffeine and alcohol validate the approach because intake above BMD clearly exhibits pharmacological action. Nevertheless, due to uncertainties in dose-response modelling as well as the need for additional uncertainty factors to consider differences in sensitivity within the human population, a "borderline range" on the dose-response curve remains. "Pharmacological action" has proven to be not very well suited as binary decision criterion between foods and medicinal product. The European legislator should rethink the definition of medicinal products, as the current situation based on complicated case-by-case decisions on pharmacological action leads to an unregulated market flooded with potentially illegal food supplements.

NMR evaluation of total statin content and HMG-CoA reductase inhibition in red yeast rice (Monascus spp.) food supplements.

BACKGROUND: Red yeast rice (i.e., rice fermented with Monascus spp.), as a food supplement, is claimed to be blood cholesterol-lowering. The red yeast rice constituent monacolin K, also known as lovastatin, is an inhibitor of the hydroxymethylglutaryl-CoA (HMG-CoA) reductase. This article aims to develop a sensitive nuclear magnetic resonance (NMR) method to determine the total statin content of red yeast rice products. METHODS: The total statin content was determined by a 400 MHz 1H NMR spectroscopic method, based on the integration of the multiplet at δ 5.37-5.32 ppm of a hydrogen at the hexahydronaphthalene moiety in comparison to an external calibration with lovastatin. The activity of HMG-CoA reductase was measured by a commercial spectrophotometric assay kit. RESULTS: The NMR detection limit for total statins was 6 mg/L (equivalent to 0.3 mg/capsule, if two capsules are dissolved in 50 mL ethanol). The relative standard deviations were consistently lower than 11%. The total statin concentrations of five red yeast rice supplements were between 1.5 and 25.2 mg per specified daily dose. A dose-dependent inhibition of the HMG-CoA reductase enzyme activity by the red yeast rice products was demonstrated. CONCLUSION: A simple and direct NMR assay was developed to determine the total statin content in red yeast rice. The assay can be applied for the determination of statin content for the regulatory control of red yeast rice products.

The dilemma of approving antidotes.

Clinical trials with antidotes are difficult to perform for a variety of practical, ethical, and financial reasons. As acute poisoning is a rare event, the commercial interest in basic and clinical research is low. Poisoned patients are usually not available for normal clinical trial procedures and, if they are, they cannot give informed consent. This situation results in a dilemma: antidotes are essential drugs. A resolution of the Council of Europe requests to guarantee the optimal availability of antidotes and the improvement of their use. As comprehensive data on the efficacy of antidotes are often missing, a marketing authorisation under exceptional circumstances according to Article 14(8) of Regulation (EC) No. 276/2004, will often be the only way to get an approval, as: (1) the indications for which the product in question is intended are encountered so rarely that the applicant cannot reasonably be expected to provide comprehensive evidence ("orphan drug"), (2) in the present state of scientific knowledge, comprehensive information cannot be provided, or (3) it would be contrary to generally accepted principles of medical ethics to collect such data. Typically, data on antidotes are obtained from a patchwork of studies with animals, human tissue and a few observations from human poisoning corroborated with data from clinical observations and biochemistry. Generalisations from chemical and mechanistic similarities between groups of poisons are usual, but often lack scientific evidence. Current standards of good clinical practice can rarely be observed. Therefore, public funding and other financial support are necessary incentives to initiate trials in this important area.

Role of oxidants and antioxidants in atherosclerosis: results of in vitro and in vivo investigations.

Both in vitro and in vivo studies have shown that oxidants are central in the development of atherosclerosis. Consequently, additional studies evaluated the protective effects of various natural and synthetic antioxidants, alone and in combination, with most studies focusing on alpha-tocopherol (vitamin E). Here, we summarize the role of oxidants in the pathomechanism of atherosclerosis. We also discuss epidemiological studies and others focused on the protective effect of vitamin E against atherosclerosis. Other antioxidants are also considered if they were included in studies involving vitamin E. The protective effect of antioxidants on atherosclerotic pathomechanisms has been confirmed in vitro, but only in some animal studies. Various epidemiological and observational studies have produced conflicting results on the protective effect of antioxidants. Most studies of primary or secondary prevention failed to show a protective effect. These conflicting results are biased by a number of factors, including differences between the study groups. Therefore, we describe these studies in detail.

Development of novel cancer chemopreventive agents in Europe--neglected Cinderella or rising phoenix? A critical commentary. ESF Workshop on Cancer Chemoprevention, DKFZ, Heidelberg, September 18-20, 2005.

Agents that prevent cancer, delay its onset, or revert premalignant conditions could have dramatic beneficial impacts on human health. Although there is an urgent need to develop cancer chemopreventive agents, researchers in the field suspect that this area of scientific endeavour in Europe leads a Cinderella existence, both in terms of perception of importance and research funding. In order to review current activities in this prevention field and to seek a consensus position, an exploratory workshop was held in September 2005 at the German Cancer Research Center (DKFZ) in Heidelberg, Germany, sponsored mainly by the European Science Foundation (ESF), and also supported by the European Association for Cancer Research (EACR) and the German Cancer Society (DKG). The 35 experts from European countries and the United States of America assessed state-of-the-art cancer chemoprevention research in Europe. The aims that the workshop organizers had pre-defined were: i) assessment of the usefulness of animal models for agent identification; ii) review of ongoing preclinical and clinical work on novel agents; iii) discussion of potential biomarkers predictive for cancer preventive efficacy; and finally iv) the potential role that European pharmaceutical industries could play in furthering chemopreventive agent development. Overall the workshop aimed at raising awareness among European clinical and laboratory researchers of the importance of the development of novel, efficacious and safe cancer preventive agents.

Digital 3D reconstruction of two parahissian accessory bundles in a case of Wolff-Parkinson-White syndrome.

Three-dimensional reconstruction of digitized histological serial sections of the cardiac conduction system yielded two accessory pathways in a case of a 24-day-old male infant who died after a short period of illness with ECG findings of Wolff-Parkinson-White syndrome. In infants, the differential diagnosis of possible accessory pathways connecting the AV conduction system, atrial or ventricular septum includes dispersed conduction system tissue without connecting features. This is why three-dimensional reconstruction is necessary in order to refute or establish connectivity of cell groups as found in histological serial slice images.