Effectiveness of workplace interventions in Europe promoting healthy eating: a systematic review.

BACKGROUND: The worksite is a promising setting for health promotion. This review summarizes the evidence of effect of intervention studies in European countries promoting a healthy diet solely and in combination with increasing physical activity at the workplace. METHODS: A systematic review of published literature was carried out. Inclusion criteria were: studies conducted in European countries; papers published from 1 January 1990 to 1 October 2010; worksite-based interventions promoting a healthy diet solely or in combination with physical activity; primary prevention; measurement of anthropometrical or behavioural change and adults (≥18 years old). Levels of evidence for intervention effectiveness on behavioural determinants, nutrition and physical activity behaviours and body composition and the quality of the included interventions were assessed. RESULTS: Seventeen studies solely focusing on promotion of a healthy diet were identified. Eight were educational, one used worksite environmental change strategies, and eight used a combination of both (multi-component). None of the interventions were rated as 'strong'; seven met the criteria for 'moderate' quality. The reviewed studies show moderately evidence for effects on diet. Thirteen studies focusing both on nutrition and physical activity (nine educational and four multi-component studies) were identified. Ten were rated as having 'weak' and three as having 'moderate' methodological quality, providing inconclusive evidence for effects. CONCLUSION: Limited to moderate evidence was found for positive effects of nutrition interventions implemented at the workplace. Effects of workplace health promotion interventions may be improved if stronger adherence to established quality criteria for such interventions is realized.

Exploring stem cell biology in pituitary tumors and derived organoids.

Pituitary tumorigenesis is highly prevalent and causes major endocrine disorders. Hardly anything is known on the behavior of the local stem cells in this pathology. Here, we explored the stem cells' biology in mouse and human pituitary tumors using transcriptomic, immunophenotyping and organoid approaches. In the prolactinoma-growing pituitary of dopamine receptor D2 knock-out mice, the stem cell population displays an activated state in terms of proliferative activity and distinct cytokine/chemokine phenotype. Organoids derived from the tumorous glands' stem cells recapitulated these aspects of the stem cells' activation nature. Upregulated cytokines, in particular interleukin-6, stimulated the stem cell-derived organoid development and growth process. In human pituitary tumors, cells typified by expression of stemness markers, in particular SOX2 and SOX9, were found present in a wide variety of clinical tumor types, also showing a pronounced proliferative status. Organoids efficiently developed from human tumor samples, displaying a stemness phenotype as well as tumor-specific expression fingerprints. Transcriptomic analysis revealed fading of cytokine pathways at organoid development and passaging, but their reactivation did not prove capable of rescuing early organoid expansion and passageability arrest. Taken together, our study revealed and underscored an activated phenotype of the pituitary-resident stem cells in tumorigenic glands and tumors. Our findings pave the way to defining the functional position of the local stem cells in pituitary tumor pathogenesis, at present barely known. Deeper insight can lead to more efficient and targeted clinical management, currently still not satisfactorily.

Safety effects of dynamic speed limits on motorways.

Dynamic speed limits (DSL) are limits that change according to real-time traffic, road or weather conditions. In DSL-schemes road users are typically informed of speed limit changes by electronic signs that are housed within gantries situated above lanes. Dynamic speed limit systems are increasingly applied worldwide, usually on motorways. One of the objectives of dynamic speed limits is to improve traffic safety through reductions in speed variations within and across lanes and between upstream and downstream flows. This paper shows the results of an empirical evaluation of the effects on traffic safety of a dynamic speed limit system on motorways in Flanders, Belgium. The evaluation was done by means of a before-after analysis of crashes, completed with a cost-benefit analysis. The results show that the number of injury crashes decreased significantly (-18%) after the introduction of the system. A separate analysis for serious and fatal injury crashes revealed a non-significant decrease of 6%. A distinction according to crash type showed an almost significant decrease of 20% in the number of rear-end crashes whereas the number of single-vehicle crashes decreased by 15% (ns). However, no effect was found for side crashes. In addition to the analysis of the effects, a cost-benefit analysis was applied. The costs of the implementation of these systems were compared with the benefits of crash prevention. The cost-benefit analyses of the crash effects showed a benefits-to-costs ratio of approximately 0.7, which means that the costs tend to exceed the benefits. Taking into account the important margins of uncertainty with respect to both costs and benefits, we have also explored how the net benefits are affected by some key assumptions. The general conclusion is that there is no convincing evidence that the costs of the system currently outweigh the expected benefits in terms of crash prevention.

Application of a Rule-Based Approach in Real-Time Crash Risk Prediction Model Development Using Loop Detector Data.

OBJECTIVES: There is a growing trend in development and application of real-time crash risk prediction models within dynamic safety management systems. These real-time crash risk prediction models are constructed by associating crash data with the real-time traffic surveillance data (e.g., collected by loop detectors). The main objective of this article is to develop a real-time risk model that will potentially be utilized within traffic management systems. This model aims to predict the likelihood of crash occurrence on motorways. METHODS: In this study, the potential prediction variables are confined to traffic-related characteristics. Given that the dependent variable (i.e., traffic safety condition) is dichotomous (i.e., "no-crash" or "crash"), a rule-based approach is considered for model development. The performance of rule-based classifiers is further compared with the more conventional techniques like binary logistic regression and decision trees. The crash and traffic data used in this study were collected between June 2009 and December 2011 on a part of the E313 motorway in Belgium between Geel-East and Antwerp-East exits, on the direction toward Antwerp. RESULTS: The results of analysis show that several traffic flow characteristics such as traffic volume, average speed, and standard deviation of speed at the upstream loop detector station and the difference in average speed on upstream and downstream loop detector stations significantly contribute to the crash occurrence prediction. The final chosen classifier is able to predict 70% of crash occasions accurately, and it correctly predicts 90% of no-crash instances, indicating a 10% false alarm rate. CONCLUSIONS: The findings of this study can be used to predict the likelihood of crash occurrence on motorways within dynamic safety management systems.

Safety effects of an extensive black spot treatment programme in Flanders-Belgium.

Black spot management is a widely implemented measure to improve traffic safety. This study evaluates the safety effects of an extensive black spot programme that has been implemented in Flanders-Belgium. In total, around 800 black spots were selected, from which 134 locations, redesigned between 2004 and 2007, were included in this study. The adopted approach is an empirical Bayes before- and after study that accounts for effects of general trends and for the stochastic nature of crashes, including regression to the mean. Two different comparison groups were established. The analyses showed a decrease in the number of injury crashes of 24-27%, significant at the 1%-level. A separate analysis for crashes with serious or fatal injuries showed a decrease of 46-57%, also significant at the 1% level. The highest effects were found for the implementation of changes in the layout of priority controlled intersections and for the installation of traffic signals, which showed a decrease of respectively 42% and 35% in the number of injury crashes. Signalized intersections at which left-turn phasing was implemented resulted in a decrease of 22% in the number of injury crashes, changes in the layout leaded to a decrease of 11%. The conversion of intersections (both signalized and priority controlled) into roundabouts resulted in a decrease of 21% in injury crashes. The black spot programme generated a favourable effect on each of the road user categories (car occupants, moped riders, cyclists, motorcyclist, pedestrians and truck drivers).

Safety effects of reducing the speed limit from 90km/h to 70km/h.

Speed is one of the main risk factors in traffic safety, as it increases both the chances and the severity of a crash. In order to achieve improved traffic safety by influencing the speed of travel, road authorities may decide to lower the legally imposed speed limits. In 2001 the Flemish government decided to lower speed limits from 90km/h to 70km/h on a considerable number of highways. The present study examines the effectiveness of this measure using a comparison group before- and after study to account for general trend effects in road safety. Sixty-one road sections with a total length of 116km were included. The speed limits for those locations were restricted in 2001 and 2002. The comparison group consisted of 19 road sections with a total length of 53km and an unchanged speed limit of 90km/h throughout the research period. Taking trend into account, the analyses showed a 5% decrease [0.88; 1.03] in the crash rates after the speed limit restriction. A greater effect was identified in the case of crashes involving serious injuries and fatalities, which showed a decrease of 33% [0.57; 0.79]. Separate analyses between crashes at intersections and at road sections showed a higher effectiveness at road sections. It can be concluded from this study that speed limit restrictions do have a favorable effect on traffic safety, especially on severe crashes. Future research should examine the cause for the difference in the effect between road sections and intersections that was identified, taking vehicle speeds into account.

Behavioural effects of fixed speed cameras on motorways: overall improved speed compliance or kangaroo jumps?

The present study evaluates the speed effects of fixed speed cameras on motorways. Two locations with speed cameras were extensively examined in a quasi-experiment: (1) a two-lane motorway and (2) a three-lane motorway, each with a posted speed limit of 120 km/h and sited in Flanders, Belgium. The effect is analysed through a before-and-after comparison of travel speeds. General time trends and fluctuations were controlled through the analysis of the speeds at comparison locations. At each of the two roads, data were gathered at five measurement points from 3 km upstream to 3.8 km downstream of the camera. Three outcomes were analysed: (1) average speed, (2) the odds of drivers exceeding the speed limit and (3) the odds of drivers exceeding the speed limit by more than 10%. Speeds decreased on average by 6.4 km/h at the camera locations. Both the odds of drivers exceeding the speed limit (-80%) and the odds of drivers exceeding the speed limit by more than 10% (-86%) decreased considerably. However, before and beyond the cameras the speeds hardly, if at all, reduced. Moreover, the analyses of the speed profiles before and beyond the cameras show that drivers do slow down quite abruptly before the camera and speed up again after passing the camera. It is concluded that a V-profile is found in the spatial speed distribution for both locations.

Automated section speed control on motorways: an evaluation of the effect on driving speed.

Automated section speed control is a fairly new traffic safety measure that is increasingly applied to enforce speed limits. The advantage of this enforcement system is the registration of the average speed at an entire section, which would lead to high speed limit compliances and subsequently to a reduction in the vehicle speed variability, increased headway, more homogenised traffic flow and increased traffic capacity. However, the number of studies that analysed these effects are limited. The present study evaluates the speed effect of two section speed control systems in Flanders, Belgium. Both sections are located in the opposite direction of a three-lane motorway with a posted speed limit of 120 km/h. Speed data were collected at different points: from 6 km before the entrance of the section to 6 km downstream from the section. The effect was analysed through a before- and after comparison of travel speeds. General time trends and fluctuations were controlled through the analysis of speeds at comparison locations. On the enforced sections considerable decreases were found of about 5.84 km/h in the average speed, 74% in the odds of drivers exceeding the speed limit and 86% in the odds of drivers exceeding the speed limit by more than 10%. At the locations up- and downstream from the section also favourable effects were found for the three outcomes. Furthermore a decrease in the speed variability could be observed at all these data points.

To brake or to accelerate? Safety effects of combined speed and red light cameras.

INTRODUCTION: The present study evaluates the traffic safety effect of combined speed and red light cameras at 253 signalized intersections in Flanders, Belgium that were installed between 2002 and 2007. METHOD: The adopted approach is a before-and-after study with control for the trend. RESULTS: The analyses showed a non-significant increase of 5% in the number of injury crashes. An almost significant decrease of 14% was found for the more severe crashes. The number of rear-end crashes turned out to have increased significantly (+44%), whereas a non-significant decrease (-6%) was found in the number of side crashes. The decrease for the severe crashes was mainly attributable to the effect on side crashes, for which a significant decrease of 24% was found. PRACTICAL APPLICATIONS: It is concluded that combined speed and red light cameras have a favorable effect on traffic safety, in particular on severe crashes. However, future research should examine the circumstances of rear-end crashes and how this increase can be managed.