Altered Transcriptome Response in PBMCs of Czech Adults Linked to Multiple PFAS Exposure: B Cell Development as a Target of PFAS Immunotoxicity.

While the immunomodulation effects of per- and polyfluoroalkyl substances (PFASs) are described on the level of clinical signs in epidemiological studies (e.g., suppressed antibody response after vaccination), the underlying mechanism has still not been fully elucidated. To reveal mechanisms of PFAS exposure on immunity, we investigated the genome-wide transcriptomic changes of peripheral blood mononuclear cells (PBMCs) responding to PFAS exposure (specifically, exposure to PFPA, PFOA, PFNA, PFDA, PFUnDA, PFHxS, and PFOS). Blood samples and the chemical load in the blood were analyzed under the cross-sectional CELSPAC: Young Adults study. The overall aim of the study was to identify sensitive gene sets and cellular pathways conserved for multiple PFAS chemicals. Transcriptome networks related to adaptive immunity were perturbed by multiple PFAS exposure (i.e., blood levels of at least four PFASs). Specifically, processes tightly connected with late B cell development, such as B cell receptor signaling, germinal center reactions, and plasma cell development, were shown to be affected. Our comprehensive transcriptome analysis identified the disruption of B cell development, specifically the impact on the maturation of antibody-secreting cells, as a potential mechanism underlying PFAS immunotoxicity.

Impact of PFAS exposure on prevalence of immune-mediated diseases in adults in the Czech Republic.

BACKGROUND: Per- and polyfluoroalkyl substances (PFASs) are emerging environmental contaminants with multiple hazardous properties including immunomodulation potency. Human exposure to PFASs has been associated with various immune-mediated diseases and outcomes. This study aimed to investigate the association between PFAS exposure and immune-mediated diseases such as allergies, eczemas, and autoimmune diseases in a population of adults in the Czech Republic. METHODS: This study included 309 adults from the Central European Longitudinal Study of Parents and Children: Young Adults (CELSPAC: YA). 12 PFASs were measured in participants' serum by HPLC-MS/MS, 3 PFASs were removed from the subsequent analyses due to low detection frequency. The associations of 9 PFASs with 9 immune-mediated diseases were assessed by logistic regression. Furthermore, Bayesian kernel machine regression (BKMR) was used to estimate the effect of the PFAS mixture on immune-mediated diseases. All analyses were adjusted for sex, age, BMI, smoking, education, and family history of immune-mediated diseases. In cases of a statistically significant interaction of PFASs and sex, stratified analyses were performed for men and women. RESULTS: Perfluorooctanoate (PFOA) and perfluorooctane sulfonate (PFOS) were negatively associated with both atopic eczema (OR per IQR increase 0.58 (95% CI 0.37-0.90) for PFOA and 0.56 (0.32-0.95) for PFOS) and contact dermatitis (0.37 (0.16-0.85) for PFOA and 0.33 (0.11-0.94) for PFOS). Perfluoroundecanoate (PFUnDA) was negatively associated with pollen, dust, and mite allergy (0.62 (0.43-0.89)). BKMR modelling showed a negative tendency in the overall effect of PFAS mixture on immune-health outcomes. Based on the stratified analysis, sex was suggested to be an effect modifier in the association of PFOS and atopic eczema. CONCLUSION: Our results contribute to the body of literature that observes the immunosuppressive effect of PFAS exposure during eczemas and allergies, both for PFASs individually and as a mixture.

Personal care product use and lifestyle affect phthalate and DINCH metabolite levels in teenagers and young adults.

Humans are widely exposed to phthalates and their novel substitutes, and considering the negative health effects associated with some phthalates, it is crucial to understand population levels and exposure determinants. This study is focused on 300 urine samples from teenagers (aged 12-17) and 300 from young adults (aged 18-37) living in Czechia collected in 2019 and 2020 to assess 17 plasticizer metabolites as biomarkers of exposure. We identified widespread phthalate exposure in the study population. The diethyl phthalate metabolite monoethyl phthalate (MEP) and three di (2-ethylhexyl) phthalate metabolites were detected in the urine of >99% of study participants. The highest median concentrations were found for metabolites of low-molecular-weight (LMW) phthalates: mono-n-butyl phthalate (MnBP), monoisobutyl phthalate (MiBP) and MEP (60.7; 52.6 and 17.6 µg/L in young adults). 1,2-cyclohexanedicarboxylic acid diisononyl ester (DINCH) metabolites were present in 68.2% of the samples with a median of 1.24 µg/L for both cohorts. Concentrations of MnBP and MiBP were similar to other European populations, but 5-6 times higher than in populations in North America. We also observed large variability in phthalate exposures within the study population, with 2-3 orders of magnitude differences in urinary metabolites between high and low exposed individuals. The concentrations varied with season, gender, age, and lifestyle factors. A relationship was found between high levels of MEP and high overall use of personal care products (PCPs). Cluster analysis suggested that phthalate exposures depend on season and multiple lifestyle factors, like time spent indoors and use of PCPs, which combine to lead to the observed widespread presence of phthalate metabolites in both study populations. Participants who spent more time indoors, particularly noticeably during colder months, had higher levels of high-molecular weight phthalate metabolites, whereas participants with higher PCP use, particularly women, tended to have higher concentration of LMW phthalate metabolites.

Tracking of anthropometric characteristics from childhood to adolescence: an 8-year follow-up findings from the Czech ELSPAC study.

BACKGROUND: Although evidence suggests that obesity track well from childhood to adolescence, most of the research has been done in Western and high-income countries. Moreover, most of the studies have tracked body-mass index, as a proxy of nutritional status, while tracking characteristics of circumferences and skinfold thicknesses have been less studies. Therefore, the main purpose of the study was to explore tracking characteristics of complete anthropometric data from childhood to adolescence. METHODS: This sub-study was part of the Czech ELSPAC study. In the present 8-year longitudinal study, we collected information from pediatrician's medical records at the ages of 8 y (n = 888), 11 y (n = 1065), 13 y (n = 811) and 15 y (n = 974), including circumferences (head, chest, waist, hips, and arm), indices (body-mass index, waist-to-hip ratio and waist-to-height ratio) and skinfold thicknesses (biceps, triceps, subscapula, suprailiaca, thigh and the sum of 5 skinfolds). Participants were recruited from the two selected regions of the Czech Republic (Brno and Znojmo). Linear generalized estimating equations were conducted to analyze tracking patterns over an 8-year follow-up period for all anthropometric measurements. RESULTS: Tracking coefficients were moderate to strong, ranging from 0.40 to 0.62 for circumferences, 0.41 to 0.74 for indices and 0.72 to 0.86 for skinfolds. According to body-mass index and waist circumference standards, overweight/obese children and children with abdominal obesity at the age of 8 y were 11.31 (95% CI = 8.41 to 15.22, p < 0.001) and 10.73 (95% CI = 7.93 to 14.52, p < 0.001) more likely to remain overweight/obese and to have abdominal obesity at the age of 15 y. CONCLUSIONS: Findings show moderate to strong tracking of anthropometric characteristics, i.e. circumferences track moderately well, while strong tracking for indices and skinfold thicknesses is observed. Moreover, strong tracking of general overweight/obesity and abdominal obesity between ages 8 y and 15 y indicates that the detection of these risk factors at the beginning of primary school should be advocated.

Long-term donor-site morbidity after thumb reconstruction with twisted-toe technique.

BACKGROUND: Traumatic thumb loss is a serious injury affecting patient´s ability to work and participate in activities of daily life. The main goal for a plastic surgeon is to restore hand grip, often by microsurgical methods. However, patients should be informed of all effects associated with tissue harvesting. The aim of the study was to assess the impact on donor foot and gait cycle in patients who have undergone thumb reconstruction using twisted-toe technique modified by Kempný. MATERIAL AND METHODS: Twelve patients participated in the study: all suffered a thumb loss between the years 2003 and 2011 and the twisted-toe technique for thumb reconstruction was utilized. The changes in foot pressure distribution and lower extremity joint loading were evaluated. RESULTS: The differences in total maximal plantar pressure, pressure time integral, contact area, and maximum force between the affected and non-affected foot were statistically significant (P 0.1). No significant differences of temporal gait parameters between the affected and non-affected extremity were observed; however, statistically significant differences in kinetics parameters, frontal ankle and knee moments were detected. CONCLUSION: Donor limb functionality and anatomical disability were assessed using pedobarography systems and 3D-gait analysis. The recorded differences in plantar pressure distribution (increased pressure in I., IV. and V. metatarsal areas) and overload of the medial compartment of the knee joint were the most significant findings. Therefore, wearing individually adapted shoe insoles as prevention of osteoarthrosis might be beneficial for patients after thumb reconstruction by a twisted-toe technique.

Overweight and obesity in Slovak high school students and body composition indicators: a non-randomized cross-sectional study.

BACKGROUND: Physical development can be considered as an indicator of the overall health status of the youth population. Currently, it appears that the increasing trend of the prevalence of obesity among children and youths has stopped in a number of countries worldwide. Studies point to the fact that adolescence is a critical period for the development of obesity. Body mass index (BMI) seems to be an orientation parameter in the assessment of prevalence of obesity which is not sufficient for more accurate identification of at risk individuals. The purpose of this study was to evaluate association between BMI percentile zones as health-risk for being overweight and obese and body composition indicators in high-school students from the Presov (Slovakia) region. METHODS: A non-randomized cross-sectional study in high school students from the Presov (Slovakia) region was conducted. The research sample consisted of 1014 participants (boys n = 466, girls n = 549). Body composition was measured using direct segmental multi-frequency bioelectrical impedance analysis (DSM-BIA). To examine the association between obesity and selected body composition indicators, Kruskal-Wallis ANOVA and Eta(2) were used. The relationship between selected body composition indicators and percentile BMI zones was determined using the Kendall tau correlation. RESULTS: In groups with different BMI percentile zones (normal weight, overweight, obese), ANOVA showed significant differences for girls and boys (p ˂.05) with high effect size (η(2) ˂.26) in body weight, body fat mass index, body fat percentage, fat free mass index, fat-free mass percentage, visceral fat area, waist-to-hip ratio, waist circumference, protein mass and mineral mass. The highest degree of correlation among boys was between BMI values indicating overweight and obesity and fat free mass index and waist circumference, respectively (τ = .71, τ = .70, respectively). In girls, the highest correlation was found between classification of BMI percentile zones and waist circumference (t = .78). CONCLUSION: The characteristics of body composition are very useful determinants of health and nutrition status. Our data revealed a direct association between BMI value and chosen body composition indicators. The most accurate indicator of overweight and obesity in our study appears to be waist circumference for both male and female population.

Gene expression patterns associated with PFOA exposure in Czech young men and women.

Perfluorooctanoic acid (PFOA), a member of per- and polyfluoroalkyl substances (PFASs), has been widely used in manufacturing for decades. Currently, PFOA is strictly regulated, but due to its high stability and persistence, it is detected in both environmental as well as in human matrices. To elucidate mechanisms of PFOA toxicity in humans, we determined the genome-wide transcriptomic changes of peripheral blood mononuclear cells (PBMC) responding to PFOA exposure in a sex-stratified analysis. This work employed samples from 145 female and 143 male participants of the CELSPAC: YA study to characterize PFOA-associated transcripts in a broader context using computational analysis. PFOA-associated gene expression differed significantly between men and women, as only 2 % of mapped genes were expressed in both sexes. Disease-specific enrichment analysis revealed cancer and immune-related disease terms as those most enriched in male and female populations. Patterns of enriched terms within the gene set enrichment analysis indicated three main targets of PFOA toxicity: i) lipid metabolism for women; ii) cell cycle regulation for men; and iii) immune system response for both sexes. In summary, our genome-wide transcriptomics analysis described sex-specific differences in PFOA-associated gene expression and provided evidence about biological pathways underlying PFOA toxicity in humans.

Basic motor competencies in Slovak children from the 3rd and 4th grade elementary age group.

Background: The development of movement skills is the basic goal of physical and sports education. Their level is a determining factor in the subsequent involvement of the child in physical activities. Goal is to contribute to the knowledge of basic motor competencies (BMC) in the 3rd and 4th grade boys and girls from elementary schools. Methods: We collected data from 468 children (Mage = 9.6, SD = 0.6 years; 228 girls and 240 boys) from 16 third grade and 16 fourth grade classes at ten elementary schools in different parts (central, west, north) of the Slovak Republic. The primary data on the basic motor competencies of the examined groups were obtained by means of the MOBAK-3 test battery. Construct validity was analyzed by confirmatory factorial analysis and relationships between BMC and age, gender and BMI were analyzed by structural equation modeling. Results: Boys had a better performance in object movement activities than the girls p < 0.01. Situation in self-movement activities was different, girls had a better performance than boys p < 0.05. The general expectation that grade is a factor to improve the performance in basic motor competencies in the compared 3rd- and 4th-graders was not clearly fulfilled. This assumption was only confirmed in girls (object movement p < 0.05, self movement p < 0.01). Confirmatory factor analysis confirmed the two-factor structure of basic motor competencies on object-movement and self-movement, while gender, BMI and age were confirmed as significant covariances. Conclusions: The theory of BMC in the 3rd- and 4th-graders at elementary schools is an appropriate method to uncover the grounds for a positive attitude to physical activities later in life.

Human biomonitoring of essential and toxic trace elements (heavy metals and metalloids) in urine of children, teenagers, and young adults from a Central European Cohort in the Czech Republic.

BACKGROUND: Exposure to toxic trace elements, which include metals and metalloids, can induce adverse health effects, including life-threatening diseases. Conversely, essential trace elements are vital for bodily functions, yet their excessive (or inadequate) intake may pose health risks. Therefore, identifying levels and determinants of exposure to trace elements is crucial for safeguarding human health. METHODS: The present study analyzed urinary concentrations of 14 trace elements (arsenic, cadmium, cobalt, chromium, copper, mercury, manganese, molybdenum, nickel, lead, antimony, selenium, thallium, and zinc) and their exposure determinants in 711 individuals, spanning from children to young adults from a Central European population from the Czech Republic. Multivariate linear regression and non-parametric Kruskal-Wallis ANOVA were used to investigate exposure determinants. Estimates of 95th percentile concentrations and confidence intervals were carried out to establish reference values (RV95). The study also assessed the percentage of population exceeding health-based guidance values (GVs) to gauge health risks. RESULTS: Young adults showed elevated toxic element concentrations, whereas children exhibited higher concentrations of essential elements. Mercury concentrations were associated with both dental amalgam filling count and seafood intake; arsenic concentrations were associated with seafood, rice, and mushroom consumption. Mushroom consumption also influenced lead concentrations. Sex differences were found for cadmium, zinc, nickel, and cobalt. Between 17.9% and 25% of the participants exceeded recommended GV for arsenic, while 2.4% to 2.8% exceeded GV for cadmium. Only one participant exceeded the GV for mercury, and none exceeded GVs for chromium and thallium. Essential trace elements' GVs were surpassed by 38% to 68.5% participants for zinc, 1.3% to 1.8% for molybdenum, and 0.2% to 0.3% for selenium. IMPACT: The present study examines trace element exposure in a Central European population from the Czech Republic, unveiling elevated exposure levels of toxic elements in young adults and essential elements in children. It elucidates key determinants of trace element exposure, including dietary and lifestyle indicators as well as dental amalgam fillings. Additionally, the study establishes novel reference values and a comparison with established health-based human biomonitoring guidance values, which are crucial for public health decision-making. This comprehensive biomonitoring study provides essential data to inform public health policies and interventions.

The Use of Visual Analysis for Gait and Foot Posture in Children with Developmental Dysplasia of the Hip.

BACKGROUND: Developmental dysplasia of the hip (DDH) is recognized as a leading cause of significant long-term complications, including inaccurate gait patterns, persistent pain, and early regressive joint disorder, and it can influence families functionally, socially, and psychologically. METHODS: This study aimed to determine foot posture and gait analysis across patients with developmental hip dysplasia. We retrospectively reviewed participants referred to the pediatric rehabilitation department of KASCH from the orthopedic clinic between 2016 and 2022 (patients born 2016-2022) with DDH for conservative brace treatment. RESULTS: The foot postural index for the right foot showed a mean of 5.89 (n = 203, SD 4.15) and the left food showed a mean of 5.94 (n = 203, SD 4.19). The gait analysis mean was 6.44 (n = 406, SD 3.84). The right lower limb mean was 6.41 (n = 203, SD 3.78), and the left lower limb mean was 6.47 (n = 203, SD 3.91). The correlation for general gait analysis was r = 0.93, presenting the very high impact of DDH on gait. Significant correlation results were found between the right (r = 0.97) and left (r = 0.25) lower limbs. Variation between the right and left lower limb p-values was 0.88 (p < 0.05). DDH affects the left lower limb more than the right during gait. CONCLUSION: We conclude that there is a higher risk of developing foot pronation on the left side, which is altered by DDH. Gait analysis has shown that DDH affects the right lower limb more than the left. The results of the gait analysis showed gait deviation in the sagittal mid- and late stance phases.

From science to policy: How European HBM indicators help to answer policy questions related to phthalates and DINCH exposure.

Within the European Human Biomonitoring (HBM) Initiative HBM4EU we derived HBM indicators that were designed to help answering key policy questions and support chemical policies. The result indicators convey information on chemicals exposure of different age groups, sexes, geographical regions and time points by comparing median exposure values. If differences are observed for one group or the other, policy measures or risk management options can be implemented. Impact indicators support health risk assessment by comparing exposure values with health-based guidance values, such as human biomonitoring guidance values (HBM-GVs). In general, the indicators should be designed to translate complex scientific information into short and clear messages and make it accessible to policy makers but also to a broader audience such as stakeholders (e.g. NGO's), other scientists and the general public. Based on harmonized data from the HBM4EU Aligned Studies (2014-2021), the usefulness of our indicators was demonstrated for the age group children (6-11 years), using two case examples: one phthalate (Diisobutyl phthalate: DiBP) and one non-phthalate substitute (Di-isononyl cyclohexane-1,2- dicarboxylate: DINCH). For the comparison of age groups, these were compared to data for teenagers (12-18 years), and time periods were compared using data from the DEMOCOPHES project (2011-2012). Our result indicators proved to be suitable for demonstrating the effectiveness of policy measures for DiBP and the need of continuous monitoring for DINCH. They showed similar exposure for boys and girls, indicating that there is no need for gender focused interventions and/or no indication of sex-specific exposure patterns. They created a basis for a targeted approach by highlighting relevant geographical differences in internal exposure. An adequate data basis is essential for revealing differences for all indicators. This was particularly evident in our studies on the indicators on age differences. The impact indicator revealed that health risks based on exposure to DiBP cannot be excluded. This is an indication or flag for risk managers and policy makers that exposure to DiBP still is a relevant health issue. HBM indicators derived within HBM4EU are a valuable and important complement to existing indicator lists in the context of environment and health. Their applicability, current shortcomings and solution strategies are outlined.

Current exposure to phthalates and DINCH in European children and adolescents - Results from the HBM4EU Aligned Studies 2014 to 2021.

Phthalates are mainly used as plasticizers for polyvinyl chloride (PVC). Exposure to several phthalates is associated with different adverse effects most prominently on the development of reproductive functions. The HBM4EU Aligned Studies (2014-2021) have investigated current European exposure to ten phthalates (DEP, BBzP, DiBP, DnBP, DCHP, DnPeP, DEHP, DiNP, DiDP, DnOP) and the substitute DINCH to answer the open policy relevant questions which were defined by HBM4EU partner countries and EU institutions as the starting point of the programme. The exposure dataset includes ∼5,600 children (6-11 years) and adolescents (12-18 years) from up to 12 countries per age group and covering the North, East, South and West European regions. Study data from participating studies were harmonised with respect to sample size and selection of participants, selection of biomarkers, and quality and comparability of analytical results to provide a comparable perspective of European exposure. Phthalate and DINCH exposure were deduced from urinary excretions of metabolites, where concentrations were expressed as their key descriptor geometric mean (GM) and 95th percentile (P95). This study aims at reporting current exposure levels and differences in these between European studies and regions, as well as comparisons to human biomonitoring guidance values (HBM-GVs). GMs for children were highest for ∑DEHP metabolites (33.6 µg/L), MiBP (26.6 µg/L), and MEP (24.4 µg/L) and lowest for∑DiDP metabolites (1.91 µg/L) and ∑DINCH metabolites (3.57 µg/L). In adolescents highest GMs were found for MEP (43.3 µg/L), ∑DEHP metabolites (28.8 µg/L), and MiBP (25.6 µg/L) and lowest for ∑DiDP metabolites (= 2.02 µg/L) and ∑DINCH metabolites (2.51 µg/L). In addition, GMs and P95 stratified by European region, sex, household education level, and degree of urbanization are presented. Differences in average biomarker concentrations between sampling sites (data collections) ranged from factor 2 to 9. Compared to the European average, children in the sampling sites OCC (Denmark), InAirQ (Hungary), and SPECIMEn (The Netherlands) had the lowest concentrations across all metabolites and ESTEBAN (France), NAC II (Italy), and CROME (Greece) the highest. For adolescents, comparably higher metabolite concentrations were found in NEB II (Norway), PCB cohort (Slovakia), and ESTEBAN (France), and lower concentrations in POLAES (Poland), FLEHS IV (Belgium), and GerES V-sub (Germany). Multivariate analyses (Survey Generalized Linear Models) indicate compound-specific differences in average metabolite concentrations between the four European regions. Comparison of individual levels with HBM-GVs revealed highest rates of exceedances for DnBP and DiBP, with up to 3 and 5%, respectively, in children and adolescents. No exceedances were observed for DEP and DINCH. With our results we provide current, detailed, and comparable data on exposure to phthalates in children and - for the first time - in adolescents, and - for the first time - on DINCH in children and adolescents of all four regions of Europe which are particularly suited to inform exposure and risk assessment and answer open policy relevant questions.

Tracking of Maternal Physical Activity and Sport Participation over 11 Years: Findings from the Czech ELSPAC Study.

Purpose: Tracking of physical activity (PA) and sport participation (SP) during motherhood is poorly understood. The purpose of the study was to analyze the extent of tracking of maternal PA and SP. Methods: In this investigation, data were collected from the Czech ELSPAC study subsample of 4811 and 2609 women measured postnatally (1991-1992) and after 11 years of follow-up (2002-2003), respectively. The structured questionnaire was used to assess the participation and average weekly time spent in PA, and the frequency of engaging in different sports (running, cycling, strength training, racket sports, swimming, and team sports). Tracking was calculated using generalized estimating equations (GEE) with beta coefficients (ß), odds ratios (ORs), and 95% confidence intervals (95% CI). Results: Moderately high tracking coefficients were observed for cycling (ß = 0.69, 95% 0.67-0.72), strength training (ß = 0.59, 95% 0.56-0.63), and weekly time spent in PA (ß = 0.53, 95% 0.38-0.66); meanwhile, moderate tracking coefficients were generated for swimming (ß = 0.48, 95% 0.44-0.52), team sports (ß = 0.44, 95% 0.39-0.48), racket sports (ß = 0.44, 95% 0.39-0.48), and running (ß = 0.35, 95% 0.30-0.40). Mothers who did not participate in PA at baseline were 81% more likely not to participate in it at follow-up (OR = 1.81, 95% CI 1.53-2.13). Conclusion: Cycling- and strength-related activities and weekly PA were tracked moderately-to-moderately high during motherhood. Moreover, the strong tracking of physical inactivity indicates that the detection of this risk factor before pregnancy should be advocated.

Longitudinal associations between sport participation and fat mass with body posture in children: A 5-year follow-up from the Czech ELSPAC study.

The main purpose of the study was to examine longitudinal associations between sport participation and fat mass with body posture in children. We used data from children recruited in the Czech European Longitudinal Study of Pregnancy and Childhood (CELSPAC) at the ages of 11 y (n = 1065), 13 y (n = 811) and 15 y (n = 974). Information on body posture, practicing sport in a club and at a competitive level, and skinfold thicknesses (biceps, triceps, subscapula, suprailiaca and thigh) from pediatrician's medical records were collected. Body posture was inspected by a pediatrician. The sum of 5 skinfolds was used as a proxy of fat mass. The 85th and 95th percentiles defined 'overfat' and 'obese'children. Practicing sport in a club and at a competitive level were included as 'yes/no' answers. General linear mixed models with risk ratios (RR) and 95% confidence intervals (95% CI) were calculated. Overall, 35.6% of children and adolescents had impaired body posture; the prevalence of 'incorrect' body posture increased by age (from 41.0% to 28.0%, p<0.001). Practicing sport in a club and at a competitive level decreased by follow-up (p<0.001), while the level of 'overfat' and 'obese' children increased (p<0.01). In separate models, 'incorrect' body posture was associated with non-practicing sport in clubs (RR = 1.68; 95% CI 1.43-1.97, p<0.001) or at competitive level (RR = 1.61; 95% CI 1.37-1.88, p<0.001) and with being 'overfat' (RR = 2.05; 95% CI 1.52-2.75, p<0.001) and 'obese' (RR = 2.15; 95% CI 1.68-2.75, p<0.001). When all variables were put simultaneously into the model additionally adjusted for sex, self-rated health and baseline body posture, similar associations remained. This study shows, that not participating in sport and being overfat/obese are longitudinally associated with 'incorrect' body posture. Therefore, the detection of these risk factors in childhood, through the development of school- and community-based interventions, should be advocated.

Maternal Pre-Pregnancy Nutritional Status and Physical Activity Levels and a Sports Injury Reported in Children: A Seven-Year Follow-Up Study.

OBJECTIVE: Our aim was to analyze dose-response associations between maternal pre-pregnancy body mass index and physical activity levels with childhood sports injury rates. METHODS: Participants included pre-pregnant mothers (n = 4811) and their children at the age of 7 years (n = 3311). Maternal anthropometry (height, weight, and body mass index), time spent in physical activity, and education level were recorded. All sports injuries were defined as injuries reported in the past year by the children at the age of 7 years. RESULTS: Children whose mothers were overweight/obese in the pre-pregnancy period were 2.04 (OR = 2.04, 95% CI = 1.12-3.71) times more likely to report a sports injury at the age of 7 years. Underweight mothers exhibited a 74% decrease in the odds of their children reporting a sports injury at follow-up (OR = 0.26, 95% CI = 0.10-0.68). Finally, an increase in maternal physical activity across the last three quartiles was associated with a lower odds of sports injuries. CONCLUSIONS: The risk of reporting a sports injury was greater for children whose mothers were overweight/obese in the pre-pregnancy period. However, there was a lower risk with both maternal underweight status and increasing minutes of physical activity.

How barefoot and conventional shoes affect the foot and gait characteristics in toddlers.

OBJECTIVES: Barefoot shoes have recently become a popular alternative to conventional shoes among the parents of pre-school children. As the long-term effect of habitual shoe-wearing on the foot is still unclear, the aim of this study was to compare the arch index, dynamic foot anthropometry and gait parameters in toddlers who had been habitually wearing barefoot shoes or conventional shoes since their first steps. METHODS: 30 toddlers- 15 habitually wearing barefoot shoes (BF group) and 15 habitually wearing conventional shoes (N-BF group)-participated in this study. Each child was measured twice during the study. The first data collection session occurred within one month after the first five consecutive unsupported steps were performed by the toddler. The second data collection session occurred seven months after this event. At each data collection session, the toddler was instructed to walk barefooted at its natural speed over an Emed® platform (Novel GmbH, Germany). The Emed ® software generated data regarding the arch index, dynamic foot anthropometry, foot progression angle, contact area, contact time, peak pressure and maximum force. The Wilcoxon signed-rank test was used to compare the differences between the 1st and 2nd data collections. The Mann-Whitney U test was used to compare the differences between the BF and N-BF groups. RESULTS: The results of this study show a higher plantar arch and a smaller foot progression angle in the BF group. The forefoot width in both the BF and N-BF groups remained proportional to the foot length after seven months of independent walking. CONCLUSIONS: These findings may encourage parents and caregivers to introduce barefoot shoes or create a habitual barefoot time for their child.

Developmental Dysplasia of the Hip: Prevalence and Correlation with Other Diagnoses in Physiotherapy Practice-A 5-Year Retrospective Review.

(1) Background: The objective of this study was to assess the prevalence of Developmental Dysplasia of the Hip (DDH) as a primary or secondary diagnosis during physiotherapy practice. No other studies have investigated the prevalence and associations of DDH within the practice of pediatric rehabilitation. (2) Methods: This retrospective review was performed on 12,225 physiotherapy referrals to the King Abdullah Specialized Children's Hospital (KASCH), Riyadh, Kingdom of Saudi Arabia, from May 2016 to October 2021. Only DDH referrals for conservative treatment were included in the study. The plan for brace treatment was carried out by the pediatric orthopedics clinic in KASCH. The diagnostic methods were either a pelvic radiograph or ultrasound, depending on the participant's age. DDH is considered one of the most common secondary complications for children with other medical diagnoses. (3) Results: The most common indication for referral was neurological diagnosis (44%), followed by orthopedic (28%), genetic (19%), cardiac (5%), ophthalmologic (3%), dermatologic (1%) and rheumatologic (0.5%) diagnoses. (4) Conclusion: The prevalence of DDH among all referrals in this study was 6%. In physiotherapy practice, neurologic, genetic, and orthopedic primary or secondary diagnoses were the most prevalent when DDH referrals were investigated. A relatively high prevalence of DDH in the pediatric rehabilitation clinic at KASCH in Riyadh was reported in this study.

The Impact of Different Periods of Walking Experience on Kinematic Gait Parameters in Toddlers.

This study aimed to analyse the kinematic differences in gait between three groups of toddlers who differed in their weeks of independent walking (IW) experience, but not in anthropometrical characteristics, to determine the relationship between walking experience without the side effect of morphological differences on gait parameters. Twenty-six toddlers participated in this study. Depending on the week of their IW, toddlers were divided into three groups: Group 1 (1-5 weeks of IW), Group 2 (6-10 weeks of IW), and Group 3 (11-15 weeks of IW). Each toddler walked barefooted over a 2-m long pathway, and 3D kinematic data were obtained. A decrease in the upper limb position, hip flexion, and step width, i.e., changes towards the adult gait pattern, were observed in Group 3. Less experienced walkers exhibited a wider step width despite no statistically significant difference in body mass and height between groups. Results of this study show no statistically significant difference in step length between groups, suggesting that step length is more related to height than to the walking experience. The increased step length in more experienced walkers reported in previous studies may therefore be a result of different heights and not walking experience.

Gait Speed as a Screening Tool for Foot Pain and the Risk of Falls in Community-Dwelling Older Women: A Cross-Sectional Study.

PURPOSE: The main purpose of the study was to establish a gait speed cut-off value to predict foot pain and the risk of falls among community-dwelling older adults. PATIENTS AND METHODS: In this cross-sectional study, one-hundred and twenty White older women speaking Croatian (mean ± SD age 71.02 ± 6.78 years, height 161.77 ± 6.23 cm, weight 70.29 ± 12.97 kg, body mass index 26.79 ± 4.42 kg/m2) were recruited. The prevalence of foot pain was assessed by a single-item question and the risk of falls by the Downtown Fall Risk Index with a proposed cut-off value of "low risk" (<3 points) vs "high risk" (≥3 points) of falls. Self-selected gait speed (the independent variable) was estimated with a pressure platform (Zebris Company, Munich, Germany). RESULTS: Mean gait speed was 0.95 m/s. Of the total sample, 53.30% and 33.30% reported foot pain and had higher risk of falls. For foot pain and the risk of falls, gait speed cut-off values were 0.88 m/s and 0.85 m/s (area under the curve = 0.80 and 0.83, standard error = 0.043 and 0.043, p < 0.001). Sensitivity for foot pain and the risk of falls was 66.20% and 85.90% and specificity was 84.80% and 69.00%. Slower gait speed was associated with higher prevalence of foot pain (OR = 10.92, 95% CI 4.28 to 27.89, p < 0.001) and higher risk of falls (OR = 13.59, 95% CI 5.45 to 33.87, p < 0.001). CONCLUSION: Proposed gait speed values of 0.88 m/s and 0.85 m/s may be used in clinical settings to predict foot pain and the risk of falls among community-dwelling older women.

Foot rotation and the risk of falls in older women: A cross-sectional study.

Although previous evidence has shown that deviated foot structure and function are associated with falls, little is known of the association between foot rotations and falls in apparently healthy older adults. Therefore, the main purpose of the study was to determine the associations between foot rotation and falls. In this cross-sectional study, we recruited 120 older women (mean±SD; age 71.01±6.77 years; height 158.92±21.41 cm; weight 70.29±12.97 kg; body-mass index 26.79±4.42 kg/m2). Foot rotations were assessed by using pressure platform (Zebris manufacturer, Munich, Germany), while the risk of falls was assessed by using Downtown Fall Risk Index questionnaire. Correlations and multiple regression models were applied to calculate the associations. In unadjusted model, higher foot rotation was associated with higher risk of falls (ß = 0.14, p<0.001 for both feet). In a model adjusted for age, body-mass index, foot pain and fitness index, higher foot rotation remained associated with higher risk of falls (ß = 0.10, p<0.001 for both feet). Our study shows that older adults with higher foot rotation are at higher risk of falls. Special interventions aiming to correct for deviated foot function in older women are warranted.