The European Union, economies and public health: not one without the other.

OBJECTIVES: In this article, we aim to discuss the historical and current challenges facing public health in the European Union (EU) and present opportunities for the EU and Member States to maintain national public health ownership, supported by more substantial EU-level approaches building on existing legislation and practice. STUDY DESIGN: This is a descriptive study design. METHODS: A narrative review of the literature was performed and described. RESULTS: Historically, the EU has played only a small role in Member States' public health systems and delivery. The EU's policies primarily affect trade and overall economic decisions pertaining to Member States, with limited emphasis on the complex but essential interplay between economies and public health. In recent years, the public health challenges facing the EU, such as climate change, antimicrobial resistance, migrant health and now COVID-19, have become increasingly apparent. CONCLUSIONS: To establish a healthier EU, the development of a European Health Union and the Health in All Policies approach of the EU and the World Health Organization must explicitly manifest itself in policies and actions.

Do gait and muscle activation patterns change at middle-age during split-belt adaptation?

Advancing age affects gait adaptability, but it is unclear if such adaptations to split-belt perturbations are already affected at middle-age. Changes in neuromuscular control, that already start at middle-age, may underlie the age-related changes in gait adaptation. Thus, we examined the effects of age on adaptations in gait and muscle activation patterns during split-belt walking in healthy young and middle-aged adults. Young (23.3 ± 3.13 years) and middle-aged adults (55.3 ± 2.91 years) walked on an instrumented split-belt treadmill. Both age groups adapted similarly by reducing asymmetry in step length and double support time. Surface EMG was recorded from eight leg muscles bilaterally. Principal Component Analysis (PCA) was applied to the EMG data of all subjects, for the fast and slow leg separately, to identify muscle activation patterns. The principal components consisted of i.e. temporal projections that were analyzed with Statistical Parametric Mapping (SPM). The functional muscle groups, identified by PCA, increased activation during early adaptation and post-adaptation, and decreased activation over time similarly in both age groups. Extra activation peaks of the plantar- and dorsiflexors suggest a role in gait modulation during split-belt walking. Both young and middle-aged adults re-established gait symmetry and showed adaptation effects in the muscle activation patterns. Since the adaptation of muscle activation patterns parallels adaptation of gait symmetry, changes in muscle activation likely underlie the changes in step parameters during split-belt adaptation. In conclusion, split-belt adaptation, in terms of gait and muscle activation patterns, is still preserved at middle-age, suggesting that age-related differences occur later in the lifespan.