Effects of two physical education programmes on health- and skill-related physical fitness of Albanian children.

This study aims to evaluate the effectiveness of two school-based physical education (PE) programmes (exercise-based and games-based) compared with traditional PE, on health- and skill-related physical fitness components in children in Tirana, Albania. Participants were 378 first-grade (6.8 years) and 389 fourth-grade (9.8 years) children attending four randomly selected schools in Tirana. Twenty-four school classes within these schools were randomly selected (stratified by school and school grade) to participate as exercise group (EG), games group (GG) and control group (CG). Both EG and GG intervention programmes were taught by professional PE teachers using station/circuit teaching framework while CG referred to traditional PE school lessons by a general teacher. All programmes ran in parallel and lasted 5 months, having the same frequency (twice weekly) and duration (45 min). Heart rate (HR) monitoring showed that intensity during PE lessons was significantly higher in the intervention groups compared with control (P < 0.001). Both PE exercise- and games programmes significantly improved several health- and skill-related fitness indicators compared with traditional PE lessons (e.g. gross motor skill summary score: 9.4 (95% CI 7.9; 10.9) for exercise vs. control and 6.5 (95% CI 5.1; 8.1) for games vs. control, cardiorespiratory fitness: 2.0 ml O2 · min(-1) · kg(-1) (95% CI 1.5; 2.4) for exercise vs. control and 1.4 ml O2 · min(-1) · kg(-1) (95% CI 1.0; 1.8) for games vs. control). Furthermore, compared to games-based PE, exercise-based PE showed more positive changes in some gross motor coordination skills outcomes, coordination skills outcomes and cardiorespiratory fitness. The results from this study show that exercise- and games-based PE represents a useful strategy for improving health- and skill-related physical fitness in Albanian elementary school children. In addition, the study shows that exercise-based PE was more effective than games-based PE in improving gross motor function and cardiorespiratory fitness.

Associations between bicycling and carotid arterial stiffness in adolescents: The European Youth Hearts Study.

The aim of the study was to investigate the associations between bicycling and carotid arterial stiffness, independent of objectively measured moderate-and-vigorous physical activity. This cross-sectional study included 375 adolescents (age 15.7 ± 0.4 years) from the Danish site of the European Youth Heart Study. Total frequency of bicycle usage was assessed by self-report, and carotid arterial stiffness was assessed using B-mode ultrasound. After adjusting for pubertal status, body height, and objectively measured physical activity and other personal lifestyle and demographic factors, boys using their bicycle every day of the week displayed a higher carotid arterial compliance {standard beta 0.47 [95% confidence interval (CI) 0.07-0.87]} and distension [standard beta 0.38 (95% CI -0.04 to 0.81)]. Boys using their bicycle every day of the week furthermore displayed a lower Young's elastic modulus [standard beta -0.48 (95% CI -0.91 to -0.06)]. Similar trends were observed when investigating the association between commuter bicycling and carotid arterial stiffness. These associations were not observed in girls. Our observations suggest that increasing bicycling in adolescence may be beneficial to carotid arterial health among boys.

Prospective association of adiposity and cardiorespiratory fitness with cardiovascular risk factors in healthy children.

This study aimed to examine the prospective association of three different measures of adiposity and cardiorespiratory fitness (CRF) with 2-year change in cardiovascular disease (CVD) risk factors in children. Two-year longitudinal data in schoolchildren aged 7-11 years (n = 365-729) was used. Total body fat (TBF) from dual-energy x-ray absorptiometry, body mass index (BMI), waist circumference (WC), CRF, blood samples, and blood pressure were obtained in 2008 and 2010 in the Childhood Health, Activity, and Motor Performance School Study in Denmark (CHAMPS study-DK). Greater adiposity at baseline was associated with increased CVD risk factor levels at follow-up. The magnitudes of associations were similar regardless of adiposity measure [TBF%: ß 0.30, 95% confidence interval (CI): 0.21-0.39; BMI: ß 0.24, 95% CI: 0.14-0.33; WC: ß 0.20, 95% CI: 0.10-0.31], and no evidence of nonlinear relationships was observed. We found less strong associations of CRF with increase in CVD risk factor levels after adjusting for adiposity; however, increasing CRF was still favorably associated with decrease in CVD risk factor levels among boys. Results suggest that any effort to shift the population distribution of adiposity downward would be valuable for early CVD prevention. The association of CRF with CVD risk factors was largely explained by adiposity, particularly among girls.

Evaluation of common genetic variants identified by GWAS for early onset and morbid obesity in population-based samples.

BACKGROUND: Meta-analysis of case-control genome-wide association studies (GWAS) for early onset and morbid obesity identified four variants in/near the PRL, PTER, MAF and NPC1 genes. OBJECTIVE: We aimed to validate association of these variants with obesity-related traits in population-based samples. DESIGN: Genotypes and anthropometric traits were available in up to 31 083 adults from the Fenland, EPIC-Norfolk, Whitehall II, Ely and Hertfordshire studies and in 2042 children and adolescents from the European Youth Heart Study. In each study, we tested associations of rs4712652 (near-PRL), rs10508503 (near-PTER), rs1424233 (near-MAF) and rs1805081 (NPC1), or proxy variants (r (2)>0.8), with the odds of being overweight and obese, as well as with body mass index (BMI), percentage body fat (%BF) and waist circumference (WC). Associations were adjusted for sex, age and age(2) in adults and for sex, age, age group, country and maturity in children and adolescents. Summary statistics were combined using fixed effects meta-analysis methods. RESULTS: We had 80% power to detect odds ratios of 1.046 to 1.092 for overweight and 1.067 to 1.136 for obesity. Variants near PRL, PTER and MAF were not associated with the odds of being overweight or obese, or with BMI, %BF or WC after meta-analysis (P>0.15). The NPC1 variant rs1805081 showed some evidence of association with %BF (ß=0.013 s.d./allele, P=0.040), but not with any of the remaining obesity-related traits (P>0.3). CONCLUSION: Overall, these variants, which were identified in a GWAS for early onset and morbid obesity, do not seem to influence obesity-related traits in the general population.

Physical activity intensity and subclinical atherosclerosis in Danish adolescents: the European Youth Heart Study.

The aim was to investigate the associations between physical activity (PA), cardiorespiratory fitness (CRF) and intima media thickness (IMT) or stiffness. This was a population-based cross-sectional study (n = 336) of Danish adolescents [mean age (standard deviation, SD): 15.6 (0.4) years]. PA intensity was assessed objectively (ActiGraph model GT3X) and CRF using a progressive maximal bicycle test. Carotid IMT and arterial stiffness were assessed using B-mode ultrasound. In a multivariate analysis (adjusted for pubertal development and smoking status), CRF was inversely associated with measures of carotid stiffness (standard beta: -0.20 to -0.15, P < 0.05) in boys, but not in girls. No associations were observed between any of PA and IMT. Boys in the least fit quartile had significantly stiffer carotid arteries compared to the most fit quartile (difference between lowest and highest quartile ranging between 0.4 and 0.5 SD, P < 0.05). This difference in arterial stiffness between low and high quartiles was similar for moderate-to-vigorous PA (MVPA). Further adjustment for sedentary time attenuated the difference observed between quartiles MVPA slightly. Adiposity did not attenuate these differences. Our observations suggest that increasing CRF or MVPA in the least active group of the population may be beneficial for vascular health.

Prenatal and early postnatal exposure to perfluoroalkyl substances and bone mineral content and density in the Odense child cohort.

INTRODUCTION: Exposure to perfluoroalkyl substances (PFAS) has been associated with lower bone mineral density (BMD) in animal and human studies, but prospective data from children are limited. OBJECTIVES: To determine associations between prenatal and early postnatal PFAS exposure and BMD at age 7 years. METHODS: In the Odense Child Cohort, Denmark, pregnant women were recruited in 2010-2012, and their children were invited for subsequent health examinations. At 12 weeks of gestation the pregnant women delivered a serum sample, and at age 18 months serum was obtained from the child to measure perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid (PFOA), perfluorohexane sulfonic acid (PFHxS), perfluorononanoic acid (PFNA) and perfluorodecanoic acid (PFDA) by LC-MS/MS. At age 7 years DXA scans were performed to measure bone mineral content (BMC) and BMD Z-score. PFAS in pregnancy (n = 924) and/or at age 18 months (n = 511) were regressed against DXA measurements, adjusted for maternal education, child height Z-score, sex (for BMC) and for postnatal exposure, additionally duration of total breastfeeding. We additionally performed structural equation models determining combined effects of pre-and postnatal PFAS exposures. RESULTS: Higher prenatal and early postnatal serum concentrations of all measured PFAS were associated with lower BMC and BMD Z-scores at age 7 years, all estimates were negative although not all significant. For each doubling of prenatal or 18-month exposure to PFDA, BMD Z-scores were lowered by -0.07 (95 % CI -0.10; -0.03) and -0.14 (-0.25; -0.03), respectively after adjustment. Pre- and postnatal PFAS were correlated, but structural equation models suggested that associations with BMD were stronger for 18-month than prenatal PFAS exposure. DISCUSSION: Bone density is established in childhood, and a reduction in BMD during early childhood may have long-term implication for peak bone mass and lifelong bone health. Future studies of the impact of PFAS exposure on fracture incidence will help elucidate the clinical relevance.

Examining the causal association of fasting glucose with blood pressure in healthy children and adolescents: a Mendelian randomization study employing common genetic variants of fasting glucose.

The aim of the study was to determine whether genetically raised fasting glucose (FG) levels are associated with blood pressure (BP) in healthy children and adolescents. We used 11 common genetic variants of FG discovered in genome-wide association studies (GWAS), including the rs560887 single-nucleotide polymorphism (SNP) located in the G6PC2 locus found to be robustly associated with FG in children and adolescents, as an instrument to associate FG with resting BP in 1506 children and adolescents from the European Youth Heart Study (EYHS). Rs560887 was associated with increased FG levels corresponding to an increase of 0.08 mmol l(-1) (P=2.4 × 10(-8)). FG was associated with BP, independent of other important determinants of BP in conventional multivariable analysis (systolic BP z-score: 0.32 s.d. per increase in mmol l(-1) (95% confidence interval (CI) 0.20-0.44, P=1.9 × 10(-7)), diastolic BP z-score: 0.13 s.d. per increase in mmol l(-1) (95% CI 0.04-0.21, P=3.2 × 10(-3)). This association was not supported by the Mendelian randomization approach, neither from instrumenting FG from all 11 variants nor from the rs560887, where non-significant associations of glucose with BP were observed. The results of this study could not support a causal association between FG and BP in healthy children and adolescents; however, it is possible that rs560887 has pleiotropic effects on unknown factors with a BP lowering effect or that these results were due to a lack of statistical power.

Benign and malignant neoplasms of the parotid gland: incidence and histology in the Danish County of Funen.

The present series is comprised of 155 patients from the county of Funen who were operated on for tumors of the parotid gland during the 5-year period, 1978 to 1982. Fifteen cases were malignant, 116 were benign, while no neoplasms were found in 24 cases. The incidence was calculated as 5.8 parotid neoplasms per year per 100,000 inhabitants. Computation of age standardized incidence rates adjusted to European and World Standard populations has been performed. It is stated that the county of Funen is a well-defined area and the series can be regarded to be representative of a certain geographical area. The histological classification was carried out according to the rules of the World Health Organization (WHO) and revealed a remarkably high occurrence of Warthin's tumors, i.e., 27.5%.

Chronic otitis media sequelae in skeletal material from medieval Denmark.

OBJECTIVES: Chronic otitis media sequelae (COMS) have been identified in archaeological skeletal materials from various ages. COMS reflecting episodes of upper respiratory tract infection may be used as a paleopathological indicator of general health. Estimation of the frequency of COMS may be useful in the gross evaluation of general standard of living. MATERIALS AND METHODS: Temporal bones and auditory ossicles from 659 individuals from two Danish medieval rural parish cemeteries, dated to 1050-1200 and 1150-1350, respectively, were examined otomicroscopically. RESULTS: Osseous fistulae from mastoid abscesses, remodelling of the hypotympanon, and erosion of the incus were among the convincing indications of COMS. A minimum frequency of COMS of 1% to 7% was found. The youngest material displayed the highest frequency of pathological changes. CONCLUSION: Indications of a rising incidence of infectious middle ear disease in early medieval Denmark were found. This may reflect a deterioration of living conditions from the 11th through the 14th centuries.

Autosomal dominant osteopetrosis: an otoneurological investigation of the two radiological types.

Otoneurological examination was performed on 14 patients with autosomal dominant osteopetrosis. Eight patients had radiological type I osteopetrosis, characterized by a pronounced osteosclerosis of the skull and an enlarged thickness of the cranial vault. Six patients had type II, in which osteosclerosis is most pronounced at the base of the skull. All investigated patients except one had otoneurological manifestations, but only two of of the 14 had otoneurological complaints. Symptoms were related to radiological types. Involvement of the trigeminal nerve was seen only in type I, whereas involvement of the facial nerve was found primarily in type II. Conductive hearing loss was particularly common in type I, and may reflect a high frequency of otosclerosis. Tomography of the petrous bones showed a significant narrowing of the internal acoustic meatus in type I (p less than 0.01) when compared to normal controls, but no significant narrowing in type II.

Gas chromatographic analysis and storage of gas samples from the middle ear.

Methods for storage and analysis of gas samples were studied prior to measuring the composition of gas in the human middle ear cavity. Storage and analysis of gas samples are beset with several pitfalls. The dead space of the sampling syringe must be considered and the gas sample can equilibrate with the surrounding atmosphere, especially if the analysis cannot be done immediately. In this study the equilibration rate was found to fit an exponential function with a time constant of 0.004 min-1. The time constant was reduced by more than a factor of ten when butyl rubber stoppers were used to seal the syringes. Silicone rubber stoppers were less efficient. Disposable plastic syringes were found just as efficient as 'gas-tight' syringes.

Studies on gas tension in the normal middle ear. Gas chromatographic analysis and a new sampling technique.

In studying mechanisms regulating the middle ear pressure it is essential to know the gas compositions of the middle ear. We have constructed a device which made it possible to sample middle ear gas without creating a negative pressure, thus eliminating the risk of admixture of atmospheric air. The samples were analysed by gas chromatography. In 26 normal subjects we found relatively stable values of carbon dioxide (median 52 mmHg, range 31-69 mmHg) and nitrogen (median 605 mmHg, range 563-627 mmHg). The values of oxygen were more fluctuating (median 54 mmHg, range 23-111 mmHg). In 10 of the subjects, arterial gases were determined simultaneously. No correlation could be shown between middle ear and arterial oxygen and carbon dioxide tensions. This investigation provides evidence contradicting the classical theory of a high negative middle ear pressure in Eustachian tube closure. We found strong indications that the Eustachian tube plays an active role in regulating the pressure in the normal middle ear, but variations in blood flow through the middle ear capillaries may also be an important regulating factor.

Ginger root against seasickness. A controlled trial on the open sea.

In a double-blind randomized placebo trial, the effect of the powdered rhizome of ginger (Zingiber officinale) was tested on seasickness. Eighty naval cadets, unaccustomed to sailing in heavy seas reported during voyages on the high seas, symptoms of seasickness every hour for 4 consecutive hours after ingestion of 1 g of the drug or placebo. Ginger root reduced the tendency to vomiting and cold sweating significantly better than placebo did (p less than 0.05). With regard to vomiting, a modified Protection Index (PI) = 72% was calculated. Remarkably fewer symptoms of nausea and vertigo were reported after ginger root ingestion, but the difference was not statistically significant. For all symptom categories, PI = 38% was calculated.

Monitoring middle ear pressure by tympanometry. A study of middle ear pressure variation through seven hours.

The aim of this investigation was to monitor fluctuations in middle ear pressure, to study tympanometric signs of Eustachian tube functioning and to assess the validity of the tympanometric readings. In 20 patients with a low initial middle ear pressure (-150 daPa or lower) and 5 normals, impedance tympanometry was performed every 3 min through 7 h. Median pressure for the patients was -150 daPa (range 100 to -400 daPa) and for the normals 0 daPa (range 50 to -50 daPa). A remarkable pressure increase was seen after changing the body position to the supine. The patients were arranged into three groups according to the lowest middle ear pressure registered. Median pressures for the groups were running at a rather constant level. However, the individual pressure fluctuations in many patients were so great that a single tympanometric reading has to be considered unreliable when selecting patients for insertion of ventilation tubes. Thirteen patients never equalized their negative middle ear pressure, indicating that their Eustachian tube did not open during the test period. In spite of this the pressure did not decrease to lower values, indicating that maintaining a relative constant middle ear pressure is independent of opening of the Eustachian tube.

The clinical significance, diagnosis and treatment of bulla formation in the nose.

Nasal stenosis as a result of a bulla formation in the middle concha and uncinate process, together with hypertrophy of the bulla ethmoidalis, is described on the basis of 4 case histories. The condition obstructs drainage from the paranasal sinuses and produces an unphysiological airstream through the nose. This results in a disease complex which is dominated, in particular, by nasal stenosis, a feeling of pressure with radiating pains to the neighbouring regions, together with chronic infection of the upper and lower airways. It appears to be difficult to make the diagnosis clinically and from routine x-rays. The importance of the differential diagnosis from nasal polyps and mucosal hypertropy is emphasized. It is suggested that the term "bulla cavi nasi" by employed as a common name for bulla formation in the nose.

Autosomal dominant osteopetrosis (a family study).

Osteopetrosis is a rare metabolic disorder, characterized by an abnormal accumulation of bone mass probably caused by diminished bone resorption. Symptoms are directly and indirectly derived from the increased amount of bone. A family study was made, starting with a proband presenting with symptoms of trigeminal neuralgia. The pedigree indicated an autosomal dominant inheritance through three generations, comprising four affected subjects, of whom two were free of symptoms.

[Foreign body in the esophagus]. / Corpus alienum esophagi.

A ten year retrospective survey of 346 cases of oesophageal foreign bodies is reported. Although coins were the most frequent foreign bodies in the pediatry group, meat was the most common offender in the material taken as a whole. Rigid oesophagoscopy in general anaesthesia was performed on 312 patients. A foreign body was removed in 281 cases (90%). Only one case of oesophageal cancer was discovered. The risk of iatrogenic perforation of the oesophagus was greatest in old patients who had a lump of meat stuck in the distal third of the oesophagus.

[Subjective symptoms and sleep apnea among persons referred to a sleep center. A questionnaire survey]. / Subjektive gener og søvnapnø blandt personer henvist til et søvncenter. En spørgeskemaundersøgelse.

The aim of this study was to evaluate the relation between symptoms and clinical characteristics and the frequency of increased apnoea and hypopnoea activity. The study population consisted of 135 persons referred to a sleep centre. One hundred and fifteen patients (85%) completed a questionnaire and were subsequently monitored during one night's sleep. Fifty-two persons (45%) had an Apnoea Hypopnoea Index (AHI = the mean number of apnoea and hypopnoea episodes per hour of sleep) > or = 10. Forty-one (36%) had an Apnoea Index (AI = the mean number of apnoea per hour of sleep) > or = 10. Symptoms and clinical characteristics had no significant correlation to increased apnoea activity; however, there was a significant relationship between self-reported frequent breathing pauses during sleep and increased AHI and AI. Symptoms and clinical characteristics are not capable of identifying persons with increased apnoea activity.

[Cochlear implantation in adults. Results and significance for communication and quality of life]. / Cochleaimplantationer hos voksne. Resultater og betydning for kommunikation og livskvalitet.

The aim of this study was to assess the benefits and complications from cochlear implantation and to evaluate the average implant usage per day. Ten profoundly deaf adults were implanted during the period April 1994 to September 1997. The patients answered questionnaires one year or more after receiving their cochlear implants. The average implant usage per day was 16 hours. The patients would again opt for a cochlear implant and would recommend a cochlear implant for a deaf friend. A paired comparison showed that the implants led to statistically significant improvement in a number of factors; self perceived communication skills, frequency of conversation with others, telephone usage, self-confidence, and the hearing impairment's impact on family life. No serious surgical complications were found.