Radiographic changes in the hip joint in children suffering from Perthes disease

The purpose was to compare radiographic parameters with a sex-matched and age-matched control group at the onset of disease and at skeletal maturity. The study comprised 143 patients with Legg-Calvé-Perthes disease, treated using a Thomas splint. Wiberg's centre-edge angle and the acetabular index angle were applied. The age at diagnosis was 6.6 years with no difference between boys and girls. At the time of diagnosis, the centre-edge angle was decreased from 18° in the control group to 10° in the affected hip. The age at follow-up was 16 (SD 2) years for the boys and 15 (SD 3) years for the girls. At the time of skeletal maturity, the centre-edge angle was decreased and the acetabular index angle increased in the affected hip and the nonaffected hip in Stulberg class III/IV/V hips compared with the control group. Initially radiographic changes only occur on the affected hip. At skeletal maturity both hips show radiographic changes.     

Muscular interleukin-6 and its role as an energy sensor

During recent years, accumulating data have shown that muscle cells are able to produce and secrete several hundred myokines. The finding that muscles produce and release myokines provides a conceptual basis for understanding some of the molecular mechanisms underlying organ cross talk, including muscle-liver and muscle-fat cross talk. The myokine prototype is interleukin-6 (IL-6). During exercise, contracting skeletal muscles release IL-6. It seems that IL-6 works as an energy sensor and exerts both local and endocrine metabolic effects. Given that the skeletal muscle is the largest organ in the human body, the discovery of contracting muscle as a cytokine-producing organ opens for a whole new paradigm: If the endocrine function of the muscle is not stimulated through contractions, it will cause malfunction of several organs and tissues of the body.     

New models for large prospective studies: is there a better way?

Large prospective cohort studies are critical for identifying etiologic factors for disease, but they require substantial long-term research investment. Such studies can be conducted as multisite consortia of academic medical centers, combinations of smaller ongoing studies, or a single large site such as a dominant regional health-care provider. Still another strategy relies upon centralized conduct of most or all aspects, recruiting through multiple temporary assessment centers. This is the approach used by a large-scale national resource in the United Kingdom known as the "UK Biobank," which completed recruitment/examination of 503,000 participants between 2007 and 2010 within budget and ahead of schedule. A key lesson from UK Biobank and similar studies is that large studies are not simply small studies made large but, rather, require fundamentally different approaches in which "process" expertise is as important as scientific rigor. Embedding recruitment in a structure that facilitates outcome determination, utilizing comprehensive and flexible information technology, automating biospecimen processing, ensuring broad consent, and establishing essentially autonomous leadership with appropriate oversight are all critical to success. Whether and how these approaches may be transportable to the United States remain to be explored, but their success in studies such as UK Biobank makes a compelling case for such explorations to begin.     

The Development and Psychometric Properties of the Humanitarian Emergency Settings Perceived Needs (HESPER) Scale

Objectives. We developed the Humanitarian Emergency Settings Perceived Needs (HESPER) Scale, a valid and reliable scale to rapidly assess perceived needs of populations in humanitarian settings in low- and middle-income countries.Methods. We generated items through a literature review; reduced the number of items on the basis of a survey with humanitarian experts; pilot-tested the scale in Gaza, Jordan, Sudan, and the United Kingdom; and field-tested it in Haiti, Jordan, and Nepal.Results. During field-testing, intraclass correlation coefficients (absolute agreement) for the total number of unmet needs were 0.998 in Jordan, 0.986 in Haiti, and 0.995 in Nepal (interrater reliability), and 0.961 in Jordan and 0.773 in Nepal (test–retest reliability). Cohen’s κ for the 26 individual HESPER items ranged between 0.66 and 1.0 (interrater reliability) and between 0.07 and 1.0 (test–retest reliability) across sites. Most HESPER items correlated as predicted with related questions of the World Health Organization Quality of Life-100 (WHOQOL-100), and participants found items comprehensive and relevant, suggesting criterion (concurrent) validity and content validity.Conclusions. The HESPER Scale rapidly provides valid and reliable population-based data on perceived needs in humanitarian settings.Needs assessments in humanitarian settings (i.e., places in which a large part of the population is at risk of dying or experiencing immense suffering) are vital in enabling effective and efficient emergency relief. However, current needs assessments are often far from ideal; indeed, in 2009, heads of 26 large humanitarian donor agencies signed a letter to the United Nations asking for an improvement in the area of needs assessment (J. Isbister, G. Weinberger, J.-P. Loir, et al., unpublished letter, 2009).There have also been repeated recommendations for increased participation of affected populations in humanitarian assessment.1–6 People’s participation in assessment is seen as a right and as essential for optimizing resource allocation, program design, and population empowerment.6 It increases the likelihood that interventions are based on needs as expressed by the affected population. The international humanitarian community’s focus on participation is exemplified by the fact that the recently revised, influential Sphere Handbook (5,6) on standards for humanitarian aid emphasizes the involvement of affected people.Participation is recommended throughout the assessment, design, monitoring, and evaluation program cycle.1,3–5 Additionally, in a recent ranking exercise for research priorities in the area of mental health and psychosocial support, 3 of the 10 most highly prioritized research questions in humanitarian settings included the participation of affected populations; the identification of affected populations’ stressors was ranked as top priority.7 Related to this is the notion of accountability within the international humanitarian response, including that humanitarian action should be accountable to affected populations.4Within this framework of increased participation and accountability, it has been recommended that the assessment of perceived needs be used to inform project design, monitoring, and evaluation,1–5,8,9 and perceived needs are considered a key determinant of psychosocial well-being.1,8,10 Perceived needs are defined here as needs expressed by members of the affected population themselves. They are thus problem areas for which people would likely want help. In the humanitarian field, perceived needs are still assessed mostly through rapid participatory assessments in the early phase of a crisis; these assessments tend to involve gaining qualitative data from selected stakeholders through focus groups or key respondent interviews.11 Although certainly valuable, such assessments cannot provide a population-level picture. Most population-based quantitative assessments are of “objective” indicators, such as mortality rates, malnutrition rates, or livelihood data.12–14 These indicators are often defined by outsiders (i.e., nonmembers of the affected population) and do not quantify the prevalence and distribution of needs as perceived by members of the population themselves.With a few exceptions,15–17 assessment tools in the humanitarian field tend to have unknown psychometric properties (i.e., indices of validity and reliability). Without published psychometric properties, it is unknown to what extent assessment tools are fit for purpose.To address these gaps, we developed a method and instrument to rapidly and quantitatively assess perceived needs in emergency-affected populations—the Humanitarian Emergency Settings Perceived Needs (HESPER) Scale.18 We describe the development and psychometric properties of the scale.     

Effects of Two vs. Four Weekly Campus Board Training Sessions on Bouldering Performance and Climbing-Specific Tests in Advanced and Elite Climbers

This study examined the effects of two or four weekly campus board training sessions among highly accomplished lead climbers. Sixteen advanced-to-elite climbers were randomly allocated to two (TG2), or four weekly campus board training sessions (TG4), or a control group (CG). All groups continued their normal climbing routines. Pre- and post-intervention measures included bouldering performance, maximal isometric pull-up strength using a shallow rung and a large hold (jug), and maximal reach and moves to failure. Rate of force development (RFD; absolute and 100ms) was calculated in the rung condition. TG4 improved maximal force in the jug condition (effect size (ES) = 0.40, p = 0.043), and absolute RFD more than CG (ES = 2.92, p = 0.025), whereas TG2 improved bouldering performance (ES = 2.59, p = 0.016) and maximal moves to failure on the campus board more than CG (ES = 1.65, p = 0.008). No differences between the training groups were found (p = 0.107–1.000). When merging the training groups, the training improved strength in the rung condition (ES = 0.87, p = 0.002), bouldering performance (ES = 2.37, p = 0.006), maximal reach (ES = 1.66, p = 0.006) and moves to failure (ES = 1.43, p = 0.040) more than CG. In conclusion, a five-week campus board training-block is sufficient for improving climbing-specific attributes among advanced-to-elite climbers. Sessions should be divided over four days to improve RFD or divided over two days to improve bouldering performance, compared to regular climbing training.Key points

• Five weeks of volume equated campus board training may similarly improve finger strength, maximal reach and number of campus moves to failure regardless of training frequency.
• Four weekly sessions may be more effective than two weekly sessions for improving rate of force development in an isometric pull-up using a climbing-specific hold
• Two weekly sessions could be more effective than four weekly sessions for improving bouldering performance when volume is equated.

Key words: Isometric, pull-up, rate of force development, strength     

A prevalent polymorphism in the promoter of the UCP3 gene and its relationship to body mass index and long term body weight change in the Danish population

Variability of the uncoupling protein 3 (UCP3) promoter has been associated with increased body mass index (BMI) and altered lipid profiles. Here we tested the hypothesis that variation of the UCP3 promoter is associated with either juvenile or maturity-onset obesity or body weight change over a 26-yr follow-up among Danish subjects. Mutation screening of approximately 1 kb 5' upstream of the UCP3 gene revealed one previously described -55 C-->T variant. The frequency of the polymorphism was evaluated by restriction fragment length polymorphism analysis in four groups of subjects: 1) a group of 744 obese Danish men who at the draft board examinations had a body mass index (BMI) of at least 31 kg/m(2), 2) a randomly selected control group consisting of 857 draftees, 3) 258 middle-aged subjects, and 4) 409 60-yr-old subjects. The frequency of the T allele was 26.0% (95% confidence interval, 23.8-28.2%) among the obese draftees and 26.9% (24.8-29.0%) in the control group (P = 0.6). The variant was not associated with BMI at a young age or with weight gain after a 26-yr follow-up. The frequency of the T allele was 29.5% (25.6-33.4%) in the middle-aged group and 25.8% (22.8-28.8%) among the 60-yr-old subjects. The polymorphism was not associated with increased BMI or percent body fat in these 2 groups. It is concluded that this variant does not play a major role in the development of common obesity among Danish subjects.