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ABSTRACT: AIMS: The long-term impact of implantable device-related complications on the patient outcome has not been thoroughly evaluated. The aims of this retrospective, bi-centre study were to analyse the rate and nature of device-related complications requiring surgical revision in a large series of patients undergoing device implantation, elective generator replacement and pacing system upgrade and to systematically assess the impact of such complications on patient outcome and healthcare utilization.METHODS AND RESULTS: Data from 2671 consecutive procedures (1511 device implantations, 1034 elective generator replacements, and 126 pacing system upgrades) performed between January 2006 and March 2011 were retrospectively analysed. The outcome measures recorded were complication-related mortality, number of re-operations, need for complex surgical procedures, number of re-hospitalizations, and additional hospital treatment days. Over a median follow-up of 27 months, the overall rate of complications was 2.8% per procedure-year [9.5% in cardiac resynchronisation therapy (CRT) device implantation, 6.1% in pacing system upgrade, 3.5% in implantable cardioverter defibrillator implantation, 1.7% in pacemaker implantation, and 1.7% in generator replacement). The procedure with the highest risk of complications was CRT device implantation (odds ratio: 6.6; P < 0.001); these complications primarily involved coronary sinus lead dislodgement and device infection. Patients with complications had a significantly higher number of device-related hospitalizations (2.3 ± 0.6 vs. 1.0 ± 0.1; P < 0.001) and hospital treatment days (15.7 ± 25.1 vs. 3.6 ± 1.1; P < 0.001) than those without complications. Device infection was the complication with the greatest negative impact on patient outcome.CONCLUSION: Cardiac resynchronisation therapy implantation was the procedure with the highest risk of complications requiring surgical revision. Complications were associated with substantial clinical consequences and a significant increase in the number and length of hospitalizations.
Europace 02/2013; · 1.98 Impact Factor
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Miguel Martín-Matillas,
Francisco B Ortega,
Jonatan R Ruiz,
David Martínez-Gómez,
Germán Vicente-Rodríguez,
Ascensión Marcos,
Laurent Béghin,
Anthony Kafatos,
Marcela González-Gross, Maria Zaccaria,
Dénes Molnár,
Stefaan De Henauw,
Michael Sjöström,
Luis A Moreno,
Manuel J Castillo On Behalf Of The Helena Study
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ABSTRACT: Abstract High physical fitness in childhood and adolescence is positively associated with favourable health-related outcomes. Our aim was to examine the relationship between relatives' (father, mother, brother, sister, and best friend) physical activity engagement and encouragement on adolescents' physical fitness. Adolescents were part of the HELENA study, a multi-centre study conducted in 10 cities from nine European countries in 2006-2008. Participants were 3288 adolescents (48% boys, 52% girls) aged 12.5-17.5 years with valid data on at least one of the three fitness variables studied: muscular strength (standing long jump), speed/agility (4×10 m shuttle run), and cardiorespiratory fitness (20 m shuttle run). The adolescents reported their relatives' physical activity engagement and encouragement. Analysis of covariance showed that relatives' physical activity engagement (father, mother, brother, and best friend) was positively related to cardiorespiratory fitness (P < 0.05); and mother's and sisters' physical activity engagement were positively associated with higher muscular strength in adolescents (P < 0.05). Furthermore, father's physical activity encouragement was positively linked to physical fitness (all fitness components) in adolescents (P < 0.05). Interventions aimed at improving physical fitness in young people might be more successful when family members, particularly mothers and fathers, are encouraged to engage in physical activity and support adolescents' physical activity.
Journal of Sports Sciences 08/2012; 30(13):1329-35. · 1.93 Impact Factor
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ABSTRACT: Closed-loop stimulation (CLS) pacing has shown greater efficacy in preventing the recurrence of vasovagal syncope (VVS) in patients with a cardioinhibitory response to head-up tilt test (HUTT) compared with conventional pacing. Moreover, there is no conclusive evidence to support the superiority of CLS over the conventional algorithms for syncope prevention. This study retrospectively evaluated the effectiveness of CLS pacing compared with dual-chamber pacing with conventional specialized sensing and pacing algorithms for syncope prevention in the prevention of syncope recurrence in patients with refractory VVS and a cardioinhibitory response to HUTT during a long-term follow-up.
Forty-one patients (44% male, 53 ± 16 years) with recurrent, refractory VVS (26% with trauma) and a cardioinhibitory response to HUTT who had undergone pacemaker implantation were included in the analysis. Twenty-five patients received a dual-chamber CLS pacemaker (CLS group) and 16 patients received a dual-chamber pacemaker with conventional algorithms for syncope prevention (conventional pacing group): 9 patients with Medtronic rate drop response algorithm and 7 patients with Guidant-Boston Scientific sudden brady response algorithm. During the follow-up (mean 4.4 ± 3.0 years, interquartile range 2.2-7.4 years) one patient (4%) in the CLS group and six (38%) in the conventional pacing group had syncope recurrences (P= 0.016). The Kaplan-Meier actuarial estimate of first recurrence of syncope after 8 years was 4% in the CLS group and 40% in the conventional pacing group (P= 0.010).
The results of this retrospective analysis show that, in order to prevent a recurrence of VVS in patients with a cardioinhibitory response to HUTT, dual-chamber CLS pacing was more effective than dual-chamber pacing with conventional algorithms for syncope prevention in preventing bradycardia-related syncope.
Europace 01/2012; 14(7):1038-43. · 1.98 Impact Factor
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David Jiménez-Pavón,
Manuel J. Castillo,
Luis A. Moreno,
Anthony Kafatos,
Yannis Manios,
Katerine Kondaki,
Laurent Béghin, Maria Zaccaria,
Stefaan de Henauw,
Kurt Widhalm,
Dénes Molnár,
Michael Sjöström,
Marcela González-Gross,
Jonatan R. Ruiz,
Helena Study Group
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ABSTRACT: Abstract Objective. To examine the independent association of total and central body fat and cardiorespiratory fitness with markers of insulin resistance after controlling for several potential confounders in European adolescents participating in the HELENA-CSS (Healthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional) study. Methods. We conducted a cross sectional study (the HELENA-CSS) which comprised 1053 (12.5–17.5 years) adolescents from 10 European cities. Weight, height, waist circumference and skinfold thickness were measured, and body mass index (BMI) was calculated. Cardiorespiratory fitness was measured by the 20-m shuttle run test. Markers of insulin resistance were fasting insulin and glucose, and homeostasis model assessment (HOMA). Results. HOMA and insulin were positively associated with BMI, skinfolds and waist circumference after controlling for center, age, pubertal status and cardiorespiratory fitness (all P ≤ 0.01). HOMA and insulin were negatively associated with cardiorespiratory fitness in adolescents with moderate to high levels of total and central body fat (all P ≤ 0.01). Conclusions. HOMA and insulin were associated with total and central body fat in European adolescents. Moreover, cardiorespiratory fitness explained a part of the HOMA and insulin variance in those adolescents with moderate to high levels of total and central body fat, and also, to some extent, in those with low to middle fat mass.
International journal of pediatric obesity: IJPO: an official journal of the International Association for the Study of Obesity 07/2011; 6(3-4):253-260. · 2.00 Impact Factor
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Juan P Rey-López,
Jonatan R Ruiz,
Francisco B Ortega,
Maite Verloigne,
German Vicente-Rodriguez,
Luis Gracia-Marco,
Frederic Gottrand,
Denes Molnar,
Kurt Widhalm, Maria Zaccaria,
Magdalena Cuenca-García,
Michael Sjöström,
Ilse De Bourdeaudhuij,
Luis A Moreno
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ABSTRACT: Although there is a growing interest in the epidemiology of sedentary behaviours, it is unknown whether sedentary behaviour questionnaires are broad markers of sedentary time. The aims of this study were to determine the: (i) reliability of the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) screen time-based sedentary behaviour questionnaire; and (ii) its validity, i.e. the ability of the questionnaire to correctly rank adolescents according to the objectively measured sedentary time.
A total of 183 adolescents (104 females aged 12.5-17.5 years) were involved in the reliability study. Participants completed the HELENA sedentary questionnaire twice (1 week apart). The validity study comprised 2048 (1212 females) adolescents (12.5-17.5 years of age) included in the HELENA cross-sectional study. Questions included television viewing, computer games, console games, Internet for study and non-study reasons and study during week and weekend days. We compared median values of sedentary time, using accelerometers, by tertiles of self-reported sedentary behaviours and their sum (composite sedentary score).
Reliability study: κ-values showed a good agreement (>0.7), except for Internet for study reasons (0.46 weekdays, 0.33 weekend). The questionnaire correctly classified boys' sedentary time when analysed by specific behaviours and by a composite sedentary score. In girls, median values of objectively measured sedentary time were not different across tertiles of self-reported sedentary behaviours or the composite sedentary score.
The HELENA sedentary questionnaire is reliable, yet only correctly classifies objectively measured sedentary time in boys.
The European Journal of Public Health 04/2011; 22(3):373-7. · 2.73 Impact Factor
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Charlene Ottevaere,
Inge Huybrechts,
Jasmin Benser,
Ilse De Bourdeaudhuij,
Magdalena Cuenca-Garcia,
Jean Dallongeville, Maria Zaccaria,
Frederic Gottrand,
Mathilde Kersting,
Juan P Rey-López,
Yannis Manios,
Dénes Molnár,
Luis A Moreno,
Emmanouel Smpokos,
Kurt Widhalm,
Stefaan De Henauw
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ABSTRACT: Evidence suggests possible synergetic effects of multiple lifestyle behaviors on health risks like obesity and other health outcomes. A better insight in the clustering of those behaviors, could help to identify groups who are at risk in developing chronic diseases. This study examines the prevalence and clustering of physical activity, sedentary and dietary patterns among European adolescents and investigates if the identified clusters could be characterized by socio-demographic factors.
The study comprised a total of 2084 adolescents (45.6% male), from eight European cities participating in the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) study. Physical activity and sedentary behavior were measured using self-reported questionnaires and diet quality was assessed based on dietary recall. Based on the results of those three indices, cluster analyses were performed. To identify gender differences and associations with socio-demographic variables, chi-square tests were executed.
Five stable and meaningful clusters were found. Only 18% of the adolescents showed healthy and 21% unhealthy scores on all three included indices. Males were highly presented in the cluster with high levels of moderate to vigorous physical activity (MVPA) and low quality diets. The clusters with low levels of MVPA and high quality diets comprised more female adolescents. Adolescents with low educated parents had diets of lower quality and spent more time in sedentary activities. In addition, the clusters with high levels of MVPA comprised more adolescents of the younger age category.
In order to develop effective primary prevention strategies, it would be important to consider multiple health indices when identifying high risk groups.
BMC Public Health 01/2011; 11:328. · 2.00 Impact Factor
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ABSTRACT: The goal of the present study was to assess the relationship between the genetic variability in six genes of methyl group (CH(3)) metabolism and the risk of obesity.
Single nucleotide polymorphisms (SNP) were selected among the methylene-tetrahydrofolate reductase (MTHFR), methionine synthase (MTR), methionine synthase reductase (MTRR), cystationine betha-syntase (CBS), transcobalamin-II (TCN2) and paraoxonase-1 (PON1) genes. The associations between SNPs and the risk of obesity were assessed in a case-control study of obese and normal-weight adolescents (age: 14.9±1.2 years), and the relationship between SNPs and body fat markers (i.e., body mass index [BMI], percentage body fat [BF%] and waist circumference [WC]) in a cross-sectional study of 1 155 European adolescents (age: 14.8±1.4 years). Genotyping was performed on an Illumina system and plasma folate level was determined by immunoassay.
In the case-control study, there was no evidence for any association between SNPs of MTHFR, MTR, CBS, TCN2 and PON1 and obesity (all p values ≥0.08). In contrast, two SNPs of MTRR were associated with a higher (rs10520873, Odds Ratio: 1.68 [1.18-2.39]; p=0.004) or lower (rs1801394, 0.61 [0.42-0.87]; p=0.007) risk of obesity. In the cross-sectional sample, rs1801394 was associated with lower BMI (p=0.03) and lower waist circumference (p=0.02). However, after Bonferroni correction these associations were no longer significant. No other significant association or interaction between folate levels and SNPs were detected for anthropometric variables.
Our findings do not support an association between MTHFR, MTR, CBS, TCN2 and PON1 SNPs and obesity in adolescence. Further investigations are necessary to confirm the possible association between the rs1801394 variant of MTRR and obesity.
International journal of pediatric obesity: IJPO: an official journal of the International Association for the Study of Obesity 10/2010; 6(2-2):e336-44. · 2.00 Impact Factor
