Objective: A large trial published in 2000 concluded that planned vaginal delivery of term breech births is associated with high neonatal risks. Because the obstetric practices in that study differed from those in countries where planned vaginal delivery is still common, we conducted an observational prospective study to describe neonatal outcome according to the planned mode of delivery for term breech births in 2 such countries. Study design: Observational prospective study with an intent-to-treat analysis to compare the groups for which cesarean and vaginal deliveries were planned. Associations between the outcome and planned mode of delivery were controlled for confounding by multivariate analysis. The main outcome measure was a variable that combined fetal and neonatal mortality and severe neonatal morbidity. The study population consisted of 8105 pregnant women delivering singleton fetuses in breech presentation at term in 138 French and 36 Belgian maternity units. Results: Cesarean delivery was planned for 5579 women (68.8%) and vaginal delivery for 2526 (31.2%). Of the women with planned vaginal deliveries, 1796 delivered vaginally (71.0%). The rate of the combined neonatal outcome measure was low in the overall population (1.59%; 95% CI [1.33-1.89]) and in the planned vaginal delivery group (1.60%; 95% CI [1.14-2.17]). It did not differ significantly between the planned vaginal and cesarean delivery groups (unadjusted odds ratio = 1.10, 95% CI [0.75-1.61]), even after controlling for confounding variables (adjusted odds ratio = 1.40, 95% CI [0.89-2.23]). Conclusion:In places where planned vaginal delivery is a common practice and when strict criteria are met before and during labor, planned vaginal delivery of singleton fetuses in breech presentation at term remains a safe option that can be offered to women. Keywords: Breech presentation Mode of delivery Neonatal morbidity Observational surveyVaginal deliveries for breech presentations have long been a topic of debate.1 The Term Breech Trial by Hannah et al, published in 2000, confirmed for many physicians that neonatal risks associated with term breech births are much higher among planned vaginal deliveries and implied that cesarean deliveries should be systematically planned for all such women. 2,3Vaginal delivery of breech infants remains standard practice in France. In 1998, the proportion of planned vaginal deliveries among term breech infants here was 51.2%, and 65.1% of this group actually delivered vaginally. 4 In 2000, the French College of Gynecologists and Obstetricians (CNGOF) defined the optimal criteria for deciding to attempt vaginal delivery (Table I). 5,6 Although the internal validity of Hannah's trial is irrefutable, some aspects raise questions about the extrapolation of its results to other settings. The absolute risk of mortality and serious perinatal morbidity for the planned vaginal birth group in countries with low perinatal mortality rates was high (5.7%), as was the difference between the 2 groups (14 times higher in ...

Implementing theory-based interventions is an effective way to influence physical activity (PA) behaviour in the population. This meta-analysis aimed to (1) determine the global effect of theory-based randomised controlled trials dedicated to the promotion of PA among adults, (2) measure the actual efficacy of interventions against their theoretical objectives and (3) compare the efficacy of single- versus combined-theory interventions. A systematic search through databases and review articles was carried out. Our results show that theory-based interventions (k = 82) significantly impact the PA behaviour of participants (d = 0.31, 95% CI [0.24, 0.37]). While moderation analyses revealed no efficacy difference between theories, interventions based on a single theory (d = 0.35; 95% CI [0.26, 0.43]) reported a higher impact on PA behaviour than those based on a combination of theories (d = 0.21; 95% CI [0.11, 0.32]). In spite of the global positive effect of theory-based interventions on PA behaviour, further research is required to better identify the specificities, overlaps or complementarities of the components of interventions based on relevant theories.

Background Patients with breast cancer undergoing chemotherapy and radiotherapy experience fatigue and other treatment side effects. Integrative therapies combining physical activity and dietary counseling are recommended; however to date no large randomized controlled trial has been conducted during adjuvant therapy. The Adapted Physical Activity and Diet (APAD) intervention was evaluated for its ability to decrease fatigue (primary outcome), anxiety, depression, body mass index (BMI), and fat mass, and enhance muscular and cognitive performances, and quality-of-life (QoL). Methods Women diagnosed with early breast cancer ( N = 143, mean age = 52 ± 10 years) were randomized to APAD or usual care (UC). APAD included thrice-weekly moderate-intensity mixed aerobic and resistance exercise sessions and 9 dietetic consultations. Patient-reported outcomes (PROs) and anthropometric, muscular, and cognitive variables were measured at baseline, 18 weeks (end of chemotherapy), and 26 weeks (end of radiotherapy and intervention), and at 6- and 12-month post-intervention follow-ups. Multi-adjusted linear mixed-effects models were used to compare groups over time. Results Significant beneficial effects of the APAD intervention were observed on all PROs (i.e., fatigue, QoL, anxiety, depression) at 18 and 26 weeks. The significant effect on fatigue and QoL persisted up to 12-month follow-up. Significant decreases in BMI, fat mass, and increased muscle endurance and cognitive flexibility were observed at 26 weeks, but did not persist afterward. Leisure physical activity was enhanced in the APAD group vs UC group at 18 and 26 weeks. No significant effect of the intervention was found on major macronutrients intake. Conclusions A combined diet and exercise intervention during chemotherapy and radiotherapy in patients with early breast cancer led to positive changes in a range of psychological, physiological and behavioral outcomes at the end of intervention. A beneficial effect persisted on fatigue and QoL at long term, i.e., 1 year post-intervention. Diet-exercise supportive care should be integrated into the management of early breast cancer patients. Trial registration The APAD study was prospectively registered on ClinicalTrials.gov ( NCT01495650 ; date of registration: December 20, 2011). Electronic supplementary material The online version of this article (10.1186/s12885-019-5896-6) contains supplementary material, which is available to authorized users.

Background: Human metabolism is influenced by dietary factors and lifestyle, environmental, and genetic factors; thus, men who exclude some or all animal products from their diet might have different metabolic profiles than meat eaters.Objective: We aimed to investigate differences in concentrations of 118 circulating metabolites, including acylcarnitines, amino acids, biogenic amines, glycerophospholipids, hexose, and sphingolipids related to lipid, protein, and carbohydrate metabolism between male meat eaters, fish eaters, vegetarians, and vegans from the Oxford arm of the European Prospective Investigation into Cancer and Nutrition.Design: In this cross-sectional study, concentrations of metabolites were measured by mass spectrometry in plasma from 379 men categorized according to their diet group. Differences in mean metabolite concentrations across diet groups were tested by using ANOVA, and a false discovery rate–controlling procedure was used to account for multiple testing. Principal component analysis was used to investigate patterns in metabolic profiles.Results: Concentrations of 79% of metabolites differed significantly by diet group. In the vast majority of these cases, vegans had the lowest concentration, whereas meat eaters most often had the highest concentrations of the acylcarnitines, glycerophospholipids, and sphingolipids, and fish eaters or vegetarians most often had the highest concentrations of the amino acids and a biogenic amine. A clear separation between patterns in the metabolic profiles of the 4 diet groups was seen, with vegans being noticeably different from the other groups because of lower concentrations of some glycerophospholipids and sphingolipids.Conclusions: Metabolic profiles in plasma could effectively differentiate between men from different habitual diet groups, especially vegan men compared with men who consume animal products. The difference in metabolic profiles was mainly explained by the lower concentrations of glycerophospholipids and sphingolipids in vegans.

Exercise intervention improved fatigue, depression, and QoL in patients with breast cancer receiving adjuvant therapy. Prescription of relatively low doses of exercise (<12 MET h/week) consisting in ∼90-120 min of weekly moderate physical exercise seems more efficacious in improving fatigue and QoL than higher doses.

ObjectiveAlthough metabolic profiles have been associated with chronic disease risk, lack of temporal stability of metabolite levels could limit their use in epidemiological investigations. The present study aims to evaluate the reliability over a two-year period of 158 metabolites and compare reliability over time in fasting and non-fasting serum samples.MethodsMetabolites were measured with the AbsolueIDQp180 kit (Biocrates, Innsbruck, Austria) by mass spectrometry and included acylcarnitines, amino acids, biogenic amines, hexoses, phosphatidylcholines and sphingomyelins. Measurements were performed on repeat serum samples collected two years apart in 27 fasting men from Turin, Italy, and 39 non-fasting women from Utrecht, The Netherlands, all participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Reproducibility was assessed by estimating intraclass correlation coefficients (ICCs) in multivariable mixed models.ResultsIn fasting samples, a median ICC of 0.70 was observed. ICC values were <0.50 for 48% of amino acids, 27% of acylcarnitines, 18% of lysophosphatidylcholines and 4% of phosphatidylcholines. In non-fasting samples, the median ICC was 0.54. ICC values were <0.50 for 71% of acylcarnitines, 48% of amino acids, 44% of biogenic amines, 36% of sphingomyelins, 34% of phosphatidylcholines and 33% of lysophosphatidylcholines. Overall, reproducibility was lower in non-fasting as compared to fasting samples, with a statistically significant difference for 19–36% of acylcarnitines, phosphatidylcholines and sphingomyelins.ConclusionA single measurement per individual may be sufficient for the study of 73% and 52% of the metabolites showing ICCs >0.50 in fasting and non-fasting samples, respectively. ICCs were higher in fasting samples that are preferable to non-fasting.

Metabolomics is now widely used to characterize metabolic phenotypes associated with lifestyle risk factors such as obesity. The objective of the present study was to explore the associations of body mass index (BMI) with 145 metabolites measured in blood samples in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Metabolites were measured in blood from 392 men from the Oxford (UK) cohort (EPIC-Oxford) and in 327 control subjects who were part of a nested case-control study on hepatobiliary carcinomas (EPIC-Hepatobiliary). Measured metabolites included amino acids, acylcarnitines, hexoses, biogenic amines, phosphatidylcholines, and sphingomyelins. Linear regression models controlled for potential confounders and multiple testing were run to evaluate the associations of metabolite concentrations with BMI. 40 and 45 individual metabolites showed significant differences according to BMI variations, in the EPIC-Oxford and EPIC-Hepatobiliary subcohorts, respectively. Twenty two individual metabolites (kynurenine, one sphingomyelin, glutamate and 19 phosphatidylcholines) were associated with BMI in both subcohorts. The present findings provide additional knowledge on blood metabolic signatures of BMI in European adults, which may help identify mechanisms mediating the relationship of BMI with obesity-related diseases.

PurposeThe aim of this study was to examine whether the efficacy of transtheoretical model (TTM)-based interventions on physical activity (PA) varied according to the following criteria: (1) interventions targeted the actual stages of change (SOCs) or did not; (2) participants were selected according to their SOC or were not; and (3) its theoretical constructs (decisional balance, temptation, self-efficacy, processes of change).MethodsThirty-three randomized controlled trials assessing TTM-based interventions promoting PA in adults were systematically identified.ResultsThe between-group heterogeneity statistic (Qb) did not reveal any differential efficacy either in interventions targeting the actual SOC compared with those that did not (Qb = 1.48, p = 0.22) or in interventions selecting participants according to their SOC compared with those that did not (Qb = 0.01, p = 0.91). TTM-based interventions enhanced PA behavior whether they targeted the actual SOC (Cohen's d = 0.36; 95% confidence interval (CI): 0.22–0.49) or not (d = 0.23; 95%CI: 0.09–0.38) and whether they selected their participants according to their SOC (d = 0.33; 95%CI: 0.13–0.53) or not (d = 0.32; 95%CI: 0.19–0.44). The moderators of the efficacy of TTM-based interventions were the number of theoretical constructs used to tailor the intervention (Qb = 8.82, p = 0.003), the use of self-efficacy (Qb = 6.09, p = 0.01), and the processes of change (Qb = 3.51, p = 0.06).ConclusionTTM-based interventions significantly improved PA behavior, and their efficacy was not moderated by SOC but by the TTM theoretical constructs.