Using the intervention mapping protocol to reduce European preschoolers' sedentary behavior, an application to the ToyBox-study

Background: High levels of sedentary behavior are often measured in preschoolers, but only a few interventions have been developed to counteract this. Furthermore, detailed descriptions of interventions in preschoolers targeting different forms of sedentary behavior could not be located in the literature. The aim of the present paper was to describe the different steps of the Intervention Mapping Protocol used towards the development of an intervention component of the ToyBox-study focusing on decreasing preschoolers' sedentary behavior. The ToyBox-study focuses on the prevention of overweight in 4- to 6-year-old children by implementing a multi-component kindergarten-based intervention with family involvement in six different European countries. Methods: Applying the Intervention Mapping Protocol, six different steps were systematically completed for the structured planning and development of the intervention. A literature search and results from focus groups with parents/caregivers and kindergarten teachers were used as a guide during the development of the intervention and the intervention materials. Results: The application of the different steps in the Intervention Mapping Protocol resulted in the creation of matrices of change objectives, followed by the selection of practical applications for five different intervention tools that could be used at the individual level of the preschool child, at the interpersonal level (i.e., parents/caregivers) and at the organizational level (i.e., kindergarten teachers). No cultural differences regarding preschoolers' sedentary behavior were identified between the participating countries during the focus groups, so cultural and local adaptations of the intervention materials were not necessary to improve the adoption and implementation of the intervention. Conclusions: A systematic and evidence-based approach was used for the development of this kindergarten-based family-involved intervention targeting preschoolers, with the inclusion of parental involvement. The application of the Intervention Mapping Protocol may lead to the development of more effective interventions. The detailed intervention matrices that were developed as part of the ToyBox-study can be used by other researchers as an aid in order to avoid repetitive work for the design of similar interventions

Cost effectiveness review of text messaging, smartphone application, and website interventions targeting T2DM or hypertension

Digital health interventions have been shown to be clinically-effective for type 2 diabetes mellitus (T2DM) and hypertension prevention and treatment. This study synthesizes and compares the cost-effectiveness of text-messaging, smartphone application, and websites by searching CINAHL, Cochrane Central, Embase, Medline and PsycInfo for full economic or cost-minimisation studies of digital health interventions in adults with or at risk of T2DM and/or hypertension. Costs and health effects are synthesised narratively. Study quality appraisal using the Consensus on Health Economic Criteria (CHEC) list results in recommendations for future health economic evaluations of digital health interventions. Of 3056 records identified, 14 studies are included (7 studies applied text-messaging, 4 employed smartphone applications, and 5 used websites). Ten studies are cost-utility analyses: incremental cost-utility ratios (ICUR) vary from dominant to €75,233/quality-adjusted life year (QALY), with a median of €3840/QALY (interquartile range €16,179). One study finds no QALY difference. None of the three digital health intervention modes is associated with substantially better cost-effectiveness. Interventions are consistently cost-effective in populations with (pre)T2DM but not in populations with hypertension. Mean quality score is 63.0% (standard deviation 13.7%). Substandard application of time horizon, sensitivity analysis, and subgroup analysis next to transparency concerns (regarding competing alternatives, perspective, and costing) downgrades quality of evidence. In conclusion, smartphone application, text-messaging, and website-based interventions are cost-effective without substantial differences between the different delivery modes. Future health economic studies should increase transparency, conduct sufficient sensitivity analyses, and appraise the ICUR more critically in light of a reasoned willingness-to-pay threshold

Biomechanical explanation of W-plasty effectiveness using a finite element method approach

Abstract The finite element method has often been used to assist analyzing local flaps in terms of deformation and stress measurements as it takes into account complex skin properties. We, herein, present an isotropic two-dimensional finite element skin model applied to the W-plasty method to demonstrate that the good outcomes of W-plasty should be attributed to the geometry itself, as it generates lower stresses. The skin was modeled as a two-dimensional (2D) planar geometry. The model was created and solved as a plane stress problem. The model was based on simulation of the loading and stitching of W-plasties of various angles. Each central triangular flap was segmented in nine triangular elements. The stitching was modeled with one suture at the top of each triangular flap with the center of the opposite corner. X- and Y-axis stresses and shearing stresses Txy in the elements involved in the broken stitching line, show lower stresses than the elements behind the stitching line. Interestingly, in the triangular flaps, the stresses were clearly lower than those of their neighboring areas. The maximum compressive stresses in the 2D model we used, correspond to the dog ears. We conclude that the effectiveness of W-plasty should be attributed not only to the scar orientation in relation to the relaxed tension skin lines but also to the special design of the triangular flaps used. This finding assists the general understanding of the method and should be taken into account by the clinician during flap designing

Η μέθοδος των πεπερασμένων στοιχείων στην ανάλυση της σύγκλισης των δερματικών ελλειμμάτων με τοπικούς κρημνούς

Advances in computer technology allowed applications of the finite element method in the study of biomedical problems. The finite element method has been used by some authors in the study of skin detect closure. This study is an attempt to develop an elastic large deformation model for the design of local flaps. This study consists of two parts. The first part is the development of finite element model and the second is the application of the model in the analysis of local flaps. Our model incorporated large deformation analysis via a multistep method which involved the first order displacement gardients in the strain displacement formuli. Piglet skin samples were used in the accompanying in vitro experiments. Good correlation was observed between the numerical and experimental results. Despite of its limitations our model provides a practical tool for research and training in the design of local skin flaps.Η πρόοδοι στην τεχνολογία των Η/Υ επέτρεψαν την εφαρμογή της μεθόδου των πεπερασμένων στοιχείων στην βιοϊατρική επιστήμη. Η μάθοδος των πεπερασμένων στοιχείων χρησιμοποιήθηκε από κάποιους συγγραφείς στην ανάλυση των δερματικών ελλειμμάτων. Στη μελέτη αυτή επιχειρείται να αναπτυχθεί ένα μοτέλο μεγάλων παραμορφώσεων του δέρματος που να λαμβάνει υπόψη του την μη γραμμικότητα που εμφανίζεται σε αυτές. Αυτή η μελέτη είχε δυο μέρη. Το πρώτο ήταν η ανάπτυξη των μοντέλων και το δεύτερο η εφαρμογή του στην ανάλυση των τοπικών κρημνών. Το μοντέλο που αναπτύχθηκε χρησιμοποιεί μια πολυβηματική μέθοδο επίλυσης. Το δέρμα που χρησιμοποιήθηκε στα in vivo πειράματα ήταν χοιρινό. Κατά τις αναλύσεις διαπιστώθηκε συμφωνία των πειραματικών με τα θεωρητικά δεδομένα. Παρά τους περιορισμούς του το μοντέλο αυτό παρέχει ένα ισχυρό εργαλείο μελέτης και εκπαίδευσης στους τοπικούς κρήμνους

Computer-aided clinical image analysis for non-invasive assessment of tumor thickness in cutaneous melanoma

Abstract Objective Computerized clinical image analysis is shown to improve diagnostic accuracy for cutaneous melanoma but its effectiveness in preoperative assessment of melanoma thickness has not been studied. The aim of this study, is to explore how melanoma thickness correlates with computer-assisted objectively obtained color and geometric variables. All patients diagnosed with cutaneous melanoma with available clinical images prior to tumor excision were included in the study. All images underwent digital processing with an automated non-commercial software. The software provided measurements for geometrical variables, i.e., overall lesion surface, maximum diameter, perimeter, circularity, eccentricity, mean radius, as well as for color variables, i.e., range, standard deviation, coefficient of variation and skewness in the red, green, and blue color space. Results One hundred fifty-six lesions were included in the final analysis. The mean tumor thickness was 1.84 mm (range 0.2–25). Melanoma thickness was strongly correlated with overall surface area, maximum diameter, perimeter and mean lesion radius. Thickness was moderately correlated with eccentricity, green color and blue color. We conclude that geometrical and color parameters, as objectively extracted by computer-aided clinical image processing, may correlate with tumor thickness in patients with cutaneous melanoma. However, these correlations are not strong enough to reliably predict tumor thickness

Longitudinal modeling of adiposity in periadolescent Greek schoolchildren.

PURPOSE: Obesity has an etiology that is multidimensional in nature. Given the dearth of longitudinal data, we examined changes in adipose tissue (Ad) in relation to physical activity levels (PA), aerobic fitness (AF), and energy intake (EI) in Greek schoolchildren, as they progressed from age 12 to 14 yr. METHODS: This was a 2-yr and three-time-point (TP) study. Participants (N=210 (TP1); =204 (TP2); =198 (TP3)) were assessed for anthropometry, maturity status, Ad, PA, AF, and EI. Mean values were used for exploratory analyses, whereas two generalized estimating equations (GEE) models examined for longitudinal associations between the studied parameters. The first (GEE1) aimed to extract inherent associations between the dependent (Ad) and independent (PA, AF, EI) variables for the entire study period. For further evidence of association, the second analysis (GEE2) used the independent variables at TP1 and TP2 to predict the dependent variables at TP3. RESULTS: Levels of Ad in boys decreased significantly (P0.05) in girls. GEE1 revealed that longitudinal changes in Ad were significantly associated only with PA (beta=-0.16; P<0.001) and AF (beta=-0.09; P<0.05) for all schoolchildren. Similarly, GEE2 revealed that the main factors (at TP1 and TP2) predicting the development of Ad (at TP3) were PA (beta=-0.14; P<0.001) followed by AF (beta=-0.10; P<0.05). CONCLUSION: With respect to data presented, we established that longitudinal changes in Ad are mainly accompanied by changes in PA and, to a lesser extent, AF levels

A systematic review to identify behavioural models underpinning school-based interventions in pre-primary and primary settings for the prevention of obesity in children aged 4-6 years.

The aim of this comprehensive systematic review was to identify the most important behavioural models underpinning school-based interventions aimed at preventing or counteracting obesity in 4-6 year olds. Searching was conducted in April 2010, with relevant literature included in the review from 1995 up to and including the search date on MEDLINE, EMBASE, CINAHL, PsycINFO and The Cochrane Library. Epidemiological studies relevant to the research question with controlled assignment of participants were included in the review, if they had follow up periods of six months or longer. Outcomes included markers of weight gain; markers of body composition; physical activity behaviour changes and dietary behaviour changes. A total of twelve individual studies were included in review. The most commonly used model was Social Cognitive Theory (SCT)/Social Learning Theory (SLT) either as a single model or in combination with other behavioural models. Studies that used SCT/SLT in the development of the intervention had significant favourable changes in one, or more, outcome measures. Those interventions that combine (a) high levels of parental involvement and interactive school-based learning and (b) that target physical activity plus dietary change, require further consideration in the development of useful interventions for children aged 4-6 years old

Does an obesogenic family environment moderate the association between sports participation and body composition in children? The ENERGY project

Background: Previous research on the association between sports participation and body composition has shown mixed findings. The family home is considered one of the most influential environments on childhood obesity. Thus, the association between sports participation and body composition in children may be influenced by an obesogenic home environment. Objectives: To investigate if an obesogenic family environment moderates the association between sports participation and body composition in children. Methods: A total of 3999 children (54% girls; 11.6 ± 0.7 years) and their parent(s) were included from the ENERGY project. A composite obesogenic family environment risk score was created from 10 questionnaire items. Height, weight (to calculate body mass index), and waist circumference were obtained by trained researchers and used as indicators of body composition. Results: The composite risk score significantly moderated the association between sports participation and both waist circumference and body mass index. In children from families with moderate and high obesogenic risk, organized sports participation was significantly associated with smaller waist circumference (moderate risk: −0.29, 95% CI −0.45 to −0.14; high risk: −0.46, 95% CI −0.66 to −0.25) and lower body mass index (moderate risk: −0.10, 95% CI −0.16 to −0.04; high risk: −0.14, 95% CI −0.22 to −0.06), but not in children with a low obesogenic family risk score. Conclusions: Enrolling children in sports activities from an early age can be important for healthy weight maintenance, especially among children from obesogenic family environments