Development and implementation of a lifestyle intervention to promote physical activity and healthy diet in the Dutch general practice setting: the BeweegKuur programme

<p>Abstract</p> <p>Background</p> <p>The number of patients with diabetes is increasing. BeweegKuur (Dutch for 'Exercise Therapy') is a Dutch lifestyle intervention which aims to effectively and feasibly promote physical activity and better dietary behaviour in primary health care to prevent diabetes.</p> <p>Methods</p> <p>The goal of this paper is to present the development process and the contents of the intervention, using a model of systematic health promotion planning. The intervention consists of a 1-year programme for diabetic and prediabetic patients. Patients are referred by their general practitioner (GP) to a lifestyle advisor (LSA), usually the practice nurse or a physiotherapist. Based on specific inclusion criteria and in close collaboration with the patient, an individual exercise programme is designed and supervised by the LSA. This programme can be attended at existing local exercise facilities or (temporarily) under the supervision of a specialized exercise coach or physiotherapist. All participants are also referred to a dietician and receive diet-related group education. In the first pilot year (2008), the BeweegKuur programme was implemented in 7 regions in the Netherlands (19 GP practices and health centres), while 14 regions (41 GP practices and health centres) participated during the second year. The aim is to implement BeweegKuur in all regions of the Netherlands by 2012.</p> <p>Discussion</p> <p>The BeweegKuur programme was systematically developed in an evidence- and practice-based process. Formative monitoring studies and (controlled) effectiveness studies are needed to examine the diffusion process and the effectiveness and cost-effectiveness of the intervention.</p

Self-reported knowledge, correct knowledge and use of UK drinking guidelines among a representative sample of the English population

Aims: Promotion of lower risk drinking guidelines is a commonly used public health intervention with various purposes, including communicating alcohol consumption risks, informing drinkers' decision-making and, potentially, changing behaviour. UK drinking guidelines were revised in 2016. To inform potential promotion of the new guidelines, we aimed to examine public knowledge and use of the previous drinking guidelines, including by population subgroup. Methods: A demographically representative, cross-sectional online survey of 2100 adults living in England in July 2015 (i.e. two decades after adoption of previous guidelines and prior to introduction of new guidelines). Univariate and multivariate logistic regressions examined associations between demographic variables, alcohol consumption (AUDIT-C), smoking, and knowledge of health conditions and self-reported knowledge and use of drinking guidelines. Multinomial logistic regression examined the same set of variables in relation to accurate knowledge of drinking guidelines (underestimation, accurate-estimation, overestimation). Results: In total, 37.8% of drinkers self-reported knowing their own-gender drinking guideline, of whom 66.2% gave an accurate estimate. Compared to accurate estimation, underestimation was associated with male gender, lower education and AUDIT-C score, while overestimation was associated with smoking. Few (20.8%) reported using guidelines to monitor drinking at least sometimes. Drinking guideline use was associated with higher education, overestimating guidelines and lower AUDIT-C. Correctly endorsing a greater number of health conditions as alcohol-related was associated with self-reported knowledge of guidelines, but was not consistently associated with accurate estimation or use to monitor drinking. Conclusions: Two decades after their introduction, previous UK drinking guidelines were not well known or used by current drinkers. Those who reported using them tended to overestimate recommended daily limits. SHORT SUMMARY: We examined public knowledge and use of UK drinking guidelines just before new guidelines were released (2016). Despite previous guidelines being in place for two decades, only one in four drinkers accurately estimated these, with even fewer using guidelines to monitor drinking. Approximately 8% of drinkers overestimated maximum daily limits

New national alcohol guidelines in the UK: public awareness, understanding and behavioural intentions

Background: Alcohol consumption places a significant burden on the NHS and is an important risk factor for cancer, associated with 12 800 UK cases/year. New alcohol guidelines were published in 2016, taking into account the increasing evidence of the health harms of alcohol. Methods: A survey of the UK drinker population (n = 972) was conducted 1 week before and 1 month after the release of the guidelines to capture drinking habits, guideline awareness and intended behaviour change. Results: Overall, 71% were aware of the new alcohol guidelines, however, just 8% knew what the recommended limits were. Higher socioeconomic groups were more likely to know these limits (ABC1 = 9% versus C2DE = 4%, P = 0.009). Participants who recognized the message that alcohol causes cancer were more likely to correctly identify the new guidelines (message recognition = 12% versus no recognition = 6%, P = 0.004); and were more likely to self-report an intention to reduce their alcohol consumption (message recognition = 10% versus no recognition = 6%, P = 0.01). Conclusion: The majority of the population knew the guidelines had been updated, however, communication of the new limits needs to be improved. Raising awareness of the links between alcohol and cancer may improve understanding of alcohol guidelines and could prompt behaviour change for those motivated to reduce their alcohol consumption

Coping with methodological dilemmas; about establishing the effectiveness of interventions in routine medical practice

BACKGROUND: The aim of this paper is to show how researchers balance between scientific rigour and localisation in conducting pragmatic trial research. Our case is the Quattro Study, a pragmatic trial on the effectiveness of multidisciplinary patient care teams used in primary health care centres in deprived neighbourhoods of two major cities in the Netherlands for intensified secondary prevention of cardiovascular diseases. METHODS: For this study an ethnographic design was used. We observed and interviewed the researchers and the practice nurses. All gathered research documents, transcribed observations and interviews were analysed thematically. RESULTS: Conducting a pragmatic trial is a continuous balancing act between meeting methodological demands and implementing a complex intervention in routine primary health care. As an effect, the research design had to be adjusted pragmatically several times and the intervention that was meant to be tailor-made became a rather stringent procedure. CONCLUSION: A pragmatic trial research is a dynamic process that, in order to be able to assess the validity and reliability of any effects of interventions must also have a continuous process of methodological and practical reflection. Ethnographic analysis, as we show, is therefore of complementary value

Internal medicine specialists' attitudes towards working part-time: a comparison between 1996 and 2004

BACKGROUND: Although medical specialists traditionally hold negative views towards working part-time, the practice of medicine has evolved. Given the trend towards more part-time work and that there is no evidence that it compromises the quality of care, attitudes towards part-time work may have changed as well in recent years. The aim of this paper was to examine the possible changes in attitudes towards part-time work among specialists in internal medicine between 1996 and 2004. Moreover, we wanted to determine whether these attitudes were associated with individual characteristics (age, gender, investments in work) and whether attitudes of specialists within a partnership showed more resemblance than specialists' attitudes from different partnerships. METHODS: Two samples were used in this study: data of a survey conducted in 1996 and in 2004. After selecting internal medicine specialists working in general hospitals in The Netherlands, the sample consisted of 219 specialists in 1996 and 363 specialists in 2004. They were sent a questionnaire, including topics on the attitudes towards part-time work. RESULTS: Internal medicine specialists' attitudes towards working part-time became slightly more positive between 1996 and 2004. Full-time working specialists in 2004 still expressed concerns regarding the investments of part-timers in overhead tasks, the flexibility of task division, efficiency, communication and continuity of care. In 1996 gender was the only predictor of the attitude, in 2004 being a full- or a part-timer, age and the time invested in work were associated with this attitude. Furthermore, specialists' attitudes were not found to cluster much within partnerships. CONCLUSION: In spite of the increasing number of specialists working or preferring to work part-time, part-time practice among internal medicine specialists seems not to be fully accepted. The results indicate that the attitudes are no longer gender based, but are associated with age and work aspects such as the number of hours worked. Though there is little evidence to support them, negative ideas about the consequences of part-time work for the quality of care still exist. Policy should be aimed at removing the organisational difficulties related to part-time work and create a system in which part-time practice is fully integrated and accepted

Seksueel overdraagbare aandoeningen, waaronder hiv, in Nederland in 2016

In 2016, the number of people who were tested at a Dutch STI clinic for a sexually transmitted infection (STI) increased, after a decrease in 2015. The percentage of people diagnosed with an STI has also increased, to 18.4 percent in 2016. It is estimated that the number of STI consultations at the general practitioner has decreased slightly. Chlamydia remains the most common STI in heterosexuals. Gonorrhoea is more common than chlamydia in men who have sex with men (MSM). STI clinics offer high-risk groups the opportunity for free STI testing. In 2016, a total of 143,139 consultations were registered at the STI clinics, an increase of 5 percent compared to 2015. The percentage of detected STIs varied per municipal health centre (GGD), ranging from 12.8 to 20.9 percent. Most STIs were detected in people infected with HIV, followed by people who had been notified for an STI. Chlamydia In 2016, 14.5 percent of STI clinic attendees were infected with chlamydia (20,698 diagnoses; an increase of 11 percent compared to the previous year). This increase can be explained in part because, since 2015, STI clinics more strictly prioritise people with a high risk of STI. The biggest increase was seen in heterosexual men (from 16.1 in 2015 to 18.0 percent in 2016). In women, the percentage of chlamydia diagnoses increased from 14.2 to 15.4. In MSM, the percentage has been stable around 10 percent for years. Gonorrhoea The number of gonorrhoea diagnoses at the STI clinics has risen in the past year with 13 percent, to 6,092 infections. The percentage of positive tests in heterosexual men (1.7 percent) and women (1.4 percent) remained stable, compared to previous years. In MSM, the percentage has increased from 10.7 percent in 2015 to 11.3 percent in 2016. The STI clinics have not yet found cases of gonorrhoea resistant to the first option antibiotic, Ceftriaxone. The number of gonorrhoea infections diagnosed by general practitioners in 2015 saw a slight decline among women, but an increase among men of 20 percent compared to 2014. Syphilis In 2016, the number of syphilis diagnoses increased by 30 percent compared to 2015, totalling 1,223 infections. This increase is mainly caused by an increase in the number of diagnoses in MSM, both those with and without HIV. Out of all syphilis infections, 95 percent was diagnosed in MSM. The percentage of positive diagnoses in heterosexual men and women remains very low; 0.19 and 0.07 percent of all consultations that tested for syphilis, respectively. HIV In 2016, 285 new HIV diagnoses were detected at the STI clinics, approximately the same number as in 2015 (288); 93 percent was detected in MSM. The percentage of HIV diagnoses in MSM decreased, from 2.8 percent in 2007 to 0.8 percent in 2016. The number of HIV patients that had their 'first care' encounter at a Dutch HIV treatment centre decreased again, from 1,033 cases in 2015 to 976 in 2016. Out of these people, 666 received their diagnosis in 2016Het aantal mensen dat zich bij een Centrum Seksuele Gezondheid (CSG) heeft laten testen op een seksueel overdraagbare aandoening (soa) is, na een daling in 2015, in 2016 weer toegenomen. Het percentage bij wie een soa werd vastgesteld is ook gestegen, tot 18,4 procent in 2016. Naar schatting is het aantal soa-consulten bij huisartsen licht gedaald. Chlamydia blijft de meest voorkomende soa onder heteroseksuelen. Onder mannen die seks hebben met mannen (MSM) werd vaker gonorroe dan chlamydia gevonden. De CSG's bieden hoog-risicogroepen de mogelijkheid om zich gratis te laten testen op soa's. In totaal zijn er in 2016 143.139 consulten geregistreerd bij de CSG's, een stijging van 5 procent ten opzichte van 2015. Het percentage gevonden soa's varieerde tussen de GGD-en; van 12,8 tot 20,9. De meeste soa's zijn gevonden bij mensen met hiv, gevolgd door mensen die waren gewaarschuwd voor een soa. Chlamydia In 2016 had 14,5 procent van de CSG-bezoekers een chlamydia-infectie (20.698 diagnoses; een toename van 11 procent ten opzichte van het jaar ervoor). Deze stijging is mogelijk deels te verklaren doordat GGD-en sinds 2015 eerder voorrang verlenen aan personen met hoog risico op soa. De grootste toename was te zien bij heteroseksuele mannen (van 16,1 in 2015 naar 18,0 procent in 2016). Bij vrouwen nam het percentage vastgestelde chlamydia toe van 14,2 naar 15,4. Onder MSM ligt dit percentage al jaren rond 10 procent. Gonorroe Het aantal gonorroe-diagnoses bij de CSG is het afgelopen jaar met 13 procent toegenomen tot 6.092 infecties. Het percentage positieven onder heteroseksuele mannen (1,7 procent) en vrouwen (1,4 procent) bleef stabiel ten opzichte van voorgaande jaren. Onder MSM is het percentage toegenomen van 10,7 procent in 2015 naar 11,3 procent in 2016. Bij CSG-bezoekers is nog steeds geen gonorroe resistent gevonden tegen het 'eerstekeus' antibioticum ceftriaxon. Het aantal gonorroe-infecties gediagnosticeerd door huisartsen in 2015 nam licht af onder vrouwen, maar steeg onder mannen met 20 procent ten opzichte van 2014. Syfilis In 2016 is het aantal diagnoses van syfilis met 30 procent gestegen ten opzichte van 2015, tot 1.223 infecties. Deze stijging komt voornamelijk door een toename in het aantal diagnoses onder MSM, zowel met als zonder hiv. Van alle syfilis-infecties werd 95 procent bij MSM vastgesteld. Het percentage positieve diagnoses onder heteroseksuele mannen en vrouwen blijft zeer laag; respectievelijk 0,19 en 0,07 procent van alle consulten waarin getest werd op syfilis. Hiv In 2016 zijn 285 nieuwe diagnoses van hiv gesteld bij de CSG, vrijwel evenveel als in 2015 (288). Drieënnegentig procent daarvan werd bij MSM vastgesteld. Het percentage hiv-diagnoses bij MSM is gedaald van 2,8 procent in 2007 tot 0,8 procent in 2016. Het aantal hiv-patiënten dat voor het eerst 'in zorg' was bij de Nederlandse hiv-behandelcentra daalde opnieuw, van 1.033 gevallen in 2015 tot 976 in 2016. Van hen hadden 666 personen de diagnose in 2016 gekregenMinisterie van VW

A common root for coevolution and substitution rate variability in protein sequence evolution

We introduce a simple model that describes the average occurrence of point variations in a generic protein sequence. This model is based on the idea that mutations are more likely to be fixed at sites in contact with others that have mutated in the recent past. Therefore, we extend the usual assumptions made in protein coevolution by introducing a time dumping on the effect of a substitution on its surrounding and makes correlated substitutions happen in avalanches localized in space and time. The model correctly predicts the average correlation of substitutions as a function of their distance along the sequence. At the same time, it predicts an among-site distribution of the number of substitutions per site highly compatible with a negative binomial, consistently with experimental data. The promising outcomes achieved with this model encourage the application of the same ideas in the field of pairwise and multiple sequence alignment

How Distinctive are ADHD and RD? Results of a Double Dissociation Study

The nature of the comorbidity between Attention-Deficit/Hyperactivity Disorder (ADHD) and Reading Disability (RD) was examined using a double dissociation design. Children were between 8 and 12 years of age and entered into four groups: ADHD only (n = 24), ADHD+RD (n = 29), RD only (n = 41) and normal controls (n = 26). In total, 120 children participated in the study; 38 girls and 82 boys. Both ADHD and RD were associated with impairments in inhibition and lexical decision, although inhibition and lexical decision were more severely impaired in RD than in ADHD. Visuospatial working memory deficits were specific to children with only ADHD. It is concluded that there was overlap on lexical decision and to a lesser extent on inhibition between ADHD and RD. In ADHD, impairments were dependent on IQ, which suggest that the overlap in lexical decision and inhibition is different in origin for ADHD and RD. The ADHD only group was specifically characterized by deficits in visuospatial working memory. Hence, no double dissociation between ADHD and RD was found on executive functioning and lexical decision

A hybrid BAC physical map of potato: a framework for sequencing a heterozygous genome

<p>Abstract</p> <p>Background</p> <p>Potato is the world's third most important food crop, yet cultivar improvement and genomic research in general remain difficult because of the heterozygous and tetraploid nature of its genome. The development of physical map resources that can facilitate genomic analyses in potato has so far been very limited. Here we present the methods of construction and the general statistics of the first two genome-wide BAC physical maps of potato, which were made from the heterozygous diploid clone RH89-039-16 (RH).</p> <p>Results</p> <p>First, a gel electrophoresis-based physical map was made by AFLP fingerprinting of 64478 BAC clones, which were aligned into 4150 contigs with an estimated total length of 1361 Mb. Screening of BAC pools, followed by the KeyMaps <it>in silico </it>anchoring procedure, identified 1725 AFLP markers in the physical map, and 1252 BAC contigs were anchored the ultradense potato genetic map. A second, sequence-tag-based physical map was constructed from 65919 whole genome profiling (WGP) BAC fingerprints and these were aligned into 3601 BAC contigs spanning 1396 Mb. The 39733 BAC clones that overlap between both physical maps provided anchors to 1127 contigs in the WGP physical map, and reduced the number of contigs to around 2800 in each map separately. Both physical maps were 1.64 times longer than the 850 Mb potato genome. Genome heterozygosity and incomplete merging of BAC contigs are two factors that can explain this map inflation. The contig information of both physical maps was united in a single table that describes hybrid potato physical map.</p> <p>Conclusions</p> <p>The AFLP physical map has already been used by the Potato Genome Sequencing Consortium for sequencing 10% of the heterozygous genome of clone RH on a BAC-by-BAC basis. By layering a new WGP physical map on top of the AFLP physical map, a genetically anchored genome-wide framework of 322434 sequence tags has been created. This reference framework can be used for anchoring and ordering of genomic sequences of clone RH (and other potato genotypes), and opens the possibility to finish sequencing of the RH genome in a more efficient way via high throughput next generation approaches.</p

Can psychosocial and socio-demographic questions help identify sexual risk among heterosexually-active women of reproductive age? Evidence from Britain’s third National Survey of Sexual Attitudes and Lifestyles (Natsal-3)

Background: Contraceptive advice and supply (CAS) and sexually transmitted infection (STI) testing are increasingly provided in primary care. Most risk assessment tools are based on sexual risk behaviours and socio-demographics, for use online or in specialist services. Combining socio-demographic and psychosocial questions (e.g. religious belief and formative experience) may generate an acceptable tool for targeting women in primary care who would benefit from intervention. We aimed to identify psychosocial and socio-demographic factors associated with reporting key sexual risk behaviours among women in the British general population. Methods: We undertook complex survey analysis of data from 4,911 hetero-sexually active women aged 16-44 years, who participated in Britain’s third National Survey of Sexual Attitudes and Lifestyles (Natsal-3), a national probability sample survey undertaken 2010-2012. We used multivariable regression to examine associations between the available psychosocial and socio-demographic variables in Natsal-3 and reports of 3 key sexual behaviours: a) 2+ partners in the last year (2PP); b) non-use of condoms with 2+ partners in the last year (2PPNC); c) non-use of condoms at first sex with most recent sexual partner (FSNC). We adjusted for key socio-demographic factors: age, ethnicity and socio-economic status (measured by housing tenure). Results: Weekly binge drinking (6+ units on one occasion), and first sex before age 16 were each positively associated with all three sexual behaviours after adjustment. Current relationship status, reporting drug use (ever), younger age and living in rented accommodation were also associated with 2+ partners and 2+partners without condoms after adjustment. Currently being a smoker, older age and respondent ethnicity were associated with FSNC after adjustment for all other variables. Current smoking status, treatment for depression (last year), and living at home with both parents until the age of 14 were each associated with 1 or more of the behaviours. Conclusions: Reported weekly binge drinking, early sexual debut, and age group may help target STI testing and/or CAS among women. Further research is needed to examine the proportion of sexual risk explained by these factors, the acceptability of these questions to women in primary care and the need to customise them for community and other settings