Using a gamified monitoring app to change adolescents' snack intake : the development of the REWARD app and evaluation design

Background: As the snacking pattern of European adolescents is of great concern, effective interventions are necessary. Till now health promotion efforts in children and adolescents have had only limited success in changing adolescents' eating patterns and anthropometrics. Therefore, the present study proposes an innovative approach to influence dietary behaviors in youth based on new insights on effective behavior change strategies and attractive intervention channels to engage adolescents. This article describes the rationale, the development, and evaluation design of the 'Snack Track School' app. The aim of the app is to improve the snacking patterns of Flemish 14- to 16-year olds. Methods: The development of the app was informed by the systematic, stepwise, iterative, and collaborative principles of the Intervention Mapping protocol. A four week mHealth intervention was developed based on the dual-system model with behavioral change strategies targeting both the reflective (i.e., active learning, advance organizers, mere exposure, goal-setting, monitoring, and feedback) and automatic processes (i.e., rewards and positive reinforcement). This intervention will be evaluated via a controlled pre-post design in Flemish schools among 1400 adolescents. Discussion: When this intervention including strategies focused on both the reflective and automatic pathway proves to be effective, it will offer a new scientifically-based vision, guidelines and practical tools for public health and health promotion (i.e., incorporation of learning theories in intervention programs)

Simultane Behandlung von obliterativen Karotispathologien und koronarer Herzkrankheit: Aktuelles Konzept und Resultate der letzten 5Jahre

Zusammenfassung: Einführung: Die kombinierte Karotisendarteriektomie und aorto-coronare Baypassoperation (C-CABG) weisen ein hohes peri-operatives Risiko auf. Als Alternative wird in letzter Zeit das Stenting der Artera carotis interna propagiert. Das Fehlen von Level I Evidenz hat uns motiviert, die Resultate unserer C-CABG der letzten 5 Jahre zu evaluieren. Methoden und Patienten: Retrospektive Monozenterstudie von 113C-CABG, durchgeführt zwischen Januar 2000 und Dezember 2004. Das mediane Alter der Patienten betrug 65Jahre (22Patienten waren 80Jahre alt oder älter). Die Karotisendarteriektomie wurde vor der aortokoronaren Bypassoperation in derselben Narkose durchgeführt. Resultate: Die 30-Tages-Mortalität war ausschließlich kardial bedingt und betrug 4,4% (5/113). Die neurologischen Komplikationen waren ein Schlaganfall, der innerhalb von 30Tagen vollständig regredient war, und 3TIA (3,5%, 4/113). Schlussfolgerung: C-CABG mit initial durchgeführter Karotisendarteriektomie ist ein sicheres Verfahren mit niedriger neurologischer Komplikationsrate. Der riskante Anteil des kombinierten Eingriffs ist nicht die Karotisendarteriektomie, sondern die aortokoronare Revaskularisation. Demzufolge scheint das Stenting beim kombinierten Eingriff als Alternative nicht gerechtfertigt, solange keine klaren Vorteile hinsichtlich der Früh- und Langzeitresultate gegenüber der alleinigen Karotisendarteriektomie vorliege

Predictors of complications in acute type B aortic dissection

Objectives: Medical treatment is generally advocated for patients with acute type B aortic dissection without complications. The objective of this retrospective analysis was to determine whether there are any initial findings that can help predict the long-term course of the disease. Methods: Case records of the 130 patients treated for type B aortic dissection between 1988 and 1997 were reviewed; 41 (31%) were operated on in the acute phase (≪14 days), 31 (24%) were operated on in the chronic phase and 58 (45%) were treated medically. Results: Overall acute mortality was 10.8%; 22% for patients operated on in the early phase and 5.6% for medically treated patients. Age (P=0.002), persistent pain (P=0.01) and malperfusion (P=0.001) were significant independent predictors of the need for surgery. Paraplegia/para paresis (P=0.0001), leg ischaemia (P=0.003), pleural effusion (P=0.003), rupture (P=0.0001), shock (P=0.0001), age (P=0.003), cardiac failure (P=0.002) and aortic diameter ≫4.5cm (P=0.002) were significant predictors of poor survival. Age and shock also emerged as independent risk factors. Patients without malperfusion (P=0.0001), pleural effusion (P=0.003), rupture (P=0.0001) and shock (P=0.0001) had a significantly better event-free survival (freedom from repeat surgery and death). The actuarial survival rate for high-risk patients (malperfusion, rupture, shock) was 62% at 1 year and 40% at 5 years; the corresponding values for low-risk patients were 94 and 84%, respectively. Conclusions: Rupture, shock and malperfusion are significant predictors of poor survival in patients with acute type B aortic dissectio

High field brain proton magnetic resonance spectroscopy and volumetry in children with chronic, compensated liver disease - A pilot study.

There is increasing evidence that children or young adults having acquired liver disease in childhood display neurocognitive impairment which may become more apparent as they grow older. The molecular, cellular and morphological underpinnings of this clinical problem are incompletely understood. Therefore, we used the advantages of highly-resolved proton magnetic resonance spectroscopy at ultra-high magnetic field to analyze the neurometabolic profile and brain morphometry of children with chronic, compensated liver disease, hypothesizing that with high field spectroscopy we would identify early evidence of rising brain glutamine and decreased myoinositol, such as has been described both in animals and humans with more significant liver disease. Patients (n = 5) and age-matched controls (n = 19) underwent 7T MR scans and short echo time <sup>1</sup> H MR spectra were acquired using the semi-adiabatic SPECIAL sequence in two voxels located in gray and white matter dominated prefrontal cortex, respectively. A 3D MP2RAGE sequence was also acquired for brain volumetry and T <sub>1</sub> mapping. Liver disease had to have developed at least 6 months before entering the study. Subjects underwent routine blood analysis and neurocognitive testing using validated methods within 3 months of MRI and MRS. Five children aged 8-16 years with liver disease acquired in childhood were included. Baseline biological characteristics were similar among patients. There were no statistically significant differences between subjects and controls in brain metabolite levels or brain volumetry. Finally, there were minor neurocognitive fluctuations including attention deficit in one child, but none fell in the statistically significant range. Children with chronic, compensated liver disease did not display an abnormal neurometabolic profile, neurocognitive abnormalities, or signal intensity changes in the globus pallidus. Despite the absence of neurometabolic changes, it is an opportunity to emphasize that it is only by developing the use of <sup>1</sup> H MRS at high field in the clinical arena that we will understand the significance and generalizability of these findings in children with CLD. Healthy children displayed neurometabolic regional differences as previously reported in adult subjects

Post-harvest interventions decrease aflatoxin and fumonisin contamination in maize and subsequent dietary exposure in Tanzanian infants : a cluster randomised-controlled trial

A cluster randomised controlled trial was performed in three agro-ecological zones of Tanzania to evaluate the effectiveness of locally available post-harvest mitigation strategies in preventing and reducing aflatoxin and fumonisin contamination in maize. A total of 300 children, each from one household, were randomly selected from 30 villages (intervention: n=15). The mitigation strategies focused on hand sorting (prior to storage and use), drying maize on mat/raised platforms, proper sun drying, application of storage insecticides and de-hulling before milling. Maize sample was collected from each household at harvest (baseline) and six months after harvest. Maize intake by each child, estimated using the 24 h dietary recall technique and its body weight measured using standard procedures were taken at six months after harvest. Aflatoxins and fumonisins in the maize samples were determined using HPLC. Follow-up (six month after harvest) data were available for 261 of the 300 households (intervention: n=136). Mean concentration of aflatoxins, or fumonisins was significantly (P<0.05) lower in the intervention than in the control group: intervention effects: mu g/kg (95% confidence interval (CI)) -4.9 (-7.3,-2.5), and -405, (-647,-162), respectively. The difference corresponds to 83 and 70% for aflatoxins, and fumonisins, respectively. At the end of the intervention, aflatoxin and fumonisin estimated mean intakes were lower in the intervention than in the control group by 78 and 65%, respectively. Six months after harvest, prevalence of underweight in the intervention group was 6.7% lower (P=0.014) than in the control group. Mean weight-for-age Z-score difference between the groups was 0.57 (95% CI; 0.16,-0.98; P=0.007). Post-harvest practices are effective in preventing and reducing aflatoxin and fumonisin contamination in maize and subsequent dietary exposure to infants. The interventions may be applied in these and other communities with similar environmental conditions or agricultural practices that favour production of aflatoxin and fumonisins in food crops

Long-term results of simplified frozen elephant trunk technique in complicated acute type A aortic dissection: A case–control study

Aim: To describe the long-term experience of a simplified frozen elephant trunk technique (sFETT) used in complicated acute type A aortic dissection (AAAD) treatment. Methods and results: Between January 2001 and December 2012, 34 patients (mean age 59.9 ± 11.0 years) with complicated AAAD (DeBakey I) underwent an emergency surgery including sFETT. sFETT consisted in gluing the dissected aortic arch wall layers with gelatine-resorcinol adhesive and video-assisted antegrade open arch aortic stent-graft deployment in the arch or proximal descending aorta. In addition to sFETT, the aortic root was addressed with standard techniques. A 30-day mortality was 14.7% (five patients) due to bleeding (1), multiple organ failure (2), and colon ischemia (2). Postoperative morbidity included neurological (2), renal (1) and cardio-pulmonary complications (4), as well as wound infection (1). Mean follow-up was 74.4 ± 45.0 months. Actual survival rates were 73.5% at 1 year, 70.2% at 5 years, and 58.5% at 13 years of follow-up. Six patients died during long-term follow-up from heart failure (1) and unknown reasons (5). Five patients required reoperation for aortic arch (3) or aorto-iliac (2) progression of aneurysm during the mid- and long-term follow-up. The remaining patients showed favorable evolution of the dissected aorta with false lumen occlusion in most cases and stable aortic diameters. Conclusions: In AAAD patients, sFETT as used in our series is an easy and safe technique to repair the aortic arch. Long-term results after sFETT showed false lumen occlusion and stable aortic diameter in up to 13 years of follow-up

Diet and Physical Activity for the Prevention of Noncommunicable Diseases in Low- and Middle-Income Countries: A Systematic Policy Review

Background: Diet-related noncommunicable diseases (NCDs) are increasing rapidly in low-and middle-income countries (LMICs) and constitute a leading cause of mortality. Although a call for global action has been resonating for years, the progress in national policy development in LMICs has not been assessed. This review of strategies to prevent NCDs in LMICs provides a benchmark against which policy response can be tracked over time. Methods and Findings: We reviewed how government policies in LMICs outline actions that address salt consumption, fat consumption, fruit and vegetable intake, or physical activity. A structured content analysis of national nutrition, NCDs, and health policies published between 1 January 2004 and 1 January 2013 by 140 LMIC members of the World Health Organization (WHO) was carried out. We assessed availability of policies in 83% (116/140) of the countries. NCD strategies were found in 47% (54/116) of LMICs reviewed, but only a minority proposed actions to promote healthier diets and physical activity. The coverage of policies that specifically targeted at least one of the risk factors reviewed was lower in Africa, Europe, the Americas, and the Eastern Mediterranean compared to the other two World Health Organization regions, South-East Asia and Western Pacific. Of the countries reviewed, only 12% (14/116) proposed a policy that addressed all four risk factors, and 25% (29/116) addressed only one of the risk factors reviewed. Strategies targeting the private sector were less frequently encountered than strategies targeting the general public or policy makers. Conclusions: This review indicates the disconnection between the burden of NCDs and national policy responses in LMICs. Policy makers urgently need to develop comprehensive and multi-stakeholder policies to improve dietary quality and physical activity

Simultane Behandlung von obliterativen Karotispathologien und koronarer Herzkrankheit

Einführung: Die kombinierte Karotisendarteriektomie und aorto-coronare Baypassoperation (C-CABG) weisen ein hohes peri-operatives Risiko auf. Als Alternative wird in letzter Zeit das Stenting der Artera carotis interna propagiert. Das Fehlen von Level I Evidenz hat uns motiviert, die Resultate unserer C-CABG der letzten 5 Jahre zu evaluieren. Methoden und Patienten: Retrospektive Monozenterstudie von 113C-CABG, durchgeführt zwischen Januar 2000 und Dezember 2004. Das mediane Alter der Patienten betrug 65Jahre (22Patienten waren 80Jahre alt oder älter). Die Karotisendarteriektomie wurde vor der aortokoronaren Bypassoperation in derselben Narkose durchgeführt. Resultate: Die 30-Tages-Mortalität war ausschließlich kardial bedingt und betrug 4,4% (5/113). Die neurologischen Komplikationen waren ein Schlaganfall, der innerhalb von 30Tagen vollständig regredient war, und 3TIA (3,5%, 4/113). Schlussfolgerung: C-CABG mit initial durchgeführter Karotisendarteriektomie ist ein sicheres Verfahren mit niedriger neurologischer Komplikationsrate. Der riskante Anteil des kombinierten Eingriffs ist nicht die Karotisendarteriektomie, sondern die aortokoronare Revaskularisation. Demzufolge scheint das Stenting beim kombinierten Eingriff als Alternative nicht gerechtfertigt, solange keine klaren Vorteile hinsichtlich der Früh- und Langzeitresultate gegenüber der alleinigen Karotisendarteriektomie vorliege

When who and how matter: explaining the success of referendums in Europe

This article aims to identify the institutional factors that make a referendum successful. This comparative analysis seeks to explain the success of top-down referendums organized in Europe between 2001 and 2013. It argues and tests for the main effect of three institutional factors (popularity of the initiator, size of parliamentary majority, and political cues during referendum campaigns) and controls for the type of referendum and voter turnout. The analysis uses data collected from referendums and electoral databases, public opinion surveys, and newspaper articles. Results show that referendums proposed by a large parliamentary majority or with clear messages from political parties during campaign are likely to be successful