Validity of the Physical Activity Scale for the Elderly (PASE): according to energy expenditure assessed by the doubly labeled water method.

Department of Epidemiology and Public Health, University of Wageningen, The Netherlands. The study investigates the validity of the Physical Activity Scale for the Elderly (PASE) in 21 Dutch elderly men and women. The PASE is an easily scored, brief questionnaire for elderly, suitable for large epidemiologic studies. The PASE score was compared with physical activity measured with the doubly labeled water method. The correlation coefficient of the PASE score with the residuals from the regression analysis using total energy expenditure as dependent and resting metabolic rate as independent variate was 0.58 (95% CI = 0.50-0.81). Women had greater engagement in extremely high scoring activities as housework and taking care of others, resulting in higher PASE scores than men (97.9 and 71.9). The higher scores in women were not linked to higher activity levels, which suggests that the mentioned activities may be overvalued. Sex specific correlation coefficients were 0.79 (CI = 0.32-0.95) and 0.68 (CI = 0.15-0.90) for men and women, respectively. In conclusion, the PASE proved to be a reasonable valid method to classify healthy elderly men and women into categories of physical activity. Some possible refinements were suggested, which may improve the accuracy of the PASE questionnaire

Outdoor play among children in reletion to neighborhood characteristics. A cross-sectional neighborhood observation study.

<p>Abstract</p> <p>Background</p> <p>Although environmental characteristics as perceived by parents are known to be related to children’s outdoor play behavior, less is known about the relation between independently measured neighborhood characteristics and outdoor play among children. The purpose of this study was to identify quantitative as well as qualitative neighborhood characteristics related to outdoor play by means of neighborhood observations.</p> <p>Methods</p> <p>Questionnaires including questions on outdoor play behavior of the child were distributed among 3,651 parents of primary school children (aged 4–12 years). Furthermore, neighborhood observations were conducted in 33 Dutch neighborhoods to map neighborhood characteristics such as buildings, formal outdoor play facilities, public space, street pattern, traffic safety, social neighborhood characteristics, and general impression. Data of the questionnaires and the neighborhood observations were coupled via postal code of the respondents. Multilevel GEE analyses were performed to quantify the correlation between outdoor play and independently measured neighborhood characteristics.</p> <p>Results</p> <p>Parental education was negatively associated with outdoor play among children. Neither the presence nor the overall quality of formal outdoor play facilities were (positively) related to outdoor play among children in this study. Rather, informal play areas such as the presence of sidewalks were related to children’s outdoor play. Also, traffic safety was an important characteristic associated with outdoor play.</p> <p>Conclusions</p> <p>This study showed that, apart from individual factors such as parental education level, certain modifiable characteristics in the neighborhood environment (as measured by neighborhood observations) were associated with outdoor play among boys and girls of different age groups in The Netherlands. Local policy makers from different sectors can use these research findings in creating more activity-friendly neighborhoods for children.</p

A systematic review of financial incentives given in the healthcare setting:Do they effectively improve physical activity levels?

Background According to current physical activity guidelines, a substantial percentage of the population in high-income countries is inactive, and inactivity is an important risk factor for chronic conditions and mortality. Financial incentives may encourage people to become more active. The objective of this review was to provide insight in the effectiveness of financial incentives used for promoting physical activity in the healthcare setting. Methods A systematic literature search was performed in three databases: Medline, EMBASE and SciSearch. In total, 1395 papers published up until April 2015 were identified. Eleven of them were screened on in- and exclusion criteria based on the full-text publication. Results Three studies were included in the review. Two studies combined a financial incentive with nutrition classes or motivational interviewing. One of these provided a free membership to a sports facility and the other one provided vouchers for one episode of aerobic activities at a local leisure center or swimming pool. The third study provided a schedule for exercise sessions. None of the studies addressed the preferences of their target population with regard to financial incentives. Despite some short-term effects, neither of the studies showed significant long-term effects of the financial incentive. Conclusions Based on the limited number of studies and the diversity in findings, no solid conclusion can be drawn regarding the effectiveness of financial incentives on physical activity in the healthcare setting. Therefore, there is a need for more research on the effectiveness of financial incentives in changing physical activity behavior in this setting. There is possibly something to be gained by studying the preferred type and size of the financial incentive

The preferences of users of electronic medical records in hospitals: Quantifying the relative importance of barriers and facilitators of an innovation

Background: Currently electronic medical records (EMRs) are implemented in hospitals, because of expected benefits for quality and safety of care. However the implementation processes are not unproblematic and are slower than needed. Many of the barriers and facilitators of the adoption of EMRs are identified, but the relative importance of these factors is still undetermined. This paper quantifies the relative importance of known barriers and facilitators of EMR, experienced by the users (i.e., nurses and physicians in hospitals).Methods: A discrete choice experiment (DCE) was conducted among physicians and nurses. Participants answered ten choice sets containing two scenarios. Each scenario included attributes that were based on previously identified barriers in the literature: data entry hardware, technical support, attitude head of department, performance feedback, flexibility of interface, and decision support. Mixed Multinomial Logit analysis was used to determine the relative importance of the attributes.Results: Data on 148 nurses and 150 physicians showed that high flexibility of the interface was the factor with highest relative importance in their preference to use an EMR. For nurses this attribute was followed by support from the head of department, presence of performance feedback from the EMR and presence of decisions support. While for physicians this ordering was different: presence of decision support was relatively more important than performance feedback and support from the head of department.Conclusion: Considering the prominent wish of all the intended users for a flexible interface, currently used EMRs only partially comply with the needs of the users, indicating the need for closer incorporation of user needs during development stages of EMRs. The differences in priorities amongst nurses and physicians show that different users have different needs during the implementation of innovations. Hospital management may use this information to design implementation trajectories to fit the needs of various user groups

School food policy at Dutch primary schools: Room for improvement? Cross-sectional findings from the INPACT study

Background: Schools can play an important role in the prevention of obesity, e.g. by providing an environment that stimulates healthy eating habits and by developing a food policy to provide such an environment. The effectiveness of a school food policy is affected by the content of the policy, its implementation and its support by parents, teachers and principals. The aim of this study is to detect opportunities to improve the school food policy and/or implementation at Dutch primary schools. Therefore, this study explores the school food policy and investigates schools' (teachers and principals) and parents' opinion on the school food policy. Methods. Data on the schools' perspective of the food policy was collected from principals and teachers by means of semi-structured interviews. In total 74 principals and 72 teachers from 83 Dutch primary schools were interviewed. Data on parental perceptions about the school food policy were based on a cross-sectional survey among 1,429 parents from the same schools. Results: Most principals (87.1%) reported that their school had a written food policy; however in most cases the rules were not clearly defined. Most of the principals (87.8%) believed that their school paid sufficient attention to nutrition and health. Teachers and principals felt that parents were primarily responsible to encourage healthy eating habits among children, while 49.8% of the parents believed that it is also a responsibility of the school to foster healthy eating habits among children. Most parents reported that they appreciated the school food policy and comply with the food rules. Parents' opinion on the enforcement of the school food policy varied: 28.1% believed that the school should enforce the policy more strongly, 32.1% was satisfied, and 39.8% had no opinion on this topic. Conclusion: Dutch primary schools could play a more important role in fostering healthy eating habits among children. The school food policy could be improved by clearly formulating food rules, simplifying supervision of the food rules, and defining how to enforce the food rules. In addition, the school food policy will only influence children's dietary behaviour if both the school and the parents support the policy

Willingness to participate in a lifestyle intervention program of patients with type 2 diabetes mellitus: a conjoint analysis

Background: Several studies suggest that lifestyle interventions can be effective for people with, or at risk for, diabetes. The participation in lifestyle interventions is generally low. Financial incentives may encourage participation in lifestyle intervention programs. Objetive: The main aim of this exploratory analysis is to study empirically potential effects of financial incentives on diabetes patients' willingness to participate in lifestyle interventions. One financial incentive is negative ("copayment") and the other incentive is positive ("bonus"). The key part of this research is to contrast both incentives. The second aim is to investigate the factors that influence participation in a lifestyle intervention program. Methods: Conjoint analysis techniques were used to empirically identify factors that influence willingness to participate in a lifestyle intervention. For this purpose diabetic patients received a questionnaire with descriptions of various forms of hypothetical lifestyle interventions. They were asked if they would be willing to participate in these hypothetical programs. Results: In total, 174 observations were rated by 46 respondents. Analysis showed that money was an important factor independently associated with respondents' willingness to participate. Receiving a bonus seemed to be associated with a higher willingness to participate, but having to pay was negatively associated with participation in the lifestyle intervention. Conclusion: Conjoint analysis results suggest that financial considerations may influence willingness to participate in lifestyle intervention programs. Financial disincentives in the form of copayments might discourage participation. Although the positive impact of bonuses is smaller than the negative impact of copayments, bonuses could still be used to encourage willingness to participate

Identifying advanced stage NSCLC patients who benefit from afatinib therapy using 18F-afatinib PET/CT imaging

Objectives: Non-small cell lung cancer (NSCLC) tumors harboring common (exon19del, L858R) and uncommon (e.g. G719X, L861Q) activating epidermal growth factor receptor (EGFR) mutations are best treated with EGFR tyrosine kinase inhibitors (TKI) such as the first-generation EGFR TKI erlotinib, second-generation afatinib or third-generation osimertinib. However, identifying these patients through biopsy is not always possible. Therefore, our aim was to evaluate whether 18F-afatinib PET/CT could identify patients with common and uncommon EGFR mutations. Furthermore, we evaluated the relation between tumor 18F-afatinib uptake and response to afatinib therapy.Materials and methods: 18F-afatinib PET/CT was performed in 12 patients: 6 EGFR wild type (WT), 3 EGFR common and 3 EGFR uncommon mutations. Tumor uptake of 18F-afatinib was quantified using TBR_WB60-90 (tumor-to-whole blood activity ratio 60-90 min post-injection) for each tumor. Response was quantified per lesion using percentage of change (PC): [(response measurement (RM)?baseline measurement (BM))/BM]?100. Statistical analyses were performed using t-tests, correlation plots and sensitivity/specificity analysis.Results: Twenty-one tumors were identified. Injected dose was 348 ? 31 MBq. Group differences were significant between WT versus EGFR (common and uncommon) activating mutations (p = 0.03). There was no significant difference between EGFR common versus uncommon mutations (p = 0.94). A TBR_WB60-90 cut-off value of 6 showed the best relationship with response with a sensitivity of 70 %, a specificity of 100 % and a positive predictive value of 100 %.Conclusion: 18F-afatinib uptake was higher in tumors with EGFR mutations (common and uncommon) compared to WT. Furthermore, a TBR_WB60-90 cut-off of 6 was found to best predict response to therapy. 18F-afatinib PET/ CT could provide a means to identify EGFR mutation positive patients who benefit from afatinib therapy.Pathogenesis and treatment of chronic pulmonary disease

Regular physical activity in old age : effect on coronary heart disease risk factors and well-being

&nbsp;Background. Regular physical activity is considered an important aspect of a healthy lifestyle. It may improve fitness, physical competence and may lower the risk of coronary heart disease (CHD). However, until now, data on the effects of regular exercise on CHD risk factors in elderly are limited, and there is a particular lack of data about the training effects on recently indicated risk factors, such as fibrinolytic and coagulation factors, and factors involved in the autonomic regulation of the heart.Methods . We have conducted a randomised, controlled intervention study, which addressed the effect of a 6 months training programme on 'classical' and 'new' CHD risk factors and well-being in 229 (intervention: 143 and control:86) apparently healthy, free- living elderly men and women (60-80 years).Results . Physical fitness (maximal exercise capacity) improved significantly in subjects of the intervention group (mean increase 14.1 Watt , 95%Cl: 10.1-18.1, +9%), compared to the controls. Among the classical CHD risk factors, only the reduction in serum triglyceride concentration in women was significant (-0.11 mmol/L, 95%Cl: -0.22-0.0, -7%). Blood pressure, high- and low density lipoprotein and total serum cholesterol concentration changed in a favourable direction, but not significantly from the control group. No effect of training on body weight and fasting insulin concentration was found. Among the new risk factors, the concentration of tissue type plasminogen activator (t-PA), a fibrinolytic factor, was significantly increased (+0.07 IU/mL, 95%Cl: 0.0-0.14,+11%) in subjects of the intervention group, while plasminogen activator inhibitor (PAI-1, inhibitor of fibrinolysis) was reduced, but not significantly different from the controls. These changes reflect an increase in fibrinolytic activity. However, fibrinogen concentration increased (+0.18 g/L 95%Cl 0.04-0.32,+6%). In addition, heart rate variability was increased and heart-rate- adjusted-QT interval was reduced in subjects of the intervention group (P<0.05). Both changes probably represent increase in parasympathetic activity and a more favourable autonomic regulation of the heart. Finally, physical self-efficacy was significantly improved in the subjects of the intervention group. Symptoms of depression were reduced, but not significantly different from the controls.Conclusion . Regular physical activity beneficially affected CHD risk factors, physical fitness and self-efficacy, which are important determinants of the quality of life and longevity in elderly. The magnitude of the benefits on CHD incidence remain unclear, since there is little information on the predictive value of the new risk factors in elderly. However, since elderly, in general, have advanced atherosclerosis and autonomic dysbalance, the improvements of these factors may be of particular importance in this age- group. In conclusion, our observations underline the importance of a public health policy aiming at stimulating regular physical activity in elderly peopl