A cumulative meta-analysis of the effects of individual physical activity interventions targeting healthy adults

Despite a large and increasing evidence base on physical activity interventions, the high rates of physical inactivity and associated chronic diseases are continuing to increase globally. The purpose of this cumulative meta‐analysis was to investigate the evolution of randomized controlled trial evidence of individual‐level physical activity interventions to asses if new trials are contributing novel evidence to the field. Through a two‐staged search process, primary studies examining the effects of interventions targeted at increasing physical activity within healthy adult populations were pooled and selected from eligible systematic reviews. Cumulative meta‐analyses were performed on effect sizes immediately post‐intervention (n = 62), and for long‐term behaviour change (≥12‐month post‐baseline; n = 27). Sufficiency and stability of the evidence was assessed through application of pre‐published indicators. Meta‐analyses suggest overall positive intervention effects on physical activity. The evidence base for effectiveness immediately post‐intervention reached levels of sufficiency and stability in 2007; and for long‐term follow‐up in 2011. In the time since, intervention effectiveness has not substantially changed, and further trials are unlikely to change the direction and magnitude of effect. Substantial evidence exists demonstrating that physical activity interventions can modify individual behaviour in controlled settings. Researchers are urged to shift focus towards investigating the optimization, implementation, sustainability and cost‐effectiveness of interventions

Weather and children's physical activity; how and why do relationships vary between countries?

Background: Globally most children do not engage in enough physical activity. Day length and weather conditions have been identified as determinants of physical activity, although how they may be overcome as barriers is not clear. We aim to examine if and how relationships between children’s physical activity and weather and day length vary between countries and identify settings in which children were better able to maintain activity levels given the weather conditions they experienced. Methods: In this repeated measures study, we used data from 23,451 participants in the International Children’s Accelerometry Database (ICAD). Daily accelerometer-measured physical activity (counts per minute; cpm) was matched to local weather conditions and the relationships assessed using multilevel regression models. Multilevel models accounted for clustering of days within occasions within children within study-cities, and allowed us to explore if and how the relationships between weather variables and physical activity differ by setting. Results: Increased precipitation and wind speed were associated with decreased cpm while better visibility and more hours of daylight were associated with increased cpm. Models indicated that increases in these variables resulted in average changes in mean cpm of 7.6/h of day length, −13.2/cm precipitation, 10.3/10 km visibility and −10.3/10kph wind speed (all p < 0.01). Temperature showed a cubic relationship with cpm, although between 0 and 20 degrees C the relationship was broadly linear. Age showed interactions with temperature and precipitation, with the associations larger among younger children. In terms of geographic trends, participants from Northern European countries and Melbourne, Australia were the most active, and also better maintained their activity levels given the weather conditions they experienced compared to those in the US and Western Europe. Conclusions: We found variation in the relationship between weather conditions and physical activity between ICAD studies and settings. Children in Northern Europe and Melbourne, Australia were not only more active on average, but also more active given the weather conditions they experienced. Future work should consider strategies to mitigate the impacts of weather conditions, especially among young children, and interventions involving changes to the physical environment should consider how they will operate in different weather conditions.The pooling of the data was funded through a grant from the National Prevention Research Initiative (Grant Number: G0701877) (http://www.mrc.ac.uk/research/initiatives/national-prevention-research-initiative-npri/). The funding partners relevant to this award are: British Heart Foundation; Cancer Research UK; Department of Health; Diabetes UK; Economic and Social Research Council; Medical Research Council; Research and Development Office for the Northern Ireland Health and Social Services; Chief Scientist Office; Scottish Executive Health Department; The Stroke Association; Welsh Assembly Government and World Cancer Research Fund. This work was additionally supported by the Medical Research Council [MC_UU_12015/3; MC_UU_12015/7], Bristol University, Loughborough University and Norwegian School of Sport Sciences. We also gratefully acknowledge the contribution of Professor Chris Riddoch, Professor Ken Judge and Dr. Pippa Griew to the development of ICAD. The UK Medical Research Council and the Wellcome Trust (Grant ref.: 102,215/2/13/2) and the University of Bristol provide core support for ALSPAC. The CLAN study was funded by Financial Markets Foundation for Children (baseline); follow-ups were funded by the National Health and Medical Research Council (274309). The HEAPS study was funded by VicHealth (baseline); follow-ups were funded by the Australian Research Council (DP0664206). The work of Flo Harrison and Esther M F van Sluijs was supported, wholly or in part, by the Centre for Diet and Activity Research (CEDAR), a UKCRC Public Health Research Centre of Excellence (RES-590-28-0002). Funding from the British Heart Foundation, Department of Health, Economic and Social Research Council, Medical Research Council, and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged. The work of Esther MF van Sluijs was supported by the Medical Research Council (MC_UU_12015/7). Anna Goodman’s contribution was supported by an National Institute for Health Research (NIHR) post-doctoral fellowship (PDF-2010-03-130). Anna Timperio’s contribution was supported by a National Heart Foundation of Australia Future Leader Fellowship (Award 10,046). The views and opinions expressed herein are those of the authors and do not necessarily reflect those of any study funders

Integraal waterbeheer : kritische zone en onzekerheden : integraal hoofdrapport

In het kader van het Nationaal Modellen- en Datacentrum (NMDC) is in 2011 het NMDC innovatieproject 'Integraal waterbeheer - van kritische zone tot kritische onzekerheden' gestart (www.nmdc.eu). Dit project heeft tot doel om de modellen voor bodem, water, vegetatie en klimaat(verandering) door samenwerking beter op elkaar aan te laten sluiten, daarbij beter geschikt te maken om effecten van klimaatverandering te berekenen en om de verschillende typen onzekerheden bij dit soort studies in beeld te brengen. Het project is uitgevoerd door Alterra, Deltares, KNMI, PBL en TNO. In twee cases (Baakse Beek en Walcheren) hebben zij hun state-of-the-art modellen voor meteo, gewasgroei, vegetatie-ontwikkeling, hydrologie en geologie ingezet en aan elkaar gekoppeld. Dit rapport behandelt integraal de resultaten van het innovatieproject. De resultaten van de case voor de Baakse Beek zijn specifiek opgenomen in een NMDC deelrapport (Van Ek et al., 2012). Voor de case Walcheren wordt verwezen naar een artikel in voorbereiding (Kroes, J. et al., 2013). De resultaten bieden nieuwe inzichten in de vocht- en zouthuishouding van de bodem, potenties voor grondwaterafhankelijke natuur en groei van landbouwgewassen in het huidige klimaat en projecties voor klimaatverandering rond 2050. In het project zijn verschillende methoden toegepast om inzicht te krijgen in verschillende onzekerheden, hetgeen voor dergelijke integrale (model)studies praktische aanknopingspunten biedt voor de analyse van onzekerheden en effectieve samenwerking tussen de instituten

Erratum to: Family-based interventions to increase physical activity in children: a systematic review, meta-analysis and realist synthesis: Meta-analysis/realist synthesis of family PA interventions (Obesity Reviews, (2016), 17, 4, (345-360), 10.1111/obr.12362)

Subsequent to the publication, several errors have been found in the paper and can be corrected as follows: The labelling on the studies in Figure 2 is incorrect. The referencing in Table 1 is inconsistent with the manuscript reference list. The correct Figure 2 and Table are shown here. 2 (Figure presented.) Effect on child physical activity from random effects meta-analysis of eligible studies. Overview of characteristics of 47 studies included in systematic review of family-based physical activity promotion (Table presented.) #Corresponds with a significant, positive change in outcome (see Supplementary Table 1 for full details) +Singapore, Mexico, Italy, New Zealand, Canada, Germany *Some studies employed both subjective and objective methods to measure physical activity †Some studies employed more than one intervention strategy

Integraal waterbeheer : kritische zone en onzekerheden : integraal hoofdrapport

In het kader van het Nationaal Modellen- en Datacentrum (NMDC) is in 2011 het NMDC innovatieproject 'Integraal waterbeheer - van kritische zone tot kritische onzekerheden' gestart (www.nmdc.eu). Dit project heeft tot doel om de modellen voor bodem, water, vegetatie en klimaat(verandering) door samenwerking beter op elkaar aan te laten sluiten, daarbij beter geschikt te maken om effecten van klimaatverandering te berekenen en om de verschillende typen onzekerheden bij dit soort studies in beeld te brengen. Het project is uitgevoerd door Alterra, Deltares, KNMI, PBL en TNO. In twee cases (Baakse Beek en Walcheren) hebben zij hun state-of-the-art modellen voor meteo, gewasgroei, vegetatie-ontwikkeling, hydrologie en geologie ingezet en aan elkaar gekoppeld. Dit rapport behandelt integraal de resultaten van het innovatieproject. De resultaten van de case voor de Baakse Beek zijn specifiek opgenomen in een NMDC deelrapport (Van Ek et al., 2012). Voor de case Walcheren wordt verwezen naar een artikel in voorbereiding (Kroes, J. et al., 2013). De resultaten bieden nieuwe inzichten in de vocht- en zouthuishouding van de bodem, potenties voor grondwaterafhankelijke natuur en groei van landbouwgewassen in het huidige klimaat en projecties voor klimaatverandering rond 2050. In het project zijn verschillende methoden toegepast om inzicht te krijgen in verschillende onzekerheden, hetgeen voor dergelijke integrale (model)studies praktische aanknopingspunten biedt voor de analyse van onzekerheden en effectieve samenwerking tussen de instituten

Opportunistic infections and AIDS malignancies early after initiating combination antiretroviral therapy in high-income countries

Background: There is little information on the incidence of AIDS-defining events which have been reported in the literature to be associated with immune reconstitution inflammatory syndrome (IRIS) after combined antiretroviral therapy (cART) initiation. These events include tuberculosis, mycobacterium avium complex (MAC), cytomegalovirus (CMV) retinitis, progressive multifocal leukoencephalopathy (PML), herpes simplex virus (HSV), Kaposi sarcoma, non-Hodgkin lymphoma (NHL), cryptococcosis and candidiasis. Methods: We identified individuals in the HIV-CAUSAL Collaboration, which includes data from six European countries and the US, who were HIV-positive between 1996 and 2013, antiretroviral therapy naive, aged at least 18 years, hadCD4+ cell count and HIV-RNA measurements and had been AIDS-free for at least 1 month between those measurements and the start of follow-up. For each AIDS-defining event, we estimated the hazard ratio for no cART versus less than 3 and at least 3 months since cART initiation, adjusting for time-varying CD4+ cell count and HIV-RNA via inverse probability weighting. Results: Out of 96 562 eligible individuals (78% men) with median (interquantile range) follow-up of 31 [13,65] months, 55 144 initiated cART. The number of cases varied between 898 for tuberculosis and 113 for PML. Compared with non-cART initiation, the hazard ratio (95% confidence intervals) up to 3 months after cART initiation were 1.21 (0.90-1.63) for tuberculosis, 2.61 (1.05-6.49) for MAC, 1.17 (0.34-4.08) for CMV retinitis, 1.18 (0.62-2.26) for PML, 1.21 (0.83-1.75) for HSV, 1.18 (0.87-1.58) for Kaposi sarcoma, 1.56 (0.82-2.95) for NHL, 1.11 (0.56-2.18) for cryptococcosis and 0.77 (0.40-1.49) for candidiasis. Conclusion: With the potential exception of mycobacterial infections, unmasking IRIS does not appear to be a common complication of cART initiation in high-income countries. © 2014 Wolters Kluwer Health | Lippincott Williams &amp; Wilkins