Measuring positive health: concurrent and factorial validity based on a representative Dutch sample

The definition of health has been shifting from disease absence to physical, emotional and social well-being. To demedicalise societal problems, the term Positive Health (PH) was introduced-a concept focused on the ability to adapt and to self-manage, in the face of physical, emotional and social challenges. The concept of PH receives broad attention, among others because a PH dialogue tool is intensively being used as a communication instrument while reflecting on patients' health, but a PH measurement instrument is not yet fully established. Recently, however, a 17-item PH measurement model was proposed. In this paper, a factor analysis and regression analyses were performed to test the factorial validity and concurrent validity of this PH measurement model based on a representative sample of the Dutch population (n = 1016, 50.0% women; age: from 15 until 39 = 29.8%, from 40 until 65 = 43.0%, older than 65 = 27.2%; education levels: low = 28.7%, medium = 42.6%, high = 28.7%). These tests are crucial to understand how well the PH measurement model is suitable as a measurement instrument. The factor analysis provided support for the factorial validity of the proposed PH measurement model. When comparing the proposed PH measurement model with domains of other measurements of health (i.e. BRS, HR-SWB, ICECAP, and EQ5D), to test the concurrent validity, the model explained more than half of the variance in measurements of the domains happiness (R-2 = 0.60) and overall self-rated health (R-2 = 0.57), but explained less than a quarter of the variance in measurements of autonomy (R-2 = 0.17 / R-2 = 0.13), personal growth (R-2 = 0.21), stability (R-2 = 0.20), self-care (R-2 = 0.15), and resilience (R-2 = 0.24). Two of the six domains of the PH measurement model-mental functioning and daily functioning-were weakly related to the other measurements of health. The results of this study imply that the PH measurement model is suitable to measure multiple dimensions of health. They also suggest that the PH measurement model may not be an encompassing measure for the concepts measured through other health measurements and might explain variance in health beyond these other measurements.Prevention, Population and Disease management (PrePoD)Public Health and primary car

Implementation of a group-based lifestyle intervention programme (Healthy Heart) in general practices in The Netherlands: a mixed-methods study

Background Lifestyle intervention programmes target behavioural risk factors that contribute to cardiovascular diseases (CVDs). Unfortunately, sustainable implementation of these programmes can be challenging. Gaining insights into the barriers and facilitators for successful implementation is important for maximising public health impact of these interventions. The Healthy Heart (HH) programme is an example of a combined lifestyle intervention programme.Aim To analyse the reach, adoption, and implementation of the HH programme.Design & setting A mixed-methods study conducted in a general practice setting in The Netherlands.Method Quantitative data were collected from the Healthy Heart study (HH study), a non-randomised cluster stepped-wedge trial to assess the effect of the HH programme on patients at high risk of developing CVDs at practice level. Qualitative data were obtained through focus groups.Results Out of 73 approached general practices, 55 implemented the HH programme. A total of 1082 patients agreed to participate in the HH study, of whom 64 patients were referred to the HH programme and 41 patients participated. Several barriers for participation were identified such as time investment, lack of risk perception, and being confident in changing lifestyle on their own. Important barriers for healthcare providers (HCPs) to refer a patient were time investment, lack of information to sufficiently inform patients, and preconceived notions regarding which patients the programme was suitable for.Conclusion This study has offered insights from a patient and HCP perspective regarding barriers and facilitators for implementation of the group-based lifestyle intervention programme. The identified barriers and facilitators, and the suggested improvements, can be used by others who wish to implement a similar programme.</div

A very brief description of LOFAR - the Low Frequency Array

LOFAR (Low Frequency Array) is an innovative radio telescope optimized for the frequency range 30-240 MHz. The telescope is realized as a phased aperture array without any moving parts. Digital beam forming allows the telescope to point to any part of the sky within a second. Transient buffering makes retrospective imaging of explosive short-term events possible. The scientific focus of LOFAR will initially be on four key science projects (KSPs): 1) detection of the formation of the very first stars and galaxies in the universe during the so-called epoch of reionization by measuring the power spectrum of the neutral hydrogen 21-cm line (Shaver et al. 1999) on the ~5' scale; 2) low-frequency surveys of the sky with of order $10^8$ expected new sources; 3) all-sky monitoring and detection of transient radio sources such as gamma-ray bursts, x-ray binaries, and exo-planets (Farrell et al. 2004); and 4) radio detection of ultra-high energy cosmic rays and neutrinos (Falcke & Gorham 2003) allowing for the first time access to particles beyond 10^21 eV (Scholten et al. 2006). Apart from the KSPs open access for smaller projects is also planned. Here we give a brief description of the telescope.Comment: 2 pages, IAU GA 2006, Highlights of Astronomy, Volume 14, K.A. van der Hucht, e

Development and validation of a Context-sensitive Positive Health Questionnaire (CPHQ): a factor analysis and multivariate regression study

Background The concept of Positive Health (PH) has gained increasing attention as a way of measuring individuals’ ability to adapt in the face of contextual challenges. However, a suitable measurement instrument for PH that encompasses contextual factors has not yet been developed. This paper responds to this need by developing a Context-specific Positive Health (CPH) measurement instrument that aligns with the Capability Approach (CA). Methods The measurement instrument was developed and tested among a representative sample of 1002 Dutch internet survey panel members with diverse sociodemographic backgrounds. The instrument was developed in two stages: a preparation phase consisting of focus groups and expert consultations, and a validation among a representative panel of Dutch citizens. The goal of the preparation phase, was to pilot test and refine previously proposed Positive Health questionnaires into an initial version of the CPHQ. The validation phase aimed to examine the initial CPHQ’s factorial validity using Factor Analysis, and its concurrent validity using Multivariate Regression Analysis. Results The developed questionnaire demonstrated adequate factorial and concurrent validity. Furthermore, it explicitly includes an assessment of resilience, this being a key component of PH. Conclusions The introduced measurement tool, the CPHQ, comprises 11 dimensions that we have labeled as follows: relaxation, autonomy, fitness, perceived environmental safety, exclusion, social support, financial resources, political representation, health literacy, resilience, and enjoyment. In this article, we present four major contributions. Firstly, we embedded the measurement in a theoretical framework. Secondly, we focused the questionnaire on a key concept of Positive Health - the “ability to adapt.” Thirdly, we addressed issues of health inequality by considering contextual factors. Finally, we facilitated the development of more understandable measurement items</p

Unresectable Intermediate-Size (3–5 cm) Colorectal Liver Metastases:Stereotactic Ablative Body Radiotherapy Versus Microwave Ablation (COLLISION-XL): Protocol of a Phase II/III Multicentre Randomized Controlled Trial

Background: Although microwave ablation (MWA) has a low complication rate and good efficacy for small-size (≤ 3 cm) colorectal liver metastases (CRLM), local control decreases with increasing size. Stereotactic body radiotherapy (SBRT) is gaining interest as a potential means to treat intermediate-size CRLM and might be less susceptible to increasing volume. The objective of this study is to compare the efficacy of MWA to SBRT in patients with unresectable, intermediate-size (3–5 cm) CRLM. Methods: In this two-arm, multicentre phase II/ III randomized controlled trial, 68 patients with 1–3 unresectable, intermediate-size CRLM suitable for both MWA and SBRT, will be included. Patients will be treated with MWA or SBRT as randomised. The Primary endpoint is local tumour progression-free survival (LTPFS) at 1 year (intention-to-treat analysis). Main secondary endpoints are overall survival, overall and distant progression-free survival (DPFS), local control (LC) and procedural morbidity and mortality and assessment of pain and quality of life. Discussion: Current guidelines lack clear recommendations for the local treatment of liver only intermediate-size, unresectable CRLM and studies comparing curative intent SBRT and thermal ablation are scarce. Although safety and feasibility to eradicate tumours ≤ 5 cm have been established, both techniques suffer from lower LTPFS and LC rates for larger-size tumours. For the treatment of unresectable intermediate-size CRLM clinical equipoise has been reached. We have designed a two-armed phase II/ III randomized controlled trial directly comparing SBRT to MWA for unresectable CRLM 3–5 cm. Level of Evidence : Level 1, phase II/ III Randomized controlled trial. Trial Registration: NCT04081168, September 9th 2019. Graphical Abstract: [Figure not available: see fulltext.]</p

Unresectable Intermediate-Size (3–5 cm) Colorectal Liver Metastases:Stereotactic Ablative Body Radiotherapy Versus Microwave Ablation (COLLISION-XL): Protocol of a Phase II/III Multicentre Randomized Controlled Trial

Background: Although microwave ablation (MWA) has a low complication rate and good efficacy for small-size (≤ 3 cm) colorectal liver metastases (CRLM), local control decreases with increasing size. Stereotactic body radiotherapy (SBRT) is gaining interest as a potential means to treat intermediate-size CRLM and might be less susceptible to increasing volume. The objective of this study is to compare the efficacy of MWA to SBRT in patients with unresectable, intermediate-size (3–5 cm) CRLM. Methods: In this two-arm, multicentre phase II/ III randomized controlled trial, 68 patients with 1–3 unresectable, intermediate-size CRLM suitable for both MWA and SBRT, will be included. Patients will be treated with MWA or SBRT as randomised. The Primary endpoint is local tumour progression-free survival (LTPFS) at 1 year (intention-to-treat analysis). Main secondary endpoints are overall survival, overall and distant progression-free survival (DPFS), local control (LC) and procedural morbidity and mortality and assessment of pain and quality of life. Discussion: Current guidelines lack clear recommendations for the local treatment of liver only intermediate-size, unresectable CRLM and studies comparing curative intent SBRT and thermal ablation are scarce. Although safety and feasibility to eradicate tumours ≤ 5 cm have been established, both techniques suffer from lower LTPFS and LC rates for larger-size tumours. For the treatment of unresectable intermediate-size CRLM clinical equipoise has been reached. We have designed a two-armed phase II/ III randomized controlled trial directly comparing SBRT to MWA for unresectable CRLM 3–5 cm. Level of Evidence : Level 1, phase II/ III Randomized controlled trial. Trial Registration: NCT04081168, September 9th 2019. Graphical Abstract: [Figure not available: see fulltext.]</p

Incidência do míldio em cebola sob adubação mineral e orgânica.

Analisou-se a relação entre adubação mineral e orgânica sobre a incidência de míldio (Peronospora destructor) em cebola (Allium cepa). O trabalho constituiu-se de dois experimentos localizados em Ituporanga, conduzidos entre agosto e dezembro de 1998. O experimento 1, com fontes orgânicas, constou dos tratamentos: esterco de suínos, esterco de aves, composto, esterco de peru e húmus, na dosagem de 75 kg/ha de N; esterco de suínos, na dosagem de 37,5 kg/ha de N; adubação mineral, 30-120-60 kg/ha de N-P2O5-K2O; 60-240-120 kg/ha de N-P2O5-K2O e testemunha sem adubação. O experimento 2 constou dos tratamentos: fontes minerais, 30-120-60 kg/ha de N-P2O5-K2O; 90-360-180 kg/ha de N-P2O5-K2O; 75 kg/ha de N; 225 kg/ha de N; 80 kg/ha de P2O5; 240 kg/ha de P2O5; 60 kg/ha de K2O; 180 kg/ha de K2O; esterco de suínos + fosfato natural, em três combinações, 7,9+0,1, 15,7+0,2 e 47,2+0,6 t/ha, respectivamente; testemunha sem adubação. Não houve diferença entre as fontes mineral e orgânica sobre a incidência de míldio. A relação entre nutrientes e doença foi variável entre datas de amostragem e distinta para fontes minerais e orgânicas