Correlates of light and moderate-to-vigorous objectively measured physical activity in four-year-old children

Correlates of physical activity (PA) are hypothesized to be context and behaviour specific, but there is limited evidence of this in young children. The aim of the current study is to investigate associations between personal, social and environmental factors and objectively measured light and moderate-to-vigorous PA (LPA and MVPA, respectively) in four-year-old children.Cross-sectional data were used from the Southampton Women's Survey, a UK population-based longitudinal study. Four-year old children (n = 487, 47.0% male) had valid PA data assessed using accelerometry (Actiheart) and exposure data collected with a validated maternal questionnaire (including data on child personality, family demographics, maternal behaviour, rules and restrictions, and perceived local environment). Linear regression modelling was used to analyse associations with LPA and MVPA separately, interactions with sex were explored.LPA minutes were greater in children whose mothers reported more PA (vs. inactive: regression coefficient±standard error: 6.70±2.94 minutes), and without other children in the neighbourhood to play with (-6.33±2.44). MVPA minutes were greater in children with older siblings (vs. none: 5.81±2.80) and those whose mothers used active transport for short trips (vs. inactive: 6.24±2.95). Children accumulated more MVPA in spring (vs. winter: 9.50±4.03) and, in boys only, less MVPA with availability of other children in the neighbourhood (-3.98±1.70).Young children's LPA and MVPA have differing associations with a number of social and environmental variables. Interventions targeting PA promotion in young children outside of formal care settings should consider including intensity specific factors

Onderwijs in kwaliteitszorg binnen de initiële opleidingen tot fysiotherapeut, verpleegkundige en arts.

Opleidingen in de gezondheidszorg blijken te verschillen in de mate waarin zij op dit moment aandacht besteden aan de systematische bewaking, beheersing en verbetering van de kwaliteit, ook wel kwaliteitszorg genoemd. Dat komt meer voor bij opleidingen fysiotherapie en verpleegkunde dan bij opleidingen tot basisarts. Dat blijkt uit een onderzoek van het NIVEL in samenwerking met onderwijskundigen van het ICLON (Interfacultair Centrum voor Lerarenopleiding, Onderwijsontwikkeling en Nascholing) van de Universiteit Leiden. Opdrachtgever is het Ministerie van VWS. Onderwijs in kwaliteitszorg hoort thuis in alle basisopleidingen in de gezondheidszorg. Dat is afgesproken op de Leidschendamconferenties, waarop zorgaanbieders, patiënten/consumentenorganisaties, verzekeraars en overheid afspraken gemaakt hebben over het kwaliteitsbeleid in de gezondheidszorg). Die afspraken worden onderscheven door het Ministerie van VWS. Daartoe zouden aankomende beroepsbeoefenaren een aantal competenties (kennis, vaardigheden en attitudes die in samenhang worden verworven) op het gebied van kwaliteitszorg moeten verwerven. De vraag was: Welke competenties zouden dat moeten zijn? In het onderzoek zijn 16 competenties beschreven die idealiter in de opleiding verworven zouden moeten worden om kwaliteitszorg in praktijk te kunnen brengen. Bij een beperkt aantal opleidingen is nagegaan of zij zich in deze competenties kunnen vinden en of zij daar op dit moment al aandacht aan besteden. Daartoe zijn interviews gehouden met vertegenwoordigers van elf opleidingen (3 opleidingen fysiotherapie, 3 HBO opleidingen verpleegkunde, 2 MBO-opleidingen verpleegkunde en 3 opleidingen tot basisarts). Drie zaken vallen daarbij op.Ten eerste zijn veel geinterviewden van mening dat de attitude het belangrijkst is. Studenten moeten zich een houding eigen maken van kritische reflectie op de kwaliteit van zorg en op het eigen handelen én de bereidheid hebben te vernieuwen en te veranderen. Dat is de basis voor kwaliteitszorg. Ten tweede blijkt dat de drie bezochte opleidingen tot basisarts minder aandacht aan kwaliteitszorg besteden dan de opleidingen fysiotherapie en verpleegkunde. Wel blijkt dat zaken als richtlijnen en toetsing al lang in het reguliere medische onderwijs aan bod komen, echter niet onder de noemer van kwaliteitszorg. Vanuit de medische opleidingen wordt gesteld dat het begrip kwaliteitszorg onduidelijk is en nader moet worden gedefinieerd en afgebakend. Ook is nog onduidelijk welke competenties thuishoren in de initiële opleiding tot arts en welke in de vervolgopleidingen (tot huisarts, medisch specialist et cetera.). Een derde bevinding is dat sommige opleidingen 'kwaliteitszorg' als aparte module geven, terwijl kwaliteitszorg bij andere opleidingen volledig in het onderwijspakket is geïntegreerd. Wat onderwijstechnisch het meest effectief is, is nog niet bekend. Op basis van de resultaten beraadt men zich binnen het Ministerie van VWS op welke wijze onderwijs in kwaliteitszorg verder kan worden gestimuleerd

Methodisch werken: de ontwikkelingen sinds 1976.

In dit artikel wordt beschreven wat 'methodisch werken`- een algemen

Correlates of exercise compliance in physical therapy.

BACKGROUND AND PURPOSE: This correlational study describes factors that are related to patient compliance with exercise regimens during physical therapy. We investigated whether patient compliance was related to characteristics of the patient or the patient's illness, to the patient's attitude, or to the physical therapist's behavior. SUBJECTS AND METHODS: Of a random sample of 300 physical therapists in private practice in the Netherlands, 222 therapists responded to a questionnaire survey. Eighty-four respondents also made audio recordings. Materials of the study were 1,931 registration forms, 1,837 audio-recorded sessions of physical therapy sessions, and 1,681 patient questionnaires. RESULTS: The results show that the three main factors related to noncompliance were (1) the barriers patients perceive and encounter, (2) the lack of positive feedback, and (3) the degree of helplessness. The first factor, the barriers patients perceive and encounter, shows the strongest relation with noncompliance. The results also show that noncompliance is more strongly related to the characteristics of the illness than to the illness, a bad prognosis is negatively related to compliance, and much hindrance of the complaint is positively related to compliance. There was no difference between men and women with regard to patient compliance, but less educated patients were slightly more compliant than more highly educated patients. CONCLUSION AND DISCUSSION: These correlational findings can be used to formulate hypotheses of cause and effect in future clinical research. Future research should take into account the type and efficacy of therapeutic exercise for different diseases. For physical therapy practice, it seems important that physical therapists carefully explore which problems patients encounter in their efforts to comply and that they seek solutions to those problems in mutual cooperation with their patients. (aut. ref.

Differences between physical therapists in attention paid to patient education.

This article describes differences between physical therapists in terms of the attention they pay to educating patients. The differences between therapists were identified from audiotaped treatment sessions of 1837 patients, recorded by physical therapists in non-institutional care in the Netherlands. Trained judges assessed the quantity and the quality of the education by means of a checklist. Therapists' opinions about patient education and their work setting were also examined as possible factors associated with between-therapist diffences. The results showed that the therapists differed in their opinions about patient compliance, the number of exercise instructions given to their patients, the amount of stress-related counselling and the attention given to patients' demands and perceptions. Those therapists with high expectations about the effects of education compliance paid more attention to the education of their patients. The results also indicated that therapists who spent more time with their patients had a better relationship with them. (aut.ref.

Physical Activity and Relaxation During and After Work are Independently Associated With Need for Recovery

BACKGROUND:To study the associations between during and after work hours physical activity and relaxation and need for recovery (NFR) in office workers at a financial service provider. METHODS:Self-reported baseline data of 412 employees (mean age 41.3 years; 39.6% women) were used. Linear regression analyses were performed to test associations of physical activity, relaxation, detachment and breaks at work with NFR. RESULTS: A lower NFR was significantly positively associated with standing, stair climbing, active lunchbreak, relaxation, detachment at work, physical detachment at work, relaxation and detachment at home. In the multiple model, a lower NFR was independently positively associated with frequency of stair climbing, minutes spent in leisure activities, detachment at work, physical detachment at work, relaxation and detachment at home (p<0.05). Significant effect modification indicated that the positive association between relaxation at home and NFR was stronger with high job demands. CONCLUSION: Although prospective evidence is necessary to confirm the causal relationships, our findings suggest that engaging in stair climbing, leisure activities, (physical) detachment at work, relaxation and detachment after work is associated with a lower NFR. For future worksite health promotion initiatives, interventions might be targeted at improving physical activity and relaxation

Post-normal science in practice at the Netherlands Environmental Assessment Agency

About a decade ago, the Netherlands Environmental Assessment Agency (PBL) unwittingly embarked on a transition from a technocratic model of science advising to the paradigm of ‘‘post-normal science’’ (PNS). In response to a scandal around uncertainty management in 1999, a Guidance for ‘‘Uncertainty Assessment and Communication’’ was developed with advice from the initiators of the PNS concept and was introduced in 2003. This was followed in 2007 by a ‘‘Stakeholder Participation’’ Guidance. In this article, the authors provide a combined insider/outsider perspective on the transition process. The authors assess the extent to which the PNS paradigm has delivered new approaches in the agency’s practice and analyze two projects—on long-term options for Dutch sustainable development policy and for urban development policy—the latter in somewhat more detail. The authors identify several paradoxes PBL encounters when putting the PNS concept into practice. It is concluded that an openness to other styles of work than the technocratic model has become visible, but that the introduction of the PNS paradigm is still in its early stage

Objectively measured physical activity in four-year-old British children: a cross-sectional analysis of activity patterns segmented across the day

Background: little is known about preschool-aged children’s levels of physical activity (PA) over the course of the day. Using time-stamped data, we describe the levels and patterns of PA in a population-based sample of four-year-old British children.Methods: within the Southampton Women’s Survey the PA levels of 593 4-year-old children (51% female) were measured using (Actiheart) accelerometry for up to 7 days. Three outcome measures: minutes spent sedentary (&lt;20 cpm); in light (LPA: ?20 – 399 cpm) and in moderate-to-vigorous activity (MVPA: ?400 cpm) were derived. Average daily activity levels were calculated and then segmented across the day (morning, afternoon and evening). MVPA was log-transformed. Two-level random intercept models were used to analyse associations between activity level and temporal and demographic factors.Results: children were active for 67% (mean 568.5 SD 79.5 minutes) of their daily registered time on average, with 88% of active time spent in LPA. All children met current UK guidelines of 180 minutes of daily activity. There were no differences in children’s average daily levels of sedentary activity and LPA by temporal and demographic factors: differences did emerge when activity was segmented across the day. Sex differences were largest in the morning, with girls being more sedentary, spending fewer minutes in LPA and 18% less time in MVPA than boys. Children were more sedentary and less active (LPA and MVPA) in the morning if they attended childcare full-time compared to part-time, and on weekend mornings compared to weekdays. The reverse was true for weekend afternoons and evenings. Children with more educated mothers were less active in the evenings. Children were less sedentary and did more MVPA on summer evenings compared to winter evenings.Conclusions: preschool-aged children meet current physical activity guidelines, but with the majority of their active time spent in LPA, investigation of the importance of activity intensity in younger children is needed. Activity levels over the day differed by demographic and temporal factors, highlighting the need to consider temporality in future interventions. Increasing girls’ morning activity and providing opportunities for daytime activity in winter months may be worthwhil