Standardised criteria for classifying the International Classification of Activities for Time-use Statistics (ICATUS) activity groups into sleep, sedentary behaviour, and physical activity

Background Globally, the International Classification of Activities for Time-Use Statistics (ICATUS) is one of the most widely used time-use classifications to identify time spent in various activities. Comprehensive 24-h activities that can be extracted from ICATUS provide possible implications for the use of time-use data in relation to activity-health associations; however, these activities are not classified in a way that makes such analysis feasible. This study, therefore, aimed to develop criteria for classifying ICATUS activities into sleep, sedentary behaviour (SB), light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA), based on expert assessment. Method We classified activities from the Trial ICATUS 2005 and final ICATUS 2016. One author assigned METs and codes for wakefulness status and posture, to all subclass activities in the Trial ICATUS 2005. Once coded, one author matched the most detailed level of activities from the ICATUS 2016 with the corresponding activities in the Trial ICATUS 2005, where applicable. The assessment and harmonisation of each ICATUS activity were reviewed independently and anonymously by four experts, as part of a Delphi process. Given a large number of ICATUS activities, four separate Delphi panels were formed for this purpose. A series of Delphi survey rounds were repeated until a consensus among all experts was reached. Results Consensus about harmonisation and classification of ICATUS activities was reached by the third round of the Delphi survey in all four panels. A total of 542 activities were classified into sleep, SB, LPA, and MVPA categories. Of these, 390 activities were from the Trial ICATUS 2005 and 152 activities were from the final ICATUS 2016. The majority of ICATUS 2016 activities were harmonised into the ICATUS activity groups (n = 143). Conclusions Based on expert consensus, we developed a classification system that enables ICATUS-based time-use data to be classified into sleep, SB, LPA, and MVPA categories. Adoption and consistent use of this classification system will facilitate standardisation of time-use data processing for the purpose of sleep, SB and physical activity research, and improve between-study comparability. Future studies should test the applicability of the classification system by applying it to empirical data

Young people's daily activity in a globalized world: a cross-national comparison using time use data

How much do young people’s daily activities differ according to where they live? As a global generation, young people are disproportionally subject to the risks and insecurity of globalization. However, countries differ in their support for young people’s inclusion through economic and social participation. Using time use surveys from Australia, Italy, Finland, France, Korea, Spain, the UK and the USA (n=23,271), this paper investigates national differences in the amount of time young people (20-34 years) spend on paid and unpaid work, study and leisure in each country. Gender gaps in market work and non-market work were widest in the Anglo and southern European countries. In France and Finland, gender differences in daily market and non-market activity were narrower. Young women spent more daily time in study than young men in all countries except Korea, where study time was highest. Young men and young women in social democratic Finland had more leisure time than young people elsewhere. Results suggest that young people’s experience of the consequences of globalization is not universal, but that nation-states remain relevant in determining their welfare

The incidence and treatment of bleeding episodes in non-severe haemophilia A patients with inhibitors

The development of an inhibitory antibody in non-severe haemophilia A patients may aggravate the bleeding phenotype considerably. Effective treatment of bleeding episodes may be challenging, with ensuing severe complications. At present, evidence is scarce for optimal treatment of bleeding episodes in this patient group. The aim of this study was to describe the incidence and the treatment of bleeding episodes in inhibitor patients in a population-based unselected cohort of non-severe haemophilia A patients with clinically relevant inhibitors. Data were available for 100 of the 107 non-severe haemophilia A patients (factor VIII (FVIII) baseline, 2-40 IU/dl) from 29 centres in Europe and one centre in Australia who had developed a clinically relevant inhibitor between 1980 and 2011. The majority (89 %) of the patients were treated during the inhibitor period for bleeding episodes or a surgical intervention: 66 % needed treatment for bleeding episodes, at a median annual bleeding rate (ABR) of 1.1 (interquartile range (IQR) 0.1-2.5) and a median total of 2 (IQR 1-6) bleeding episodes. Compared to the median ABR before inhibitor development of 0.095 bleeds per year (IQR 0.02-0.42), the increase in ABR is more than a 10-fold. More than 90 % of the bleeding episodes were treated with only one type of product, most frequently (51 %) FVIII concentrates. This study provides the incidence of bleeding episodes and treatment choices in non-severe haemophilia A patients with inhibitors. The 10-fold increase to a median ABR of 1.1 episodes per year emphasizes the impact of inhibitor development for non-severe haemophilia A patients

Inhibitor development and mortality in non-severe hemophilia A

BackgroundThe life expectancy of non-severe hemophilia A (HA) patients equals the life expectancy of the non-hemophilic population. However, data on the effect of inhibitor development on mortality and on hemophilia-related causes of death are scarce. The development of neutralizing factor VIII antibodies in non-severe HA patients may dramatically change their clinical outcome due to severe bleeding complications. ObjectivesWe assessed the association between the occurrence of inhibitors and mortality in patients with non-severe HA. MethodsIn this retrospective cohort study, clinical data and vital status were collected for 2709 non-severe HA patients (107 with inhibitors) who were treated between 1980 and 2011 in 34 European and Australian centers. Mortality rates for patients with and without inhibitors were compared. ResultsDuring 64200 patient-years of follow-up, 148 patients died (mortality rate, 2.30 per 1000 person-years; 95% confidence interval (CI), 1.96-2.70) at a median age of 64years (interquartile range [IQR], 49-76). In 62 patients (42%) the cause of death was hemophilia related. Sixteen inhibitor patients died at a median age of 71years (IQR, 60-81). In ten patients the inhibitor was present at time of death; seven of them died of severe bleeding complications. The all-cause mortality rate in inhibitor patients was >5 times increased compared with that for those without inhibitors (age-adjusted mortality rate ratio, 5.6). ConclusionInhibitor development in non-severe hemophilia is associated with increased mortality. High rates of hemophilia-related mortality in this study indicate that non-severe hemophilia is not mild at all and stress the importance of close follow-up for these patients