Personalized web-based advice in combination with well-child visits to prevent overweight in young children: Cluster randomized controlled trial

Background: Overweight is a major health issue, and parent-targeted interventions to promote healthy development in children are needed. Objective: The study aimed to evaluate E-health4Uth Healthy Toddler, an intervention that educates parents of children aged 18 to 24 months regarding health-related behaviors, as compared with usual care. The effect of this intervention on the following primary outcomes was evaluated when the children were 36 months of age: health-related behaviors (breakfast daily, activity and outside play, sweetened beverage consumption, television (TV) viewing and computer time), body mass index (BMI), and the prevalence of overweight and obesity. Methods: The BeeBOFT (acronym for breastfeeding, breakfast daily, outside playing, few sweet drinks, less TV viewing) study is a cluster randomized controlled trial involving 51 Youth Health Care (YHC) teams. In total, 1094 parents participated in the control group, and 1008 parents participated in the E-health4Uth Healthy Toddler intervention group. The intervention consisted of Web-based personalized advice given to parents who completed an eHealth module and discussion of the advice during a regular well-child visit. In this study the eHealth module was offered to parents before two regular well-child visits at 18 and 24 months of age. During the well-child visits, the parents’ personalized advice was combined with face-to-face counseling provided by the YHC professional. Parents in the control group received usual care, consisting of the regular well-child visits during which general information on child health-related behavior was provided to parents. Parents completed questionnaires regarding family characteristics and health-related behaviors when the child was 1 month (inclusion), 6 months, 14 months, and 36 months (follow-up) of age. The child’s height and weight were measured by trained health care professionals from birth through 36 months of age at fixed time points. Multilevel linear and logistic regression models were used to evaluate the primary outcomes at 36 months of age. Results: At 36 months, we observed no differences between health-related behaviors of children, BMI or the percentage of children having overweight or obesity in the control and intervention group (P>.05). An analysis of the intervention effect revealed that boys benefited from eating breakfast daily, non-Dutch children spent more time being active or playing outdoors, children of low-educated parents and of overweight and obese mothers spent less time watc

Increasing girls' knowledge about human papillomavirus vaccination with a pre-test and a national leaflet: A quasi-experimental study

Background: Adolescent girls are at an age to be involved in the decision about HPV vaccination uptake and therefore need adequate information about the vaccination. This study assesses to what extent reading an official information leaflet about HPV contributes to girls' knowledge levels, and to what extent an increase in knowledge is boosted by a pre-test measurement. Methods. Participants (girls aged 11-14 years) were systematically allocated to group A that completed a pre-test measurement (12 true/false statements) or to group B that did not complete it. Subsequently, both groups read the HPV leaflet and completed the post-test measurement. Results: The response rate was 237/287 (83%). Pre-test scores in group A (M = 3.6, SD = 1.81, p < 0.001) were lower than post-test mean knowledge scores (0-10) in group B (M = 4.6, SD = 2.05). Post-test knowledge scores in group A were higher than those in group B [6.2 (SD = 2.06) versus 4.6 (SD = 2.05), p < 0.001]. In the post-test measurement, about a third of both groups knew that vaccinations do not give 100% protection against cervical cancer and that the duration of protection is unknown. Conclusions: Reading the information leaflet had a positive effect on knowledge, even more so when boosted by a pre-test measurement. However, knowledge on the degree and duration of protection against cervical cancer remained limited. Focusing girls' attention on important aspects before they start reading the leaflet (e.g. by including a quiz on the first page) may serve to raise their awareness of these aspects

Magnetic resonance imaging of the coronary arteries: clinical results from three dimensional evaluation of a respiratory gated technique

BACKGROUND: Magnetic resonance coronary angiography is challenging because of the motion of the vessels during cardiac contraction and respiration. Additional challenges are the small calibre of the arteries and their complex three dimensional course. Respiratory gating, turboflash acquisition, and volume rendering techniques may meet the necessary requirements for appropriate visualisation. OBJECTIVE: To determine the diagnostic accuracy of respiratory gated magnetic resonance imaging (MRI) for the detection of significant coronary artery stenoses evaluated with three dimensional postprocessing software. METHODS: 32 patients referred for elective coronary angiography were studied with a retrospective respiratory gated three dimensional gradient echo MRI technique. Resolution was 1.9 x 1.25 x 2 mm. After manual segmentation three dimensional evaluation was performed with a volume rendering technique. RESULTS: Overall 74% (range 50% to 90%) of the proximal and mid coronary artery segments were visualised with an image quality suitable for further analysis. Sensitivity and specificity for the detection of significant stenoses were 50% and 91%, respectively. CONCLUSIONS: Volume rendering of respiratory gated MRI techniques allows adequate visualisation of the coronary arteries in patients with a regular breathing pattern. Significant lesions in the major coronary artery branches can be identified with a moderate sensitivity and a high specificity

MR coronary angiography with breath-hold targeted volumes: preliminary clinical results

PURPOSE: To assess the clinical value of a magnetic resonance (MR) coronary angiography strategy involving a small targeted volume to image one coronary segment in a single breath hold for the detection of greater than 50% stenosis. MATERIALS AND METHODS: Thirty-eight patients referred for elective coronary angiography were included. The coronary arteries were localized during single-breath-hold, three-dimensional imaging of the entire heart. MR coronary angiography was then performed along the major coronary branches with a double-oblique, three-dimensional, gradient-echo sequence. Conventional coronary angiography was the reference-standard method. RESULTS: Adequate visualization was achieved with MR coronary angiography in 85%-91% of the proximal coronary arterial branches and in 38%-76% of the middle and distal branches. Overall, 187 (69%) of 272 segments were suitable for comparison between conventional and MR coronary angiography. The diagnostic accuracy of MR coronary angiography for the detection of hemodynamically significant stenoses was 92%; sensitivity, 68%; and specificity, 97%. The sensitivity in individual segments was 50%-77%, whereas the specificity was 94%-100%. CONCLUSION: Adequate visualization of the major coronary arterial branches was possible in the majority of patients. The observed accuracy of MR coronary angiography for detection of hemodynamically significant coronary arterial stenosis is promising, but it needs to be higher before this modality can be used reliably in a clinical setting

Primary prevention of overweight in preschool children, the BeeBOFT study (breastfeeding, breakfast daily, outside playing, few sweet drinks, less TV viewing): Design of a cluster randomized controlled trial

Background: Two overweight prevention interventions were developed to be offered by preventive Youth Health Care (YHC) in addition to the currently applied overweight prevention protocol to parents of 0-3 year old children. The two interventions aim to support parents of preschool children to realize healthy child nutrition and activity behaviors of their young child. The aim of this study is to assess the effects of the two overweight prevention interventions with regard to child health behaviors and child Body Mass Index. Methods/Design. A cluster randomized controlled trial was conducted among parents and their preschool children who attend one of 51 participating YHC teams. The teams were randomly allocated to one of the two intervention groups, or to the control group (care as usual).The 'BBOFT+' intervention focuses on effective child rearing by parents from birth onwards by enlarging parental skills concerning healthy behavioural life-style habits. Parents who are allocated to the 'E-health4Uth Healthy toddler' intervention group, at the child age of circa 18 and 24 months old, are invited to complete an online E-health module providing tailored health education regarding healthy child nutrition and activity behaviors. The E-health messages are discussed and reinforced during the subsequent regularly scheduled visits by YHC professionals, and were repeated after 4 weeks.The primary outcome measures at child age 3 years are: overweight inducing/reducing behaviors, (for 'BBOFT+' only) healthy sleep, Body Mass Index and prevalence of overweight and obesity. Secondary outcome measures are attitudes and other cognitive characteristics of the parents regarding the overweight-related behaviors of their child, parenting styles and practices, and health-related quality of life of the children. Discussion. We hypothesize that the use of the additional interventions will result in a healthier lifestyle of preschool children and an improved BMI and less development of overweight and obesity compared to usual care. Trial registration. Nederlands Trial Register NTR1831

Central Santa Catarina coastal dunefields chronology and their relation to relative sea level and climatic changes

During the past decades, there have been contrarian explanations for the formation and stabilization of coastal dunefields: while many authors believe the dunes formation would be enhanced by falling sea level, others argue that a rising or stable sea level context would be favorable. For Brazilian coastal dunefields, the second hypothesis seems to be more consistent with the luminescence ages found so far; however, most of these data were obtained without using the SAR protocol. Another point of concern is the role of climate change in the aeolian system, which is still not very clear. The aim of this paper is to try to clarify these two questions. To this end, five coastal dunefields were selected in central Santa Catarina coast. The remote sensing and dating results allowed the discrimination and mapping of at least four aeolian generations. Their age distribution in relation to the global curve of relative sea level variation during the Late Pleistocene allows us to suggest that the formation of Aeolian dunefields in the coastal context is supported by stable relative sea level. However, relative sea level is not the only determinant for the formation and preservation of the aeolian coastal dunes. Evidences of climatic control indicate that the initiation of dunefields would be favored by periods of less humidity while their stabilization would occur preferably during the periods of rain intensification, connected to monsoon activity

Electroweak Bubble Nucleation, Nonperturbatively

We present a lattice method to compute bubble nucleation rates at radiatively induced first order phase transitions, in high temperature, weakly coupled field theories, nonperturbatively. A generalization of Langer's approach, it makes no recourse to saddle point expansions and includes completely the dynamical prefactor. We test the technique by applying it to the electroweak phase transition in the minimal standard model, at an unphysically small Higgs mass which gives a reasonably strong phase transition (lambda/g^2 =0.036, which corresponds to m(Higgs)/m(W) = 0.54 at tree level but does not correspond to a positive physical Higgs mass when radiative effects of the top quark are included), and compare the results to older perturbative and other estimates. While two loop perturbation theory slightly under-estimates the strength of the transition measured by the latent heat, it over-estimates the amount of supercooling by a factor of 2.Comment: 48 pages, including 16 figures. Minor revisions and typo fixes, nothing substantial, conclusions essentially unchange

Sleep and body mass index in infancy and early childhood (6-36mo): a longitudinal study

Summary Background: Relatively, few longitudinal studies have evaluated the association between sleep and body mass index (BMI) among younger children. In addition, few studies have evaluated the bidirectional longitudinal association between sleep duration and child BMI. Objective: The objective of the study is to determine in children aged 6 to 36 months (1) the cross‐sectional association of sleep duration and sleep problems with child BMI z score, (2) whether sleep duration predicts changes in child BMI z score, and (3) and whether BMI z score can predict changes in child sleep duration. Methods: This study used longitudinal data from the BeeBOFT study (N = 2308). Child sleep duration and sleep problems (indicated by night awakenings and sleep‐ onset latency) were parent reported, and child BMI was measured using a standardized protocol by trained healthcare professionals at approximately 6, 14, and 36 months of age. Linear mixed models and linear regression models were applied to assess the cross‐sectional and bidirectional longitudinal associations between sleep and BMI z scores. Results: Cross sectionally, shorter sleep duration was associated with higher BMI z scores at 14 (β = −0.034, P < 0.05) and 36 months (β = −0.045, P < 0.05). S

Factors associated with early introduction of complementary feeding and consumption of non-recommended foods among Dutch infants: the BeeBOFT study

The present study aimed to investigate the factors associated with early introduction of complementary feeding (i.e., before age 4 months), and factors associated with infants consumption of non-recommended foods, including sweet beverages and snack foods. Methods: This study used cross-sectional data from the BeeBOFT study (n = 2157). Data on complementary feeding practices and potential determinants were obtained by questionnaire at infant’s age of 6 months. Logistic regression models were used to investigate factors associated with early introduction of complementary feeding and infants’ consumption of non-recommended foods. Results: 21.4% of infants had received complementary feeding before 4 months of age. At the age of 6 months, 20.2% of all infants were consuming sweet beverages daily and 16.5% were consuming snack foods daily. Younger maternal age, lower maternal educational level, absence or shorter duration of breastfeeding, parental conviction that “my child always wants to eat when he/she sees someone eating” and not attending day-care were independently associated with both early introduction of complementary feeding and the consumption of non-recommended foods. Higher maternal pre-pregnancy BMI and infant postnatal weight gain were associated only with early introduction of complementary feeding. Conclusions: We identified several demographical, biological, behavioral, psychosocial, and social factors associated with inappropriate complementary feeding practices. These findings are relevant for designing intervention programs aimed at educating parents

Resonant X ray photoelectron spectroscopy identification of atomic contributions to valence states

Valence electronic structure is crucial for understanding and predicting reactivity. Valence non resonant Xray photoelectron spectroscopy NRXPS provides a direct method for probing the overall valence electronic structure. However, it is often difficult to separate the varying contributions to NRXPS; for example, contributions of solutes in solvents or functional groups in complex molecules. In this work we show that valence resonant X ray photoelectron spectroscopy RXPS is a vital tool for obtaining atomic contributions to valence states. We combine RXPS with NRXPS and density functional theory calculations to demonstrate the validity of using RXPS to identify atomic contributions for a range of solutes both neutral and ionic and solvents both molecular solvents and ionic liquids . Furthermore, the one electron picture of RXPS holds for all of the closed shell molecules ions studied, although the situation for an open shell metal complex is more complicated. Factors needed to obtain a strong RXPS signal are investigated in order to predict the types of systems RXPS will work best for; a balance of element electronegativity and bonding type is found to be important. Additionally, the dependence of RXPS spectra on both varying solvation environment and varying local covalent bonding is probed. We find that RXPS is a promising fingerprint method for identifying species in solution, due to the spectral shape having a strong dependence on local covalency but a weak dependence on solvation environmen