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Currently, there are many diagnostic self-tests on body materials available to consumers. The aim of this study was to assess the effect of an online decision aid on diagnostic self-testing for cholesterol and diabetes on knowledge among consumers with an intention to take these tests. A randomized controlled trial was designed. A total of 1259 consumers with an intention to use a diagnostic cholesterol or diabetes self-test were selected from an existing Dutch Internet panel. The intervention group was invited to view an online decision aid offering general information on self-testing and test-specific information on cholesterol and diabetes self-testing, including indications for testing, how to perform the test and interpreting the result. The placebo condition consisted of a limited information sheet. Multiple regression analysis showed that the knowledge level in the diabetes arm was higher in the intervention group than in the control group (B = 0.657; 95% CI, 0.011-1.303), as was the number of participants with an informed choice (OR, 1.672; 95% CI, 1.134-2.465). No differences were found in the cholesterol arm. Consumers who are considering doing a self-test should have access to independent information on self-testing and be encouraged to read this information.

Purpose: Intersectoral collaboration is often a prerequisite for effective interventions in public health. The purpose of this paper is to assess the facilitating and hindering conditions regarding intersectoral collaboration between health authorities, public health services (PHSs), public services stakeholders (PPSs) and the education sector in comprehensive school health promotion (CSHP) in the Netherlands. Design/methodology/approach: CSHP collaborations in five Dutch regions were studied using a questionnaire based on the DIagnosis of Sustainable Collaboration (DISC) model, focusing on: change management; perceptions, intentions and actions of collaborating parties; project organization; and factors in the wider context. Univariate and multivariate analyses with bootstrapping were applied to 106 respondents (62 percent response). Findings: A similar pattern of facilitating and hindering conditions emerged for the five regions, showing positive perceptions, but fewer positive intentions and actions. An overall favorable internal and external context for collaboration was found, but limited by bureaucratic procedures and prioritizing stakeholders' own organizational goals. Change management was rarely applied. Some differences between sectors emerged, with greatest support for collaboration found among the coordinating organizations (PHSs) and least support among the financing organization (municipalities). Research limitations/implications: The generalization of the findings is limited to the initial formation stage of collaboration, and may be affected by selection bias, small sample size and possible impact of interdepartmental collaboration within organizations. Practical implications: The authors recommend establishing stronger change management to facilitate translation of positive perceptions into intentions and actions, and coordination of divergent organizational structures and orientations among collaborating parties. Originality/value: The results show that it is valuable for collaborating parties to conduct DISC analyses to improve intersectoral collaboration in CSHP.

Background: From a complex systems perspective, implementation should be understood as the introduction of an intervention in a context with which it needs to interact in order to achieve its function in terms of improved health. The presence of intervention-context interactions could mean that during implementation particular patterns of crucial interaction points might arise. We examined the presence of – and regularities in – such 'bottlenecks for implementation', as this could create opportunities to predict and intervene in potential implementation problems. Methods: We conducted a cross-sectional observational study against the background of municipal intersectoral policymaking in the Netherlands. We asked implementers of health promotion interventions to identify bottlenecks by rating the presence and importance of conditions for implementation in a range of intervention systems. We used descriptive statistics to characterize these systems (by their behaviour change method, health theme and implementation setting) and the conditions that acted as bottlenecks. After stratifying bottlenecks by intervention system and the system's characteristics, we tested our hypotheses by comparing the number and nature of the bottlenecks that emerged. Results: More than half of the possible conditions were identified as a bottleneck for implementation. Bottlenecks occurred in all categories of conditions, e.g., relating to the implementer, the intervention, and political and administrative support, and often connected with intersectoral policymaking, e.g., relating to the co-implementer and the co-implementer's organization. Both our hypotheses were supported: (1) Each intervention system came across a unique set of – a limited number of – conditions hampering implementation; (2) Most bottlenecks were associated with the characteristics of the system in which they occurred, but bottlenecks also appeared in the absence of such an association, or remained absent in the presence thereof. Conclusions: We conclude that intervention-context interactions in integrated health policymaking may lead to both regularities and variations in bottlenecks for implementation. Regularities may partly be predicted by the function of an intervention system, and may serve as the basis for building the capacity needed for the structural changes that can bring about long-lasting health improvements. Variations may point at the need for flexibility in further tailoring the implementation approach to the – mostly unpredictable – problems at individual sites. [ABSTRACT FROM AUTHOR]

Purpose: This case study aimed to examine the factors influencing the implementation of health promotion (HP) policies and programs in secondary schools and the consequences for professional assistance. Design/methodology/approach: Group interviews were held in two schools that represented the best and worst case of implementation of a health promotion program "Schoolbeat") in the Southern Limburg region. Both schools were represented by the school manager, the health care coordinator and their school health promotion (SHP) advisor. The main purpose of the group interview was to describe the organization of HP in the school. Findings: Efforts to improve organizational aspects like change management, collaborative support and project management contributed to the implementation of HP. Practical implications: Based on these results the authors advise SHP advisors to focus more on the organizational aspects of HP in schools. Originality/value: This study contributes to the discussion about the tasks of HP professionals assisting secondary schools. Results show that effective assistance in shaping school health promotion requires competencies that go beyond organizing practical HP activities. HP professionals assisting schools need skills covering many aspects of the field, ranging from professional assistance for the process of implementing HP to organizational skills to advise and guide schools on the organizational changes needed for the implementation of HP. (Contains 2 tables.)

Physical activity in the form of consistently opting for stair use instead of elevator use can have important health benefits. The article discusses a study assessing whether increasing the attractiveness and accessibility of a stairwell had an impact on stair use among students and employees of Maastricht University, the Netherlands. The intervention involves multiple environmental changes, including prompts and enhanced aesthetics, visibility, and accessibility of the stairwell. Stair and elevator use by students and employees of Maastricht University are observed using video cameras. Data are collected continuously during 1 week before and 4 weeks after the implementation of the intervention. A total of 21,786 observations are made. Findings reveal that total stair use increased significantly, by 8.2% and that effects remain stable over the 4-week postintervention period. Stair use can be positively and continuously influenced by improving the stairwell environment. (Contains 1 table and 1 figure.)

Purpose: The purpose of this study is to explore adults' cognitive deliberations in deciding to visit an internet intervention, to extend the visit to use and process the intervention's content, and to revisit the intervention. Design/methodology/approach: A qualitative study was conducted consisting of five focus group interviews (n = 29, 25-69 years). The interview transcriptions were subjected to systematic content analysis. Findings: The results indicate that being motivated to change a health behavior and curiosity about the content were important factors in the decision to visit an internet intervention. To extend a visit, mainly intervention aspects were considered such as visual appeal, the number of questions needed to complete within the program, and the existence of a registration procedure. To induce revisits, regularly updated content and the possibility to monitor behavior change were important. Practical implications: These findings suggest that activities to promote use of internet interventions need to be directed at motivating adults to think about potential behavior change. Furthermore, intervention aspects need to meet various criteria, such as a professional appearance, concise and easy to understand texts and an explanation for the use of a registration procedure. Originality/value: The results of this explorative study can be used as a basis for further studies aimed at improving dissemination and use of internet-delivered behavior change interventions. (Contains 2 tables.)

Background: The worldwide increase in the rates of childhood overweight and physical inactivity requires successful prevention and intervention programs for children. The aim of the Active Living project is to increase physical activity and decrease sedentary behavior of Dutch primary school children by developing and implementing tailored, multicomponent interventions at and around schools.Methods/design: In this project, school-centered interventions have been developed at 10 schools in the south of the Netherlands, using a combined top-down and bottom-up approach in which a research unit and a practice unit continuously interact. The interventions consist of a combination of physical and social interventions tailored to local needs of intervention schools. The process and short- and long-term effectiveness of the interventions will be evaluated using a quasi-experimental study design in which 10 intervention schools are matched with 10 control schools. Baseline and follow-up measurements (after 12 and 24 months) have been conducted in grades 6 and 7 and included accelerometry, GPS, and questionnaires. Primary outcome of the Active Living study is the change in physical activity levels, i.e. sedentary behavior (SB), light physical activity (LPA), moderate-to-vigorous physical activity (MVPA), and counts-per-minute (CPM). Multilevel regression analyses will be used to assess the effectiveness of isolated and combined physical and social interventions on children's PA levels.Discussion: The current intervention study is unique in its combined approach of physical and social environmental PA interventions both at school(yard)s as well as in the local neighborhood around the schools. The strength of the study lies in the quasi-experimental design including objective measurement techniques, i.e. accelerometry and GPS, combined with more subjective techniques, i.e. questionnaires, implementation logbooks, and neighborhood observations.Trial Registration: Current Controlled Trials ISRCTN25497687 (registration date 21/10/2015), METC 12-4-077, Project number 200130003. [ABSTRACT FROM AUTHOR]

We assessed the perceived sustainability of community health programs organized by local intersectoral coalitions, as well as the factors that collaborating partners think might influence sustainability. Semi-structured interviews were conducted among 31 collaborating partners of 5 community health programs in deprived neighborhoods in the southern part of the Netherlands. The interview guide was based on a conceptual framework that includes factors related to the context, the leading organization, leadership, the coalition, collaborating partners, interventions and outcomes. Interviews were recorded, transcribed and content analyzed using NVivo 8.0. Participants in each of the programs varied in their perceptions of the sustainability of the program, but those people collaborating in pre-existing neighborhood structures expressed relatively high faith in their continuation. The participating citizens in particular believed that these structures would continue to address the health of the community in the future. We found factors from all categories of the conceptual framework that were perceived to influence sustainability. The program leaders appeared to be crucial to the programs, as they were frequently mentioned in close interaction with other factors. Program leaders should use a motivating and supportive leadership style and should act as ‘program champions'. [ABSTRACT FROM AUTHOR]

This study examined the relationship between the physical environment characteristics of primary schools and active school transport among 3,438 5- to 12-year-old primary school children in the Netherlands. The environmental characteristics were categorized into four theory-based clusters (function, safety, aesthetics, and destination). The correlations between the clusters and active school transport were examined, and multilevel regression analyses were used to examine the association between the clusters and active school transport. No correlations were found between environmental clusters and active school transport for younger children (age 5-9), but for older children (age 9-12), strong positive correlations were found between aesthetics and active transport as were found for safety and active transport. School neighborhood aesthetics were related to active transport for older primary school children. Presence of parks, good maintenance of green spaces, and absence of litter in the school environment contributed most to the positive association between aesthetics and active school transport. [ABSTRACT FROM AUTHOR]

Purpose -- A systematic review of effects and mediators was conducted to determine whether school health promotion interventions (SHPIs) can enhance children's academic performance (AP). Design/methodology/approach -- PubMed and PsycINFO database searches and subsequent reference list reviews were conducted for papers published before 18 January 2012 with a standard form of eligibility criteria encompassing standardized measures of AP (e.g. grade-point averages, end of year marks) and methodology sound studies (e.g. randomized controlled trials, cross-over controlled trials, quasi-experimental designs with pre- and posttest) of interventions addressing healthy lifestyles in the general school population. Information for the study description was extracted from the original article (e.g. country, study purpose, research design, effects on AP measures, components of Health Promoting School, author's explanations for observed effects). Effect sizes were calculated for effects on AP measures. Findings -- Remaining SHPIs targeted exclusively the maintenance of energy balance (physical activity (PA) and nutrition) and had small to large positive effects on AP; no negative effects were reported. Effects of different kinds of interventions varied across academic domains. One PA intervention reported large effects of vigorous activity on mathematics; another PA intervention had small to medium impact on language scores. Small to medium effects were found for interventions combining nutrition and PA elements; one affected mathematics and another both mathematics and language scores. Slight improvements in language scores were observed for breakfast provision in schools. Limitations -- The small number of interventions, little homogeneity in intervention components (content, length and measurement instruments), reporting bias and some inconsistent results should be considered when interpreting our results. Our review did not allow definite conclusions concerning mechanisms responsible for effects of SHPIs on AP. Practical implications -- Planned development of school health promotion will need to be based on evidence. Measures of AP should be included in evaluations of SHPIs. Schools and health professionals should be made aware of the importance of these measures. Originality/value -- We provide evidence that SHPIs promoting energy balance can affect AP, also if they do not target children at risk or with specific symptoms, nor employ elements directly connected to school education. [ABSTRACT FROM AUTHOR]

PurposeTo estimate the lifetime cost consequences for society and the National Health Service (NHS) of bilateral monofocal (SI40NB) or multifocal (ReSTOR or Array-SA40) intraocular lense (IOL) implantation after cataract surgery.SettingPublic hospital in the Netherlands.MethodsA Markov model simulated three cohorts of patients followed 69 until 100 years of age, or death. Spectacle independence rates for each IOL were adjusted to the results of a randomized clinical trial that compared monofocal and multifocal Array-SA40 IOL implants, together with a prospective cohort of patients implanted with ReSTOR. Adjustment was performed using the propensity score method in a multivariate analysis. Resource consumption was estimated from a dedicated Dutch survey. Dutch unit costs were applied to spectacles, cataract surgery, IOLs, visits to ophthalmologists, optometrists, transport, and spectacle cleaning materials. Cost discounted at 4% and undiscounted economic results were calculated.ResultsSpectacle independence rates were 86.0% for ReSTOR, 8.7% for monofocal IOLs, and 8.5% for Array-SA40. Patients lived without needing spectacles for 12.9 years after ReSTOR, for 1.4 years after monofocal IOLs, and 1.3 years after Array-SA40. ReSTOR patients bought 6.4 fewer pairs of spectacles than monofocal patients. Lifetime discounted cost consequences for the society were ReSTOR \[euro]3969, monofocal IOLs \[euro]4123, and Array-SA40 \[euro]5326. Corresponding costs for the NHS were \[euro]2415, \[euro]2555, and \[euro]2556, respectively.ConclusionsReSTOR IOLs provided higher levels of spectacle independence than monofocal SI40NB or multifocal Array-SA40 IOLs resulting in savings, compared to a monofocal, over the period modelled of \[euro]315 for society and \[euro]140 for the NHS. [ABSTRACT FROM AUTHOR]

Background: Previous research has shown that children in child-care do not comply with dietary intake recommendations (i.e. either exceeding or not meeting recommendations), which may be attributable to specific features of the child-care environment. The present study explored the relationship between the social and physical child-care (day-care) environment and dietary intake of 2- and 3-year-olds in Dutch child-care centres. Methods: The dietary intake of 135 children, aged 2 and 3 years, who were in child-care was assessed by observing randomly selected children at three meals (morning snack, lunch and afternoon snack) to determine dietary intake (i.e. saturated fat, dietary fibre and energy intake). The environment was observed using the Environment and Policy Assessment and Observation checklist, a structured instrument assessing the physical and social environment. Results: Children consumed a mean of 486 kJ (116 kcal) during the morning snack, 2043 kJ (488 kcal) during lunch and 708 kJ (169 kcal) during the afternoon snack. There were some gender and age differences in dietary intake. Several environmental factors (e.g. serving style and staff’s model dietary behaviour) were significantly associated with the children’s dietary intake. Conclusions: Overall, energy intake was in the upper range of recommended intake for children in child-care. The associations of several environmental factors with dietary intake stress the importance of the child-care environment for children’s dietary behaviour. Intervening in this setting could possibly contribute to the comprehensive prevention of childhood obesity. [ABSTRACT FROM AUTHOR]

Although much research has been done on the existence and formation of risk and issue based health policies, there is only little insight in health policy development processes in a broader context. This hampers intervention in these policy processes to adequately develop integrated and effective health policies. Legislation in the Netherlands requires municipalities to develop and implement local health policies. These policies are supposed to aim at the promotion of health across sectors and with a strong community involvement. Health policy development processes have been studied in four Dutch municipalities. For each case, we identified a range of stakeholders and monitored the change or stability of their characteristics over 3 years. In addition, for each case, three overlaying maps of networks were made addressing communication and collaboration actions within the defined set of stakeholders. We point out a number of barriers which impede integrated policy development at the local level: the importance given to local health policy, the medical approach to health development, the organizational self-interest rather than public health concern, the absence of policy entrepreneurial activity. Furthermore, this article advocates the use of complementary theoretical frameworks and the expansion of the methodological toolbox for health promotion. The value of stakeholder and network analysis in the health promotion domain, at this stage, is two-fold. First, mapping relevant actors, their positions and connections in networks provides us with insight into their capacity to participate and contribute to health policy development. Second, these new tools contribute to a further understanding of policy entrepreneurial roles to be taken up by health promotion professionals and health authorities in favour of the socio-environmental approach to health. Notwithstanding the value of this first step, more research is required into both the practical application as well as in the theoretical connections with, for example, Multiple Streams theory. [ABSTRACT FROM AUTHOR]

To date, comprehensive community health projects have not been evaluated in terms of their effect at the individual level, because outcomes are usually not defined at this level. In a community health project in the Netherlands, evaluation outcome mapping, a technique derived from intervention mapping, was used to identify distal as well as proximal programme objectives from which outcome measures could be derived. The intervention took place in a deprived area, where community members themselves defined stress, lack of area safety and parenting problems as the health-related problems they wanted to see addressed in the project. Local organizations wrote and implemented an action plan. The effects among residents were studied in a quasi-experimental design. Although no significant effects on improved perceived health or health-related problems were found at the level of the residents, the problems identified and their assumed causes showed significant coherence. This study is believed to be of relevance to evidence-based health promotion theory and practice as it demonstrates that it is possible to conduct an individual effect evaluation in a comprehensive community approach without jeopardizing the process of the intervention. [ABSTRACT FROM AUTHOR]

Background: People with mental illness have a reduced life expectancy compared to the general population. Despite the increasing evidence for the efficacy of lifestyle interventions there is little change in routine clinical care. This discrepancy is often referred to as the implementation gap and has caused a need for effectiveness and implementation research in real-world settings. Our study assesses the effectiveness and implementation of a multidisciplinary lifestyle focused approach in the treatment of inpatients with mental illness (MULTI +)., Methods: An open cohort stepped wedge cluster randomized trial in inpatients psychiatric wards of GGz Centraal, the Netherlands. The wards are divided into three clusters based on geographical region. These clusters are randomly allocated to one of the three pre-defined steps to integrate MULTI + . MULTI + can be tailored to fit individual psychiatric wards and includes 10 core components aimed at improving lifestyle factors. The primary outcome is to investigate the difference in the mean QRISK3 score of patients receiving MULTI + compared to patients receiving TAU. Secondary outcomes include somatic and mental health outcomes, lifestyle factors, and implementation factors. Findings will be analysed using mixed model analyses., Discussion: The MULTI + study is the first large-scale study evaluating the long-term effects of a multidisciplinary, multicomponent approach aimed at improving lifestyle factors in routine inpatient mental health care. A limitation of this study is the risk of missing data due to the large-scale, real-world setting of this study. Furthermore, implementation monitoring and external events that may influence outcomes could be difficult to account for. Strengths of this study are the focus on effectiveness as well as implementation and the inclusion of both patient and health care professionals' perspectives. Effectiveness studies in routine clinical care can advance our knowledge on lifestyle interventions in real-world settings., Trial Registration: ClinicalTrials.gov registration. Identifier: NCT04922749 . Retrospectively registered 3th of June 2021., (© 2022. The Author(s).)

Palbociclib is an oral inhibitor of cyclin-dependent kinases 4 and 6 used in the treatment of locally advanced and metastatic breast cancer, and is extensively metabolized by cytochrome P450 enzyme 3A4 (CYP3A4). A pharmacokinetic/pharmacodynamic relationship between palbociclib exposure and neutropenia is well known. This study aimed to investigate the effects of the moderate CYP3A4 inhibitor erythromycin on the pharmacokinetics of palbociclib. We performed a randomized crossover trial comparing the pharmacokinetics of palbociclib monotherapy 125 mg once daily (q.d.) with palbociclib 125 mg q.d. plus oral erythromycin 500 mg three times daily for seven days. Pharmacokinetic sampling was performed at steady-state for both dosing schedules. Eleven evaluable patients have been enrolled. For palbociclib monotherapy, geometric mean area under the plasma concentration-time curve from zero to infinity (AUC 0-24h ), maximum plasma concentration (C max ), and minimum plasma concentration (C min ) were 1.46 × 10 3  ng•h/mL (coefficient of variation (CV) 45.0%), 80.5 ng/mL (CV 48.5%), and 48.4 ng/mL (CV 38.8%), respectively, compared with 2.09 × 10 3  ng•h/mL (CV 49.3%, P = 0.000977), 115 ng/mL (CV 53.7%, P = 0.00562), and 70.7 ng/mL (CV 47.5%, P = 0.000488) when palbociclib was administered concomitantly with erythromycin. Geometric mean ratios (90% confidence intervals) of AUC 0-24h , C max , and C min for palbociclib plus erythromycin vs. palbociclib monotherapy were 1.43 (1.24-1.66), 1.43 (1.20-1.69), and 1.46 (1.30-1.63). Minor differences in adverse events were observed, and only one grade ≥ 3 toxicity was observed in this short period of time. To conclude, concomitant intake of palbociclib with the moderate CYP3A4 inhibitor erythromycin resulted in an increase in palbociclib AUC 0-24h and C max of both 43%. Therefore, a dose reduction of palbociclib to 75 mg q.d. is rational, when palbociclib and moderate CYP3A4 inhibitors are used concomitantly., (© 2021 The Authors. Clinical Pharmacology & Therapeutics © 2021 American Society for Clinical Pharmacology and Therapeutics.)

Intersectoral policymaking to improve public health includes integrated health promotion (HP) intervention packages that address a variety of health behavior determinants. The involvement of different partners is assumed to be necessary to implement such integrated packages. We examined how partnership diversity was associated with the composition of intervention packages implemented in Dutch municipalities. In a longitudinal multiple-case study (2012-14), we collected questionnaire data among 31 project leaders and 152 intervention implementers in 31 (alliances of) municipalities. Package composition was assessed in terms of intervention strategies, implementation settings and targeted behavioral determinants. Partnership diversity during the adoption and implementation phases was assessed in terms of the actors and sectors, as well as private partners and citizens involved. The association between partnership diversity and package composition was examined using crosstabs. Almost all packages integrated multiple strategies, but mostly education, facilitation and case finding, in multiple, but mostly health and public settings, such as schools. The packages targeted diverse behavioral determinants, although mainly personal and social environmental factors. A variety of partners from multiple sectors was involved, during both adoption and implementation of the packages. However, partners from the health, welfare and education sectors were mostly involved. More partnership diversity, especially during implementation, was associated with more integrated intervention packages. In intersectoral policymaking, investment in diversely composed partnerships seems worthwhile for implementing integrated intervention packages. However, investments in other conditions, like framing health issues and network management, are also needed to make environmental determinants of health behavior the object of HP., (© The Author(s) 2020. Published by Oxford University Press.)

Background: Registration rates are low for organ donation among lower educated adolescents in The Netherlands. This could be improved by preparing them for making a decision regarding donation when they become 18 years old. To do so, more insight is needed into their beliefs about organ donation and registration., Methods: A cross-sectional quantitative study was conducted among students in intermediate vocational education schools. Data were gathered my means of self-administrated questionnaires. The outcome measurements included current registration status, being an organ donor, intention to register, and intention to become a donor. Correlation coefficients were used to assess the strength of associations between beliefs and each of the 4 outcome measurements., Results: A total of 405 participants (mean age, 18.86 years) were included, of whom 26.6% had already registered a decision. Most beliefs showed a significant correlation with one or more of the outcomes. In general, the correlations were of small to medium size and participants scored around the middle of the scales on the beliefs., Conclusion: Means and correlations need to be combined to gain insight into the importance of certain beliefs for future interventions. However, it is plausible that, in addition to these explicit beliefs, implicit factors play a role in registration behavior. This could be explored in future research. Results could support intervention development for increasing registration rates., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: One third of bariatric surgery patients have an apnea-hypopnea index (AHI)>15/hr, representing moderate and severe forms of obstructive sleep apnea (OSA). Treating these forms of OSA is recommended to reduce the risk of perioperative complications. The AHI derived from poly(somno)graphy [P(S)G] is the gold standard for OSA diagnosis. However, performing P(S)G in all patients scheduled for bariatric surgery is time consuming and expensive. An accurate and simple screening tool able to rule out moderate to severe OSA would reduce the number of patients needing mandatory P(S)Gs., Objectives: To assess the validity of a simple sleep monitor (Checkme Health Monitor) as a screening tool for OSA in bariatric surgery patients., Setting: Obesity Center Amsterdam, OLVG-West, Amsterdam, the Netherlands METHODS: Patients scheduled for bariatric surgery were prospectively enrolled in this study. All patients underwent preoperative P(S)G and simultaneously used the Checkme to assess the oxygen desaturation index. The diagnostic performance of the Checkme for AHI ≥15/hr was assessed using receiver operating characteristic curve analysis., Results: A total of 50 patients were analyzed. Sensitivity and negative predictive value were 100% and 100%, respectively, specificity and positive predictive value were 69% and 64%, respectively, for the optimal cutoff value of Checkme-3% oxygen desaturation index ≥9/hr for P(S)G-AHI ≥15. The area under the curve value expressed by the receiver operating characteristic curve was .95., Conclusion: The Checkme is valid for exclusion of moderate and severe OSA in bariatric surgery patients. The Checkme enables bariatric clinics not to perform P(S)G in all patients scheduled for bariatric surgery., (Copyright © 2018 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Distinguishing perihilar cholangiocarcinoma (PHC) from benign forms of sclerosing cholangitis affecting the hilar bile ducts is challenging, since histological confirmation of PHC is difficult to obtain and accurate non-invasive diagnostic tests are not available. IgG4-associated cholangitis (IAC), an imitator of PHC, may present with clinical and radiographical signs of PHC. IAC can be accurately diagnosed with a novel qPCR test. The aim of this study was to investigate the incidence and long-term activity of IAC in patients resected for PHC in a single tertiary center over a period of 30 years., Methods: All patients with benign disease who underwent surgery for presumed PHC in our institute between 1984 and 2015 were identified. Benign liver and bile duct specimens were re-evaluated by a pathologist and scored according to international consensus pathology criteria for IgG4-related disease (IgG4-RD). Patients with benign disease still alive were followed-up and a clinical diagnosis of IAC was made using a combination of the HISORt group C (response to steroids) criteria and elevated serum IgG4 levels and/or the novel IgG4/IgG RNA ratio. Also, recurrent symptomatic disease at any time after surgery requiring immunosuppression was assessed., Results: Out of 323 patients who underwent surgery for presumed PHC, 50 patients (15%) had benign disease. In 42% (n = 21/50) of these patients a histological (n = 17) or clinical (n = 4) diagnosis of IAC was established. The remaining patients were diagnosed with unclassified sclerosing inflammation, cystadenoma, or sclerosing hemangioma. Nine out of 12 IAC patients who were followed-up showed episodes of recurrent disease requiring immunosuppressive treatment., Conclusions: Liver and bile duct resections for PHC during three decades disclosed in 15% benign biliary disorders mimicking PHC of which 42% were definitely diagnosed as IAC. IgG4-RD remains active in the majority of patients with IAC years after surgery. Novel diagnostic tests for IAC might reduce misdiagnosis, unnecessary surgery, and life-threatening complications.

The ability to predict upper respiratory infections (URI), lower respiratory infections (LRI), and gastrointestinal tract infections (GI) in independently living older persons would greatly benefit population and individual health. Social network parameters have so far not been included in prediction models. Data were obtained from The Maastricht Study, a population-based cohort study (N = 3074, mean age (±s.d.) 59.8 ± 8.3, 48.8% women). We used multivariable logistic regression analysis to develop prediction models for self-reported symptomatic URI, LRI, and GI (past 2 months). We determined performance of the models by quantifying measures of discriminative ability and calibration. Overall, 953 individuals (31.0%) reported URI, 349 (11.4%) LRI, and 380 (12.4%) GI. The area under the curve was 64.7% (95% confidence interval (CI) 62.6-66.8%) for URI, 71.1% (95% CI 68.4-73.8) for LRI, and 64.2% (95% CI 61.3-67.1%) for GI. All models had good calibration (based on visual inspection of calibration plot, and Hosmer-Lemeshow goodness-of-fit test). Social network parameters were strong predictors for URI, LRI, and GI. Using social network parameters in prediction models for URI, LRI, and GI seems highly promising. Such parameters may be used as potential determinants that can be addressed in a practical intervention in older persons, or in a predictive tool to compute an individual's probability of infections.

The objective of this study was to determine the surface contamination with platinum-containing antineoplastic drugs in veterinary and human oncology centres. Inductively coupled plasma mass spectrometry was used to measure platinum levels in surface samples. In veterinary and human oncology centres, 46.3 and 68.9% of the sampled surfaces demonstrated platinum contamination, respectively. Highest platinum levels were found in the preparation rooms (44.6 pg cm(-2)) in veterinary centres, while maximal levels in human centres were found in oncology patient-only toilets (725 pg cm(-2)). Transference of platinum by workers outside areas where antineoplastic drugs were handled was observed in veterinary and human oncology centres. In conclusion, only low levels of platinum contamination attributable to carboplatin were found in the sampled veterinary oncology centres. However, dispersion of platinum outside areas where antineoplastic drugs were handled was detected in veterinary and human oncology centres. Consequently, not only personnel, but also others may be exposed to platinum., (© 2013 Blackwell Publishing Ltd.)

Background: With the aim of targeting high-risk hidden heterosexual young people for Chlamydia trachomatis (CT) testing, an innovative web-based screening strategy using Respondent Driven Sampling (RDS) and home-based CT testing, was developed, piloted and evaluated., Methods: Two STI clinic nurses encouraged 37 CT positive heterosexual young people (aged 16-25 years), called index clients, to recruit peers from their social and sexual networks using the web-based screening strategy. Eligible peers (young, living in the study area) could request a home-based CT test and recruit other peers., Results: Twelve (40%) index clients recruited 35 peers. Two of these peers recruited other peers (n = 7). In total, 35 recruited peers were eligible for participation; ten of them (29%) requested a test and eight tested. Seven tested for the first time and one (13%) was positive. Most peers were female friends (80%). Nurses were positive about using the strategy., Conclusions: The screening strategy is feasible for targeting the hidden social network. However, uptake among men and recruitment of sex-partners is low and RDS stopped early. Future studies are needed to explore the sustainability, cost-effectiveness, and impact of strategies that target people at risk who are not effectively reached by regular health care.

Background: Active modes of transport like walking and cycling have been shown to be valuable contributions to daily physical activity. The current study investigates associations between personal and neighbourhood environmental characteristics and active transport among inhabitants of Dutch deprived districts., Method: Questionnaires about health, neighbourhoods, and physical activity behaviour were completed by 742 adults. Data was analysed by means of multivariate linear regression analyses., Results: Being younger, female, and migrant and having a normal weight were associated with more walking for active transport. Being younger, male, and native Dutch and having a normal weight were associated with more cycling for active transport. Neighbourhood characteristics were generally not correlated with active transport. Stratified analyses, based on significant person-environment interactions, showed that migrants and women walked more when cars did not exceed maximum speed in nearby streets and that younger people walked more when speed of traffic in nearby streets was perceived as low. Among migrants, more cycling was associated with the perceived attractiveness of the neighbourhood surroundings., Discussion and Conclusion: Results indicated that among inhabitants of Dutch deprived districts, personal characteristics were associated with active transport, whereas neighbourhood environmental characteristics were generally not associated with active transport. Nevertheless, interaction effects showed differences among subgroups that should be considered in intervention development.

The Dutch government encourages municipalities to develop 'Health in All Policies' (HiAP). The development of such a policy requires inter-sectoral collaboration, however municipalities show little initiative in this regard. Operating in an advisory role, the regional Public Health Service (PHS) has supported municipalities in South-Limburg in setting up inter-sectoral collaboration. A coaching program for municipal stakeholders was developed and implemented to improve HiAP, using obesity as an example. To determine the effectiveness of this coaching program, civil servants, managers and municipal councilors were invited to fill in an Internet questionnaire prior to and at the completion of the program. By means of a log-book all activities were registered in coached municipalities and in-depth interviews were held with municipal managers. Outcomes were scored depending on the stage of HiAP proposals. Six of the nine coached municipalities showed concrete outcomes in terms of HiAP proposals. The results show that more support and involvement at each system level stimulates the development of HiAP. The program contributed positively to the implementation of HiAP interventions targeting obesity. The pretest results for coached municipalities were better compared to non-coached municipalities. However, after 30 months of coaching this positive starting position faded away. We recommend that the municipal management become more involved in the development of HiAP and advise the PHS to increasingly demonstrate their expertise. Here lies a challenge for municipalities and their regional PHS., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Background: The aim of the study was to identify promoting and impeding factors for successful implementation of a Dutch primary health care-based lifestyle programme called 'BeweegKuur'. BeweegKuur aims to increase the physical activity and change the diet of people at increased health risk due to overweight or obesity., Objective: To determine perceived promoting and impeding factors in the implementation of the BeweegKuur programme for overweight and obese people., Methods: This study consisted of 3 focus group meetings with intervention participants, 15 interviews with health care professionals (HCPs) and 1 focus group session with dieticians. The interviews and focus groups were recorded and transcribed verbatim. The data were analysed with the Nvivo qualitative research software package., Results: For some intervention participants, the invitation to participate in BeweegKuur came unexpectedly, as they had not been diagnosed with an illness. HCPs were aware of this and took time to explain to participants that the programme was appropriate and safe for them. Participants as well as professionals were generally positive about the feasibility of the programme for overweight and obese people., Conclusions: HCPs as well as intervention participants were motivated to participate in the programme, and generally indicated that the intervention was in accordance with their needs. The multidisciplinary approach and the combination of physical activity and dietary behaviour change can make the BeweegKuur programme a success if potential impeding factors like those identified in the present study are overcome.

Background: In the West, removal of the uvula is predominantly undertaken as part of palatal surgery, in cases of obstructive sleep apnoea. In the developing world, such as the Middle East and Africa, uvulectomy is a more common practice. The uvula is removed for curative or preventive purposes, or as part of ritual practice. Due to immigration from developing to developed world countries, and to Western doctors working abroad, such doctors are increasingly being confronted with unfamiliar traditional healing practices, within a medical context., Methods: The Medline and Embase online databases were systematically searched for literature on traditional uvulectomy. We present a review of this literature. We also present the first report, to our best knowledge, of obstructive sleep apnoea as a late complication of traditional uvulectomy., Discussion: Traditional uvulectomy may be complicated by post-operative haemorrhage and local infections, among many other problems. We report cases of obstructive sleep apnoea and snoring caused by palatal stenosis resulting from traditional uvulectomy during childhood.

Objectives: Studies regarding the association of child-care use with body mass index (BMI), overweight or obesity development show contradictory results. This study examined the relationship between child-care use and BMI z-scores and overweight, as well as associates of child-care use in children up to 2 years old., Methods: Longitudinal data originated from the Dutch KOALA Birth Cohort Study. Questionnaires assessed child-care use at ages 7 months and 1 and 2 years (N=2396). Height and weight assessed at 1 and 2 years were used to calculate BMI z-scores. Overweight was defined as a BMI z-score of ≥85th percentile. The influence of child-care use on weight development was tested using backward linear and logistic regression analyses. Outcomes were: (1) BMI z-score at 1 and 2 years; (2) change in BMI z-score between 1 and 2 years; (3) overweight vs non-overweight at 1 and 2 years; and (4) change from normal weight to overweight vs remaining normal weight between 1 and 2 years. The association between child-care use and parental background characteristics was tested using backward logistic regression analyses., Results: Child-care use (no/yes) at 1 and 2 years positively predicted BMI z-scores at age 2 years, as well as change in BMI z-score between 1 and 2 years. These associations were adjusted for various covariates (for example, parental working hours). Furthermore, child-care use significantly increased the odds of being overweight at age 1 year. There were few differences in BMI or overweight between intensive (>16 h per week) and limited child-care use (≤16 h). Child-care use was positively associated with various parental characteristics, including parental working hours and maternal educational level., Conclusion: The findings suggest a small influence of child-care use on weight development in very young children. The child-care setting could have an important role in preventive interventions against overweight and obesity development in young children.

Rheumatoid arthritis was diagnosed in a 65-year-old man from Suriname, on the basis of clinical and radiological findings. However, he was eventually diagnosed with leprosy. This emerged when the patient developed skin lesions and complained of increasing sensibility disorders during treatment for the alleged rheumatoid arthritis. He was treated with a combination therapy consisting of rifampicin, clofazimine, dapsone, and prednisone. The skin lesions and joint symptoms were resolved as a result of this, but the sensibility disorders persisted. As physicians are not sufficiently familiar with leprosy and the condition has many manifestations that can mimic more frequently occurring diseases, leprosy is often diagnosed at a later stage. This may result in irreversible damage, especially to the peripheral nerves, which may lead to disability. Therefore, for patients who originate from areas where leprosy is endemic and who suffer from joint complaints in combination with skin or sensibility disorders, the diagnosis of leprosy should be considered.

Background: To ensure the continuation of a successful pilot programme, the change process and the concept of sustainability need to be elaborated. So far, there are different theories on organizational change and sustainability but its practical application stay far behind., Objectives: To test the practical application of a theory-based concept of sustainability and to assess the role of the change agent. A health counselling programme for high-risk cardiovascular patients, called Heartbeat 2, was used as a case study., Methods: Outcome indicators were assessed based on the questions: Why should health counselling be sustained? How should this be done and by whom? How much needs to occur and by when? Data were derived from registrations, reports and focus group interviews., Results: The results indicate a need for a linkage system in the final stages of change so that the programme is maintained. Limitations of the external change agent are described. The outcome indicators appeared to be an adequate operationalization to monitor sustainability. The change process leading up to sustainability appeared to be highly complex due to unpredictable and unforeseen external factors., Conclusions: Our concept of sustainability appeared to be an adequate tool for the change agent to assess the extent of sustainability. An external change agent has limited influence on the management's decision-making processes during the sustainability stage. As long as the context is changing, definite choices to sustain the innovative service of health counselling in hospitals will not be made, which inherently means an ongoing change process to sustainability.

Objectives: To assess participants' acquaintance with and willingness to try healthful food alternatives, and to test the psychometric properties of an adapted Dutch version of the Food Neophobia Scale (FNS) in order to study the role of food neophobia in this context., Design: A cross-sectional study incorporating two web-based questionnaires, including a retest of the FNS one week later. Measures included acquaintance with and willingness to try 15 healthful food alternatives, level of food neophobia, level of education, gender and age. Multiple linear regression analyses were used to study associations between demographics and level of food neophobia as well as associations between level of food neophobia and acquaintance with and willingness to try the healthful alternatives., Setting: The study was conducted in The Netherlands using a representative Internet panel., Participants: A total of 326 participants aged 18-50 years participated., Results: Internal consistency and test-retest reliability of the FNS version used were sufficient. On average participants were acquainted with 7.9 of the products and modestly willing to try the products. Lowly educated participants had significantly higher FNS scores than highly educated participants (beta = -0.23, P < 0.01). FNS score was significantly associated with acquaintance with (beta = -0.21, P < 0.001) and willingness to try the healthful alternatives (beta = -0.26, P < 0.001)., Conclusion: Further research into the role of food neophobia is warranted when wanting to stimulate the integration of healthful alternative products in the daily diet, especially among persons with low education.

The revised guideline 'Allergic and nonallergic rhinitis' of the Dutch College of General Practitioners contains adequate and well-documented recommendations for the diagnosis and treatment of patients with allergic and non-allergic rhinitis. However, the role of surgery in the treatment of hypertrophy of inferior and medial concha, deviated nasal septum and nasal polyps is underrated.

Objective: To measure the effects of two school-based interventions on children's intake of fruit and vegetables (F&V)., Design and Methods: A total of six primary schools were randomly assigned to (1) a free F&V distribution programme, or (2) a multicomponent programme, consisting of a classroom curriculum and parental involvement. The two interventions were evaluated on their effects and compared with six control schools in a pre-test-post-test design. Two methods were used for dietary assessment: a pre-structured food recall and a food-frequency questionnaire including only F&V., Subjects: A total of 939 parents of children aged 4-12 years filled out the questionnaire at both pre-test and post-test. The response rate was 54%., Results: Multilevel analyses showed that both programmes were equally effective in increasing children's fruit consumption by 0.2 portions per day. The free F&V distribution increased vegetable intake among non-native children and the oldest age group, and the multicomponent programme among the oldest children and girls. The distribution also caused an increased 24 h fruit, juice and vegetable intake among the youngest and the oldest age groups, and the multicomponent programme among all children., Conclusion: The results of this study indicate that both interventions were shown to be effective for different subgroups regarding age, gender and ethnicity. When comparing both interventions, the distribution programme was shown to be more effective, especially in increasing vegetable consumption. An important next step will be to investigate which intervention has the greatest potential to be implemented in primary schools.

In recent decades, school health promotion programs have been developing into whole-school health approaches. This has been accompanied by a greater understanding among health promoters of the core-business of schools, namely education, and how health promotion objectives can be integrated into this task. Evidence of the positive impact of school health promotion on health risk behavior of students is increasing. This article focuses on the processes and initial results of developing a collaborative model tailored for whole-school health in the Netherlands, named schoolBeat. The Dutch situation is characterized by fragmentation, a variety of health and welfare groups supporting schools, and a lack of sound integrated youth policies. A literature review, observations, and stakeholder consultation provided a clear picture of the current situation in school health promotion, and factors limiting a comprehensive and needs-based approach to school health. This revealed that a health promotion team within a school is fundamental to an effective approach to tailored school health promotion. A respected member of school staff should chair this team. To strengthen the link with the school care team, the school care coordinator should be a member of both teams. To provide coordinated support to all schools in a region, participating organizations decided to share advisory tasks. These tasks are included in the regular health promotion work of their staff. This means working with one advisor representing all school-health organizations per school, and using a comprehensive overview of possible support and projects promoting health. Empowering schools in needs assessments and comprehensive school health promotion is an important element of the developed approach. This article concludes with an examination of emerging issues in evaluating collaborative school health support during the first 18 months of development, and implementation and future perspectives regarding sustainable collaboration and quality improvement.

In the hospital of the Free University in Amsterdam (the Netherlands) 727 patients with primary squamous cell carcinoma of the oral cavity and lip have been studied for the incidence of second primary tumors occurring in the respiratory and upper digestive tract. Out of the 727 patients, 74 (10.2%) developed a second primary tumor in these tracts. The incidence of second primary tumors was expressed per 1.000 person-years of follow-up; 28 second primary tumors per 1.000 person-years of follow-up were seen in the respiratory and upper digestive tract. The patients ran the risk of developing a second primary tumor at a steady rate of approximately 2.8% per year during at least ten years. Furthermore, an increasing incidence of second primary tumors could be observed in case of increasing use of tobacco.

727 patients with squamous cell carcinoma (SCC) of the lip and oral cavity have been followed for the occurrence of second primary tumours (SPTs) in the respiratory and upper digestive tract (RUDT). 74 patients (10%) developed at least one SPT in the RUDT. The incidence of SPTs was expressed per 1000 person-years of follow-up. In our study about 28 SPTs per 1000 person-years of follow-up were seen in the RUDT. Patients were at risk for a second primary tumour, at a steady rate of approximately 2.8% per year during at least 10 years. Furthermore, patients with an index tumour in the lower part of the mouth (floor of mouth, retromolar area and lower alveolar process), which is more related to tobacco and/or alcohol, seem to be more at risk for SPTs than patients with an index tumour in the other (sub)sites of the mouth.

Endoscopic sinus surgery has become popular during recent years. We report the complications of endoscopic sinus surgery in 593 patients in whom 1235 sides were operated on. Forty-five patients had complications, in three of whom they were systemic. The remaining 42 patients had complications on 52 (4.2%) sides; these complications were mostly minor. In 0.3% of the sides operated on, potentially serious complications, such as orbital hematoma or cerebrospinal fluid leak, were seen. None of these patients developed loss of vision or meningitis. Absence of the middle turbinate is a risk factor for developing complications. We conclude that endoscopic sinus surgery is a safe procedure in experienced hands.

All 748 patients with squamous cell carcinomas of the larynx treated in the Free University Hospital, Amsterdam, between 1964 and 1983 were analysed retrospectively with regards to the occurrence of multiple primary tumours. One hundred and four (14 per cent) second primary tumours were reported. Seventy-three (10 per cent) were situated in the respiratory tract and upper digestive tract. Of these 73, 64 were localized in the lung. No esophageal carcinomas were reported. Male patients, with a glottic carcinoma had a statistically higher change of developing a second primary than female patients (14.5 per cent versus 0 per cent). In both sexes more multiple primary tumours occurred in supraglottic than in glottic cancers. Only in female patients was the difference statistically significant. Because of the high rate of lung carcinomas, and since most tumours are metachronous, bronchoscopy is justified at the initial work-up and is also to be considered at regular intervals during the follow-up period.