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In the absence of visible mucosal damage, it is hypothesized that the esophageal mucosal barrier is functionally impaired in patients with non-erosive reflux disease (NERD). The aim of the present study was to perform an exploratory analysis of the mucosal barrier in NERD compared to erosive esophagitis (EE) and controls. A second aim was to explore TRPV1 gene transcription in relation to the mucosal barrier function and heartburn symptoms. In this prospective study, 10 NERD patients, 11 patients with active erosive esophagitis and 10 healthy volunteers were included. Biopsies from non-eroded mucosa were obtained for (1) ex vivo analyses (Ussing chamber) of transepithelial electrical resistance (TEER) and permeability (2) gene transcription of tight-junction proteins and transient receptor potential vanilloid subfamily member 1 (TRPV1). No differences in TEER or permeability were found between NERD and healthy volunteers, whereas TEER was lower in patients with erosive esophagitis. TRPV1 gene transcription was not significantly different between EE, NERD and controls. Conclusions: esophageal mucosal barrier function and TRPV1 transcription is not significantly altered in NERD patients. Future research is needed to explore other potential mechanisms that may account for the high symptom burden in these patients.

They say that things occur in 'pig cycles' of 7 years. If that is true, if you would be superstitious, then we have just completed 7 very good years and are heading towards 7 worse years. Our Impact Factor (IF) has increased steadily over this first 7 year period from 1.474 in 2013 (IF over 2012), to 1.5 in 2014, to 2.647 in 2015, and then to 3.301 last year! Since the IF is one of the criteria used by researchers to select the journal they publish in, we have seen a steady increase in submissions reaching 237 manuscripts last year, which is a 21% increase compared to 2015 and a 32% increase compared to 2014. That is of course great news! It has led to the fact that we decided to publish 6 issues in 2015, rather than the usual 4, and 5 issues in 2016, to prevent that the waiting time between acceptance and appearance in hard-copy would be too long. However, since submissions have gone up and since the IF has gone up as well, we are more critical about which manuscripts we select for review, because we now have sufficient numbers of manuscripts and we still have to worry about a backlog. Last year, I predicted that the IF would decline, due to the fact that we are publishing more papers than in the years before, and that because of this we add more papers in the denominator of the formula for the calculation of the IF. But that would have meant that already last year the IF should have gone down, but instead it has gone up. I guess, that means that my abilities to predict the future are horrible. I wonder if there is a probiotic to improve that...

The aim of this study was to investigate the effects of three Lactobacillus plantarum strains on in-vivo small intestinal barrier function and gut mucosal gene transcription in human subjects. The strains were selected for their differential effects on TLR signalling and tight junction protein rearrangement, which may lead to beneficial effects in a stressed human gut mucosa. Ten healthy volunteers participated in four different intervention periods: 7-day oral intake of either L. plantarum WCFS1, CIP104448, TIFN101 or placebo, proceeded by a 4 weeks wash-out period. Lactulose-rhamnose ratio (an indicator of small intestinal permeability) increased after intake of indomethacin, which was given as an artificial stressor of the gut mucosal barrier (mean ratio 0.06 ± 0.04 to 0.10 ± 0.06, p = 0.001), but was not significantly affected by the bacterial interventions. However, analysis in small intestinal biopsies, obtained by gastroduodenoscopy, demonstrated that particularly L. plantarum TIFN101 modulated gene transcription pathways related to cell-cell adhesion with high turnover of genes involved in tight- and adhesion junction protein synthesis and degradation (e.g. actinin alpha-4, metalloproteinase-2). These effects were less pronounced for L. plantarum WCFS1 and CIP104448. In conclusion, L. plantarum TIFN101 induced the most pronounced probiotic properties with specific gene transcriptional effects on repair processes in the compromised intestine of healthy subjects.

BACKGROUND: Protein infusion in the small intestine results in intestinal brake activation: a negative feedback mechanism that may be mediated by the release of gastrointestinal peptides resulting in a reduction in food intake. It has been proposed that duodenum, jejunum and ileum may respond differently to infused proteins.OBJECTIVE: To investigate differences in ad libitum food intake, feelings of hunger and satiety and the systemic levels of cholecystokinin (CCK), glucagon-like peptide-1 (GLP-1), peptide YY (PYY), glucose and insulin after intraduodenal, intrajejunal and intraileal protein infusion.METHODS: Fourteen subjects (four male, mean age: 23 +/- 2.1 years, mean body mass index: 21.6 +/- 1.8 kg m(-2)) were intubated with a naso-ileal catheter in this double-blind, randomized, placebo-controlled crossover study. Test days (four in total, executed on consecutive days) started with the ingestion of a standardized breakfast, followed by the infusion of 15 g of protein in the duodenum, jejunum or ileum over a period of 60 min. Food intake was measured by offering an ad libitum meal and Visual Analogue Scale (VAS) scores were used to assess feelings of hunger and satiety. Blood samples were drawn at regular intervals for CCK, GLP-1, PYY, glucose and insulin analyses. RESULTS: Intraileal protein infusion decreased ad libitum food intake compared with both intraduodenal and placebo infusion (ileum: 628.5 +/- 63 kcal vs duodenum: 733.6 +/- 50 kcal, P CONCLUSIONS: Protein infusion into the ileum decreases food intake during the next meal compared with intraduodenal infusion, whereas it increases systemic levels of GLP-1 compared with protein infusion into the jejunum and placebo respectively.

There is an elevated incidence of cases of obesity worldwide. Therefore, the development of strategies to tackle this condition is of vital importance. This review focuses on the necessity of optimising in vitro systems to model human colonic fermentation in obese subjects. This may allow to increase the resolution and the physiological relevance of the information obtained from this type of studies when evaluating the potential role that the human gut microbiota plays in obesity. In light of the parameters that are currently used for the in vitro simulation of the human gut (which are mostly based on information derived from healthy subjects) and the possible difference with an obese condition, we propose to revise and improve specific standard operating procedures. © 2016 Wageningen Academic Publishers.

BACKGROUND & AIMS: The gut microbiota affects host lipid and glucose metabolism, satiety, and chronic low-grade inflammation to contribute to obesity and type 2 diabetes. Fermentation end products, in particular the short-chain fatty acid (SCFA) acetate, are believed to be involved in these processes. We investigated the long-term effects of supplementation with galacto-oligosaccharides (GOS), an acetogenic fiber, on the composition of the human gut microbiota and human metabolism.METHODS: We performed a double-blinded, placebo-controlled, parallel intervention study of 44 overweight or obese (body mass index, 28-40 kg/m(2)) prediabetic men and women (ages, 45-70 y) from October 2014 through October 2015 in Maastricht, The Netherlands. The participants were assigned randomly to groups who ingested 15 g GOS or isocaloric placebo (maltodextrin) daily with their regular meals for 12 weeks. Before and after this period, we collected data on peripheral and adipose tissue insulin sensitivity, fecal microbiota composition, plasma and fecal SCFA, energy expenditure and substrate oxidation, body composition, and hormonal and inflammatory responses. The primary outcome was the effect of GOS on peripheral insulin sensitivity, measured by the hyperinsulinemic-euglycemic clamp method.RESULTS: Supplementation of diets with GOS, but not placebo, increased the abundance of Bifidobacterium species in feces by 5-fold (P = .009; q = 0.144). Microbial richness or diversity in fecal samples were not affected. We did not observe any differences in fecal or fasting plasma SCFA concentrations or in systemic concentrations of gut-derived hormones, incretins, lipopolysaccharide-binding protein, or other markers of inflammation. In addition, no significant alterations in peripheral and adipose tissue insulin sensitivity, body composition, and energy and substrate metabolism were found.CONCLUSIONS: Twelve-week supplementation of GOS selectively increased fecal Bifidobacterium species abundance, but this did not produce significant changes in insulin sensitivity or related substrate and energy metabolism in overweight or obese prediabetic men and women. ClincialTrials.gov number, NCT02271776.

Background. The role of health broker is a relatively new one in public health. Health brokers aim to create support for efforts to optimise health promotion in complex or even “wicked” public health contexts by facilitating intersectoral collaborations and by exchanging knowledge with different stakeholders. The current study aimed to explore the role of health brokers, by examining the motivational, contextual, and behaviour-related factors they have to deal with. Methods. Fifteen professionals from various backgrounds and from various policy and practice organisations were recruited for a semistructured interview. To structure the interviews, we developed the “Health Broker Wheel” (HBW), a framework we then specified with more details derived from the interviews. Results. We identified seven primary types of behaviour that health brokers need to engage in: recognizing opportunities, agenda setting, implementing, network formation, intersectoral collaboration, adaptive managing, and leadership. Determinants of health brokers’ behaviours were identified and categorised as capability, opportunities, motivation, and local or national contextual factors. Conclusion. The health brokers’ role can be seen as an operational approach and is visualised in the HBW. This framework can assist further research to monitor and evaluate this role, and health promotion practitioners can use it as a tool to implement the health brokers’ role and to facilitate intersectoral collaboration.

This study simulates the fermentation process of barley ?-glucan and sugar beet pectin in the human colon and monitors the degradation products formed. Additionally, immune effects of the degradation products were investigated.Immunostimulatory activity of fermentation digesta was investigated using bone marrow derived dendritic cells (BMDCs) from toll-like receptor 2/4 (TLR2/4) knockout mice, which were unresponsive to microbe-associated molecular patterns. Cytokine responses were elicited to dietary fibers and not to the SCFA and microbiota. The fermentation digesta were analyzed for their SCFA profiles and glycan metabolites over time. During fermentation the amount of insoluble precipitating fibers increased and induced as well as soluble molecules of lower molecular mass greater amounts of cytokines in BMDCs than the parental fiber. Additionally, high amounts of cytokines can be attributed to soluble galactose-rich beet pectin molecules.The fermentation of the two fibers led to fiber-specific amounts of SCFA, glycosidic metabolites, and different immunomodulatory properties. BMDC from TLR2/4 knockout mice did not respond to the digest microbiota and SCFA, making it a useful approach to study temporal effects of fermentation on the immunomodulatory effects of fibers.? 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Relations between children’s mathematics achievement and their basic number processing skills have been reported in both cross-sectional and longitudinal studies. Yet, some key questions are currently unresolved, including which kindergarten skills uniquely predict children’s arithmetic fluency during the first year of formal schooling and the degree to which predictors are contingent on children’s level of arithmetic proficiency. The current study assessed kindergarteners’ non-symbolic and symbolic number processing efficiency. In addition, the contribution of children’s underlying magnitude representations to differences in arithmetic achievement was assessed. Subsequently, in January of Grade 1, their arithmetic proficiency was assessed. Hierarchical regression analysis revealed that children’s efficiency to compare digits, count, and estimate numerosities uniquely predicted arithmetic differences above and beyond the non-numerical factors included. Moreover, quantile regression analysis indicated that symbolic number processing efficiency was consistently a significant predictor of arithmetic achievement scores regardless of children’s level of arithmetic proficiency, whereas their non-symbolic number processing efficiency was not. Finally, none of the task-specific effects indexing children’s representational precision was significantly associated with arithmetic fluency. The implications of the results are 2-fold. First, the findings indicate that children’s efficiency to process symbols is important for the development of their arithmetic fluency in Grade 1 above and beyond the influence of non-numerical factors. Second, the impact of children’s non-symbolic number processing skills does not depend on their arithmetic achievement level given that they are selected from a nonclinical population.

PLoS one 11(11), e0166161 (2016). doi:10.1371/journal.pone.0166161, Published by PLoS, Lawrence, Kan.

Here, we describe a Dutch family with idiopathic pulmonary fibrosis (IPF). We hypothesized that there might be an association between the presence of Vitamin K epoxide reductase complex 1 (VKORC1) and/or cytochrome P450 2C9 (CYP2C9) variant alleles and the early onset of IPF in the members of this family. VKORC1 (rs9923231 and rs9934438) and CYP2C9 (rs1799853 and rs1057910) were genotyped in this family, which includes a significant number of pulmonary fibrosis patients. In all family members, at least one of the variant alleles tested was present. The presence of the VKORC1 variant alleles in all of the IPF cases and CYP2C9 variants in all but one, which likely leads to a phenotype that is characterized by the early onset and progressive course of IPF. Our findings indicate a role of these allelic variants in (familial) IPF. Therefore, we suggest that the presence of these variants, in association with other pathogenic mutations, should be evaluated during genetic counselling. Our findings might have consequences for the lifestyle of patients with familial IPF in order to prevent the disease from becoming manifest. ispartof: INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES vol:20 issue:5 ispartof: location:Switzerland status: published

Human laboratory studies have shown that eating desires are easily learned through classical conditioning: after a few pairings of an initially neutral stimulus (e.g., a box) with the intake of palatable food (e.g., chocolate), the stimulus elicits increased eating expectancies and eating desires (acquisition). After repeated non-reinforced presentations of the chocolate-associated stimulus, eating expectancies and desires decrease again (extinction). It is commonly assumed that eating desires in daily life are acquired and extinguished in a similar manner, but to date, this has not been empirically tested. In two studies, we examined whether the repeated consumption of chocolate at a specific time of day elicits increased eating expectancies and eating desires over a period of 5 days (study 1) or 15 days (study 2), and relative to a time of day not paired with chocolate intake. Further, it was tested whether acquired responding diminishes again during extinction (study 1). Ecological momentary assessment was used to carry out the studies in daily life. Results showed that eating expectancies were acquired in both studies. Only in study 2, eating desires were also successfully learned. It is concluded that eating expectancies and eating desires can be conditioned to ecologically valid cues and under real-life circumstances. This highlights the importance of associative learning processes in the experience of eating desires in daily life.

Background Overweight youngsters are better in absolute strength exercises than their normal-weight counterparts; a physiological phenomenon with promising psychological impact. In this paper we describe the study protocol of the Dutch, school-based program ‘Focus on Strength’ that aims to improve body composition of 11–13 year old students, and with that to ultimately improve their quality of life. Methods The development of this intervention is based on the Intervention Mapping (IM) protocol, which starts from a needs assessment, uses theory and empirical research to develop a detailed intervention plan, and anticipates program implementation and evaluation. This novel intervention targets first year students in preparatory secondary vocational education (11–13 years of age). Teachers are the program implementers. One part of the intervention involves a 30 % increase of strength exercises in the physical education lessons. The other part is based on Motivational Interviewing, promoting autonomous motivation of students to become more physically active outside school. Performance and change objectives are described for both teachers and students. The effectiveness of the intervention will be tested in a Randomized Controlled Trial in 9 Dutch high schools. Discussion Intervention Mapping is a useful framework for program planning a school-based program to improve body composition and motivation to exercise in 11–13 year old adolescents by a “Focus on Strength”. Trial registration NTR5676, registered 8 February 2016 (retrospectively registered). Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3150-6) contains supplementary material, which is available to authorized users.

Sufficient dietary fibre intake reduces the risk of several diseases, but the mechanisms linking fibre structure and health effects remain unclear. To analyse the influence of the amount of methyl groups esterified to the backbone, lemon pectins of different degrees of methyl esterification (30, 56, and 74DM) were studied for immune receptor activating potential and epithelial barrier protection. In reporter assays, the pectins demonstrated TLR/MyD88 dependent activation of NF-kappa B/AP-1, which increased with increasing pectin DM. To analyse the importance of backbone structure, the pectins were enzymatically digested into oligomers, which abrogated TLR activating potential. The 30 and 74DM pectins induced strong protection of the epithelial barrier measured by T84 transepithelial electrical resistance (TEER). These results indicate that activation of immune cells by lemon pectins is TLR dependent, and the intact polymer backbone is indispensable for activation. In addition, DM is a determining factor in activating potential and epithelial barrier protective effects. (C) 2016 Elsevier Ltd. All rights reserved.

Responsible Research and Innovation (RRI) has recently emerged as a new framework for science and technology governance. The concept articulates the need for mutual exchange by which societal actors become responsive to each other early on in the process of innovation, with a view to facilitate ethically acceptable and sustainable innovation. There is relatively limited evidence to explore the extent to which the process of research and innovation under the terms of RRI is realised in practice, particularly in the context of food and health research. Although research to date has been examining innovation from the point of view of inputs and outputs-R&D funding and patents we propose to examine the cognitive framing of innovation that shapes decisions of those who constitute a part of the innovation chain. This paper explores how the concept of innovation is understood and used in policy implementation, with a particular focus upon 'food and health' science and research policy and funding. Our analysis is based on 55 interviews of various actors engaged in research funding decision-making across eight European countries. Three themes emerged from the analysis: concept of innovation; conditions for innovation; and drivers of innovation; through these themes, the cognitive framing was drawn out. The cognitive framing suggests that innovation in the food and health domain is perceived to be focused on biosciences and marketable applications to the neglect of social sciences and broader public interest; that the "innovation network" is primarily viewed as centred around scientific/technical and industrial actors; and that the demand-pull dynamic is relevant to innovation in the area of food and health, despite having been relegated in contemporary thinking and policies around innovation. These findings point to the inadequate consideration of the normative issues how problems are to be defined and addressed among national research funders in the food and health domain, and indicate a gap between the ideas of innovation under the terms of RRI and innovation as conceptualised by those involved in its governance.

BACKGROUND AND AIMS: Probiotics, prebiotics and synbiotics have been suggested as dietary strategies to improve intestinal barrier function. This study aimed to assess the effect of two weeks synbiotic supplementation on intestinal permeability under basal and stressed conditions. Secondary aims were the assessment of two weeks synbiotic supplementation on systemic immune function and gastrointestinal symptoms including defecation pattern.DESIGN: Twenty healthy adults completed a double-blind, controlled, randomized, parallel design study.INTERVENTION: Groups either received synbiotic (1.5 × 1010 CFU Ecologic® 825 + 10 g fructo-oligosaccharides (FOS P6) per day) or control supplements for two weeks.OUTCOMES: Intestinal segment specific permeability was assessed non-invasively by oral administration of multiple sugar probes and, subsequently, assessing the excretion of these probes in urine. This test was conducted at baseline and at the end of intervention, in the absence and in the presence of an indomethacin challenge. Indomethacin was applied to induce a compromised gut state. Plasma zonulin, cytokines and chemokines were measured at baseline and at the end of intervention. Gastrointestinal symptoms and stool frequency were recorded at baseline and daily during intervention.RESULTS: Significantly more male subjects were in the synbiotic group compared to the control group (P = 0.025). Indomethacin significantly increased urinary lactulose/rhamnose ratio versus without indomethacin, both in the control group (P = 0.005) and in the synbiotic group (P = 0.017). Urinary sugar recoveries and ratios, plasma levels of zonulin, cytokines and chemokines, and gastrointestinal symptom scores were not significantly different after control or synbiotic intervention. Stool frequency within the synbiotic group was significantly increased during synbiotic intervention compared to baseline (P = 0.039) and higher compared to control intervention (P = 0.045).CONCLUSION: Two weeks Ecologic® 825/FOS P6 supplementation increased stool frequency, but did not affect intestinal permeability neither under basal nor under indomethacin-induced stressed conditions, immune function or gastrointestinal symptoms in healthy adults.

Man is born with few flavor preferences. Most flavor preferences are acquired through direct experiential learning. One type of such learning concerns Pavlovian conditioning in which a flavor becomes better liked through its association with an already liked taste, nutritive outcome, or another positive postingestive effect. Pavlovian conditioning also underlies the experience of food craving, an intense desire for a certain food item. Food craving is elicited by cues predicting the intake of a particularly palatable food. Pavlovian food cues thus motivate instrumental food seeking and eating. Research demonstrates that increased liking and preference for healthier foods can be conditioned by pairing a healthy flavor with a positive outcome (Pavlovian conditioning), and by pairing the consumption of healthy foods with a rewarding outcome (instrumental conditioning).

Background An aberrant metabolic activity or a compositional alteration of the gut microbiota has been proposed as a factor that makes us more prone to disease. Therefore, we explored the effect of two dietary fibers (arabinogalactan and inulin) on the microbiota from lean and obese subjects during 72 h in vitro fermentation experiments using the validated TNO dynamic in vitro model of the proximal colon: TIM-2. Metabolically, arabinogalactan fermentation showed a higher production of propionate when compared to n-butyrate in the obese microbiota fermentations. In general, lean microbiota produced more n-butyrate from the fermentation of both substrates when compared to the obese microbiota. Furthermore, the obese microbiota extracted more energy from the fermentation of both fibers. Results Compositionally, bacteria belonging to Gemmiger, Dorea, Roseburia, Alistipes, Lactobacillus and Bifidobacterium genera were found to be highly abundant or stimulated by the prebiotics in the lean microbiota suggesting a potential role in leanness. Furthermore, a significant correlation between known butyrogenic strains including B. adolescentis,an unclassified Bifidobacterium and F. prausnitzii with this metabolite in the fermentation of inulin in both microbiotas was found. Conclusions Although supplementary in vivo studies are needed, the current study provides more evidence for the consumption of specific ingredients with the aim of modulating the gut microbiota in the context of obesity. © 2016 Aguirre et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Die Qualitat der Gesundheitsversorgung wird immer haufiger in Form von Qualitatsindikatoren ausgedruckt. Auch in der Manuellen Therapie haben in den vergangenen Jahren aufgrund der Empfehlungen aus den Leitlinien Qualitatsindikatoren Einzug gehalten. In der vorliegenden Arbeit geht es um die Qualitat der Gesundheitsversorgung bei Patienten mit unspezifischen lumbalen Ruckenschmerzen, die auch einen relevanten Untersuchungsgegenstand der Manuellen Therapie darstellt. Die Untersuchung bestimmte die Behandlungsqualitat bei Patienten mit lumbalen Ruckenschmerzen mit Prozess- und Ergebnisindikatoren auf der Grundlage der KNGF-Leitlinien Lumbale Ruckenschmerzen und Manuelle Therapie bei lumbalen Ruckenschmerzen. Physio- und Manualtherapeuten scheinen den Qualitatsanforderungen in gleichem Mase zu entsprechen. Im Mittel waren die Werte fur die Prozessindikatoren in beiden Gruppen „vollig ausreichend“ und die Unterschiede bei den Ergebnisindikatoren klinisch relevant.

Combined lifestyle interventions (CLIs) can be effective in reducing weight and improving lifestyle-related behaviours but it is unclear how CLIs can best be implemented in practice in order to achieve sustained lifestyle changes. The Coaching on Lifestyle programme (CooL) is a CLI in the Netherlands, in which professional lifestyle coaches counsel adults and children (and/or their parents) who are obese or at high risk of obesity to achieve a sustained healthier lifestyle. The CooL intervention consists of group and individual sessions addressing the topics of physical activity, dietary behaviours, sleep and stress. Our longitudinal one-group pre-post study aimed to identify lifestyle changes among participants (adults, children and their parents) at 8 and 18 months after initiation. We assessed constructs ranging from motivation and behaviour-specific cognitions to behaviours and health outcomes. Positive and sustained changes among adults were found regarding perceived autonomy, motivation, perceived barriers, lifestyle behaviours, quality of life and weight. Among children and their parents, few improvements were found regarding behaviours and quality of life. CooL has been successful in coaching adult participants towards sustained behavioural change during the intervention period. Mixed results and smaller effect sizes were found for children and their parents.

BackgroundVarious guidelines for the management of low back pain have been developed to enhance the effectiveness and efficiency of care. Evidence that guideline-adherent care results in better health outcomes, however, is not conclusive.ObjectiveThe main objective of this study was to assess whether a higher percentage of adherence to the Dutch physical and manual therapy guidelines for low back pain is related to improved outcomes. The study further explored whether this relationship differs for the individual steps of the process of care and for distinct subgroups of patients.DesignThis was an observational prospective cohort study (2005–2006) in the Netherlands that included a sample of 61 private practice therapists and 145 patients.MethodsTherapists recorded the process of care and the number of treatment sessions in Web-based patient files. Guideline adherence was assessed using quality indicators. Physical functioning was measured by the Dutch version of the Quebec Back Pain and Disability Scale, and average pain was measured with a visual analog scale. Relationships between the percentage of guideline adherence and outcomes of care were evaluated with regression analyses.ResultsHigher percentages of adherence were associated with fewer functional limitations (β=−0.21, P=.023) and fewer treatment sessions (β=−0.27, P=.005).LimitationsThe relatively small self-selected sample might limit external validity, but it is not expected that the small sample greatly influenced the internal validity of the study. Larger samples are required to enable adequate subgroup analyses.ConclusionsThe results indicate that higher percentages of guideline adherence are related to better improvement of physical functioning and to a lower utilization of care. A proper assessment of the relationship between the process of physical therapy care and outcomes may require a comprehensive set of process indicators to measure guideline adherence.

BackgroundEvidence-based practice has become a major issue in physical therapy. Many evidence-based guidelines, however, are not used extensively after dissemination, and interventions aimed at increasing guideline adherence often have limited effects.ObjectiveAs a prerequisite for changing this situation, the aims of this study were to gain an in-depth understanding of the determinants of guideline adherence among physical therapists in the Netherlands and to evaluate the opportunities of a theoretical framework in this respect.Design and MethodsThis observational study consisted of 3 focus group interviews (n=12, 10, and 8) between November 2002 and January 2003. Physical therapists were asked to discuss their opinions about and experiences with the Dutch guidelines for low back pain. Data were analyzed qualitatively using a directed approach to content analysis. Both the interview route and the analysis of the interviews were informed by Rogers’ Diffusion of Innovations Theory.ResultsOur study yielded in-depth insights into the various determinants of guideline adherence. Overall, the participants had rather unfavorable opinions about issues related to the dissemination of the guidelines (first phase of the diffusion process) and provided relatively little information on the subsequent adoption process (second phase of the diffusion process). The theoretical framework appeared to be a useful tool to properly structure the focus group interviews, to systematically analyze the data collected, and to determine that supplementary interviews would be necessary to cover the entire diffusion process.ConclusionsOur findings indicated that the diffusion process of guidelines among physical therapists was not yet completed. The use of theory can provide added value to guideline implementation studies.

There is growing evidence of climate change affecting infectious disease risk in Western Europe. The call for effective adaptation to this challenge becomes increasingly stronger. This paper presents the results of a survey exploring Dutch expert perspectives on adaptation responses to climate change impacts on infectious disease risk in Western Europe. Additionally, the survey explores the expert sample’s prioritization of mitigation and adaptation, and expert views on the willingness and capacity of relevant actors to respond to climate change. An integrated view on the causation of infectious disease risk is employed, including multiple (climatic and non-climatic) factors. The results show that the experts consider some adaptation responses as relatively more cost-effective, like fostering interagency and community partnerships, or beneficial to health, such as outbreak investigation and response. Expert opinions converge and diverge for different adaptation responses. Regarding the prioritization of mitigation and adaptation responses expert perspectives converge towards a 50/50 budgetary allocation. The experts consider the national government/health authority as the most capable actor to respond to climate change-induced infectious disease risk. Divergence and consensus among expert opinions can influence adaptation policy processes. Further research is necessary to uncover prevailing expert perspectives and their roots, and compare these.

Despite many claims of functional reorganization following tumour surgery, empirical studies that investigate changes in functional activation patterns are rare. This study investigates whether functional recovery following surgical treatment in patients with a low-grade glioma in the left hemisphere is linked to inter-hemispheric reorganization. Based on literature, we hypothesized that reorganization would induce changes in the spatial pattern of activation specifically in tumour homologue brain areas in the healthy right hemisphere. An experimental group (EG) of 14 patients with a glioma in the left hemisphere near language related brain areas, and a control group of 6 patients with a glioma in the right, non-language dominant hemisphere were scanned before and after resection. In addition, an age and gender matched second control group of 18 healthy volunteers was scanned twice. A verb generation task was used to map language related areas and a novel technique was used for data analysis. Contrary to our hypothesis, we found that functional recovery following surgery of low-grade gliomas cannot be linked to functional reorganization in language homologue brain areas in the healthy, right hemisphere. Although elevated changes in the activation pattern were found in patients after surgery, these were largest in brain areas in proximity to the surgical resection, and were very similar to the spatial pattern of the brain shift following surgery. This suggests that the apparent perilesional functional reorganization is mostly caused by the brain shift as a consequence of surgery. Perilesional functional reorganization can however not be excluded. The study suggests that language recovery after transient post-surgical language deficits involves recovery of functioning of the presurgical language system.Keywords: Language, Functional reorganization, Variability, Low-grade glioma,Surgery

BackgroundClinical practice guidelines are considered important instruments to improve quality of care. However, success is dependent on adherence, which may be improved using peer assessment, a strategy in which professionals assess performance of their peers in a simulated setting.ObjectiveThe aim of this study was to determine whether peer assessment is more effective than case-based discussions to improve knowledge and guideline-consistent clinical reasoning in the Dutch physical therapy guideline for low back pain (LBP).DesignA cluster randomized controlled trial was conducted.Setting and ParticipantsTen communities of practice (CoPs) of physical therapists were cluster randomized (N=90): 6 CoPs in the peer-assessment group (n=49) and 4 CoPs in the case-based discussion group (control group) (n=41).InterventionBoth groups participated in 4 educational sessions and used clinical patient cases. The peer-assessment group reflected on performed LBP management in different roles. The control group used structured discussions.MeasurementsOutcomes were assessed at baseline and at 6 months. The primary outcome measure was knowledge and guideline-consistent reasoning, measured with 12 performance indicators using 4 vignettes with specific guideline-related patient profiles. For each participant, the total score was calculated by adding up the percentage scores (0–100) per vignette, divided by 4. The secondary outcome measure was reflective practice, as measured by the Self-Reflection and Insight Scale (20–100).ResultsVignettes were completed by 78 participants (87%). Multilevel analysis showed an increase in guideline-consistent clinical reasoning of 8.4% in the peer-assessment group, whereas the control group showed a decline of 0.1% (estimated group difference=8.7%, 95% confidence interval=3.9 to 13.4). No group differences were found on self-reflection.LimitationsThe small sample size, a short-term follow-up, and the use of vignettes as a proxy for behavior were limitations of the study.ConclusionsPeer assessment leads to an increase in knowledge and guideline-consistent clinical reasoning.

BackgroundCombined lifestyle interventions (CLIs) have been advocated as an effective instrument in efforts to reduce overweight and obesity. The odds of maintaining higher levels of physical activity (PA) and healthier dietary behaviour improve when people are more intrinsically motivated to change their behaviour. To promote the shift towards more autonomous types of motivation, facilitator led CLIs have been developed including lifestyle coaching as key element. The present study examined the shift in types of motivation to increase PA and healthy dieting among participants of a primary care CLI, and the contribution of lifestyle coaching to potential changes in motivational quality.MethodsThis prospective cohort study included participants of 29 general practices in the Netherlands that implemented a CLI named `BeweegKuur inverted question mark. Questionnaires including items on demographics, lifestyle coaching and motivation were sent at baseline and after 4 months. Aspects of motivation were assessed with the Behavioural Regulation and Exercise Questionnaire (BREQ-2) and the Regulation of Eating Behaviour Questionnaire (REBS). We performed a drop out analysis to identify selective drop-out. Changes in motivation were analysed with t-tests and effect size interpretations (Cohen inverted question marks d), and multivariate regression analysis was used to identify predictors of motivational change.ResultsFor physical activity, changes in motivational regulation were fully in line with the tenets of Self Determination Theory and Motivational Interviewing: participants made a shift towards a more autonomous type of motivation (i.e. controlled types of motivation decreased and autonomous types increased). Moreover, an autonomy supportive coaching style was generally found to predict a larger shift in autonomous types of motivation. For healthy dietary behaviour, however, except for a small decrease in external motivation, no favourable changes in different types of motivation were observed. The relation between coaching and motivation appeared to be influenced by the presence of physical activity guidance in the programme.ConclusionsMotivation of participants of a real life primary care CLI had changed towards a more autonomous motivation after 4 months of intervention. Autonomy-supportive lifestyle coaching contributed to this change with respect to physical activity. Lifestyle coaching for healthy diet requires thorough knowledge about the problem of unhealthy dieting and solid coaching skills.

Climate change is considered to be a significant influence for infectious disease risk in Western Europe. Climatic and non-climatic developments act together resulting in current and future infectious disease risk. This study uses a survey to explore Dutch expert perspectives on climate change induced infectious disease risk. The results show that the experts consider temperature change, precipitation change, humidity change, and climate change induced habitat change to be relatively important for water-related infectious disease risk, vector-borne disease risk excluding zoonoses, and the risk of zoonoses. The climatic drivers are seen as relatively less important for food-related infectious disease risk. The experts rate many non-climatic drivers to be highly important for infectious disease risk. Comparatively, the majority of the non-climatic drivers assessed are seen as more important than climate change drivers. The degree of uncertainty in the future development of climatic drivers is viewed as moderate to high, and for non-climatic drivers mostly as moderate. An analysis of subsamples based on professional backgrounds reveals differences in experts’ opinions for e.g., socio-cultural drivers, and similarities. Diversity and consensus amongst expert perspectives on climate change and infectious diseases can have implications for policy. Further research to uncover and compare prevailing perspectives is necessary.

Contains fulltext : 134594.pdf (Publisher’s version ) (Closed access) This study investigates the delivered care in a multidisciplinary lifestyle intervention by dieticians and physiotherapists compared to the protocol of this intervention. Participants with a body mass index (BMI) between 25 and 40 kg m-2 were divided over three different programs depending on their BMI and comorbidities. All these programs consisted of individual and group sessions with the dietician, while care by the physiotherapist differed by program. The dieticians and physiotherapists of 30 locations were contacted to provide data about health care use within the intervention from their health records. Data of 379 participants were available and showed that group sessions by dieticians were often not attended. Care by the physiotherapist was delivered according to the protocol to a larger extent. An average of 43-93% of the sessions was attended. The level of attendance is comparable to other interventions, but especially attendance at group sessions with dieticians should be improved. 7 p.

Item does not contain fulltext BACKGROUND: Systematic planning could improve the generally moderate effectiveness of interventions to enhance adherence to clinical practice guidelines. The aim of our study was to demonstrate how the process of Intervention Mapping was used to develop an intervention to address the lack of adherence to the national CPG for low back pain by Dutch physical therapists. METHODS: We systematically developed a program to improve adherence to the Dutch physical therapy guidelines for low back pain. Based on multi-method formative research, we formulated program and change objectives. Selected theory-based methods of change and practical applications were combined into an intervention program. Implementation and evaluation plans were developed. RESULTS: Formative research revealed influential determinants for physical therapists and practice quality managers. Self-regulation was appropriate because both the physical therapists and the practice managers needed to monitor current practice and make and implement plans for change. The program stimulated interaction between practice levels by emphasizing collective goal setting. It combined practical applications, such as knowledge transfer and discussion-and-feedback, based on theory-based methods, such as consciousness raising and active learning. The implementation plan incorporated the wider environment. The evaluation plan included an effect and process evaluation. CONCLUSIONS: Intervention Mapping is a useful framework for formative data in program planning in the field of clinical guideline implementation. However, a decision aid to select determinants of guideline adherence identified in the formative research to analyse the problem may increase the efficiency of the application of the Intervention Mapping process.

Purpose: To examine a process for evaluating physiotherapy (PT) students' knowledge of and adherence to the Ambassador Low Back Pain (LBP) guideline using vignettes. Methods: The study used a cross-sectional survey design. Participants were PT students who had received information related to the guideline as part of their curriculum. Primary measures were responses to questions about the management of four clinical vignettes. Adherence to guideline recommendations was measured by comparing participant scores to a “guideline-based” set of responses from a physiotherapist involved in developing the Ambassador guideline, which was considered a criterion standard. Results: A total of 74 respondents provided complete data, for a response rate of 89%; 65 (88%) reported no knowledge of the guideline. Overall consistency with the criterion standard was high (>70%). Respondents demonstrated high adherence when identifying red flags and deciding whether to refer to another provider. Conclusion: Despite known exposure, knowledge of the guideline was low in this sample of Canadian PT students. Nevertheless, in several key areas, unconscious adherence was high relative to the guideline-based criterion standard. With minor modifications, the vignettes are suitable for evaluating the Ambassador LBP guidelines in a larger study.

Item does not contain fulltext RATIONALE, AIMS AND OBJECTIVES: Little is currently known about the quality of physiotherapy care for patients with musculoskeletal pain. Neck pain was used as an example. The aim is to develop a set of quality indicators, including a practice test. METHODS: A systematic method is used to develop potential process and outcome indicators. An expert and user panel is used to appraise the potential quality indicators regarding clarity, relevancy, feasibility, acceptability and improvement potential. An invitation to participate in the practice test was sent to physiotherapy practices. The resulting algorithm is used to calculate the degree to which physiotherapists met these indicators (0-100%). Differences in valid outcomes are tested for significance (Student's t-test; alpha = 0.05) and compared with established values for clinical relevance [minimal clinically important change (MCIC)]. RESULTS: A representative set of 40 quality indicators (28 process indicators and 12 outcome indicators) is selected from 44 initial guidelines and literature-based recommendations. The process indicators (n = 28) are classified per step of the clinical reasoning process of physiotherapy care. Of the 106 potential participants from 27 practices, 38 physiotherapists (35.8%) submitted data on 96 patients with non-specific neck pain. On average, the participating physiotherapists showed a 55.6% adherence to process indicators with a great variation in scores per step of the clinical reasoning process. The outcomes for 'pain', 'headache' and 'daily functioning' were significantly better compared with baseline, and the mean differences exceeded established values for MCICs. CONCLUSION: Guardedly, we can conclude that a systematic approach is a valuable means to develop a preliminary set of process and outcome indicators for physiotherapy care for patients with non-specific neck pain, and a practice test should be an intrinsic part of such a systematic approach as it provides valuable information on the key attributes of the set indicators.

Combined lifestyle interventions in the netherlands: experiences gained with the beweegkuur intervention this paper gives a reflection on the development, implementation and dissemination processes of the beweegkuur in primary care. The implementation of the programme took a lot of time and energy on the part of the health care providers. During the implementation process, multidisciplinary networks were formed and the contacts with local exercise facilities improved. Although it is plausible that without beweegkuur, some of these processes would also have come about, they would probably have taken more time and effort and would have remained more local.

Contains fulltext : mmubn000001_583420451.pdf (Publisher’s version ) (Open Access) Radboud Universiteit Nijmegen, 30 mei 2012 Promotores : Oostendorp, R.A.B., Vries, N.K. de Co-promotor : Harting, J.

It is clear that globalization is something more than a purely economic phenomenon manifesting itself on a global scale. Among the visible manifestations of globalization are the greater international movement of goods and services, financial capital, information and people. In addition, there are technological developments, more transboundary cultural exchanges, facilitated by the freer trade of more differentiated products as well as by tourism and immigration, changes in the political landscape and ecological consequences. In this paper, we link the Maastricht Globalization Index with health indicators to analyse if more globalized countries are doing better in terms of infant mortality rate, under-five mortality rate, and adult mortality rate. The results indicate a positive association between a high level of globalization and low mortality rates. In view of the arguments that globalization provides winners and losers, and might be seen as a disequalizing process, we should perhaps be careful in interpreting the observed positive association as simple evidence that globalization is mostly good for our health. It is our hope that a further analysis of health impacts of globalization may help in adjusting and optimising the process of globalization on every level in the direction of a sustainable and healthy development for all.

CLIMATE change is considered a major threat to human health and wellbeing, with increasing evidence of it affecting infectious diseases ([Dufour and others 2008][1], [Gale and others 2009b][2], [Semenza and Menne 2009][3]). But how large is this threat? Will many diseases respond to climate change

Contains fulltext : 186499.pdf (Publisher’s version ) (Open Access) BACKGROUND: Guideline adherence in physical therapy is far from optimal, which has consequences for the effectiveness and efficiency of physical therapy care. Programmes to enhance guideline adherence have, so far, been relatively ineffective. We systematically developed a theory-based Quality Improvement in Physical Therapy (QUIP) programme aimed at the individual performance level (practicing physiotherapists; PTs) and the practice organization level (practice quality manager; PQM). The aim of the study was to pilot test the multilevel QUIP programme's effectiveness and the fidelity, acceptability and feasibility of its implementation. METHODS: A one-group, pre-test, post-test pilot study (N = 8 practices; N = 32 PTs, 8 of whom were also PQMs) done between September and December 2009. Guideline adherence was measured using clinical vignettes that addressed 12 quality indicators reflecting the guidelines' main recommendations. Determinants of adherence were measured using quantitative methods (questionnaires). Delivery of the programme and management changes were assessed using qualitative methods (observations, group interviews, and document analyses). Changes in adherence and determinants were tested in the paired samples T-tests and expressed in effect sizes (Cohen's d). RESULTS: Overall adherence did not change (3.1%; p = .138). Adherence to three quality indicators improved (8%, 24%, 43%; .000