Effectiveness and implementation of a multidisciplinary lifestyle focused approach in the treatment of inpatients with mental illness (MULTI +): a stepped wedge study protocol.

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.

[Thinking inside the box: improving the lifestyle of inpatients with severe mental illness]. / Thinking inside the box: leefstijl­verbetering bij mensen met een ernstige psychiatrische aandoening in de kliniek.

BACKGROUND: An unhealthy lifestyle plays an important role in the substantially reduced life-expectancy of inpatients with severe mental illness (SMI). However, there is a lack of evidence on the long-term effectiveness and implementation of lifestyle improvements in inpatient mental healthcare.
AIM: Increasing knowledge and understanding of (the implementation of) lifestyle changes in inpatients with SMI in longer-term clinical care.
METHOD: Cross-sectional research followed by an observational study to evaluate a multidisciplinary lifestyle enhancing treatment (MULTI) for both changes in health-related outcomes after 18 months compared to treatment as usual (TAU), and the implementation barriers and facilitators.
RESULTS: Patients were very sedentary and less physically active compared to people without SMI. After 18 months, MULTI showed significant improvements in total physical activity, cardiometabolic risk factors, psychosocial functioning and mediation use, compared to TAU. Physical health did not improve in TAU. The implementation of MULTI was hampered by organisational factors and facilitated by positive attitudes of healthcare professionals and patients towards MULTI and their own role in it.
CONCLUSION: Using a multidisciplinary integrated approach, it is possible to improve the lifestyle, and thus the health status, of SMI inpatients, within the current context of routine mental healthcare.

The cost-effectiveness and return-on-investment of a combined social and physical environmental intervention in office employees.

This study explored the cost-effectiveness and return-on-investment of a combined social and physical environmental worksite health promotion program compared with usual practice, and of both intervention conditions separately. Participants were randomized to the combined intervention (n = 92), social environmental intervention (n = 118), physical environmental intervention (n = 96), or control group (n = 106). The social environmental intervention consisted of group motivational interviewing and the physical environmental intervention of workplace modifications. Both interventions were aimed at improving physical activity and relaxation. Effects included need for recovery (NFR), general vitality and job satisfaction. Cost-effectiveness analyses were performed from the societal and employer's perspective, and return-on-investment analyses from the employer's perspective. Compared with usual practice, the combined intervention was significantly more effective in improving NFR (-8.4;95% CI:-14.6;-2.2) and significantly more expensive to the employer (3102; 95%CI:598;5969). All other between-group differences were non-significant. For NFR, the combined intervention became the preferred option at willingness-to-pays of ≥€170/point improvement (society) and ≥€300/point improvement (employer). For general vitality and job satisfaction, the interventions' maximum probabilities of cost-effective were low (≤0.55). All interventions had a negative return-on-investment. The combined intervention may be cost-effective for NFR depending on the decision-makers' willingness-to-pay. Both separate interventions are not cost-effective for NFR. All interventions were neither cost-effective for general vitality and job satisfaction, nor cost-saving to the employer.

Can strenuous leisure time physical activity prevent psychological complaints in a working population?

AIMS: To investigate the longitudinal relation between strenuous leisure time physical activity and psychological complaints (depression and emotional exhaustion) in a Dutch working population in order to find evidence for the preventive role of physical activity in the development of psychological complaints. METHODS: All data came from the Study on Musculoskeletal disorders, Absenteeism, Stress, and Health (SMASH), a three year follow up study that started between 1994 and 1995. The study population consisted of 1747 workers from 34 companies. Generalised estimating equation (GEE) analyses were performed to investigate the longitudinal relation between strenuous leisure time physical activity and psychological complaints using models with and without a time lag. Logistic regression analyses were performed to study the relation between physical activity and sickness absence due to psychological complaints during the three year follow up study. RESULTS: Only in workers with a sedentary job was strenuous leisure time physical activity (1-2 times per week) significantly associated with a reduced risk of future depression and emotional exhaustion. This was not the case for physical activity at higher frequencies (> or =3 times per week). There was a dose-response relation between strenuous leisure time physical activity and poor general health which was strongest in workers with a sedentary job. Strenuous leisure time physical activity (1-2 times per week) was associated with a lower risk of long term absenteeism (>21 days), whereas physical activity at a higher frequency was not. CONCLUSIONS: Results suggest that strenuous leisure time physical activity might play a role in the prevention of future psychological complaints, poor general health, and long term absenteeism in a working population. Workers with a sedentary job seem to benefit more from strenuous leisure time physical activity than workers without a sedentary job.

Prevalence and incidence of shoulder pain in the general population; a systematic review.

OBJECTIVE: To investigate the incidence and prevalence of shoulder complaints in the general population. METHOD: A systematic review of the literature was conducted. Medline, Embase, and Cinahl were searched for relevant studies. RESULTS: Eighteen studies on prevalence and one study on incidence met the inclusion criteria. Incidence figures of 0.9-2.5% were found for different age groups. Prevalence figures differed from 6.9 to 26% for point prevalence, 18.6-31%, for 1-month prevalence, 4.7-46.7% for 1-year prevalence and 6.7-66.7% for lifetime prevalence. Prevalence rates decreased when the case definition was restricted, in terms of duration of pain or the presence of limited movements, and increased when the location for pain was enlarged. CONCLUSION: The reported prevalence figures on shoulder complaints diverged strongly. Health professionals and policymakers who estimate the amount of medical care needed and related costs should be aware of the variations in prevalence rate and the underlying reasons for these differences.

The use of EEG in aircrew selection.

The value of the electroencephalograph (EEG) as a screening device in aviation medicine is questioned, because few subjects are disqualified on grounds of an EEG exam. At the Netherlands Aeromedical Institute, pilot applicants are rejected with a diagnosis of epilepsy or with severe EEG abnormalities (including epileptiform patterns where epilepsy is highly suspected). Although several studies have shown a low incidence of epileptiform EEG abnormalities in candidate pilots, subjects with an epileptiform EEG have a substantially increased risk of sudden incapacitation during their flying careers. In this review, we calculate the probability that a candidate with epileptiform EEG, but no history of epileptic seizures, will develop seizures during his flying career. This probability is about 25%, more than 12 times higher than for subjects with normal EEG and no history of epileptic seizures (2%). Subjects with epileptiform EEGs not only have increased risk of future epileptic seizures, but additionally it is recognized that epileptiform EEG discharges may be associated with episodic functional impairment, which can be a danger when a subject is flying. Taking this into account, one should consider rejecting all candidates with epileptiform EEGs in the future. This is at the expense of a small group of subjects with false-positive EEGs, but we believe that concern for public safety must override other considerations in these rare cases. To improve the understanding of the usefulness of the EEG in pilot screening procedures, an international classification and coding system should be developed, so that data from different countries can be compared.

Training-induced increases in sea-level performance are enhanced by acute intermittent hypobaric hypoxia.

The goal of this study was to investigate to what extent intermittent exposure to altitude in a hypobaric chamber can improve performance at sea-level. Over a 10-day period, elite male triathletes trained for 2 h each day on a cycle ergometer placed in a hypobaric chamber. Training intensity was 60-70% of the heart rate reserve. Eight subjects trained at a simulated altitude of 2.500 m (hypoxia group), the other eight remained at sea-level (sea-level group). Baseline measurements were done on a cycle ergometer at sea-level, which included an incremental test until exhaustion and a Wingate Anaerobic Test. Nine days after training in hypoxia, significant increases were seen in all important parameters of the maximal aerobic as well as the anaerobic test. A significant increase of 7.0% was seen in the mean maximal oxygen uptake per kilogram body weight (VO2max), and the mean maximal power output per kilogram body weight (Wmax) increased significantly by 7.4%. The mean values of both mean power per kilogram body weight and peak power per kilogram body weight increased significantly by 5.0%, and the time-to-peak decreased significantly by 37.7%. In the sea-level group, no significant changes were seen in the abovementioned parameters of both the maximal aerobic and the maximal anaerobic test at the second post-test. The results of this study indicate that intermittent hypobaric training can improve both the aerobic and the anaerobic energy-supply systems.

Effect of commuter cycling on physical performance of male and female employees.

PURPOSE: The purpose of this study was to determine the effect of commuter cycling on physical performance. Eighty-seven male and 35 female employees volunteered to cycle regularly to their work. METHODS: Sixty-one participants went commuter cycling for 1 yr (cycling group); the others cycled only in the second half year (control group). A maximal exercise test on a cycle ergometer was carried out at the start of the study, after 6 months, and after 1 yr to measure maximal external power (Wmax) and maximal oxygen uptake (VO2max). RESULTS: After the first 6 months of commuter cycling, with a mean single trip distance of 8.5 km and a mean frequency of more than three times a week, a significant increase of 13% was found in the Wmax per kilogram body weight (Wmax x kg(-1)) in both sexes of the cycling group. The improvement in VO2max x kg(-1) was significant for the male participants (6%) but not for the female participants (-2%). At the end of the second half year, the control group also showed a mean gain in Wmax x kg(-1) of 13%. Their VO2max x kg(-1) declined in the first half year, but this was counteracted in the second half year. A dose-response relationship was found between two independent variables and the physical performance; the lower the physical performance at the start of the study and the higher the total amount of kilometers cycled, the higher the gain in Wmax. For subjects with a low initial fitness level, a single trip distance of only 3 km turned out to be enough to improve physical performance. CONCLUSION: Commuter cycling can yield much the same improvement in physical performance as specific training programs.

Degenerative changes of the spine of fighter pilots of the Royal Netherlands Air Force (RNLAF).

HYPOTHESIS: The aim of this study was to examine whether F-16 pilots are at an increased risk of (cervical) spine degeneration. METHOD: Retrospectively, X-ray slides were examined of pilots of the Royal Netherlands Air Force who were systematically radiographed (at least twice). In total, 316 pilots were evaluated: 188 F-16 pilots and 128 pilots in the control group. Two radiologists, who were blinded as to whether the X-ray films were of F-16 pilots or the control group, examined these X-rays separately. In both groups, the time between the two X-rays was on average 6 yr. RESULTS: Though the inter-rater agreement of the X-rays was rather low, both radiologists found comparable statistically significant differences between the two groups. In the F-16 group, an increased osteophytic spurring was found at levels C4-C5 and C6-C7, and increased arthrosis deformans was found in the cervical spine. Further analysis of the data of a selected group of pilots, whereby the difference in age between both groups was minimized, showed that the higher mean age of the F-16 pilots was possibly correlated with the increased degeneration in this group. No consistent relationship was found between spinal degeneration and initial radiological status. Also, a clear relationship between spinal degeneration and flying hours could not be demonstrated. CONCLUSION: These findings suggest that frequent exposure to high +Gz forces might cause premature degeneration of the spine of F-16 pilots. Future research must demonstrate to what extent age, mission, and number of flying hours have influenced the results. An uniform international classification and coding system in combination with establishing an international database is recommended.

[Variation in serum cholesterol level in the same person: what is the true value and when is it called a significant change?]. / Schommeling van het serumcholesterolgehalte bij één persoon: wat is de werkelijke waarde en wanneer is er sprake van een significante verandering?

The blood cholesterol level is not constant over time. Changing values may be found when rechecking high values, especially in patients on a diet or receiving medication. Repeated measurements are necessary. It will then be possible to estimate the 'true mean value'. This is the theoretical average of a large number of measurements taken from one person. The study concentrated on the intra-individual variation of the serum cholesterol and the consequences for screening and follow-up. For this purpose, during a period of four weeks, cholesterol levels were measured 12 times in 33 men aged 25-40. The mean coefficient of variation was 5.7%, with wide differences between participants, ranging from 2.9% to 9.8%. The position of the 'true mean value' was estimated (with 90% confidence), after I resp. 3 determinations. These findings have consequences for the classification of subjects in the different risk categories as defined in the Dutch Cholesterol Consensus. It is also possible to determine if, after a period of intervention, there is a significant decline in the cholesterol level. Roughly, a decline of 10-12% indicates a significant difference.