Determinants of physical activity behaviour change in (online) interventions, and gender-specific differences: a Bayesian network model.

BACKGROUND: Physical activity (PA) is known to be beneficial for health, but adherence to international PA guidelines is low across different subpopulations. Interventions have been designed to stimulate PA of different target groups by influencing relevant psycho-social determinants, essentially based on a combination of the Integrated Model for Change, the Theory of Planned Behaviour, its successor the Reasoned Action Approach and the self-determination theory. The current study investigates the pathways through which interventions influence PA. Further, gender differences in pathways of change are studied. METHODS: An integrated dataset of five different randomised controlled trial intervention studies is analysed by estimating a Bayesian network. The data include measurements, at baseline and at 3, 6 (short-term), and 12 (long-term) months after the baseline, of important socio-cognitive determinants of PA, demographic factors, and PA outcomes. A fragment is extracted from the Bayesian network consisting of paths between the intervention variable, determinants, and short- and long-term PA outcomes. For each relationship between variables, a stability indicator and its mutual information are computed. Such a model is estimated for the full dataset, and in addition such a model is estimated based only on male and female participants' data to investigate gender differences. RESULTS: The general model (for the full dataset) shows complex paths, indicating that the intervention affects short-term PA via the direct determinants of intention and habit and that self-efficacy, attitude, intrinsic motivation, social influence concepts, planning and commitment have an indirect influence. The model also shows how effects are maintained in the long-term and that previous PA behaviour, intention and attitude pros are direct determinants of long-term PA. The gender-specific models show similarities as well as important differences between the structures of paths for the male- and female subpopulations. For both subpopulations, intention and habit play an important role for short-term effects and maintenance of effects in the long-term. Differences are found in the role of self-efficacy in paths of behaviour change and in the fact that attitude is relevant for males, whereas planning plays a crucial role for females. The average of these differences in subpopulation mechanisms appears to be presented in the general model. CONCLUSIONS: While previous research provided limited insight into how interventions influence PA through relevant determinants, the Bayesian network analyses show the relevance of determinants mentioned by the theoretical framework. The model clarifies the role that different determinants play, especially in interaction with each other. The Bayesian network provides new knowledge about the complex working mechanism of interventions to change PA by giving an insightful overview of influencing paths. Furthermore, by presenting subpopulation-specific networks, the difference between the influence structure of males and females is illustrated. These new insights can be used to improve interventions in order to enhance their effects. To accomplish this, we have developed a new methodology based on a Bayesian network analysis which may be applicable in various other studies.

Adherence to the Dutch healthy diet index and change in glycemic control and cardiometabolic markers in people with type 2 diabetes.

PURPOSE: To investigate whether adherence to the Dutch Healthy Diet index 2015 (DHD15-index) is associated with change in glycemic control and cardio-metabolic markers over two-year follow-up in people with type 2 diabetes (T2D). METHODS: This prospective cohort study included 1202 individuals with T2D (mean age 68.7 ± 9.0 years; 62.5% male; mean HbA1c 53.8 ± 11.7 mmol/mol) from the Diabetes Care System cohort. Baseline dietary intake was assessed using a validated food frequency questionnaire, and adherence to the DHD15-index was estimated (range 0-130). HbA1c, fasting glucose, blood lipids (HDL and LDL cholesterol, cholesterol ratio), blood pressure, estimated glomerular filtration rate (eGFR), and BMI were measured at baseline, and after one- and two-year follow-up. Linear mixed model analyses were conducted to examine the associations between adherence to the DHD15-index and glycemic control and the cardio-metabolic outcomes, adjusting for energy intake, sociodemographic and lifestyle characteristics, and medication. RESULTS: Highest adherence (T3) to the DHD15-index was not associated with change in HbA1c, compared to lowest adherence (T1) [ßT3vsT1: 0.62 mmol/mol (- 0.94; 2.19), Ptrend = 0.44]. There was a non-linear association with fasting glucose, where moderate adherence (T2) was associated with a decrease in fasting glucose [ßT2vsT1: - 0.29 mmol/L (- 0.55; - 0.03), Ptrend = 0.30]. Higher adherence to the DHD15-index was associated with a decrease in BMI [ß10point: - 0.41 kg/m2 (- 0.60; - 0.21), Ptrend < 0.001], but not with blood lipids, blood pressure or kidney function. CONCLUSION: In this well-controlled population of people with T2D, adherence to the DHD15-index was associated with a decrease in BMI, but not with change in glycemic control or other cardio-metabolic parameters.

Psychological risk indicators for peri-implantitis: A cross-sectional study.

AIM: The aim of this analytical cross-sectional study was to evaluate the association between peri-implantitis and psychological distress, and potentially related/mediating factors such as general health, bruxism, and lifestyle factors. MATERIALS AND METHODS: Patients who received dental implants at a private practice in the Netherlands between January 2011 and January 2014 were recalled on a 5-year clinical and radiographic follow-up examination. Presence of peri-implantitis was examined, and patients completed questionnaires measuring psychological distress (Symptom Checklist [SCL]-90), bruxism, general health, and lifestyle factors. Associations between the self-reported factors and peri-implantitis were analysed with univariate and multivariate logistic regression models. RESULTS: A total of 230 patients (with 347 implants) were included in the analysis. Prevalence of (mild to severe) peri-implantitis was 30% (69 patients). Variables that showed a significant univariable association with peri-implantitis (p < .10) were the SCL-90 subdomain depression, smoking, current medical treatment, and lung problems. In the multivariate regression analysis, depression was the only variable that was significantly associated with peri-implantitis (p < .05). CONCLUSIONS: The presence of depressive symptoms is a risk indicator for peri-implantitis. Recognizing the potential negative impact of depressive symptoms may allow for better identification of high-risk patients.

The Clinical Nurse Practitioner's Essential Role in Early Diagnosis and Management of Multiple Sclerosis in Europe: A Consensus Report.

Timely diagnosis of multiple sclerosis (MS) is a challenge due to factors such as prompt identification of symptoms and consequent delays in hospital visits and treatment initiation. In part to address this challenge, an expert scientific advisory panel of clinical nurse practitioners (CNPs) from different European nations was convened by Viatris on October 25, 2022, in Amsterdam, the Netherlands. This meeting was an interactive discussion to understand the role of clinical nurse practitioners in MS management. The objectives were to (1) understand the current delays in MS diagnosis from the perspective of expert CNPs; (2) determine the role of the CNP in MS management; and (3) identify the opportunities to improve accessibility, foster collaboration among stakeholders, and promote initiatives to educate people with MS. The recommendations of the panel underline the multidimensional role of CNPs in the management of MS at all stages. Health care stakeholders need to work together to achieve better access to treatment regimens and facilitate outcomes in the management of MS through shared decision-making and follow-ups. Further exploration of the role of CNPs in the management of MS, as well as recommendations for early diagnosis, will help both general practitioners and specialists better manage MS care.

Cost of the Diet (CoD) tool: first results from Indonesia and applications for policy discussion on food and nutrition security.

BACKGROUND: The Minimum Cost of a Nutritious Diet (MCNut) is the cost of a theoretical diet satisfying all nutrient requirements of a family at the lowest possible cost, based on availability, price, and nutrient content of local foods. A comparison with household expenditure shows the proportion of households that would be able to afford a nutritious diet. OBJECTIVE: To explore using the Cost of Diet (CoD) tool for policy dialogue on food and nutrition security in Indonesia. METHODS: From October 2011 to June 2012, market surveys collected data on food commodity availability and pricing in four provinces. Household composition and expenditure data were obtained from secondary data (SUSENAS 2010). Focus group discussions were conducted to better understand food consumption practices. Different types of fortified foods and distribution mechanisms were also modeled. RESULTS: Stark differences were found among the four areas: in Timor Tengah Selatan, only 25% of households could afford to meet the nutrient requirements, whereas in urban Surabaya, 80% could. The prevalence rates of underweight and stunting among children under 5 years of age in the four areas were inversely correlated with the proportion of households that could afford a nutritious diet. The highest reduction in the cost of the child's diet was achieved by modeling provision of fortified blended food through Social Safety Nets. Rice fortification, subsidized or at commercial price, can greatly improve nutrient affordability for households. CONCLUSIONS: The CoD analysis is a useful entry point for discussions on constraints on achieving adequate nutrition in different areas and on possible ways to improve nutrition, including the use of special foods and different distribution strategies.

The influence of claw morphology on gripping efficiency.

This paper considers the effects of claw morphology on the gripping efficiency of arboreal (Varanus varius) and burrowing (Varanus gouldii and Varanus panoptes) lizards. To ensure a purely morphological comparison between the lizards, we circumvent the material effects of claws from different species, by modelling and testing claw replicates of the same material properties. We correlate climbing efficiency to critical morphological features including; claw height (hc), width (wc), length (lc), curvature () and tip angle (γ), which are expressed as ratios to normalise mechanically beneficial claw structures. We find that there is strong correlation between the static grip force Fsg and the claw aspect and the cross-sectional rigidity ratio , and milder correlation (i.e. higher scatter) with the profile rigidity ratio . These correlations are also true for the interlocking grip force Fint over different shaped and sized protuberances, though we note that certain protuberance size-shape couplings are of detriment to the repeatability of Fint. Of the three lizard species, the claws of the arboreal (V. varius) are found to be superior to those of the burrower lizards (V. gouldii and V. panoptes) as a result of the V. varius claws having a smaller aspect, a higher cross-sectional rigidity ratio and a small profile rigidity ratio, which are deemed noteworthy morphological parameters that influence a claw's ability to grip effectively.

Prospective Integrated Individualized Clinical Decision-making and Outcome Evaluation for Surgery in Patients with Acromegaly: A New Paradigm?

BACKGROUND: Growth-hormone-producing pituitary adenomas have variable likelihood for biochemical remission (BR). During preoperative counseling, individual estimated surgical likelihoods/risks should be balanced against alternative (medical) treatments, which is necessary for accurate outcome presentation. Preoperative estimation of BR or total resection (TR) likelihoods have not been reported, resulting in extrapolation of individual outcomes. AIMS: To share an innovative outcome reporting paradigm by integrating surgical decision-making, and expected/realized results, resulting from the Value-Based Health Care (VBHC) care path with periodical performance evaluation and care innovation cycle. METHODS: Prospective cohort study of consecutive patients with acromegaly undergoing surgery (January 2016-December 2020; postoperative follow-up ≥6 months) reporting on both classic, and novel innovative outcome evaluations. RESULTS: Fifty eight patients (66 procedures) were included. Intended TR was achieved in 34/50 procedures, whereas intended debulking was achieved in 15/16 procedures. 38/66 procedures resulted in BR, and 4 procedures resulted in permanent complications. Achieving intended surgical goal was estimated preoperatively as likely in 33 (goal achieved (GA) in 28/33), potentially in 27 (GA in 19/27), and unlikely in 6 procedures (GA in 2/6). Integrated Outcome Square 1 (IOQ1) -intended effect achieved without complications- was achieved in 46/66 patients. CONCLUSION: Implementation of the developed quality process positively affects preoperative individual shared decision-making, resulting in improved (individual) outcomes, particularly in complex patients for whom preoperative chances are not fully reflected by tumor size and KNOSP grade, e.g., reoperations, or other challenging circumstances identified during preoperative counseling. Through repeated evaluations, our own team's knowledge increased, allowing for improved individualized treatment strategies.

Efficacy and Safety of Endoscopic Transsphenoidal Resection for Prolactinoma: A Retrospective Multicenter Case-series.

BACKGROUND: Endoscopic transsphenoidal surgery (ETSS) for prolactinoma is reserved for dopamine agonist (DA) resistance, intolerance, or apoplexy. High remission (overall 67%, microprolactinoma up to 90%), low recurrence (5-20%) rates highlighted that surgery might be first-line treatment. AIMS: To report on outcomes of ETSS in a cohort of prolactinomas. METHODS: Multicenter retrospective cohort of 137 prolactinoma patients (age 38.2 ± 13.7 years; 61.3% female, median follow-up 28.0 [15.0-55.5] months) operated between 2010-2019 with histopathological confirmation. RESULTS: Median preoperative prolactin levels were 166 (98-837 µg/L; males 996 [159-2145 µg/L] vs. females 129 [84-223 µg/L], p <0.001). 56 (40.9%) microprolactinomas, 69 (50.4%) macroprolactinomas, and 7 (5.1%) giant prolactinomas were included, whereas no adenoma was detected in 5 (3.6%) patients. Males had larger tumors (macroprolactinomas: 38, 71.7%) vs. 31 (36.9%), p <0.001; giant prolactinomas: 7 (13.2%) vs. 0 (0.0%), (p <0.001). Prolactinomas were graded as KNOSP-3 in 15 (11.5%), and KNOSP-4 in 20 (15.3%) patients. Primary indication was DA intolerance (59, 43.1%); males 14 (26.4%) vs. females 45 (53.6%), p = 0.006. Long-term remission (i.e., DA-free prolactin level <1xULN) was achieved in 87 (63.5%) patients, being higher in intended complete resection (69/92 [75.0%]), and lower in males (25 [47.2%] vs. 62 females [73.8%], p = 0.002). Transient DI (n = 29, 21.2%) was the most frequent complication. CONCLUSIONS: Despite high proportions of macroprolactinoma and KNOSP 3-4, long-term remission rates were 63.5% overall, and 83.3% in microprolactinoma patients. Males had less favorable remission rate compared to females. These findings highlight that ETSS may be a safe and efficacious treatment to manage prolactinoma.

Postoperative surveillance and long-term outcome after endovascular aortic aneurysm repair in the Netherlands: study protocol for the retrospective ODYSSEUS study.

INTRODUCTION: Strict imaging surveillance protocols to detect complications following endovascular aneurysm repair (EVAR) are common practice. However, controversy exists as to whether all EVAR patients need intense surveillance. The 2019 European Society for Vascular Surgery guidelines for management of abdominal aortic aneurysm (AAA) suggest that patients may be considered for limited follow-up with imaging if classified as 'low risk' for complications based on their initial postoperative imaging. The current study aims to investigate the intervention-free survival and overall survival stratified for patients with and without yearly imaging surveillance. METHODS AND ANALYSIS: The Observing a Decade of Yearly Standardised Surveillance in EVAR patients with Ultrasound or CT Scan study comprises a national multicentre retrospective cohort study in 17 medical centres. Consecutive patients with an asymptomatic or symptomatic infrarenal AAA who underwent EVAR between January 2007 and January 2012 will be included in this study with follow-up until December 2018. Clinical variables and all follow-up information will be retrieved in extensive data collection from the patient's medical records. In addition, an e-survey was sent to vascular surgeons at the 17 participating centres to gauge their opinions regarding the possibility of safely reducing the frequency of imaging surveillance. Primary endpoints are intervention after EVAR and aneurysm-related mortality. The initial estimated sample size is 1997 patients. ETHICS AND DISSEMINATION: The study has been approved by the Medical Ethics Review Committee of the Amsterdam UMC, location Academic Medical Centre, Amsterdam, the Netherlands. Study findings will be disseminated via presentations at conferences and publications in peer-reviewed journal. TRIAL REGISTRATION NUMBER: The Netherlands Trial Registry, NL6953 (old: NTR28773).

How do people with moderate intellectual disability evaluate restrictions in daily care?

OBJECTIVES: One of the general articles of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) focuses on the right of freedom to make one's own choices and being aware of the importance for persons with disabilities to obtain independence. People with intellectual disability (ID) are, to a greater or lesser degree, dependent on significant others, such as support staff with respect to decision making. For that reason, the UNCRPD also stresses the relevance of supportive decision making, which should be stimulated by service policies. However, support staff may find it necessary to restrict people with ID to make their own choices, for example to prevent them from harm. Since restrictions should be applied in the interest of people with ID, it is essential to examine their own perception. In this study, we have examined how people with moderate ID themselves perceive and evaluate restrictions in daily care, using a qualitative methodology. METHOD: Based on an extensive pilot study, we conducted interviews being close in time and place in which possible restrictions might occur. Additionally, we applied triangulation of sources. After conducting interviews with eight persons with a moderate ID, we examined their clinical files and interviewed their key workers. Qualitative analysis was carried out by two researchers, using an inductive, thematic approach. RESULTS: Results demonstrate communality between the participating people with ID and their key workers in perception and evaluation of restrictions, in people with ID tending to comply with the applied restrictions. When the participants with ID and their key workers differ in their evaluation of applied restrictions, this appears a value based dissensus. CONCLUSION: To ensure that restrictions are applied in the best interest of people with ID, it is essential that staff are attentive to the wishes of people with ID, which might be based on different values. By asking people with ID about their experiences and views of the restrictions imposed on them, we hope to contribute to an ongoing and open dialogue to inform the planning and delivery of services for people with ID based on 'best interest' principles.

Syndrome in question.

Muir-Torre syndrome is a rare genodermatosis characterized by the occurrence of at least one sebaceous tumor associated with visceral neoplasia, but with no predisposing factors. The sebaceous neoplasm may appear before, during or after the diagnosis of colorectal cancer. As it is regarded as a subtype of nonpolyposis hereditary colorectal cancer, it is important to evaluate the patient's first-degree relatives. The clinical course of the neoplasm is usually more indolent and the syndrome has a good prognosis. We report the case of a patient who, after a ten-year diagnosis of colorectal cancer, presented with multiple sebaceous neoplasms.

Granulomatous mycosis fungoides--a diagnostic challenge.

Granulomatous mycosis fungoides is a rare subtype of T-cell cutaneous lymphoma. Due to its clinical heterogenicity the diagnosis is delayed and based on histopathological and immuno-histochemical findings, sometimes requiring gene rearrangement studies for confirmation. We report the case of a patient who was submitted to several biopsies before diagnostic conclusion.

Syndrome in question

AbstractMuir-Torre syndrome is a rare genodermatosis characterized by the occurrence of at least one sebaceous tumor associated with visceral neoplasia, but with no predisposing factors. The sebaceous neoplasm may appear before, during or after the diagnosis of colorectal cancer. As it is regarded as a subtype of nonpolyposis hereditary colorectal cancer, it is important to evaluate the patient's first-degree relatives. The clinical course of the neoplasm is usually more indolent and the syndrome has a good prognosis. We report the case of a patient who, after a ten-year diagnosis of colorectal cancer, presented with multiple sebaceous neoplasms.

Granulomatous mycosis fungoides - A diagnostic challenge

AbstractGranulomatous mycosis fungoides is a rare subtype of T-cell cutaneous lymphoma. Due to its clinical heterogenicity the diagnosis is delayed and based on histopathological and immuno-histochemical findings, sometimes requiring gene rearrangement studies for confirmation. We report the case of a patient who was submitted to several biopsies before diagnostic conclusion.

Adipokines and cardiometabolic function: How are they interlinked?

OBJECTIVE: Adipokines contribute directly to the coexistence of insulin resistance and endothelial dysfunction. Most studies focus on a single adipokine. We therefore investigated the independent relationships of leptin, adiponectin, tumor necrosis factor-alpha, resistin and visfatin, as well as the gut hormone ghrelin with blood pressure and insulin resistance. Secondly we evaluated the interrelationships of adipokines and ghrelin in concert with various cardiometabolic markers. METHODS AND RESULTS: Caucasian women (N=115) with varying levels of obesity (aged 31.3 + or - 9.18 years) were included. Significant correlations of leptin, adiponectin, ghrelin and visfatin with mean arterial pressure (p<0.05) disappeared after adjustment for age, body mass index and waist circumference. But significant correlations with insulin resistance (HOMA) (for leptin, adiponectin and ghrelin) remained significant after adjustments. Factor analyses yielded five factors, but two main clusters, namely a metabolic syndrome cluster (including leptin, adiponectin and ghrelin) and a vascular atherosclerotic cluster (including tumor necrosis factor-alpha, visfatin and resistin). CONCLUSION: Factor analyses identified patterns which indicate specific roles of the various adipokines. Leptin, adiponectin and ghrelin were more closely related to insulin resistance and central obesity as core components of the metabolic syndrome. Visfatin, tumor necrosis factor-alpha and resistin seem to direct their effects onto the vascular system possibly by means of mechanisms such as inflammation, vasoconstriction and coagulation.

Manifestaçöes da cavidade oral que influenciam na fala de um doente de aids / Manifestations of a HIV - infected (AIDS) patients which interfere in the speech an voice

Neste artigo, a autora se propöe a focalizar as diversas manifestaçöes clínicas num doente do HIV (AIDS) que interferem na fala, na voz e na deglutiçäo. Dentre essas manifestaçöes clínicas, cita-se os casos de: Candidíase Oral e Leucoplasia Pilosa, Gengivites, Ulceraçöes Aftosas, Abcessos Dentários e Papilomas Intraorais, Queilites, Estomatites, Glossites, Amigdalites, Faringites, Laringites, Bronquites, Pneumopatias Típicas e Atípicas, e, manifestaçöes otorrinolaringológicas de origem infecciosa ou alérgica do aparelho auditivo e nasal. Estas afecçöes säo causadas geralmente pelos agentes etiológicos a seguir: a. Candida Albicans; b. Bactérias Virulentas; c. Clarmídia; d. Neisseeria Gonocócica; e. Treponema Palidum; f. Citomegalovírus; g. Vírus do Herpes Simples; h. Papovavírus. Algumas destas enfermidades poderäo exigir um tratamento paralelo, pelo respectivo médico especialista. Também dá-se ênfase ao valor de uma detalhada anamnese, para que possamos firmar o diagnóstico com precisäo e evidentemente, instituir uma terapia adequada, beneficiando, acima de tudo, o paciente. Ficou claro, neste artigo, que realmente as manifestaçöes da cavidade oral em um doente do HIV (AIDS), influenciam diretamente em sua fala e a participaçäo do Fonoaudiólogo se torna imperativa para a recuperaçäo da sua fonaçäo