Trends in and relations between children's health-related behaviors pre-, mid- and post-Covid.

BACKGROUND: Covid-19 has had a major negative impact on children's engagement in health-related behaviors. This study examines trends in children's screen time, outdoor play and sports club membership in pre- (2016-19), mid- (2020-21) and post- (2021-22) Covid years. Also, predicting factors (gender, age and active commuting) of these health-related behaviors are examined. METHODS: Data were collected via yearly self-report questionnaires among pupils in Grades 3-6 (mean age 10.14 ± 1.25 years; total n over the five cohorts = 6351, 50.8% girls). Multilevel path models were constructed in Mplus to examine whether children's screen time, outdoor play and sports club membership differed between pre-, mid- and post-Covid years; and which factors predicted engagement in these health-related behaviors (using data of all cohorts). RESULTS: During and after Covid-19, children's screen time was higher, while they engaged less in outdoor play and were less often member of a sports club than before. Although these negative trends peaked during Covid-19, they slowly seem to be returning to pre-Covid levels in recent year. Younger children, girls and active commuters had less minutes screen time per day and played outdoors more days per week; boys and active commuters were more often sports club member. CONCLUSIONS: Although in the first year post-Covid children seem to be engaging more in health-related behaviors than during Covid-19, we still found lower levels of engagement than in the years before Covid-19, underlining the importance of early intervention to ensure an appropriate amount of engagement in health-related behaviors for all children.

Cross-Theoretical Compliance: An Integrative Compliance Analysis of COVID-19 Mitigation Responses in Israel.

To understand the question why people obey or break rules, different approaches have focused on different theories and subsets of variables. The present research develops a cross-theoretical approach that integrates these perspectives. We apply this in a survey of compliance with COVID-19 pandemic mitigation rules in Israel. The data reveal that compliance in this setting was shaped by a combination of variables originating from legitimacy, capacity, and opportunity theories (but not rational choice or social theories). This demonstrates the importance of moving beyond narrow theoretical perspectives of compliance, to a cross-theoretical understanding-in which different theoretical approaches are systematically integrated.

Cardiovascular fitness and executive functioning in primary school-aged children.

Previous research in children has shown that higher cardiovascular fitness is related to better executive functioning. However, the available literature is hampered by methodological limitations. The present study investigates the relationship between cardiovascular fitness and executive functioning in a large sample of healthy children (N = 814). Cardiovascular fitness was assessed with estimated VO2Max from 20 m Shuttle Run Test performance. Executive functioning was assessed using a set of computerized neurocognitive tasks aimed at executive functions (working memory, motor inhibition, interference control) and lower-level neurocognitive functions (information processing and attention). Dependent measures derived from the neurocognitive tests were subjected to principal component analysis. Mixed model analyses tested the relation between cardiovascular fitness and neurocognitive functioning components. Results showed that children with higher cardiovascular fitness performed better on the neurocognitive function components Information Processing and Control, Visuospatial Working Memory and Attention Efficiency. The following measures contained in these components contributed to the observed relations: information processing measures, visuospatial working memory, and speed of alerting attention. No relationship was found between cardiovascular fitness and the other components: Verbal Working Memory, Attention Accuracy, and Interference Control. The present study suggests that there is a relationship between cardiovascular fitness and a specific set of executive functions and lower level neurocognitive functions. These findings highlight the importance of cardiovascular fitness for the overall health of school-aged children.

Effects of aerobic exercise and cognitively engaging exercise on cardiorespiratory fitness and motor skills in primary school children: A cluster randomized controlled trial.

This paper examined effects of two interventions on cardiorespiratory fitness and motor skills, and whether these effects are influenced by baseline levels, and dose of moderate-to-vigorous physical activity (MVPA) during the intervention. A cluster randomized controlled trial was implemented in 22 schools (n = 891; 9.2 ± 07 years). Intervention groups received aerobic or cognitively engaging exercise (14-weeks, four lessons per week). Control groups followed their regular physical education programme. Cardiorespiratory fitness, motor skills and MVPA were assessed. Multilevel analysis showed no main effects on cardiorespiratory fitness and motor skills although the amount of MVPA was higher in the aerobic than in the cognitively engaging and control group. Intervention effects did not depend on baseline cardiorespiratory fitness and motor skills. Children with a higher dose of MVPA within the intervention groups had better cardiorespiratory fitness after both interventions and better motor skills after the cognitively engaging intervention. In conclusion, the interventions were not effective to enhance cardiorespiratory fitness and motor skills at a group level, possibly due to large individual differences and to a total dose of MVPA too low to find effects. However, the amount of MVPA is an important factor that influence the effectiveness of interventions.

Effects of aerobic and cognitively-engaging physical activity on academic skills: A cluster randomized controlled trial.

This cluster randomized controlled trial (trial-number #) compares effects of two school-based physical activity interventions (aerobic vs. cognitively-engaging) on reading, mathematics, and spelling achievement; and whether effects are influenced by volume of moderate-to-vigorous physical activity and baseline achievement. Twenty-two primary schools participated, where a third and fourth grade class were randomly assigned to the intervention or control group. Intervention groups were randomly assigned to a 14-week aerobic or cognitively-engaging intervention, receiving four physical education lessons a week. Control groups followed their regular physical education program. Academic achievement of 891 children (mean age 9.17 years, 49.4% boys) was assessed with standardized tests before and after the interventions. Post-Test academic achievement did not significantly differ between intervention groups and control group. A higher volume of moderate-to-vigorous physical activity resulted in better post-test mathematics achievement in both intervention groups, and post-test spelling achievement in the cognitively engaging intervention group. Compared to the control group, lower achievers in reading performed better in reading after the cognitively-engaging intervention. A combination of moderate-to-vigorous physical activity and cognitively-engaging exercises seems to have the most beneficial effects. Future intervention studies should take into account quantitative and qualitative aspects of physical activity, and children's baseline academic achievement.

Examining the Effect of Depicting a Patient Affected by a Negative Reimbursement Decision in Healthcare on Public Disagreement with the Decision.

BACKGROUND: The availability of increasingly advanced and expensive new health technologies puts considerable pressure on publicly financed healthcare systems. Decisions to not-or no longer-reimburse a health technology from public funding may become inevitable. Nonetheless, policymakers are often pressured to amend or revoke negative reimbursement decisions due to the public disagreement that typically follows such decisions. Public disagreement may be reinforced by the publication of pictures of individual patients in the media. Our aim was to assess the effect of depicting a patient affected by a negative reimbursement decision on public disagreement with the decision. METHODS: We conducted a discrete choice experiment in a representative sample of the public (n = 1008) in the Netherlands and assessed the likelihood of respondents' disagreement with policymakers' decision to not reimburse a new pharmaceutical for one of two patient groups. We presented a picture of one of the patients affected by the decision for one patient group and "no picture available" for the other group. The groups were described on the basis of patients' age, health-related quality of life (HRQOL) and life expectancy (LE) before treatment, and HRQOL and LE gains from treatment. We applied random-intercept logit regression models to analyze the data. RESULTS: Our results indicate that respondents were more likely to disagree with the negative reimbursement decision when a picture of an affected patient was presented. Consistent with findings from other empirical studies, respondents were also more likely to disagree with the decision when patients were relatively young, had high levels of HRQOL and LE before treatment, and large LE gains from treatment. CONCLUSIONS: This study provides evidence for the effect of depicting individual, affected patients on public disagreement with negative reimbursement decisions in healthcare. Policymakers would do well to be aware of this effect so that they can anticipate it and implement policies to mitigate associated risks.

Dietary strategies can increase cloacal endotoxin levels and modulate the resident microbiota in broiler chickens.

Endotoxins released from poultry feces have been associated with impaired human health. Because endotoxins are released from gram-negative intestinal bacteria, it was hypothesized that dietary strategies may influence endotoxin excretion via modulation of gut microbiota. We therefore tested dietary strategies that could potentially reduce cloacal endotoxin levels in broiler chickens. One-day-old male Ross 308 (N = 1,344) broilers were housed in 48 pens (N = 8 pens/treatment, 28 chickens per pen) and fed 1 of 6 diets for 35 days (d) in a 3-phase feeding program: a basic diet (CON) that served as the reference diet, or basic diet supplemented with butyrate (BUT), inulin (INU), medium-chain fatty acids (MCFA) or Original XPC™LS (XPC), or a high-fiber-low-protein (HF-LP) diet. A significant (P < 0.05) increase in cloacal endotoxin concentration at d 35 was observed in BUT as compared to CON. Analysis of cloacal microbiota showed a trend (P < 0.07) for a higher gram-negative/gram-positive ratio and for a higher relative abundance of gram-negative bacteria at d 35 (P ≤ 0.08) in BUT and HF-LP as compared to CON. A significant (P < 0.05) increase in average daily gain (ADG) and improved feed conversion ratio (P < 0.05) were observed in MCFA during the grower phase (d 14-28), and a significant (P < 0.05) increase in average daily feed intake (ADFI) was observed in MCFA during d 0 to 28. Broilers fed HF-LP had a significantly (P < 0.05) higher FCR and lower ADG throughout the rearing period. No treatment effects were found on footpad dermatitis, but BUT had worst hock burn scores at d 35 (P < 0.01) and MCFA had worst cleanliness scores at d 21 but not at d 35 (treatment*age P < 0.05), while INU had better cleanliness as compared to CON at d 35 (P < 0.05). In conclusion, especially BUT and HF-LP were able to modulate resident microbiota and BUT also increased cloacal endotoxin levels, which was opposite to our hypothesis. The present study indicates that cloacal endotoxin release can be affected by the diet but further study is needed to find dietary treatments that can reduce cloacal endotoxin release.

Oncologic outcomes of de-escalating axillary treatment in clinically node-positive breast cancer patients treated with neoadjuvant systemic therapy - A two center cohort study.

BACKGROUND: The aim of the present study was to report the 5-year axillary recurrence-free interval (aRFI) in clinically node-positive breast cancer patients treated according to a de-escalating axillary treatment protocol after neoadjuvant systemic therapy (NST). METHODS: All patients diagnosed in two hospitals between October 2014 and March 2021 were identified retrospectively. Data on diagnostic workup, treatment and follow-up was collected. Adjuvant axillary treatment was considered based on the initial staging using 18F-FDG PET/CT and the results of axillary lymph node marking with a radioactive-iodine seed protocol or a targeted axillary dissection procedure. Follow-up was updated until 27th April 2024. Kaplan-Meier curves were calculated to report the 5-year aRFI with corresponding 95 % confident intervals (95%-CI). RESULTS: A total of 199 patients were included. Axillary pathological complete response was reported in 66 (33.2 %). Based on the treatment protocol and initial clinical staging, no adjuvant axillary treatment was indicated in 30 patients (15 %), while 139 (70 %) received axillary radiotherapy without performance of an axillary lymph node dissection (ALND). The remaining 30 patients (15 %) underwent an ALND with additional locoregional radiotherapy. A median follow-up of 62 months (30-106) showed that 4 (2 %) patients experienced an axillary recurrence after 7, 8, 36 and 36 months, respectively. In all 4 patients, synchronous distant metastases were diagnosed. The estimated 5-year aRFI was 97.8 % (95%-CI 95.6-99.9 %) CONCLUSION: Although longer follow-up should be awaited before final conclusions can be drawn regarding the oncological safety of this approach, the implementation of a de-escalating axillary treatment protocol appears to be safe since the estimated 5-year aRFI is 97.8 %.

Social Acceptance in Physical Education and the Regular Classroom: Perceived Motor Competency and Frequency and Type of Sports Participation.

This study examined relations of primary school children's perceived physical competence and sports participation (frequency and type) with social acceptance in the regular classroom and physical education (PE) and whether these relations differed depending on the type of sport children participated in (team vs. individual sports). In total, 182 children (48.9% boys, mean age 9.90 years, SD = 1.23) filled out questions on their perceived physical competence and sports participation and indicated three peers with whom they liked/disliked working in PE and the regular classroom. Multilevel structural equation models in Mplus showed that frequency of sports participation was positively related to social acceptance in the context of PE. Additionally, for children in team sports, the frequency of sports participation was related to their social acceptance in PE, whereas for children in individual sports, perceived physical competence was related to social acceptance in PE. No relations were found in the regular classroom. Relations of perceived physical competence and sports participation with social acceptance seem to depend on the school context and the type of sport involved. In designing PE classrooms, children's physical competence and sports participation seem essential factors to take into account to provide all children with positive social experiences.

The mediating role of neurocognitive functions in the relation between physical competencies and academic achievement of primary school children.

Previous studies into associations between physical, neurocognitive and academic skills have reported inconsistent results. This study aimed to get more insight into these relations by examining all three domains simultaneously, testing a complete mediational model including measures of physical competencies (cardiovascular fitness and motor skills), neurocognitive skills (attention, information processing, and core executive functions), and academic achievement (reading, mathematics, and spelling). Dutch primary school students (n = 891, 440 boys, mean age 9.17 years) were assessed on the Shuttle Run Test (cardiovascular fitness), items of the Körperkoordinationstest für Kinder and Bruininks-Oseretsky Test-II (fundamental motor skills), computerized neurocognitive tests, and standardized academic achievement tests. A multilevel structural equation model showed that physical competencies were only indirectly related to academic achievement, via specific neurocognitive functions depending on the academic domain involved. Results provide important implications, highlighting the importance of well-developed physical competencies in children.

Objectively measured physical activity during primary school physical education predicts intrinsic motivation independently of academic achievement level.

BACKGROUND: Children's participation in physical education (PE) is seen as important for developing an active lifestyle and has been positively linked to academic achievement. Physical activity (PA) levels during PE are thought to be linked to PE-motivation, although this relation is poorly understood. AIMS: This study examined (1) whether children's PA-levels during PE were predictive of their PE-motivation and (2) whether the relation between PA-levels and motivation was moderated by children's academic achievement. Where previous studies focused on moderate-to-vigorous physical activity (MVPA), disregarding the potential beneficial role of lower intensities of PA, we included MVPA, light-intensity physical activity (LPA) and sedentary behaviour (SED). SAMPLE: In total, 891 primary school students participated (mean age = 9.2 years). METHODS: During one regular PE-lesson, PA-levels (using accelerometers) and PE-motivation (Intrinsic Motivation Inventory) were measured. Academic achievement in reading, mathematics and spelling was measured with standardized tests. RESULTS: A structural equation model revealed that LPA, MVPA and academic achievement positively predicted PE-motivation. The interaction between academic achievement and PA-levels was not related to PE-motivation. SED was excluded from the models due to multicollinearity. CONCLUSION: Children who are more engaged in LPA and MVPA and who perform better academically generally seem to be more motivated for PE, suggesting that PA-intensity levels and PE-motivation are bidirectionally linked. Results underline the importance of also examining LPA.

A Network Approach to Compliance: A Complexity Science Understanding of How Rules Shape Behavior.

To understand how compliance develops both in everyday and corporate environments, it is crucial to understand how different mechanisms work together to shape individuals' (non)compliant behavior. Existing compliance studies typically focus on a subset of theories (i.e., rational choice theories, social theories, legitimacy theories, capacity theories, and opportunity theories) to understand how key variables from one or several of these theories shape individual compliance. The present study provides a first integrated understanding of compliance, rooted in complexity science, in which key elements from these theories are considered simultaneously, and their relations to compliance and each other are explored using network analysis. This approach is developed by analyzing online survey data (N = 562) about compliance with COVID-19 mitigation measures. Traditional regression analysis shows that elements from nearly all major compliance theories (except for social theories) are associated with compliance. The network analysis revealed groupings and interconnections of variables that did not track the existing compliance theories and point to a complexity overlooked in existing compliance research. These findings demonstrate a fundamentally different perspective on compliance, which moves away from traditional narrow, non-network approaches. Instead, they showcase a complexity science understanding of compliance, in which compliance is understood as a network of interacting variables derived from different theories that interact with compliance. This points to a new research agenda that is oriented on mapping compliance networks, and testing and modelling how regulatory and management interventions interact with each other and compliance within such networks. Supplementary Information: The online version contains supplementary material available at 10.1007/s10551-022-05128-8.

Social distancing in America: Understanding long-term adherence to COVID-19 mitigation recommendations.

A crucial question in the governance of infectious disease outbreaks is how to ensure that people continue to adhere to mitigation measures for the longer duration. The present paper examines this question by means of a set of cross-sectional studies conducted in the United States during the COVID-19 pandemic, in May, June, and July of 2020. Using stratified samples that mimic the demographic characteristics of the U.S. population, it seeks to understand to what extent Americans continued to adhere to social distancing measures in the period after the first lockdown ended. Moreover, it seeks to uncover which variables sustained (or undermined) adherence across this period. For this purpose, we examined a broad range of factors, relating to people's (1) knowledge and understanding of the mitigation measures, (2) perceptions of their costs and benefits, (3) perceptions of legitimacy and procedural justice, (4) personal factors, (5) social environment, and (6) practical circumstances. Our findings reveal that adherence was chiefly shaped by three major factors: respondents adhered more when they (a) had greater practical capacity to adhere, (b) morally agreed more with the measures, and (c) perceived the virus as a more severe health threat. Adherence was shaped to a lesser extent by impulsivity, knowledge of social distancing measures, opportunities for violating, personal costs, and descriptive social norms. The results also reveal, however, that adherence declined across this period, which was partly explained by changes in people's moral alignment, threat perceptions, knowledge, and perceived social norms. These findings show that adherence originates from a broad range of factors that develop dynamically across time. Practically these insights help to improve pandemic governance, as well as contributing theoretically to the study of compliance and the way that rules come to shape behavior.

Rate and predictors of nodal pathological complete response following neoadjuvant endocrine treatment in clinically biopsy-proven node-positive breast cancer patients.

BACKGROUND: Data on effectiveness and optimal use of neoadjuvant endocrine therapy (NET) in clinically biopsy-proven node-positive breast cancer is lacking. This study examined the incidence of axillary pathological complete response (pCR) on NET in clinically biopsy-proven node-positive breast cancer patients. Secondary, patient and tumour characteristics, as well as the optimal duration of NET in relation to the occurrence of axillary pCR were investigated. MATERIAL AND METHODS: Patients diagnosed with primary hormone receptor positive, HER2 negative breast cancer between 2014 and 2019, with at least one positive axillary lymph node (pathologically proven), treated with NET were selected from the Netherlands Cancer Registry. The incidence of axillary pCR in combination with patient, tumour and treatment characteristics was analysed. RESULTS: In a population of 561 patients, an axillary pCR of 7.3% on NET was observed. Median length of treatment was 8.1 months in the patients without vs. 8.8 months in those with axillary pCR, with no statistically significant difference. A p-value <0.30 was found for age, histologic type, clinical tumour status, hormone receptor status and the type of NET in univariable analysis. After multivariable logistic regression analyses, none of these variables were independently associated with the likelihood of an axillary pCR. CONCLUSION: The rate of axillary pCR after NET in HR + HER2-clinically biopsy-proven node-positive breast cancer patients is low. Factors independently associated with the likelihood of an axillary pCR could not be identified. More research is warranted regarding optimizing the duration of NET and the prognostic value of residual disease in the axilla after NET.

Relations between gross motor skills and executive functions, controlling for the role of information processing and lapses of attention in 8-10 year old children.

This study aimed to systematically investigate the relation between gross motor skills and aspects of executive functioning (i.e. verbal working memory, visuospatial working memory, response inhibition and interference control) in 8-10 year old children. Additionally, the role of information processing (speed and variability) and lapses of attention in the relation between gross motor skills and executive functions was investigated. Data of 732 Dutch children from grade 3 and 4 were analyzed (50.0% boys, 50.4% grade 3, age = 9.16 ± 0.64 years). Gross motor skills were assessed using three items of the Körper Koordinationstest für Kinder and one item of the Bruininks-Oseretsky test of Motor Proficiency, Second Edition. Executive functions were assessed using the Wechsler Digit Span task (verbal working memory), the Visuospatial Memory task (visuospatial working memory), the Stop Signal task (response inhibition) and a modified version of the Flanker task (interference control). Information processing and lapses of attention were obtained by applying an ex-Gaussian analysis on go trials of the Stop Signal task. Multilevel regression analysis showed that gross motor skills were significantly related to verbal working memory, visuospatial working memory and response inhibition, but not to interference control. Lapses of attention was a significant predictor for all executive functions, whereas processing speed was not. Variability in processing speed was only predictive for visuospatial working memory. After controlling for information processing and lapses of attention, gross motor skills were only significantly related to visuospatial working memory and response inhibition. The results suggest that after controlling for information processing and lapses of attention, gross motor skills are related to aspects of executive functions that are most directly involved in, and share common underlying processes with, gross motor skills.