Serum proteomics reveals hemophagocytic lymphohistiocytosis-like phenotype in a subset of patients with multisystem inflammatory syndrome in children.

Children with Multisystem Inflammatory Syndrome in Children (MIS-C) can present with thrombocytopenia, which is a key feature of hemophagocytic lymphohistiocytosis (HLH). We hypothesized that thrombocytopenic MIS-C patients have more features of HLH. Clinical characteristics and routine laboratory parameters were collected from 228 MIS-C patients, of whom 85 (37%) were thrombocytopenic. Thrombocytopenic patients had increased ferritin levels; reduced leukocyte subsets; and elevated levels of ASAT and ALAT. Soluble IL-2RA was higher in thrombocytopenic children than in non-thrombocytopenic children. T-cell activation, TNF-alpha and IFN-gamma signaling markers were inversely correlated with thrombocyte levels, consistent with a more pronounced cytokine storm syndrome. Thrombocytopenia was not associated with severity of MIS-C and no pathogenic variants were identified in HLH-related genes. This suggests that thrombocytopenia in MIS-C is not a feature of a more severe disease phenotype, but the consequence of a distinct hyperinflammatory immunopathological process in a subset of children.

Parents' and Children's Experiences with a Coordinating Professional in Integrated Care for Childhood Overweight and Obesity-A Novel Dutch Approach.

BACKGROUND: In the new integrated program of care for childhood overweight and obesity (ICCO), a Youth Health Care (YHC) nurse has the role of a coordinating professional. After a broad assessment of strengths and weaknesses in the family setting, this coordinating professional makes a plan of action with the child and parents and involves other professionals when needed. The aim of this study was to explore the experiences of parents and children with the coordinating professional in the ICCO. MATERIAL & METHODS: Semi-structured interviews were conducted with eight families. Interview data were analyzed using content analysis. In addition, descriptive data on involved professionals and referrals was collected with an online questionnaire in 38 families. RESULTS: In total, eight families (8 mothers, 2 fathers, four boys and three girls aged 10-12 yrs) were interviewed and 38 children and parents filled in (three consecutive) online questionnaires. FINDINGS: The main themes related to the experiences of parents and children with the CP: parents and children felt supported and understood by the coordinating professional. They appreciated the broad perspective and personal approach. Contacts with the coordinating professional were not always frequent. Major points of improvement concerned the intensity of the follow-up and collaboration. Only few parents experienced collaboration between the coordinating professional and other professionals in the ICCO. CONCLUSIONS: Parents and children appreciated the personal approach of the Youth Health Care nurse as a CP. The role of the coordinating professional, however, appears not fully implemented yet. Strengthening the promising role of the coordinating professional in the ICCO is recommended.

Implementation of a guideline for local health policy making by regional health services: exploring determinants of use by a web survey.

BACKGROUND: Previous evaluation showed insufficient use of a national guideline for integrated local health policy by Regional Health Services (RHS) in the Netherlands. The guideline focuses on five health topics and includes five checklists to support integrated municipal health policies. This study explores the determinants of guideline use by regional Dutch health professionals. METHODS: A web survey was send to 304 RHS health professionals. The questionnaire was based on a theory- and research-based framework of determinants of public health innovations. Main outcomes were guideline use and completeness of use, defined as the number of health topics and checklists used. Associations between determinants and (completeness of) guideline use were explored by multivariate regression models. RESULTS: The survey was started by 120 professionals (39%). Finally, results from 73 respondents (24%) were eligible for analyses. All 28 Dutch RHS organizations were represented in the final dataset. About half of the respondents (48%) used the guideline. The average score for completeness of use (potential range 1-10) was 2.37 (sd = 1.78; range 1-7). Knowledge, perceived task responsibility and usability were significantly related to guideline use in univariate analyses. Only usability remained significant in the multivariate model on guideline use. Only self-efficacy accounted for significant proportions of variance in completeness of use. CONCLUSIONS: The results imply that strategies to improve guideline use by RHSs should primarily target perceived usability. Self-efficacy appeared the primary target for improving completeness of guideline use. Methods for targeting these determinants in RHSs are discussed.

Impact of Cross-Sectoral Alcohol Policy on Youth Alcohol Consumption.

OBJECTIVE: Cross-sectoral alcohol policy is recommended to reduce youth alcohol consumption, but little evidence is available on its effectiveness. Therefore, we examined whether regions and municipalities in the Dutch province of Noord-Brabant with stronger cross-sectoral alcohol policy showed larger reductions in alcohol consumption among adolescents aged 12-15. METHOD: Strong regional cross-sectoral alcohol policy was defined as participation in a regional alcohol prevention program. Strong municipal cross-sectoral alcohol policy was operationalized by measures on (a) sector variety: involvement of different policy sectors, and (b) strategy variety: formulation of different policy strategies. Relevant data from policy documents were searched for on the Internet. Data on trends in alcohol consumption were extracted from the 2007 and 2011 cross-sectional Youth Health Monitor that includes a random subset of adolescents aged 12-15 (n = 15,380 in 2007 and n = 15,437 in 2011). We used multilevel regression models. RESULTS: Two of the three regions in which municipalities participated in a regional alcohol prevention program showed a larger reduction in weekly drinking than the region in which municipalities did not participate (-12.2% and -13.4% vs. -8.3%). Municipalities with strong compared to weak sector variety showed a larger increase in adolescents' age at consuming their first alcoholic drink (0.63 vs. 0.42 years). Municipalities with strong strategy variety showed a decrease (-3.8%) in heavy weekly drinking, whereas those with weak variety showed an increase (5.1%). Cross-sectoral alcohol policy did not affect trends in other alcohol outcomes. CONCLUSIONS: Our results suggest that strong cross-sectoral alcohol policy may contribute to reducing some aspects of youth alcohol consumption. Monitoring policy implementation is needed to assess the full impact.

Combining risk estimates from observational studies with different exposure cutpoints: a meta-analysis on body mass index and diabetes type 2.

Studies on a dose-response relation often report separate relative risks for several risk classes compared with a referent class. When performing a meta-analysis of such studies, one has to convert these relative risks into an overall relative risk for a continuous effect. Apart from taking the dependence between separate relative risks into account, this implies assigning an exposure level to each risk factor class and allowing for the nonlinearity of the dose-response relation. The authors describe a relatively simple method solving these problems. As an illustration, they applied this method in a meta-analysis of the association between body mass index and diabetes type 2, restricted to results of follow-up studies (n=31). Results were compared with a more ad hoc method of assigning exposure levels and with a method in which the nonlinearity of the dose-response method was not taken into account. Differences with the ad hoc method were larger in studies with fewer categories. Not incorporating the nonlinearity of the dose response leads to an overestimation of the pooled relative risk, but this bias is relatively small.