Movement behavior remains stable in stroke survivors within the first two months after returning home.

BACKGROUND AND PURPOSE: The aim of this study is to investigate changes in movement behaviors, sedentary behavior and physical activity, and to identify potential movement behavior trajectory subgroups within the first two months after discharge from the hospital to the home setting in first-time stroke patients. METHODS: A total of 140 participants were included. Within three weeks after discharge, participants received an accelerometer, which they wore continuously for five weeks to objectively measure movement behavior outcomes. The movement behavior outcomes of interest were the mean time spent in sedentary behavior (SB), light physical activity (LPA) and moderate to vigorous physical activity (MVPA); the mean time spent in MVPA bouts ≥ 10 minutes; and the weighted median sedentary bout. Generalized estimation equation analyses were performed to investigate overall changes in movement behavior outcomes. Latent class growth analyses were performed to identify patient subgroups of movement behavior outcome trajectories. RESULTS: In the first week, the participants spent an average, of 9.22 hours (67.03%) per day in SB, 3.87 hours (27.95%) per day in LPA and 0.70 hours (5.02%) per day in MVPA. Within the entire sample, a small but significant decrease in SB and increase in LPA were found in the first weeks in the home setting. For each movement behavior outcome variable, two or three distinctive subgroup trajectories were found. Although subgroup trajectories for each movement behavior outcome were identified, no relevant changes over time were found. CONCLUSION: Overall, the majority of stroke survivors are highly sedentary and a substantial part is inactive in the period immediately after discharge from hospital care. Movement behavior outcomes remain fairly stable during this period, although distinctive subgroup trajectories were found for each movement behavior outcome. Future research should investigate whether movement behavior outcomes cluster in patterns.

Prediction of Preadolescent Overweight and Poor Cardiometabolic Outcome in Children up to 6 Years of Age: Research Protocol.

BACKGROUND: Dynamic risk estimations may enable targeting primary prevention of overweight and overweight-related adverse cardiometabolic outcome in later life, potentially serving as a valuable addition to universal primary prevention. This approach seems particularly promising in young children, as body mass index (BMI) changes at a young age are highly predictive of these outcomes, and parental lifestyle interventions at a young age are associated with improved long-term outcome. OBJECTIVE: This paper describes the design of our study, which aims to develop digitized tools that can be implemented in the Dutch Child Health Care (CHC) system or by pediatricians for children up to 6 years of age. These tools will enable (1) dynamically predicting the development of overweight, hypertension or prehypertension, low high-density lipoprotein cholesterol (HDL-C) values, and high total cholesterol to HDL-C ratio by early adolescence and (2) identifying children who are likely to have poor cardiometabolic outcome by the age of 5-6 years and by the age of 10 years. METHODS: Data will be obtained from the Generation R (n=7893) and Prevention and Incidence of Asthma and Mite Allergy (PIAMA; n=3963) cohorts, two Dutch prenatally recruited cohorts. We will select candidate predictors that can be assessed during the first visit and/or during subsequent visits to the CHC center or pediatrician, including sex; parental age, education level, and BMI; smoking exposure; ethnicity; birth weight; gestational age; breastfeeding versus formula feeding; and growth data through the age of 6 years. We will design dynamic prediction models that can be updated with new information obtained during subsequent CHC visits, allowing each measurement to be added to the model. Performance of the model will be assessed in terms of discrimination and calibration. Finally, the model will be validated both internally and externally using the combined cohort data and then converted into a computer-assisted tool called ProCOR (Prediction Of Child CardiOmetabolic Risk). RESULTS: This is an ongoing research project financed by the Dutch government. The first results are expected in 2016. CONCLUSIONS: This study may contribute to the national implementation of digitized tools for assessing the risk of overweight and related cardiometabolic outcome in young children, enabling targeted primary prevention, ultimately yielding relevant health gains and improved resource allocation.

Predicting pulmonary hypertension with standard computed tomography pulmonary angiography.

The most common feature of pulmonary hypertension (PH) on computed tomography pulmonary angiography (CTPA) is an increased diameter-ratio of the pulmonary artery to the ascending aorta (PA/AAAX). The aim of this study was to investigate whether combining PA/AAAX measurements with ventricular measurements improves the predictive value of CTPA for precapillary PH. Three predicting models were analysed using baseline CTPA scans of 51 treatment naïve precapillary PH patients and 25 non-PH controls: model 1: PA/AAAX only; model 2: PA/AAAX combined with the ratio of the right ventricular and left ventricular diameter measured on the axial view (RV/LVAX); model 3: PA/AAAX combined with the RV/LV-ratio measured on a four chamber view (RV/LV4CH). Prediction models were compared using multivariable binary logistic regression, ROC analyses and decision curve analyses (DCA). Multivariable binary logistic regression showed an improvement of the predictive value of model 2 (-2LL = 26.48) and 3 (-2LL = 21.03) compared to model 1 (-2LL = 21.03). ROC analyses showed significantly higher AUCs of model 2 and 3 compared to model 1 (p = 0.011 and p = 0.007, respectively). DCA showed an increased clinical benefit of model 2 and 3 compared to model 1. The predictive value of model 2 and 3 were almost equal. We found an optimal cut-off value for the RV/LV-ratio for predicting precapillary PH of RV/LV ≥ 1.20. The predictive value of CTPA for precapillary PH improves when ventricular and pulmonary artery measurements are combined. A PA/AAAX ≥ 1 or a RV/LVAX ≥ 1.20 needs further diagnostic evaluation to rule out or confirm the diagnosis.