Physical behavior and associations with health outcomes in operable NSCLC patients: A prospective study.

OBJECTIVES: Our objectives were to 1) characterize daily physical behavior of operable non-small cell lung cancer (NSCLC) patients, from preoperative to six months postoperative using accelerometry, and explore if physical behavior preoperative or one month postoperative is associated with better health outcomes at six months postoperative. METHODS: A prospective study with 23 patients (13 female) diagnosed with primary NSCLC and scheduled for curative lung resection was performed. Outcome measures were assessed two weeks preoperative, and one, three and six months postoperative, and included accelerometer-derived physical behavior measures and the following health outcomes: six minute walking distance (6MWD), questionnaires concerning health-related quality of life (HRQOL), fatigue and distress. RESULTS: On group average, physical behavior showed significant changes over time. Physical behavior worsened following surgery, but improved between one and six months postoperative, almost reaching preoperative levels. However, physical behavior showed high variability between patients in both amount as well as change over time. More time in moderate-to-vigorous physical activity in bouts of 10 min or longer in the first month postoperative was significantly associated with better 6MWD, HRQOL, distress, and fatigue at six months postoperative. CONCLUSION: As expected, curative lung resection impacts physical behavior. Patients who were more active in the first month following surgery reported better health outcome six months postoperative. The large variability in activity patterns over time observed between patients, suggests that physical behavior 'profiling' through detailed monitoring of physical behavior could facilitate tailored goal setting in interventions that target change in physical behavior.

Ambulant monitoring and web-accessible home-based exercise program during outpatient follow-up for resected lung cancer survivors: actual use and feasibility in clinical practice.

PURPOSE: The aim of this study is to evaluate the feasibility of a telehealthcare application for operable lung cancer (OLC) patients, consisting of ambulant symptom and physical activity monitoring (S&PAM) and a web-accessible home-based exercise program (WEP), and identify possible barriers for successful adoption and implementation. METHODS: A two-stage mixed methods design was used, in which 22 OLC patients and their treating healthcare professionals (HCPs) participated from pre-surgery to three (stage 1; n = 10) or six (stage 2; n = 12) months post-surgery. Actual use and acceptability (usability, usefulness, and satisfaction) were evaluated. RESULTS: Seventeen OLC patients (age (SD): 59 (8) years; 8 female) actively used the modules. S&PAM use varied from 1 to 11 monitoring days prior to outpatient consultations. Patients used WEP most frequently during the first 5 weeks, with an average of four logins a week. Fifty-eight percent used WEP beyond 7 weeks. No adverse situations occurred, and patients felt confident using the applications. Perceived added value included active lifestyle promotion, decreased anxiety, and accessibility to specialized HCPs. Physiotherapists used WEP as intended. Contrarily, physicians scarcely used information from S&PAM. To promote future adoption, strategies should focus on high-level patient tailoring of the technology, and formalization of including the applications in the clinical workflow. CONCLUSIONS: Ambulant monitoring and web-accessible home exercise is clinically feasible for OLC patients. However, low level of adoption by referring physicians may hamper successful implementation. IMPLICATIONS FOR CANCER SURVIVORS: Patients perceived both ambulant monitoring and web-accessible exercise as an added value to regular care and feasible to use in the period before and after lung resection.

Contact dermatitis in the construction industry: the role of filaggrin loss-of-function mutations.

BACKGROUND: A high prevalence of contact dermatitis (CD) and respiratory symptoms has been observed in the construction industry, probably due to widespread exposure to irritants and allergens. It is unknown whether carriers of loss-of-function mutations in the gene encoding filaggrin (FLG), a known risk gene for eczema and asthma, are at increased risk. OBJECTIVES: To investigate associations of FLG mutations with CD and respiratory symptoms in Dutch construction workers. METHODS: A questionnaire including items on dermal and respiratory symptoms such as wheeze, shortness of breath and asthma was administered to construction workers. Total and specific serum IgE was analysed by enzyme immunoassays. Four FLG loss-of-function mutations were genotyped. CD was diagnosed by a team of a dermatologist and a clinical occupational medicine specialist using photographs of the subjects' hands and self-reported questionnaire data. RESULTS: Of the 506 participating workers, 6·3% carried at least one FLG mutation. Mild CD was diagnosed by the specialists in 34·0%, and severe CD in an additional 24·3%. CD was considered work related in 282 of 295 subjects (95·6%). Carriers of FLG variants had an increased risk of CD compared with subjects carrying wild-type alleles [mild CD: odds ratio (OR) 5·71, 95% confidence interval (CI) 1·63-20·06; severe CD: OR 8·26, 95% CI 2·32-29·39]. FLG variants and the presence of CD were not associated with respiratory symptoms and atopy. CONCLUSIONS: Contact dermatitis prevalence in construction workers is high. FLG loss-of-function mutations increase the risk of CD even further. FLG mutations were not associated with respiratory symptoms or atopy.

Relationship between patterns of daily physical activity and fatigue in cancer survivors.

PURPOSE: This study investigated: (1) physical activity behaviour of cancer survivors throughout the day, (2) the relationship between objective and subjective measures of physical activity, and (3) the relationship between daily physical activity and fatigue. METHOD: Physical activity was measured objectively using 3D-accelerometry (expressed in counts per minute (cpm)), and subjectively using a Visual Analogue Scale (VAS; 0-10) implemented on a smartphone in 18 cancer survivors (6 male; age 55.7 ± 10.2 yrs; free from cancer, last treatment ≥three months previously), and matched controls. Fatigue was scored thrice daily on a smartphone (0-10 VAS). RESULTS: Mean daily physical activity of cancer survivors did not deviate from controls (1108 ± 287 cpm versus 1223 ± 371 cpm, p = .305). However, in cancer survivors physical activity significantly decreased from morning to evening (p < .01) and increased levels of fatigue throughout the day were reported (p < .01). Furthermore, a positive correlation was found between levels of fatigue and the magnitude of the decline in physical activity from afternoon to evening (p < .05). Objective and subjective measured physical activity showed low correlations. CONCLUSIONS: This study demonstrated imbalanced activity patterns in cancer survivors. Also, the more a survivor felt fatigued, the greater the decline in activity behaviour throughout the day. The low correlation between objective and subjective physical activity suggests low awareness in cancer survivors about their daily physical activity performed. Ambulatory monitoring provides new insights in both patterns of physical activity and fatigue, which might be a valuable tool to provide activity management more efficiently during treatment of fatigue.

Developing transboundary river basin monitoring programmes using the DPSIR indicator framework.

Policymakers are often dissatisfied by the lack of what they consider useful information to support water management. Analysis of this 'water information gap' shows that this is caused by a lack of proper communication between information users and information producers. To improve this communication the process of specification of information needs has been structured. Earlier experiences showed that this not only entailed developing a structure to manage the process, but also developing a structure to guide the breakdown of policy objectives into information needs. Such a structure to organise the problem supports policy makers and monitoring specialists in their communication. This paper describes three pilot projects where the DPSIR indicator framework was used to organise the problem. It is concluded that the DPSIR framework is useful for improving the communication between information users and information producers and is helpful in breaking down policy objectives into information needs in a structured way. The structured approach in this way assists in narrowing the water information gap. Use of the DPSIR framework however leads to a bias towards water management problems and does not provide for all the relevant information needs.

A methodology to bridge the water information gap.

The metaphor of the water information gap is used to describe the discontent between information users and information producers about the use of and need for specific information. This paper describes the rugby-ball methodology for specification of information needs that was developed on the basis of an analysis of the water information gap and insights from the literature on policy- and decision-analysis, problem-structuring, and information management. The methodology consists of a process-architecture to manage the process of assessing information needs and a structure to organise the information needs related to water policy objectives. The methodology was developed and enhanced through a Reflection-in-Action process in which interaction between ideas and practice leads to improved results. The paper describes the methodology and its development, and concludes both on the development process and on the abilities of the methodology to narrow the water information gap.

Specifying information needs for Dutch National Policy evaluation.

There is mutual dissatisfaction among policy makers and monitoring specialists about producing what is considered useful information for policy development, implementation and evaluation. Insufficient or inappropriate communication between information users and producers is considered to be a main cause for this water information gap. This paper tests the rugby-ball methodology that has been designed to bridge the gap. The rugby-ball methodology consist of a five step plan that helps policy makers and monitoring specialists to communicate in a proper way and to come to a joint process of defining information needs. The methodology is first tested in a study to assess the information needs for the 4th National Policy Document on Water Management in the Netherlands. From the study it is concluded that the rugby-ball methodology is an important step in bridging the water information gap by better defining what useful information is. The methodology is also improved on the basis of this study by including a structure to support the breakdown of policy objectives into information needs.