Coping strategies and quality of life in patients with chronic symptoms visiting a Lyme Center in a Dutch teaching hospital.

INTRODUCTION: Little is known on coping strategies in patients with chronic symptoms suspected of Lyme borreliosis (LB). Different coping strategies might influence quality of life (QoL). We assessed coping strategies and QoL in patients with chronic symptoms suspected of LB. METHODS: Adult patients referred to the Lyme Center Apeldoorn were included (November 2019-April 2021). Participants completed the RAND-36 to assess QoL and the Utrecht Coping List to assess coping strategies. Patient data were extracted from medical records. Patients were categorized based on clinical LB and serology. Linear regression analyses were conducted to examine an association between coping strategies and QoL subscales. RESULTS: Included were 201 patients. Patients suspected of LB had a different coping profile and lower QoL compared to the reference population. Patients with negative serology and no clinical LB scored lowest on all QoL subscales. In multivariate analyses, correcting for age, gender, comorbidity, and patient category, a negative association was found between passive coping and the QoL subscales physical functioning (ß(SE) = - 1.1(0.5)), social functioning (ß(SE) = - 3.3(0.5)), role limitations (emotional) (ß(SE) = - 5.5(0.8)), mental health (ß(SE) = - 3.7(0.3)), vitality (ß(SE) = - 2.3(0.3)), pain (ß(SE) = - 2.3(0.5)), and general health (ß(SE) = - 2.7(0.3)). A negative association was also found between palliative coping and the QoL subscale role limitations (physical) (ß(SE) = - 1.8(0.6)) and between expressing emotions and mental health (ß(SE) = - 1.3(0.6)). A positive association was found between active coping and the QoL subscales mental health (ß(SE) = 1.0(0.3)) and role limitations (emotional) (ß(SE) = 1.9(0.8)). CONCLUSION: In patients suspected of LB, dysfunctional coping strategies were associated with worse quality of life. There is a need for interventions that can guide patients with chronic symptoms suspected of LB towards more active coping and increase QoL.

Post-acute and long-COVID-19 symptoms in patients with mild diseases: a systematic review.

BACKGROUND: It is expected that GPs are increasingly confronted with a large group of patients with symptoms persisting three weeks after initial symptoms of a mild (managed in the outpatient setting) COVID-19 infection. Currently, research on these persistent symptoms mainly focuses on patients with severe infections (managed in an inpatient setting) whereas patients with mild disease are rarely studied. OBJECTIVE: The main objective of this systematic review was to create an overview of the nature and frequency of persistent symptoms experienced by patients after mild COVID-19 infection. METHODS: Systematic literature searches were performed in Pubmed, Embase and PsychINFO on 2 February 2021. Quantitative studies, qualitative studies, clinical lessons and case reports were considered eligible designs. RESULTS: In total, nine articles were included in this literature review. The frequency of persistent symptoms in patients after mild COVID-19 infection ranged between 10% and 35%. Symptoms persisting after a mild COVID-19 infection can be distinguished into physical, mental and social symptoms. Fatigue was the most frequently described persistent symptom. Other frequently occurring persistent symptoms were dyspnoea, cough, chest pain, headache, decreased mental and cognitive status and olfactory dysfunction. In addition, it was found that persisting symptoms after a mild COVID-19 infection can have major consequences for work and daily functioning. CONCLUSION: There is already some evidence that symptoms of mild COVID-19 persist after 3 weeks in a third of patients. However, there is a lack of data about symptoms persisting after 3 months (long-COVID). More research is needed to help GPs in managing long-COVID.

Objective cognitive performance and subjective complaints in patients with chronic Q fever or Q fever fatigue syndrome.

BACKGROUND: Primary aim of this study was to compare cognitive performance of patients with chronic Q fever or Q fever fatigue syndrome (QFS) to matched controls from the general population, while taking performance validity into account. Second, we investigated whether objective cognitive performance was related to subjective cognitive complaints or psychological wellbeing. METHODS: Cognitive functioning was assessed with a neuropsychological test battery measuring the domains of processing speed, episodic memory, working memory and executive functioning. Tests for performance validity and premorbid intelligence were also included. Validated questionnaires were administered to assess self-reported fatigue, depressive symptoms and cognitive complaints. RESULTS: In total, 30 patients with chronic Q fever, 32 with QFS and 35 controls were included. A high percentage of chronic Q fever patients showed poor performance validity (38%) compared to controls (14%, p = 0.066). After exclusion of participants showing poor performance validity, no significant differences between patients and controls were found in the cognitive domains. QFS patients reported a high level of cognitive complaints compared to controls (41.2 vs 30.4, p = 0.023). Cognitive complaints were not significantly related to cognitive performance in any of the domains for this patient group. CONCLUSIONS: The high level of self-reported cognitive complaints in QFS patients does not indicate cognitive impairment. A large proportion of the chronic Q fever patients showed suboptimal mental effort during neuropsychological assessment. More research into the underlying explanations is needed. Our findings stress the importance of assessing cognitive functioning by neuropsychological examination including performance validity, rather than only measuring subjective cognitive complaints.

Incidence, presentation and management of Lyme disease in Dutch general practice.

BACKGROUND: Little is known about the presentation and management of Lyme disease in general practice. OBJECTIVE: To investigate the incidence of Lyme disease over a 6-year period, and its presentation and management in Dutch general practice. METHODS: Observational study using routine data from a practice-based research network in the Netherlands with 7 practices, 24 GPs and 30000 registered patients. From 2009 to 2014, we calculated the incidence of patients presenting with Lyme disease in general practice. We analysed patient characteristics and symptoms that patients presented with at first visit. Furthermore, we analysed General Practitioners' (GPs') diagnostic and therapeutic strategies, and adherence to the national guideline. RESULTS: Over a 6-year period, we found 212 episodes with clinical- or laboratory-based diagnosed Lyme disease, resulting in a mean incidence of 117 cases per 100000 patients per year. We did not identify a significant linear trend over time. The most frequently reported symptoms at first visit were rash (77%) and/or insect bite (58%). In 25% of patients, GPs performed a serological test, in 99% an antibiotic was prescribed and 11% were referred to a medical specialist. Frequently (in 46% of patients), the GP did not adhere to the guideline completely. CONCLUSION: This study shows that there is no linear trend in the incidence of Lyme disease over a 6-year period and that most patients present to GPs with unspecific symptoms like rash or insect bites. We show that GPs frequently (in 46% of patients) do not fully adhere to recommendations stated in the national guideline.

Exploring the Potential of a Wearable Camera to Examine the Early Obesogenic Home Environment: Comparison of SenseCam Images to the Home Environment Interview.

BACKGROUND: The obesogenic home environment is usually examined via self-report, and objective measures are required. OBJECTIVE: This study explored whether the wearable camera SenseCam can be used to examine the early obesogenic home environment and whether it is useful for validation of self-report measures. METHODS: A total of 15 primary caregivers of young children (mean age of child 4 years) completed the Home Environment Interview (HEI). Around 12 days after the HEI, participants wore the SenseCam at home for 4 days. A semistructured interview assessed participants' experience of wearing the SenseCam. Intraclass correlation coefficients (ICCs), percent agreement, and kappa statistics were used as validity estimates for 54 home environment features. RESULTS: Wearing the SenseCam was generally acceptable to those who participated. The SenseCam captured all 54 HEI features but with varying detail; 36 features (67%) had satisfactory validity (ICC or kappa ≥0.40; percent agreement ≥80 where kappa could not be calculated). Validity was good or excellent (ICC or kappa ≥0.60) for fresh fruit and vegetable availability, fresh vegetable variety, display of food and drink (except sweet snacks), family meals, child eating lunch or dinner while watching TV, garden and play equipment, the number of TVs and DVD players, and media equipment in the child's bedroom. Validity was poor (ICC or kappa <0.40) for tinned and frozen vegetable availability and variety, and sweet snack availability. CONCLUSIONS: The SenseCam has the potential to objectively examine and validate multiple aspects of the obesogenic home environment. Further research should aim to replicate the findings in a larger, representative sample.

Parental Reports of Infant and Child Eating Behaviors are not Affected by Their Beliefs About Their Twins' Zygosity.

Parental perception of zygosity might bias heritability estimates derived from parent rated twin data. This is the first study to examine if similarities in parental reports of their young twins' behavior were biased by beliefs about their zygosity. Data were from Gemini, a British birth cohort of 2402 twins born in 2007. Zygosity was assessed twice, using both DNA and a validated parent report questionnaire at 8 (SD = 2.1) and 29 months (SD = 3.3). 220/731 (8 months) and 119/453 (29 months) monozygotic (MZ) pairs were misclassified as dizygotic (DZ) by parents; whereas only 6/797 (8 months) and 2/445 (29 months) DZ pairs were misclassified as MZ. Intraclass correlations for parent reported eating behaviors (four measured at 8 months; five at 16 months) were of the same magnitude for correctly classified and misclassified MZ pairs, suggesting that parental zygosity perception does not influence reporting on eating behaviors of their young twins.

Maternal characteristics associated with the obesogenic quality of the home environment in early childhood.

The home environment is likely to influence children's diet and activity patterns and ultimately, their weight trajectories. Identifying family characteristics associated with a more 'obesogenic' home can provide insight into the determinants, and has implications for targeting and tailoring strategies to promote healthier lifestyles. The present study examined maternal characteristics associated with a more obesogenic home environment in 1113 families with preschool children. Primary caregivers (99% mothers) from the Gemini cohort completed the Home Environment Interview (HEI) when their children were 4 years old. Maternal demographics and BMI were assessed in the Gemini baseline questionnaire when the children were on average 8 months old. Maternal eating style was assessed when the children were on average 2 years old, using the Dutch Eating Behaviour Questionnaire (DEBQ). Responses to the HEI were standardised and summed to create a composite score of the obesogenic quality of the home; this was categorised into tertiles. Multivariate ordinal logistic regression showed that mothers who were younger (adjusted OR; 95% CI = 0.96; 0.94-0.98), less educated (1.97; 1.40-2.77), and had lower incomes (1.89; 1.43-2.49) at baseline were more likely to live in an obesogenic home environment at 4 years, as were mothers who scored higher on the DEBQ External Eating scale (1.40; 1.16-1.70) at 2 years, and had a higher baseline BMI (1.05; 1.02-1.08). Using a novel, composite measure of the home environment, this study finds that families who are more socio-economically deprived, and where the mothers are themselves heavier and have a more food responsive eating style, tend to provide a home environment with the hallmarks of a higher risk of weight gain.

The relationship between appetite and food preferences in British and Australian children.

BACKGROUND: Appetitive traits and food preferences are key determinants of children's eating patterns but it is unclear how these behaviours relate to one another. This study explores relationships between appetitive traits and preferences for fruits and vegetables, and energy dense, nutrient poor (noncore) foods in two distinct samples of Australian and British preschool children. METHODS: This study reports secondary analyses of data from families participating in the British GEMINI cohort study (n = 1044) and the control arm of the Australian NOURISH RCT (n = 167). Food preferences were assessed by parent-completed questionnaire when children were aged 3-4 years and grouped into three categories; vegetables, fruits and noncore foods. Appetitive traits; enjoyment of food, food responsiveness, satiety responsiveness, slowness in eating, and food fussiness were measured using the Children's Eating Behaviour Questionnaire when children were 16 months (GEMINI) or 3-4 years (NOURISH). Relationships between appetitive traits and food preferences were explored using adjusted linear regression analyses that controlled for demographic and anthropometric covariates. RESULTS: Vegetable liking was positively associated with enjoyment of food (GEMINI; ß = 0.20 ± 0.03, p < 0.001, NOURISH; ß = 0.43 ± 0.07, p < 0.001) and negatively related to satiety responsiveness (GEMINI; ß = -0.19 ± 0.03, p < 0.001, NOURISH; ß = -0.34 ± 0.08, p < 0.001), slowness in eating (GEMINI; ß = -0.10 ± 0.03, p = 0.002, NOURISH; ß = -0.30 ± 0.08, p < 0.001) and food fussiness (GEMINI; ß = -0.30 ± 0.03, p < 0.001, NOURISH; ß = -0.60 ± 0.06, p < 0.001). Fruit liking was positively associated with enjoyment of food (GEMINI; ß = 0.18 ± 0.03, p < 0.001, NOURISH; ß = 0.36 ± 0.08, p < 0.001), and negatively associated with satiety responsiveness (GEMINI; ß = -0.13 ± 0.03, p < 0.001, NOURISH; ß = -0.24 ± 0.08, p = 0.003), food fussiness (GEMINI; ß = -0.26 ± 0.03, p < 0.001, NOURISH; ß = -0.51 ± 0.07, p < 0.001) and slowness in eating (GEMINI only; ß = -0.09 ± 0.03, p = 0.005). Food responsiveness was unrelated to liking for fruits or vegetables in either sample but was positively associated with noncore food preference (GEMINI; ß = 0.10 ± 0.03, p = 0.001, NOURISH; ß = 0.21 ± 0.08, p = 0.010). CONCLUSION: Appetitive traits linked with lower obesity risk were related to lower liking for fruits and vegetables, while food responsiveness, a trait linked with greater risk of overweight, was uniquely associated with higher liking for noncore foods.

Parental control over feeding in infancy. Influence of infant weight, appetite and feeding method.

BACKGROUND AND OBJECTIVE: Parental control over feeding has been linked to child overweight. Parental control behaviours have been assumed to be exogenous to the child, but emerging evidence suggests they are also child-responsive. This study tests the hypothesis that parental control in early infancy is responsive to infant appetite and weight. SUBJECTS AND METHODS: Participants were 1920 mothers from the Gemini twin cohort, using one randomly selected child per family. Data come from questionnaires completed when the children were approximately 8 months. Mothers completed measures of 'pressure' and 'restriction', reported feeding method (breast- and bottle feeding), rated their infant's appetite during the first 3 months, provided health professional recorded weight measurements, and reported their concerns about their infant's weight. Logistic regression examined predictors of 'pressure' and 'restriction', adjusting for maternal demographics and BMI. Interactions between feeding method and control were also tested. RESULTS: 'Pressure' was associated with lower birth weight (OR = 0.79, 95% CI: 0.65-0.97), greater concern about underweight (OR = 1.88, 1.29-2.75), and lower infant appetite (OR = 0.59, 0.47-0.75). 'Restriction' was associated with higher appetite (OR = 1.44, 1.09-1.89) and bottle feeding (OR = 2.86, 2.18-3.75). A significant interaction with feeding method indicated that infants with high appetites were more likely to be restricted only if they were bottle-fed (OR = 1.52, 1.13-2.04). CONCLUSION: Mothers vary in their levels of control over milk-feeding and this is partly responsive to the infant's characteristics. They tend to pressure infants who are lighter and have a smaller appetite, and restrict infants with larger appetites if they are bottle-fed. Guidance on infant feeding may be better received if it acknowledges that parents respond to infant characteristics in order to achieve their feeding goals.

The structure and demographic correlates of cancer fear.

BACKGROUND: Cancer is often described as the 'number one' health fear, but little is known about whether this affects quality of life by translating into high levels of worry or distress in everyday life, or which population groups are most affected. This study examined the prevalence of three components of cancer fear in a large community sample in the UK and explored associations with demographic characteristics. METHODS: Questions on cancer fear were included in a survey mailed to a community sample of adults (n = 13,351; 55-64 years). Three items from a standard measure of cancer fear assessed: i) whether cancer was feared more than other diseases, ii) whether thinking about cancer caused discomfort, and iii) whether cancer worry was experienced frequently. Gender, marital status, education, and ethnicity were assessed with simple questions. Anxiety was assessed with the brief STAI and a standard measure of self-rated health was included. RESULTS: Questionnaire return rate was 60% (7,971/13,351). The majority of respondents agreed or strongly agreed that they feared cancer more than other diseases (59%), and felt uncomfortable thinking about it (52%), and a quarter (25%) worried a lot about cancer. All items were significantly inter-correlated (r = .35 to .42, p's < .001), and correlated with general anxiety (r = .16 to .28, p's < .001) and self-rated health (r = -.07 to -.16, p's < .001). In multivariable analyses including anxiety and general health, all cancer fear indicators were significantly higher in women (ORs between 1.15 and 1.48), respondents with lower education (ORs between 1.40 and 1.66), and those with higher general anxiety (ORs between 1.50 and 2.11). Ethnic minority respondents (n = 285; 4.4%) reported more worry (OR: 1.85). CONCLUSIONS: More than half of this older adult sample in the UK had cancer as greatest health fear and this was associated with feeling uncomfortable thinking about it and worrying more about it. Women and respondents with less education or from ethnic minority backgrounds were disproportionately affected by cancer fear. General anxiety and poor health were associated with cancer fear but did not explain the demographic differences.

Primary caregiver knowledge of paediatric physical activity recommendations in the United Kingdom and its association with caregiver behaviour: an observational study.

BACKGROUND: Most children in affluent developed countries do not meet basic physical activity recommendations. This study assessed primary caregiver knowledge of the UK recommendations on physical activity for children and examined the relationship between knowledge and components of parental support and modelling of physical activity. METHODS: Data were from a large, community-based twin birth cohort. Primary caregivers were invited to take part in a telephone interview on the home food and activity environment that included a question on knowledge of the minimum amount of physical activity recommended in UK child guidelines. Socio-demographic variables (maternal age, BMI, education, ethnicity and presence of co-habiting partner) were available from previously completed questionnaires. Parental support and modelling of physical activity variables were assessed during the telephone interview. Binary logistic regression analyses examined the relationship between knowledge and socio-demographic variables and components of parental support and modelling of physical activity. RESULTS: 1,113 families took part in the interview. Only 21% of participants knew the recommended amount of physical activity for children. Higher maternal education was associated with knowledge of the recommendation (Odds Ratio (OR) 2.82; 95% Confidence Interval (CI) 1.66, 4.79, p < 0.001). Knowledge of the recommendation was associated with communicating positive messages about physical activity to child (OR 1.52; 95% CI 1.12, 2.06, p = 0.008), watching the child participating in physical activity (OR 1.69; 95% CI 1.11, 2.55,p = 0.013) and showing the child they enjoyed physical activity themselves (OR 1.51; 95% CI 1.08, 2.12,p = 0.016) but not associated with encouraging the child to be active, doing physical activity with the child, being active in front of the child or showing enthusiasm about being active. CONCLUSIONS: Most primary caregivers in the UK do not know how much physical activity is recommended for children but those who do may be more supportive of physical activity for their child. Wider dissemination of the guidelines could be an important step in increasing population levels of physical activity.

Prognostic factors for persistent fatigue after COVID-19: a prospective matched cohort study in primary care.

BACKGROUND: Persistent fatigue after COVID-19 is common; however, the exact incidence and prognostic factors differ between studies. Evidence suggests that age, female sex, high body mass index, and comorbidities are risk factors for long COVID. AIM: To investigate the prevalence of persistent fatigue after COVID-19 in patients with a mild infection (managed in primary care) during the first wave of the pandemic and to determine prognostic factors for persistent fatigue. DESIGN AND SETTING: This was a prospective cohort study in Dutch general practice, combining online questionnaires with data from electronic health records. METHOD: Patients who contacted their GP between March and May 2020 and were diagnosed with COVID-19 during the first wave of the pandemic were included. Patients were matched to controls without COVID-19 based on age, sex, and GP practice. Fatigue was measured at 3, 6, and 15 months, using the Checklist of Individual Strength. RESULTS: All the participants were GP attendees and included 179 with suspected COVID-19, but who had mild COVID and who had not been admitted to hospital with COVID, and 122 without suspected COVID-19. Persistent fatigue was present in 35% (49/142) of the suspected COVID-19 group and 13% (14/109) of the non-COVID-19 group (odds ratio 3.65; 95% confidence interval = 1.82 to 7.32). Prognostic factors for persistent fatigue included low education level, absence of a partner, high neuroticism (using the Eysenck Personality Questionnaire Revised-Short Form), low resilience, high frequency of GP contact, medication use, and threatening experiences in the past. The latter three factors appeared to be prognostic factors for persistent fatigue specifically after COVID-19 infection. CONCLUSION: GP patients with COVID-19 (who were not admitted to hospital with COVID) have a fourfold higher chance of developing persistent fatigue than GP patients who had not had COVID-19. This risk is even higher in psychosocially vulnerable patients who had COVID-19.

Evaluation of a personalized, dose-sparing revaccination strategy in hepatitis B vaccine non-responders.

OBJECTIVES: The detection of low levels of antibodies against HBsAg (anti-HBs) below 10 IU/L in non-responders after a primary hepatitis B vaccination, is associated with seroconversion after revaccination. We compared the diagnostic performance of four anti-HBs assays in non-responders in their ability to differentiate between absence or presence of low levels of anti-HBs and propose a revaccination strategy guided by anti-HBs titres. METHODS: Non-responders were revaccinated with Fendrix 20 µg at 0, 1 and 2 months. Anti-HBs titres were determined by Abbott Architect, Diasorin Liaison, Roche Cobas and Siemens ADVIA Centaur. Inter-assay agreement was evaluated with Cohen's Kappa (k) in baseline samples between zero-responders without detectable antibodies and poor-responders with detectable antibodies < 10 IU/L. Seroconversion rates and geometric mean titres were analysed at 0, 1 and 3 months. A titre-based strategy (one revaccination dose and anti-HBs measurement followed by two more revaccination doses if required) was compared with the standard revaccination series of 3 doses. RESULTS: 57 participants were included in the analysis. k was ≥ 0.65 for all assays except ADVIA (k ≤ 0.41). After one revaccination dose all assays detected a mean seroconversion rate in zero-responders of 42.9%, compared to 85.1% in poor-responders. The difference between zero- and poor-responders in seroconversion rate per assay was significant (p < 0.05). After three revaccination doses the mean seroconversion rate was 88.2% in zero-responders and 98.5% in poor-responders (p > 0.286 per assay). A titre-based strategy reduced the amount of revaccinations by 17% compared with the standard. CONCLUSIONS: All assays demonstrated a comparable difference in seroconversion rate between zero- and poor-responders after one revaccination dose. The revaccination strategy could be optimised by differentiation between zero- and poor-responders followed by a titre-guided schedule.

Impact of Q-fever on physical and psychosocial functioning until 8 years after Coxiella burnetii infection: An integrative data analysis.

BACKGROUND: This study aimed to determine short- and long-term physical and psychosocial impact of Coxiella burnetii infection in three distinct entities: Q-fever fatigue syndrome (QFS), chronic Q-fever, and patients with past acute Q-fever without QFS or chronic Q-fever. METHODS: Integrative data analysis was performed, combining original data from eight studies measuring quality of life (QoL), fatigue, physical and social functioning with identical validated questionnaires, from three months to eight years after onset infection. Linear trends in each outcome were compared between Q-fever groups using multilevel linear regression analyses to account for repeated measures within patients. RESULTS: Data included 3947 observations of 2313 individual patients (228 QFS, 135 chronic Q-fever and 1950 patients with past acute Q-fever). In the first years following infection, physical and psychosocial impact was highest among QFS patients, and remained high without significant improvements over time. In chronic Q-fever patients, QoL and physical functioning worsened significantly over time. Levels of fatigue and social participation in patients with past acute Q-fever improved significantly over time. CONCLUSION: The impact differs greatly between the three Q-fever groups. It is important that physicians are aware of these differences, in order to provide relevant care for each patient group.

Individual and family environment correlates differ for consumption of core and non-core foods in children.

Children's diets contain too few fruits and vegetables and too many foods high in saturated fat. Food intake is affected by multiple individual and family factors, which may differ for core foods (that are important to a healthy diet) and non-core foods (that are eaten more for pleasure than health). Data came from a sample of twins aged 11 years (n 342) and their parents from the Twins Early Development Study. Foods were categorised into two types: core (e.g. cereals, vegetables and dairy) and non-core (e.g. fats, crisps and biscuits). Parents' and children's intake was assessed by an FFQ. Mothers' and children's preference ratings and home availability were assessed for each food type. Parental feeding practices were assessed with the child feeding questionnaire and child television (TV) watching was maternally reported. Physical activity was measured using accelerometers. Correlates of the child's consumption of each food type were examined using a complex samples general linear model adjusted for potential confounders. Children's non-core food intake was associated with more TV watching, higher availability and greater maternal intake of non-core foods. Children's core food intake was associated with higher preferences for core foods and greater maternal intake of core foods. These results suggest that maternal intake influences both food types, while preferences affect intake of core foods but not of non-core foods, and availability and TV exposure were only important for non-core food intake. Cross-sectional studies cannot determine causality, but the present results suggest that different approaches may be needed to change the balance of core and non-core foods in children's diets.

Development and factor structure of the Baby Eating Behaviour Questionnaire in the Gemini birth cohort.

The objective of this study was to develop a parent-report psychometric measure of infant appetite during the period of exclusive milk-feeding. Constructs and items for the Baby Eating Behaviour Questionnaire (BEBQ) were derived from an existing psychometric measure validated for older ages, the Children's Eating Behaviour Questionnaire, supplemented by a review of the literature on milk-feeding behaviours. Cognitive interviewing with a sample of mothers (n=10) was used to refine the questions. The factor structure of the 18-item BEBQ was assessed in infants (one per family) from the Gemini twin birth cohort (n=2402 families). Principal Component Analysis identified four distinct appetitive constructs, all of which had good internal reliability: 'enjoyment of food' (Cronbach's α=0.81), 'food responsiveness' (α=0.79), 'slowness in eating' (α=0.76), and 'satiety responsiveness' (α=0.73). A single item assessing 'general appetite' correlated with all of the constructs. The BEBQ is the first standardised measure of infant appetite designed to characterise appetitive traits that might confer susceptibility to excess weight gain.

SARS-CoV-2 antibodies in employees working in non-medical contact-intensive professions in the Netherlands: Baseline data from the prospective COco-study.

COVID-19 has made a global impact since early 2020, requiring characterization of the SARS-CoV-2 virus, including transmission risk. The COco-study aims to evaluate the risk for COVID-19 infections in two non-medical contact-intensive professions. COco is a prospective cohort study evaluating SARS-CoV-2 antibodies in hairdressers and hospitality personnel in the province of North-Brabant in the Netherlands, using a total antibody enzyme-linked immunosorbent assay. Baseline data from June/July 2020 were analyzed. Participants filled out a questionnaire, providing information on demographics, health, work situation, and risk factors for COVID-19. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated using logistic regression. In June/July 2020, 497 participants were enrolled: 236 hairdressers, 259 hospitality employees, and two participants worked in both industries. Hospitality staff was more frequently seropositive than hairdressers (14.2% versus 8.0%, respectively; OR 1.9, 95% CI 1.1-3.4). Furthermore, a high education level (OR 3.0, 95% CI: 1.7-5.6) and increased alcohol use (OR, 7 glasses per week increment: 1.3, 95% CI: 1.1-1.5) were associated with seropositivity. Of the 56 seropositive participants, 18 (32%) had not experienced any COVID-19 symptoms. The symptoms anosmia/ageusia differed most evidently between seropositive and seronegative participants (53.6% versus 5.7%, respectively; P < 0.001 (chi-squared test)). In conclusion, four months after the first identified COVID-19 patient in the Netherlands, employees in the hospitality industry had significantly more frequently detectable SARS-CoV-2 antibodies than hairdressers.

Rabies risk behaviour in a cohort of Dutch travel clinic visitors: A retrospective analysis.

BACKGROUND: Travellers to rabies endemic countries should be counselled on rabies risk and, in case of high-risk, pre-exposure vaccination is advised. However, it is not clear which travellers exactly are at high risk. In this study we determined the incidence of possible rabies exposure in travel clinic visitors and compliance with pre-travel advice. METHODS: Travellers to rabies endemic countries who visited a Dutch travel clinic between September 2017 and May 2018, were invited to participate. RESULTS: Of 980 travellers, one percent was injured by a potentially rabid animal. Compliance with advice was low as 59% reported proximity to a potentially rabid animal and only half of those exposed sought medical advice. The most important predictors of proximity to a potentially rabid animal were young age, long travel duration, visiting a monkey forest and hiking for more than one day. Travel for business was associated with lower risk. CONCLUSION: Despite pre-travel advice, rabies risk behaviour was high. Therefore, we would recommend to keep the threshold for pre-travel vaccination low. Pending more data on rabies exposure risk, the identified predictors of proximity to potentially rabid animals could be used to tailor indications for pre-travel rabies vaccination.

Gemini: a UK twin birth cohort with a focus on early childhood weight trajectories, appetite and the family environment.

Gemini is a cohort study of young twins in the United Kingdom designed to assess genetic and environmental influences on early childhood weight trajectories with a focus on infant appetite and the family environment. A total of 2402 families with twins born in England and Wales between March and December 2007 agreed to participate and returned completed baseline questionnaires. The sample includes 1586 same-sex and 816 opposite-sex twins. The study is currently funded for 5 years of follow-up, but is planned to continue into early adolescence and beyond, pending funding. With current funding of the study, families will be followed up when twins are: 8 months old (baseline), and then at 15, 20, 24, 36 and 48 months of age. Gemini is in its early stages, with baseline and first follow-up data collection completed. This is the first twin cohort to focus on childhood weight gain with detailed and repeated measures of children's appetite, food preferences, activity behavior and parental feeding styles, alongside detailed and repeated collection of anthropometrics. This article reviews the rationale for the Gemini study, its representativeness and the main measures.

Parents' underestimation of their child's weight status. Moderating factors and change over time: A cross-sectional study.

BACKGROUND: Parents' underestimation of their child's weight status can hinder active participation in overweight prevention programs. We examined the level of agreement between the parents' perception of their child's weight status and the child's actual weight status, moderating factors, and change over time. METHODS: This cross-sectional study used data collected in 2009 (n = 8105), 2013 (n = 8844) and 2017 (n = 11,022) from a community-based survey conducted among parents of children age 2-12 years in the Netherlands. Parents classified their perception of their child's weight status on a 5-point Likert scale. In 2009 and 2013, the child's BMI was calculated from self-reported data by parents. The level of agreement between the parent's perception of the weight status and the actual weight status was examined using Cohen's kappa. The role of demographic factors on parents' perception were examined using logistic regression. RESULTS: In 2009, 2013 and 2017, 6%, 6% and 5% of the parents, respectively, classified their child as heavy/extremely heavy. In 2009 and 2013, 64.7% and 61.0% of parents, respectively, underestimated the weight status of their overweight child. This was even higher among parents of obese children. Overall, the agreement between the parents' perception and the actual weight status improved from 2009 (kappa = 0.38) to 2013 (kappa = 0.43) (p<0.05), but remained unsatisfactory. The parents' underestimation of their child's overweight/obesity status was associated with the child's age in 2009 and 2013 (2-7 years; OR: 0.18), the child's gender in 2009 (male; OR: 0.55), and the parents' education level in 2009 (middle and high education; OR: 0.56 and 0.44 respectively). CONCLUSIONS: Parents' underestimation of their child's weight status remains alarmingly high, particularly among parents of young, obese children. This underestimation is a barrier to preventing childhood overweight/obesity. Healthcare professionals should take this underestimation into consideration and should actively encourage parents to take steps to prevent overweight/obesity in their children.