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Objectives: Prototypes (i.e., social images) predict health-related behaviours and intentions within the context of the Theory of Planned Behaviour (TPB). This study tested the moderating role of temporal stability of drinker prototype perceptions on prototype-intentions and prototype-behaviour relationships, within an augmented TPB. The study examined abstainer, moderate drinker, heavy drinker, tipsy, and drunk prototypes. Design and methonds: An online prospective study with 1-month follow-up was conducted among 410 young adults (18-25 years old, Mage = 21.0, SD = 2.14, 21.7% male). Assessed were prototype perceptions (favourability and similarity, T1, T2), stability of prototype perceptions, TPB variables (T1), intentions (T2), and drinking behaviour (T2). Intention analyses were corrected for baseline behaviour; drinking behaviour analyses were corrected for intentions and baseline behaviour. Results: Hierarchical regressions showed that prototype stability moderated the relationships of drunk and abstainer prototype similarity with intentions. Similarity to the abstainer prototype explained intentions to drink sensibly more strongly among individuals with stable perceptions than among those with unstable perceptions. Conversely, intentions were explained stronger among individuals with stable perceptions of dissimilarity to the drunk prototype than among those with unstable perceptions. No moderation effects were found for stability of favourability or for relationships with behaviour. Conclusions: Stable prototype similarity perceptions were more predictive of intentions than unstable perceptions. These perceptions were most relevant in enhancing the explanation of young adults' intended drinking behaviour. Specifically, young adults' health intentions seem to be guided by the dissociation from the drunk prototype and association with the abstainer prototype. Statement of contribution What is already known on this subject? Prototypes have augmented the Theory of Planned Behaviour in explaining risk behaviour. Temporal stability has been shown to successfully extend the TPB in explaining intentions. Temporal stability of TPB variables can moderate the relationships with behaviour and intentions. What does this study add? Stability of prototype perceptions moderates the prototype-intentions relationship. Stability of abstainer and drunk prototype similarity enhances the explanation of (intentional) drinking. Stable prototype perceptions are more explanatory than unstable perceptions.

Type 2 collagen disorders encompass a diverse group of skeletal dysplasias that are commonly associated with orthopedic, ocular, and hearing problems. However, the frequency of many clinical features has never been determined. We retrospectively investigated the clinical, radiological, and genotypic data in a group of 93 patients with molecularly confirmed SEDC or a related disorder. The majority of the patients (80/93) had short stature, with radiological features of SEDC (n=64), others having SEMD (n=5), Kniest dysplasia (n=7), spondyloperipheral dysplasia (n=2), or Torrance-like dysplasia (n=2). The remaining 13 patients had normal stature with mild SED, Stickler-like syndrome or multiple epiphyseal dysplasia. Over 50% of the patients had undergone orthopedic surgery, usually for scoliosis, femoral osteotomy or hip replacement. Odontoid hypoplasia was present in 56% (95% CI 38-74) and a correlation between odontoid hypoplasia and short stature was observed. Atlanto-axial instability, was observed in 5 of the 18 patients (28%, 95% CI 10-54) in whom flexion-extension films of the cervical spine were available; however, it was rarely accompanied by myelopathy. Myopia was found in 45% (95% CI 35-56), and retinal detachment had occurred in 12% (95% CI 6-21; median age 14 years; youngest age 3.5 years). Thirty-two patients complained of hearing loss (37%, 95% CI 27-48) of whom 17 required hearing aids. The ophthalmological features and possibly also hearing loss are often relatively frequent and severe in patients with splicing mutations. Based on clinical findings, age at onset and genotype-phenotype correlations in this cohort, we propose guidelines for the management and follow-up in this group of disorders. (c) 2015 Wiley Periodicals, Inc.

This study tests how repeated exposure to the same news frame influences political opinions over time. In a survey experiment (N = 296), we repeatedly exposed participants to the same news frame (at the start of the study, after one day, one week, and two weeks) and measured effects on opinions (at the start, after two weeks, and after six weeks). Participants in a control group were exposed only once and the effect was also traced over time. Results show that repetitive framing leads both to stronger and more persistent effects than single exposure. The persistence effects are most evident for individuals with moderate political knowledge. Our study contributes to a more comprehensive model of framing effects in mass communication experiments.

OBJECTIVES: The aim of study was to determine prevalence and identify demographic correlates of active and non-active gaming among adolescents.DESIGN: Cross-sectional.METHODS: A survey, assessing game behavior and correlates, was conducted among adolescents (12-16 years, n = 373), recruited via schools. Multivariable logistic regression analyses were conducted to examine demographic correlates of active gaming (≥ 1 h per week) and non-active gaming (>7h per week).RESULTS: Of all participants (n=373), 3% reported to play exclusively active games, 40% active games and non-active games, 40% exclusively non-active games, and 17% not playing video games at all. Active gaming adolescents played active games on average on 1.5 (sd = 1.2) days per school week for 36 (sd = 32.9)min and 1 (sd = 0.54) day per weekend for 42 (sd = 36.5)min. Non-active gaming adolescents played on average on 3.3 (sd = 1.6) days per school week for 65 (sd = 46.0)min and 1.4 (sd = 0.65) days per weekend for 80 (sd = 50.8)min. Adolescents attending lower levels of education were more likely to play active games ≥ 1 h per week than adolescents attending higher educational levels. Boys and older adolescents were more likely to play non-active games >7h per week, than girls or younger adolescents.CONCLUSIONS: Many adolescents play active games, especially those following a lower educational level, but time spent in this activity is relatively low compared to non-active gaming. To be feasible as a public health strategy, active gaming interventions should achieve more time is spent on active gaming at the expense of non-active gaming.

Prototypes (i.e., social images representing perceptions of typical persons engaging in or refraining from certain behaviour) have been shown to explain health-related behaviours. The present meta-analysis quantified the strength of the associations of prototype perceptions with health motivation and behaviour. Specifically, the analysis addressed (i) the relationship of prototype favourability (i.e., degree of likability) and similarity (i.e., perceived resemblance to the self) with behaviour, willingness and intentions; (ii) the effect of the interaction between favourability and similarity; and (iii) the extent to which health-risk and health-protective prototypes differed in their association with these outcomes. A total of 80 independent studies were identified based on 69 articles. The results indicated that prototype favourability and similarity were related to behaviour, intentions and willingness with small-to-medium effect sizes (r+ = 0.12-0.43). Direct measures of prototype perceptions generally produced larger effects than indirect measures. The interaction between favourability and similarity produced small-to-large effect sizes (r+ =.22-.54). The results suggest that both health-risk and health-protective prototypes might be useful targets for interventions (r+ =.22-.54). In order to increase health-protective behaviours, intentions and behaviour could be targeted by increasing similarity to health-protective prototypes. Health-risk behaviour might be decreased by targeting willingness by modifying health-risk prototype favourability and similarity. © 2014 © 2014 Taylor & Francis.

Objectives The evidence for an association between occupational asbestos exposure and pharyngeal cancer (PhC) is limited, while for oral cavity cancer (OCC) the literature is even sparser. We studied OCC and PhC risk both separately and combined (OCPC) in relation to occupational asbestos exposure, specifically addressing the influence of potential confounders, the existence of an exposure-response relation, and the presence of interaction between asbestos and smoking. Methods Using the prospective Netherlands Cohort Study (N=58 279 men, aged 55-69 years), we estimated asbestos exposure by linkage to a general population job-exposure matrix (DOMJEM) and a Finnish job-exposure matrix (FINJEM). After 17.3 years of follow-up, 58 OCC and 53 PhC cases were available for analysis. Results No association between asbestos and risk of OCC was observed for either JEM. Hazard ratios (HR) of PhC and OCPC increased after adjusting for confounders, particularly alcohol consumption and socioeconomic status. For PhC, a multivariable-adjusted increased HR was observed for "ever" versus "never" exposed to asbestos [HR 2.20, 95% confidence interval (95% CI) 1.08-4.49] when using FINJEM, but a trend of increased risks with higher cumulative exposure could not be demonstrated for either JEM. Results for OCPC showed patterns similar to those observed for PhC. None of the cancers showed a significant interaction between asbestos and smoking. Conclusions This prospective population-based study showed no convincing evidence of an association between asbestos and risk of OCC, PhC, and OCPC as an exposure-response relation was lacking, and results were not robust against the use of different JEM. However, the potentially increased HR of PhC and OCPC observed in this and previous studies warrant further research. Chemicals/CAS: asbestos, 1332-21-4. This work is licensed under a Creative Commons Attribution 4.0 International License.

Older people with intellectual disability (ID) are characterized by low physical activity (PA) levels. PA is important for reducing health risks and maintaining adequate fitness levels for performing activities of daily living. The aim of this study was to explore preferences of older adults with ID for specific physical activities, and to gain insight into facilitators and barriers to engaging into PA. Fourteen in-depth interviews and four focus groups were undertaken, with a total of 40 older adults with mild and moderate ID included in the analysis. NVivo software was used for analysing the transcribed verbatim interviews. In total, 30 codes for facilitators and barriers were identified. Themes concerning facilitators to PA were enjoyment, support from others, social contact and friendship, reward, familiarity, and routine of activities. Themes concerning barriers to PA were health and physiological factors, lack of self-confidence, lack of skills, lack of support, transportation problems, costs, and lack of appropriate PA options and materials. The results of the present study suggest that older adults with ID may benefit from specific PA programs, adapted to their individual needs and limitations. Results can be used for developing feasible health promotion programs for older adults with ID.

Recent research has revealed individual differences in the extent to which people base their intentions on affect and cognition. Two studies are presented that assess whether such differences predict the strength of individuals' intention-behaviour relationships. Participants completed measures of affect, cognition, intention, and behaviour regarding a range of health behaviours. Study 1 (N = 300) found that the strength of the intention-behaviour relationship was significantly related to the extent to which individuals based their intentions on affect, but not to the extent they based them on cognition. Study 2 (N = 387) replicated the findings of the first study. In addition, Study 2 revealed that intention stability mediated the relationship between the degree people based their intentions on affect and the strength of the intention-behaviour relationship. Thus, individuals who base their intentions strongly on affect have more stable intentions, and are therefore more likely to enact them. © 2013 The British Psychological Society.

BACKGROUND: Theoretically, individual work performance (IWP) can be divided into four dimensions: task performance, contextual performance, adaptive performance, and counterproductive work behavior. However, there is no consensus on the indicators used to measure these dimensions. OBJECTIVE: This study was designed to (1) identify indicators for each dimension, (2) select the most relevant indicators, and (3) determine the relative weight of each dimension in ratings of work performance.METHODS: IWP indicators were identified from multiple research disciplines, via literature, existing questionnaires, and expert interviews. Subsequently, experts selected the most relevant indicators per dimension and scored the relative weight of each dimension in ratings of IWP.RESULTS: In total, 128 unique indicators were identified. Twenty-three of these indicators were selected by experts as most relevant for measuring IWP. Task performance determined 36% of the work performance rating, while the other three dimensions respectively determined 22%, 20% and 21% of the rating.CONCLUSIONS: Notable consensus was found on relevant indicators of IWP, reducing the number from 128 to 23 relevant indicators. This provides an important step towards the development of a standardized, generic and short measurement instrument for assessing IWP.

This cross-sectional study empirically tested a theoretical model of pathways and inter-relationships among community, family, and individual determinants of childhood dental caries in a sample of 630, 6-year-old children from the Netherlands. Children's decayed, missing, and filled teeth (dmft) scores were extracted from dental records. A validated parental questionnaire was used to collect data on sociodemographic characteristics, psychosocial factors, and oral hygiene behaviours. Data on neighbourhood quality were obtained from the Dutch Central Bureau of Statistics. Structural equation modelling indicated that the model was valid after applying a few modifications. In the revised model, lower maternal education level was related to poorer family organization, lower levels of social support, lower dental self-efficacy, and an external dental health locus of control. These, in turn, were associated with poorer oral hygiene behaviours, which were linked to higher levels of childhood dental caries. In addition, lower maternal education level and poorer neighbourhood quality were directly associated with higher caries levels in children. This model advances our understanding of determinants of childhood dental caries and the pathways in which they operate. Conception of these pathways is essential for guiding the development of caries-preventive programmes for children. Clues for further development of the model are suggested. © 2014 Eur J Oral Sci.

Objective: Many health-promoting interventions combine multiple behavior change techniques (BCTs) to maximize effectiveness. Although, in theory, BCTs can amplify each other, the available meta-analyses have not been able to identify specific combinations of techniques that provide synergistic effects. This study overcomes some of the shortcomings in the current methodology by applying classification and regression trees (CART) to meta-analytic data in a special way, referred to as Meta-CART. The aim was to identify particular combinations of BCTs that explain intervention success. Method: A reanalysis of data from Michie, Abraham, Whittington, McAteer, and Gupta (2009) was performed. These data included effect sizes from 122 interventions targeted at physical activity and healthy eating, and the coding of the interventions into 26 BCTs. A CART analysis was performed using the BCTs as predictors and treatment success (i.e., effect size) as outcome. A subgroup meta-analysis using a mixed effects model was performed to compare the treatment effect in the subgroups found by CART. Results: Meta-CART identified the following most effective combinations: Provide information about behavior–health link with Prompt intention formation (mean effect size ḡ = 0.46), and Provide information about behavior–health link with Provide information on consequences and Use of follow-up prompts (ḡ = 0.44). Least effective interventions were those using Provide feedback on performance without using Provide instruction (ḡ = 0.05). Conclusions: Specific combinations of BCTs increase the likelihood of achieving change in health behavior, whereas other combinations decrease this likelihood. Meta-CART successfully identified these combinations and thus provides a viable methodology in the context of meta-analysis. (PsycINFO Database Record (c) 2014 APA, all rights reserved)

Purpose: To investigate the association between exposure to occupational extremely low-frequency magnetic fields (ELF-MF) and the risk of a priori selected cancer outcomes within the prospective Netherlands Cohort Study. Methods: 120,852 men and women aged 55-69 years at time of enrollment in 1986 were followed up (17.3 years) for incident lung, breast and brain cancer, and hemato-lymphoproliferative malignancies. Information on occupational history and potential confounders such as sex, age, smoking, alcohol use, and attained educational level were collected at baseline through a self-administered questionnaire. Occupational ELF-MF exposure was assigned with a job-exposure matrix. Using a case-cohort approach, associations with cancer incidence were analyzed with Cox regression stratified by sex, using three exposure metrics: (1) ever had a job with low or high exposure to ELF-MF versus background, (2) duration of exposure, and (3) cumulative exposure. Results: None of the exposure metrics showed an effect on incidence for lung, breast, and brain cancer, nor any of the assessed subtypes in men and women. Of the hemato-lymphoproliferative malignancies in men, ever high exposed to ELF-MF showed a significant association with acute myeloid leukemia (AML) [hazard ratio (HR) 2.15; 95 % confidence interval (CI) 1.06-4.35] and follicular lymphoma (FL) (HR 2.78; 95 % CI 1.00-5.77). Cumulative exposure to ELF-MF showed a significant, positive association with FL but not AML among men. Conclusions: In this large prospective cohort study, we found some indications of an increased risk of AML and FL among men with occupational ELF-MF exposure. These findings warrant further investigation. © 2013 Springer Science+Business Media Dordrecht.

ObjectivesFrom 1 January 2006, the distinction between the health insurance fund and private insurance was abolished and a basic insurance package was agreed for everyone in the Netherlands. Dental treatment for young people below the age of 18 is reimbursed under the terms of this basic package. Dental treatment for adults is not covered in this basic insurance package. Basic principles for nonreimbursing dental care for adults were that any health and financial risks for individual citizens in the future should be acceptable for them with the corollary that the oral health of young adults when they make the switch - from collectively financed care to care to be paid for individually - should be at such a level that the needed oral health care is affordable. To meet this requirement, it is important to have knowledge of the prevalence of oral diseases and trends in oral health in young people from a public health perspective. The aim of this article is to describe trends in caries experience in young people in the Netherlands from 1990 to 2009, taking into account the challenge in methodology concerning this changing social context.MethodsTo describe caries experience in young people, a repeated cross-sectional study design was used. The study consisted of a clinical oral examination and a questionnaire survey. Data were sampled from 8, 14 and 20-year-olds in 1990 and 1996, and 9, 15 and 21-year-olds in 2003 and 2009, living in Alphen a/d Rijn, Gouda, Breda and 's-Hertogenbosch. The DMF index was used for describing caries experience. The trends were studied separately in high and low socioeconomic status (SES) groups. SES was operationalized as the dichotomous variable of educational level of the mother or the adolescent. Multiple imputation was applied to predict the DMFS for missing ages for certain years, which made it possible to test the trends. Linear and logistic regression analyses were used to study the trends through the years.ResultsThis study showed, according to different age- and SES groups, either declines or no statistically significant changes in caries experience over the last two decades.ConclusionsNo deterioration was shown. However, there is still room for further improvement in oral health in children. Dental professionals and politicians should develop a vision on to what extent caries experience is acceptable in a public health perspective in young people.

When two alternative treatments (A and B) are available, some subgroup of patients may display a better outcome with treatment A than with B, whereas for another subgroup, the reverse may be true. If this is the case, a qualitative (i.e., disordinal) treatment–subgroup interaction is present. Such interactions imply that some subgroups of patients should be treated differently and are therefore most relevant for personalized medicine. In case of data from randomized clinical trials with many patient characteristics that could interact with treatment in a complex way, a suitable statistical approach to detect qualitative treatment–subgroup interactions is not yet available. As a way out, in the present paper, we propose a new method for this purpose, called QUalitative INteraction Trees (QUINT). QUINT results in a binary tree that subdivides the patients into terminal nodes on the basis of patient characteristics; these nodes are further assigned to one of three classes: a first for which A is better than B, a second for which B is better than A, and an optional third for which type of treatment makes no difference. Results of QUINT on simulated data showed satisfactory performance, with regard to optimization and recovery. Results of an application to real data suggested that, compared with other approaches, QUINT provided a more pronounced picture of the qualitative interactions that are present in the data. Copyright © 2013 John Wiley & Sons, Ltd.

Prototypes (i.e., social images representing perceptions of typical persons engaging in or refraining from certain behaviour) have been shown to explain health-related behaviours. The present meta-analysis quantified the strength of the associations of prototype perceptions with health motivation and behaviour. Specifically, the analysis addressed (i) the relationship of prototype favourability (i.e., degree of likability) and similarity (i.e., perceived resemblance to the self) with behaviour, willingness and intentions; (ii) the effect of the interaction between favourability and similarity; and (iii) the extent to which health-risk and health-protective prototypes differed in their association with these outcomes. A total of 80 independent studies were identified based on 69 articles. The results indicated that prototype favourability and similarity were related to behaviour, intentions and willingness with small-to-medium effect sizes (r+ = 0.12-0.43). Direct measures of prototype perceptions generally produced larger effects than indirect measures. The interaction between favourability and similarity produced small-to-large effect sizes (r+ =.22-.54). The results suggest that both health-risk and health-protective prototypes might be useful targets for interventions (r+ =.22-.54). In order to increase health-protective behaviours, intentions and behaviour could be targeted by increasing similarity to health-protective prototypes. Health-risk behaviour might be decreased by targeting willingness by modifying health-risk prototype favourability and similarity. © 2014 © 2014 Taylor & Francis.

Veel kennis over en ervaringen met IGB en KT was tot op heden gefragmenteerd, verspreid over diverse onderzoeksgroepen in Nederland. In het door het RIVM gecoordineerde consortium i4i komt deze kennis en ervaringen bij elkaar. Negen onderzoeksgroepen werken samen aan zowel conceptuele verheldering als praktische onderzoeksinstrumenten voor IGB en KT-BOP. De samenwerkingspartners zijn: RIVM, Erasmus Universiteit Rotterdam, AMC, Vrije Universiteit Amsterdam, TNO, Wageningen Universiteit – GGD Noord- en Oost Gelderland, Universiteit van Tilburg, Erasmus MC en Universiteit Maastricht-GGD Zuid Limburg. Het consortium i4i heeft een doorlooptijd van september 2012 tot september 2014. Het eerste jaar is gewerkt aan de uitwerking van theoretische noties en bijbehorende kwalitatieve en kwantitatieve instrumenten.

Rapport Rapportage Sport 2014 van het Sociaal en Cultureel Planbureau (SCP), zitkampioen Nederlanders zijn hoog opgeleid. En daarbij horen zittende beroepen. Niemand in Europa zit zoveel als de Nederlanders. Dat verhoogt hun risico op sterfte en kwalen.

Context : Injuries are a major adverse event in a soccer player's career. Reducing injury incidence requires a thorough knowledge of the epidemiology of soccer injuries. Objective : To investigate the incidence and characteristics of injuries in the Dutch premier soccer league. Design : Cohort study. Setting : The Dutch premier soccer league. Patients or Other Participants : During the 2009-2010 soccer season, a total of 217 professional soccer players from 8 teams were prospectively followed. Main Outcome Measure(s) : The medical staff recorded time-loss injuries, including information on injuries (ie, type, body part, duration) and exposure data for training sessions and matches. Results : A6 total of 286 injuries were recorded, affecting 62.7% of the players. The overall injury incidence was 6.2 injuries per 1000 player-hours, 2.8 in training sessions and 32.8 in matches. Most of the recorded injuries were acute (68.5%). Eight percent of the injuries were classified as recurrent. Injuries were most likely to be located in the lower extremities (82.9%). Injury time loss ranged from 1 to 752 days, with a median of 8 days. Knee injuries had the greatest consequences in terms of days of absence from soccer play (on average, 45 days). The most common diagnosis was muscle/tendon injury of the lower extremities (32.9%). Conclusions : Injury risk in the Dutch premier soccer league is high, especially during matches. Preventive measures should focus on the most common diagnoses, namely, muscle/tendon injuries of the lower extremities.

Achtergrond. Beleidmakers, professionals en onderzoekers spreken steeds vaker over vitaliteit als een aan gezondheid gerelateerd begrip. Er bestaan verschillende omschrijvingen van vitaliteit en een geschikt instrument om vitaliteit te meten ontbreekt. Om het beeld over vitaliteit aan te scherpen is gewerkt aan een eenduidige omschrijving en een bijbehorend meetinstrument (de Vita-16) ontwikkeld. Methode. Vitaliteit is omschreven op basis van (wetenschappelijke) literatuur en de kennis en ervaring van experts. De ontwikkeling van een meetinstrument (de Vita-16) bestond uit vier stappen: na het samenstellen van een ‘pool’ items op basis van literatuur (stap 1) zijn de items gereduceerd na een Delphi studie onder beleidmakers, professionals en onderzoekers (stap 2) en samengevoegd tot één vragenlijst. Deze is in een pilotstudie (stap 3) getest op kenmerken zoals begrijpelijkheid en plafondeffect. De conceptvragenlijst is afgenomen bij 1300 volwassen Nederlanders voor reductie van items, en testen van de structurele en construct validiteit (stap 4: validatiestudie). Resultaten. In het begrip ‘vitaliteit’ zijn drie kerndimensies te onderscheiden: ‘Energie’, ‘Motivatie’ en ‘Veerkracht’. Energie wordt gekenmerkt door zich energiek voelen, motivatie door doelen stellen in het leven en moeite doen om deze te behalen, en veerkracht door het vermogen om met de dagelijkse problemen en uitdagingen van het leven om te gaan. Het resultaat van stap 1 was een pool van 151 items, waaruit overlappende items (n=38) en items die determinanten van vitaliteit meten (n=59) werden verwijderd. De resterende 54-itemslijst werd in de Delphi ronde gereduceerd tot 33 items. In de validatiestudie bleef een 16-item vragenmodule (de Vita-16) over die de drie kerndimensies van vitaliteit meet en die betrouwbaar (α:0,89-0,95) bleek en (afhankelijk van het criterium) een redelijk tot goede validiteit vertoonde. Conclusie. Het begrip vitaliteit is te omschrijven met drie kerndimensies die valide meetbaar zijn in de volwassen bevolking met een 16-item vragenmodule (de Vita-16).

BACKGROUND: The European Youth Olympic Festival (EYOF) is a biennial sporting event of nine Olympic Summer Sports for talented athletes, aged 13-18 years, from all over Europe. OBJECTIVE: To analyse the injuries and illnesses that occurred during the multisport event (14-19 July 2013), with the long-term aim of enabling international sports federations, the National Olympic Committees, and the European Olympic Committee to improve protection of athletes' health in youth. METHODS: Daily occurrence or non-occurrence of injuries and illnesses was recorded by using the IOC injury and illness surveillance system for multisport events. All National Olympic Committee physicians and healthcare providers and physicians of the Local Organizing Committee were invited to participate. RESULTS: In total, 2272 athletes from 49 countries took part in the EYOF 2013. During the five competition days of EYOF, 207 injuries and 46 illnesses were reported, resulting in an incidence of 91.1 injuries and 20.2 illnesses per 1000 athletes. Almost 10% of the athletes sustained at least one injury or illness. CONCLUSIONS: This study is the first multisport surveillance study on injuries and illnesses during the EYOF or any other summer Games organised for youth elite athletes. The data form the basis for further research on risk factors and injury mechanisms for this cohort. This research is needed to gain more knowledge and finally to implement effective injury and illness prevention measures.

Context: Injuries are a major adverse event in a soccer player's career. Reducing injury incidence requires a thorough knowledge of the epidemiology of soccer injuries. Objective: To investigate the incidence and characteristics of injuries in the Dutch premier soccer league. Design: Cohort study. Setting: The Dutch premier soccer league. Patients or Other Participants: During the 2009–2010 soccer season, a total of 217 professional soccer players from 8 teams were prospectively followed. Main Outcome Measure(s): The medical staff recorded time-loss injuries, including information on injuries (ie, type, body part, duration) and exposure data for training sessions and matches. Results: A total of 286 injuries were recorded, affecting 62.7% of the players. The overall injury incidence was 6.2 injuries per 1000 player-hours, 2.8 in training sessions and 32.8 in matches. Most of the recorded injuries were acute (68.5%). Eight percent of the injuries were classified as recurrent. Injuries were most likely to be located in the lower extremities (82.9%). Injury time loss ranged from 1 to 752 days, with a median of 8 days. Knee injuries had the greatest consequences in terms of days of absence from soccer play (on average, 45 days). The most common diagnosis was muscle/tendon injury of the lower extremities (32.9%). Conclusions: Injury risk in the Dutch premier soccer league is high, especially during matches. Preventive measures should focus on the most common diagnoses, namely, muscle/tendon injuries of the lower extremities.

Background The European Youth Olympic Festival (EYOF) is a biennial sporting event of nine Olympic Summer Sports for talented athletes, aged 13–18 years, from all over Europe. Objective To analyse the injuries and illnesses that occurred during the multisport event (14–19 July 2013), with the long-term aim of enabling international sports federations, the National Olympic Committees, and the European Olympic Committee to improve protection of athletes’ health in youth. Methods Daily occurrence or non-occurrence of injuries and illnesses was recorded by using the IOC injury and illness surveillance system for multisport events. All National Olympic Committee physicians and healthcare providers and physicians of the Local Organizing Committee were invited to participate. Results In total, 2272 athletes from 49 countries took part in the EYOF 2013. During the five competition days of EYOF, 207 injuries and 46 illnesses were reported, resulting in an incidence of 91.1 injuries and 20.2 illnesses per 1000 athletes. Almost 10% of the athletes sustained at least one injury or illness. Conclusions This study is the first multisport surveillance study on injuries and illnesses during the EYOF or any other summer Games organised for youth elite athletes. The data form the basis for further research on risk factors and injury mechanisms for this cohort. This research is needed to gain more knowledge and finally to implement effective injury and illness prevention measures.

Type 2 collagen disorders encompass a diverse group of skeletal dysplasias that are commonly associated with orthopedic, ocular, and hearing problems. However, the frequency of many clinical features has never been determined. We retrospectively investigated the clinical, radiological, and genotypic data in a group of 93 patients with molecularly confirmed SEDC or a related disorder. The majority of the patients (80/93) had short stature, with radiological features of SEDC (n = 64), others having SEMD (n = 5), Kniest dysplasia (n = 7), spondyloperipheral dysplasia (n = 2), or Torrance-like dysplasia (n = 2). The remaining 13 patients had normal stature with mild SED, Stickler-like syndrome or multiple epiphyseal dysplasia. Over 50% of the patients had undergone orthopedic surgery, usually for scoliosis, femoral osteotomy or hip replacement. Odontoid hypoplasia was present in 56% (95% CI 38-74) and a correlation between odontoid hypoplasia and short stature was observed. Atlanto-axial instability, was observed in 5 of the 18 patients (28%, 95% CI 10-54) in whom flexion-extension films of the cervical spine were available; however, it was rarely accompanied by myelopathy. Myopia was found in 45% (95% CI 35-56), and retinal detachment had occurred in 12% (95% CI 6-21; median age 14 years; youngest age 3.5 years). Thirty-two patients complained of hearing loss (37%, 95% CI 27-48) of whom 17 required hearing aids. The ophthalmological features and possibly also hearing loss are often relatively frequent and severe in patients with splicing mutations. Based on clinical findings, age at onset and genotype-phenotype correlations in this cohort, we propose guidelines for the management and follow-up in this group of disorders.

Rapport Rapportage Sport 2014 van het Sociaal en Cultureel Planbureau (SCP), zitkampioen Nederlanders zijn hoog opgeleid. En daarbij horen zittende beroepen. Niemand in Europa zit zoveel als de Nederlanders. Dat verhoogt hun risico op sterfte en kwalen.

BACKGROUND:To study the associations between during and after work hours physical activity and relaxation and need for recovery (NFR) in office workers at a financial service provider. METHODS:Self-reported baseline data of 412 employees (mean age 41.3 years; 39.6% women) were used. Linear regression analyses were performed to test associations of physical activity, relaxation, detachment and breaks at work with NFR. RESULTS: A lower NFR was significantly positively associated with standing, stair climbing, active lunchbreak, relaxation, detachment at work, physical detachment at work, relaxation and detachment at home. In the multiple model, a lower NFR was independently positively associated with frequency of stair climbing, minutes spent in leisure activities, detachment at work, physical detachment at work, relaxation and detachment at home (p

Achtergrond. Beleidmakers, professionals en onderzoekers spreken steeds vaker over vitaliteit als een aan gezondheid gerelateerd begrip. Er bestaan verschillende omschrijvingen van vitaliteit en een geschikt instrument om vitaliteit te meten ontbreekt. Om het beeld over vitaliteit aan te scherpen is gewerkt aan een eenduidige omschrijving en een bijbehorend meetinstrument (de Vita-16) ontwikkeld. Methode. Vitaliteit is omschreven op basis van (wetenschappelijke) literatuur en de kennis en ervaring van experts. De ontwikkeling van een meetinstrument (de Vita-16) bestond uit vier stappen: na het samenstellen van een ‘pool’ items op basis van literatuur (stap 1) zijn de items gereduceerd na een Delphi studie onder beleidmakers, professionals en onderzoekers (stap 2) en samengevoegd tot één vragenlijst. Deze is in een pilotstudie (stap 3) getest op kenmerken zoals begrijpelijkheid en plafondeffect. De conceptvragenlijst is afgenomen bij 1300 volwassen Nederlanders voor reductie van items, en testen van de structurele en construct validiteit (stap 4: validatiestudie). Resultaten. In het begrip ‘vitaliteit’ zijn drie kerndimensies te onderscheiden: ‘Energie’, ‘Motivatie’ en ‘Veerkracht’. Energie wordt gekenmerkt door zich energiek voelen, motivatie door doelen stellen in het leven en moeite doen om deze te behalen, en veerkracht door het vermogen om met de dagelijkse problemen en uitdagingen van het leven om te gaan. Het resultaat van stap 1 was een pool van 151 items, waaruit overlappende items (n=38) en items die determinanten van vitaliteit meten (n=59) werden verwijderd. De resterende 54-itemslijst werd in de Delphi ronde gereduceerd tot 33 items. In de validatiestudie bleef een 16-item vragenmodule (de Vita-16) over die de drie kerndimensies van vitaliteit meet en die betrouwbaar (α:0,89-0,95) bleek en (afhankelijk van het criterium) een redelijk tot goede validiteit vertoonde. Conclusie. Het begrip vitaliteit is te omschrijven met drie kerndimensies die valide meetbaar zijn in de volwassen bevolking met een 16-item vragenmodule (de Vita-16).

Background The European Youth Olympic Festival (EYOF) is a biennial sporting event of nine Olympic Summer Sports for talented athletes, aged 13–18 years, from all over Europe. Objective To analyse the injuries and illnesses that occurred during the multisport event (14–19 July 2013), with the long-term aim of enabling international sports federations, the National Olympic Committees, and the European Olympic Committee to improve protection of athletes’ health in youth. Methods Daily occurrence or non-occurrence of injuries and illnesses was recorded by using the IOC injury and illness surveillance system for multisport events. All National Olympic Committee physicians and healthcare providers and physicians of the Local Organizing Committee were invited to participate. Results In total, 2272 athletes from 49 countries took part in the EYOF 2013. During the five competition days of EYOF, 207 injuries and 46 illnesses were reported, resulting in an incidence of 91.1 injuries and 20.2 illnesses per 1000 athletes. Almost 10% of the athletes sustained at least one injury or illness. Conclusions This study is the first multisport surveillance study on injuries and illnesses during the EYOF or any other summer Games organised for youth elite athletes. The data form the basis for further research on risk factors and injury mechanisms for this cohort. This research is needed to gain more knowledge and finally to implement effective injury and illness prevention measures.

BACKGROUND:To study the associations between during and after work hours physical activity and relaxation and need for recovery (NFR) in office workers at a financial service provider. METHODS:Self-reported baseline data of 412 employees (mean age 41.3 years; 39.6% women) were used. Linear regression analyses were performed to test associations of physical activity, relaxation, detachment and breaks at work with NFR. RESULTS: A lower NFR was significantly positively associated with standing, stair climbing, active lunchbreak, relaxation, detachment at work, physical detachment at work, relaxation and detachment at home. In the multiple model, a lower NFR was independently positively associated with frequency of stair climbing, minutes spent in leisure activities, detachment at work, physical detachment at work, relaxation and detachment at home (p

In the analysis of randomized controlled trials (RCTs), treatment effect heterogeneity often occurs, implying differences across (subgroups of) clients in treatment efficacy. This phenomenon is typically referred to as treatment-subgroup interactions. The identification of subgroups of clients, defined in terms of pretreatment characteristics that are involved in a treatment-subgroup interaction, is a methodologically challenging task, especially when many characteristics are available that may interact with treatment and when no comprehensive a priori hypotheses on relevant subgroups are available. A special type of treatment-subgroup interaction occurs if the ranking of treatment alternatives in terms of efficacy differs across subgroups of clients (e.g., for one subgroup treatment A is better than B and for another subgroup treatment B is better than A). These are called qualitative treatment-subgroup interactions and are most important for optimal treatment assignment. The method QUINT (Qualitative INteraction Trees) was recently proposed to induce subgroups involved in such interactions from RCT data. The result of an analysis with QUINT is a binary tree from which treatment assignment criteria can be derived. The implementation of this method, the R package quint, is the topic of this paper. The analysis process is described step-by-step using data from the Breast Cancer Recovery Project, showing the reader all functions included in the package. The output is explained and given a substantive interpretation. Furthermore, an overview is given of the tuning parameters involved in the analysis, along with possible motivational concerns associated with choice alternatives that are available to the user.

This study tests how repeated exposure to the same news frame influences political opinions over time. In a survey experiment (N = 296), we repeatedly exposed participants to the same news frame (at the start of the study, after one day, one week, and two weeks) and measured effects on opinions (at the start, after two weeks, and after six weeks). Participants in a control group were exposed only once and the effect was also traced over time. Results show that repetitive framing leads both to stronger and more persistent effects than single exposure. The persistence effects are most evident for individuals with moderate political knowledge. Our study contributes to a more comprehensive model of framing effects in mass communication experiments.

Pancreatic cancer has few early symptoms, is usually diagnosed at late stages, and has a high case-fatality rate. Identifying modifiable risk factors is crucial to reducing pancreatic cancer morbidity and mortality. Prior studies have suggested that specific foods and nutrients, such as dairy products and constituents, may play a role in pancreatic carcinogenesis. In this pooled analysis of the primary data from 14 prospective cohort studies, 2212 incident pancreatic cancer cases were identified during follow-up among 862 680 individuals. Adjusting for smoking habits, personal history of diabetes, alcohol intake, body mass index (BMI), and energy intake, multivariable study-specific hazard ratios (MVHR) and 95% confidence intervals (CIs) were calculated using the Cox proportional hazards models and then pooled using a random effects model. There was no association between total milk intake and pancreatic cancer risk (MVHR = 0.98, 95% CI = 0.82-1.18 comparing ≥500 with 1-69.9 g/day). Similarly, intakes of low-fat milk, whole milk, cheese, cottage cheese, yogurt, and icecream were not associated with pancreatic cancer risk. No statistically significant association was observed between dietary (MVHR = 0.96, 95% CI = 0.77-1.19) and total calcium (MVHR = 0.89, 95% CI = 0.71-1.12) intake and pancreatic cancer risk overall when comparing intakes ≥1300 with

Estimation in binary longitudinal data by using generalized estimating equation (GEE) becomes complicated in the presence of missing data because standard GEEs are only valid under the restrictive missing completely at random assumption. Weighted GEE has therefore been proposed to allow the validity of GEE's under the weaker missing at random assumption. Multiple imputation offers an attractive alternative, by which the incomplete data are pre-processed, and afterwards the standard GEE can be applied to the imputed data. Nevertheless, the imputation methodology requires correct specification of the imputation model. Dual imputation method provides a new way to increase the robustness of imputations with respect to model misspecification. The method involves integrating the so-called doubly robust ideas into the imputation model. Focusing on incomplete binary longitudinal data, we combine DIM and GEE (DIM-GEE) and study the relative performance of the new method in a case study of obesity among children, as well as a simulation study.

Summary: Oral health-related quality of life (OHRQoL) is associated with tooth wear and tooth loss. This study investigated the association between OHRQoL and dental status (in terms of natural dentition, partial or complete dentures, or edentulism). Sixteen hundred and twenty-two persons who participated in a large-scale Dutch dental survey were interviewed. Dentate persons (n = 1407) were additionally invited for a clinical examination (response rate: 69%). Dental status was based upon the combined data from this clinical examination and the questionnaire (seven dental status groups were defined). OHRQoL was measured by the Dutch translation of the short version of the Oral Health Impact Profile, the OHIP-NL14. Kruskal-Wallis tests and Mann-Whitney U tests were used to investigate differences in OHRQoL between the dental status groups. For all OHIP-NL14 scales, differences in OHRQoL were found between the dental status groups (all P-values

Background: This article describes the systematic development of the I Move intervention: a web-based computer tailored physical activity promotion intervention, aimed at increasing and maintaining physical activity among adults. This intervention is based on the theoretical insights and practical applications of self-determination theory and motivational interviewing. Methods/design. Since developing interventions in a systemically planned way increases the likelihood of effectiveness, we used the Intervention Mapping protocol to develop the I Move intervention. In this article, we first describe how we proceeded through each of the six steps of the Intervention Mapping protocol. After that, we describe the content of the I Move intervention and elaborate on the planned randomized controlled trial. Discussion. By integrating self-determination theory and motivational interviewing in web-based computer tailoring, the I Move intervention introduces a more participant-centered approach than traditional tailored interventions. Adopting this approach might enhance computer tailored physical activity interventions both in terms of intervention effectiveness and user appreciation. We will evaluate this in an randomized controlled trial, by comparing the I Move intervention to a more traditional web-based computer tailored intervention. Trial registration. NTR4129. © 2014 Friederichs et al.; licensee BioMed Central Ltd.

OBJECTIVE:: To examine the construct validity of the Individual Work Performance Questionnaire (IWPQ). METHODS:: A total of 1424 Dutch workers from three occupational sectors (blue, pink, and white collar) participated in the study. First, IWPQ scores were correlated with related constructs (convergent validity). Second, differences between known groups were tested (discriminative validity). RESULTS:: First, IWPQ scores correlated weakly to moderately with absolute and relative presenteeism, and work engagement. Second, significant differences in IWPQ scores were observed for workers differing in job satisfaction, and workers differing in health. CONCLUSION:: Overall, the results indicate acceptable construct validity of the IWPQ. Researchers are provided with a reliable and valid instrument to measure individual work performance comprehensively and generically, among workers from different occupational sectors, with and without health problems. © 2014 Lippincott Williams and Wilkins.

Multiple imputation methods properly account for the uncertainty of missing data. One of those methods for creating multiple imputations is predictive mean matching (PMM), a general purpose method. Little is known about the performance of PMM in imputing non-normal semicontinuous data (skewed data with a point mass at a certain value and otherwise continuously distributed). We investigate the performance of PMM as well as dedicated methods for imputing semicontinuous data by performing simulation studies under univariate and multivariate missingness mechanisms. We also investigate the performance on real-life datasets. We conclude that PMM performance is at least as good as the investigated dedicated methods for imputing semicontinuous data and, in contrast to other methods, is the only method that yields plausible imputations and preserves the original data distributions. © 2014 The Authors.

Objective: The aim of this paper is to provide a guideline to a universal understanding of the analysis of co-occurrence of risk behaviors. The use of cluster analysis and factor analysis was clarified. Method: A theoretical introduction to cluster analysis and factor analysis and examples from literature were provided. A representative sample (N=4395) of the Dutch population, aged 16-40 and participating from fall 2005 to spring 2006, was used to illustrate the use of both techniques in assessing the co-occurrence of risk behaviors. Results: Whereas cluster analysis techniques serve to focus on particular clusters of individuals showing the same behavioral pattern, factor analysis techniques are used to assess possible groups of interrelated health-risk behaviors that can be explained by an unknown common source. Choice between the techniques partly depends on the research question and the aim of the research, and has different implications for inferences and policy. Conclusion: By integrating theory and results from an illustrative example, a guideline has been provided that contributes towards a systematic approach in the assessment of co-occurrence of risk behaviors. Following this guideline, a better comparison between outcomes from various studies is expected, leading to improved effectiveness of multiple behavior change interventions.Copyright © 2014 Elsevier Inc. All rights reserved.

Recently, the Individual Work Performance Questionnaire (IWPQ) version 0.2 was developed using Rasch analysis. The goal of the current study was to improve targeting of the IWPQ scales by including additional items. The IWPQ 0.2 (original) and 0.3 (including additional items) were examined using Rasch analysis. Additional items that showed misfit or did not improve targeting were removed from the IWPQ 0.3, resulting in a final IWPQ 1.0. Subsequently, the scales showed good model fit and reliability, and were examined for key measurement requirements (e.g., category ordening, unidimensionality, and differential item functioning). Finally, calculation and interpretability of scores were addressed. Compared to its previous version, the final IWPQ 1.0 showed improved targeting for two out of three scales. As a result, it can more reliably measure workers at all levels of ability, discriminate between workers at a wider range on each scale, and detect changes in individual work performance.

De bloed-letsel-injectiefobie is een specifieke fobie, met als onderscheidend kenmerk dat patiënten die eraan lijden een neiging hebben tot flauwvallen of daadwerkelijk flauwvallen als ze worden blootgesteld aan bloed, verwondingen, naalden en invasieve medische ingrepen.1 De bloed-letsel-injectiefobie wordt vaak verward met de naaldfobie of extreme naaldangst. De behandeling van de bloed-letsel-injectiefobie richt zich op het aanspannen van de lichaamsspieren om flauwvallen te voorkomen, terwijl de behandeling van de naaldfobie zich juist richt op het ontspannen van het lichaam, om de gevoelens van angst te reduceren.

There are few epidemiological data on the dietary risk factors of Barrett's oesophagus, a precursor of oesophageal adenocarcinoma. The present study investigated the association between vegetable, fruit and nitrate intake and Barrett's oesophagus risk in a large prospective cohort. The Netherlands Cohort Study recruited 120852 individuals aged 55-69 years in 1986. Vegetable and fruit intake was assessed using a 150-item FFQ, and nitrate intake from dietary sources and drinking water was determined. After 16 center dot 3 years of follow-up, 433 cases (241 men and 192 women) of Barrett's oesophagus with specialised intestinal metaplasia and 3717 subcohort members were analysed in a case-cohort design using Cox proportional hazards models while adjusting for potential confounders. Men exhibited a lower risk of Barrett's oesophagus in the highest v. the lowest quintile of total (multivariable-adjusted hazard ratio (HR): 0 center dot 66, 95% CI 0 center dot 43, 1 center dot 01), raw (HR 0 center dot 63, 95% CI 0 center dot 40, 0 center dot 99), raw leafy (HR 0 center dot 55, 95% CI 0 center dot 36, 0 center dot 86) and Brassica (HR 0 center dot 64, 95% CI 0 center dot 41, 1 center dot 00) vegetable intake. No association was found for other vegetable groups and fruits. No significant associations were found between vegetable and fruit intake and Barrett's oesophagus risk among women. Total nitrate intake was inversely associated with Barrett's disease risk in men (HR 0 center dot 50, 95% CI 0 center dot 25, 0 center dot 99) and positively associated with it in women (HR 3 center dot 77, 95% CI 1 center dot 68, 8 center dot 45) (P for interaction=0 center dot 04). These results suggest that vegetable intake may contribute to the prevention of Barrett's oesophagus. The possible differential effect in men and women should be evaluated further.

OBJECTIVE: To investigate the effectiveness of a worksite social and physical environment intervention on need for recovery (i.e., early symptoms of work-related mental and physical fatigue), physical activity and relaxation. Also, the effectiveness of the separate interventions was investigated. METHODS: In this 2×2 factorial design study, 412 office employees from a financial service provider participated. Participants were allocated to the combined social and physical intervention, to the social intervention only, to the physical intervention only or to the control group. The primary outcome measure was need for recovery. Secondary outcomes were work-related stress (i.e., exhaustion, detachment and relaxation), small breaks, physical activity (i.e., stair climbing, active commuting, sport activities, light/moderate/vigorous physical activity) and sedentary behavior. Outcomes were measured by questionnaires at baseline, 6 and 12 months follow-up. Multilevel analyses were performed to investigate the effects of the three interventions. RESULTS: In all intervention groups, a non-significant reduction was found in need for recovery. In the combined intervention (n = 92), exhaustion and vigorous physical activities decreased significantly, and small breaks at work and active commuting increased significantly compared to the control group. The social intervention (n = 118) showed a significant reduction in exhaustion, sedentary behavior at work and a significant increase in small breaks at work and leisure activities. In the physical intervention (n = 96), stair climbing at work and active commuting significantly increased, and sedentary behavior at work decreased significantly compared to the control group. CONCLUSION: None of the interventions was effective in improving the need for recovery. It is recommended to implement the social and physical intervention among a population with higher baseline values of need for recovery. Furthermore, the intervention itself could be improved by increasing the intensity of the intervention (for example weekly GMI-sessions), providing physical activity opportunities and exercise schemes, and by more drastic environment interventions (restructuring entire department floor).

Missing values are a practical issue in the analysis of longitudinal data. Multiple imputation (MI) is a well-known likelihood-based method that has optimal properties in terms of efficiency and consistency if the imputation model is correctly specified. Doubly robust (DR) weighing-based methods protect against misspecification bias if one of the models, but not necessarily both, for the data or the mechanism leading to missing data is correct. We propose a new imputation method that captures the simplicity of MI and protection from the DR method. This method integrates MI and DR to protect against misspecification of the imputation model under a missing at random assumption. Our method avoids analytical complications of missing data particularly in multivariate settings, and is easy to implement in standard statistical packages. Moreover, the proposed method works very well with an intermittent pattern of missingness when other DR methods can not be used. Simulation experiments show that the proposed approach achieves improved performance when one of the models is correct. The method is applied to data from the fireworks disaster study, a randomized clinical trial comparing therapies in disaster-exposed children. We conclude that the new method increases the robustness of imputations. © 2013 The British Psychological Society.