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Background: Although principles of the health promoting school (HPS) approach are followed worldwide, differences between countries in the implementation are reported. The aim of the current study was (1) to examine the implementation of the HPS approach in European countries in terms of different implementation indicators, that is, percentage of schools implementing the HPS approach, implementation of core components, and positioning on so-called HPS-related spectra, (2) to explore patterns of consistency between the implementation indicators across countries, and (3) to examine perceived barriers and facilitators to the implementation of the HPS approach across countries. Methods: This study analyzed data from a survey that was part of the Schools for Health in Europe network's Monitoring Task 2020. The survey was completed by HPS representatives of 24 network member countries. Results: Large variations exist in (the influencing factors for) the implementation of the HPS approach in European countries. Observed patterns show that countries with higher percentages of schools implementing the HPS approach also score higher on the implementation of the core components and, in terms of spectra, more toward implementing multiple HPS core components, add-in strategies, action-oriented research and national-level driven dissemination. In each country a unique mix of barriers and facilitators was observed. Conclusion: Countries committed to implementing the HPS approach in as many schools as possible also seem to pay attention to the quality of implementation. For a complete and accurate measurement of implementation, the use of multiple implementation indicators is desirable.

Purpose: Adapting the Health Promotion School (HPS) approach to context specifics is acknowledged as being essential for implementation and achieving optimal effectiveness. This study aims to explore implementation variations on seven HPS spectra (such as top-down to bottom-up involvement of stakeholders) on which implementation of the HPS approach can vary, and the factors that relate to navigation on these spectra. Design/methodology/approach: In 2020, fourteen HPS researchers and professionals from ten European countries participated in semi-structured interviews. Findings: Navigation variations on the HPS spectra occurred throughout most spectra. Further, a tendency was found towards spectrum extremes of addressing multiple core-components, implementing non-disruptive Health Promotion (HP) programmes, and evaluating the HPS approach through an action-oriented research approach. Important general factors were resources, staff capacity and time available to staff members for implementing the HPS approach. Some spectra required more specific factors like organisational skills, leadership or a certain level of democracy. Practical implications: The implementation of the HPS approach should be supported by implementation strategies addressing the spectrum-specific factors, but more generic factors such as staff capacity, resources and the level of democracy should also be considered. Originality/value: This study explores navigation variations throughout HPS spectra rather than the HPS approach in general. It also nuances implementation diversity across and within different European contexts.

SuperFIT aims to improve the dietary and physical activity behaviour of children (2-4 years) in the Dutch childcare and home setting. Healthy parenting practices, policies, and availability of materials, fruits, and vegetables were promoted over the course of a year. This pilot study, with a quasi-experimental design, examined the effectiveness of children's intake of fruits, vegetables, water, and sweet beverages. Families attending intervention preschools could participate in the partial (preschool) or full (preschool + home) intervention. Parental 24-hour recalls assessed the child's diet at baseline and two follow-ups. Data from 81 control and 88 intervention children was included in a three-level hierarchical logistic regression. The full intervention showed significantly favourable effects for sweet beverages (B = -1.85, P < 0.05) and unfavourable effects for vegetables (B = -1.94, P < 0.05), compared to the control between the second follow-up and baseline. No significant effects were found for fruit or water, nor for the partial intervention. More research in a larger sample is needed to confirm current findings.

Background: Increasing numbers of children are facing health problems as a result of physical inactivity. Besides the home, school is a natural place to promote children's daily physical activity (PA). Knowledge about factors promoting or preventing children's PA at school, from the perspective of children, is limited. Purpose: The purpose of this study is to learn the factors that eight- and nine-year-old schoolchildren identify from their school environment related to physical activity during their school day. This study was established as a sub-project within a larger, sixteen-country collaboration project by HEPCOM (Promoting Healthy Eating and Physical Activity in Local Communities) and reports on a piloting phase. Sample: Finnish second-graders (age 8-9 years, n = 22) from one primary school participated in the study. Method: A photo-elicitation methodology was used, including photographs taken by children and interviews in groups based on the photographs. The data were analysed qualitatively by inductive content analysis. Results: The children described factors appearing in the physical environment, such as the playground, and those in the nonmaterial, abstract environment, such as the weather. According to the findings, three categories emerged: (1) personal and economic, related to children's individual preferences and opportunities; (2) sociocultural, related to friends and belonging in a group; and (3) environmental, related to physical and political outdoor and indoor solutions at the school, as well as to policies and rules in the school community. Children emphasised the importance of friends and games, but play areas were also experienced as significant. Based on children's experiences, rules and laws direct all activities at school, which was not always perceived as a positive thing. Conclusions: Although the findings of this small-scale study cannot be generalised, the children's perceptions suggest some crucial areas for future research. Playing and exercising during the school day are important in fulfilling the recommendations for daily PA for children, as well as in promoting their mental and social health. To enable equal possibilities for an active lifestyle for all children at school, positive and encouraging adults, as well as age-appropriate and safe infrastructure, are needed. The children's day should be viewed as a whole, not as single situations, where physical activities are offered.

This paper describes the evaluation of an adoption strategy for the school-based healthy diet programme Krachtvoer. Health promotion (HP) professionals from five Regional Public Health Services (RPHSs) in The Netherlands were asked to recruit a total of 25 schools to adopt the Krachtvoer programme in accordance with this strategy. Afterwards, they were interviewed about their adherence to and subjective evaluation of the strategy. The adoption rate of the programme was calculated and 10 adopting and 9 rejecting teachers were interviewed about the reasons for their decision. The HP professionals' adherence to the strategy was good, as well as their appreciation and the perceived feasibility of the strategy. The person-to-person approach that characterized this strategy was considered important. The strategy led to an adoption rate of 53.2%. On average, adopters mentioned 4.4 reasons and rejecters mentioned 5.4 reasons for their decision. Most reasons were school related and programme related and in case of the adopters also teacher related. The diversity of reasons revealed the complexity of teachers' decision making. Although there is some room for improvement of the adoption strategy and the programme itself, especially socio-political conditions in schools and in RPHSs need change for a further increase in programme adoption. (Contains 2 tables.)

To enable improvements in school health promotion, this paper examines associations between the number of health-promotion issues addressed by primary school teachers in the Netherlands and factors thought to influence this behavior. The main factors studied are context characteristics and constructs of attitude, social influence, self-efficacy (SE) and perceived barriers. A total of 180 primary school teachers teaching 9- to 12-year olds (Grades 6, 7 and 8) participated in a cross-sectional survey. The results show that it is possible to differentiate between teachers addressing three or more health issues per year versus those who address fewer based on grade level (more health issues are addressed at higher grades), perceived disadvantages, SE and staff support. The latter seems to exert the greatest influence and may be one of the most promising focus points for improvements of school health promotion in the Netherlands. (Contains 5 tables and 1 figure.)

Feasible screening methods are important to identify older patients who might benefit from adjuvant chemotherapy. The aim of this study was to investigate the associations between the outcomes of screening for frailty with the Geriatric-8 questionnaire (G8) and the 4-meter gait speed test (4MGST) and subsequent delivery of adjuvant chemotherapy and treatment tolerance in older patients with colon cancer. This retrospective multicentre study included all patients aged ≥70 with primary colon carcinoma who underwent elective surgery between May 2016 and December 2018 and for whom adjuvant chemotherapy was indicated. Data were analysed using multivariate regression models. 97 (73.5%) of 132 eligible patients were screened by the G8 and 85 (64.4%) by the 4MGST. In univariate analyses, patients who scored indicative for frailty on both the G8 (≤14) and the 4MGST (>4 s) significantly more often did not proceed with adjuvant chemotherapy than patients who scored fit on both instruments (OR = 5.10, p = 0.01). After adjustment for gender, stage, and postoperative complications, the OR decreased to 4.22 (p = 0.04). Tolerance of treatment was very high (93%) and did not differ between screening groups. Although patients who scored indicative for frailty on both the G8 and the 4MGST significantly more often did not proceed with adjuvant chemotherapy, it is still unknown whether the G8 and the 4MGST are reliable tools for identifying patients who are at high risk for severe chemotoxicity. Nonetheless, this study shows that current selection for adjuvant chemotherapy among older patients with colon cancer is safe with low rates of severe chemotoxicity. [ABSTRACT FROM AUTHOR]

Identification of frail older colorectal cancer patients might help to select those prone to adverse events and may lead to adjustment of treatment plans. However, the prognostic validity of screening for frailty is unknown. This retrospective study evaluates colorectal cancer patients ≥70 years who underwent elective surgery between May 2016 and December 2018. The Geriatric-8 (G8) and 4-m gait speed test (4MGST) were used as frailty screening tools. According to hospital guidelines, patients were referred to a geriatrician when screening was indicative for frailty (G8 ≤ 14 and/or 4MGST < 1 m/s). Patients were categorized as fit, vulnerable or frail by comprehensive geriatric assessment (CGA). The clinical implications and prognostic validity of frailty screening and CGA were evaluated. 149 patients were included, of whom 132 (89%) were screened for frailty. Frailty was suspected in 40% of screened patients (n = 53) of whom 89% (n = 47) was referred for CGA. A higher complication rate was seen in patients with G8 ≤ 14 and/or 4MGST < 1 m/s compared to those with G8 > 14 and 4MGST ≥1 m/s (respectively 62% versus 28%, p < 0.001). Pneumonia (21% versus 6%, p = 0.013) and cardiac complications (11% versus 4%, p = 0.093) were more prevalent in patients with G8 ≤ 14 and/or 4MGST < 1 m/s. CGA identified frail patients as a group with a high complication rate of 68%. Screening for frailty with subsequent referral for CGA is feasible in older colorectal cancer patients. Our study suggests that screening for frailty by G8 + 4MGST can identify patients with higher risk for postoperative complications. [ABSTRACT FROM AUTHOR]

Abstract Introduction One-year mortality after hospital discharge is higher among older patients with colorectal cancer who underwent surgery compared to younger patients. Taking care of older adults with multi-morbidity is often fragmented with lack of coordination and information exchange between healthcare professionals. The aim of this study was to evaluate emerging health problems and quality of life after implementing a standardized shared-care model. Material and Methods 141 patients aged ≥70 years who underwent surgery for colorectal carcinoma in two hospitals were included. A standardized transmission from hospital to primary care was set up. Patients' health status and quality of life was evaluated during subsequent follow-up moments. Results A reduction in one-year mortality rate from 10.9% to 9.2% was observed after implementation of the standardized shared-care model. Almost all health status domains improved to 'good' during follow-up moments, still the general condition remained poor in 26% of patients at week fourteen. Although quality of life improved during subsequent follow-up moments, fatigue, dyspnoea and insomnia were the most prominent persisting problems at the end of follow-up. Discussion The implementation of a standardized shared-care model for older patients after surgery for colorectal cancer resulted in a reduction in the one year mortality rate. Although most aspects of both health status and quality of life improved during subsequent follow-up moments, especially the general condition remained poor for a long time after surgery. This means that, besides a good preoperative counseling of patients, future research should focus on possible interventions to improve general condition. [ABSTRACT FROM AUTHOR]