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There is an increasing interest in outdoor play, both in research and in policy. However, in (re)designing, planning and managing the public space, there is still limited attention for children’s actual playing behavior. A lot of urban planning decisions are based on adults’ perceptions of children’s playing behavior and focus on formal play spaces, rather than on their actual behavior and on other, more informal, play places children might also use. Therefore, the purpose of this study was to explore where children play outdoors, with whom and what kind of activities they are performing there. Between February 2022 and March 2023 1,127 – mainly primary school - children were systematically observed after school in three post-war residential districts in three cities in The Netherlands. The majority of the children were between 5-8 years old (50%). Above the age of 8 years, substantially more boys (70%) than girls (30%) were playing outdoors. Most of the children (79%) were playing with other children, 8% were playing alone. The playground was the most popular play space (36% of the observed children were playing there), followed by public sports fields (14%) and sidewalks (13%). With respect to the type of activities, relaxing (21%) was the most common activity, followed by ball sports (14%), climbing or hanging (11%), swinging (10%), and riding on wheels (9%). This study showed differences in play behavior by gender, age, district and play space and stress the need for a broader definition of play, and for focusing on formal as well as informal play spaces.

Prevention of non-communicable diseases through, among other factors, increasing vegetables and fruit (V&F) intake is a cost-effective strategy for risk reduction but requires behavioral change. Such changes in adolescents benefit from their active involvement. The Food Boost Challenge (FBC) was developed using a participatory action research approach to enhance healthy eating behaviors, namely V&F products among adolescents. The FBC is an innovation process, involving adolescents, (peer) researchers, and food system partners, like non-governmental and commercial organizations. In 2021–2022, 34 partners provided both cash and in-kind contributions to join the FBC community. Phase 1 involved 200 students identifying barriers and drivers for consumption of F&V products among 1000 pre-vocational adolescents, aged 12–20 years. In phase 2, student teams submitted innovative ideas, resulting in 25 concepts fitting into ≥1 of 4 routes: (I) innovative technology for a healthy diet, (II) new food products/concepts for adolescents, (III) hotspots improving the F&V product experience, and (IV) new routes to market. In phase 3, consortia of adolescents, students, and partners were formed to develop 10 selected concepts into prototypes, and phase 4 offered teams a national platform. Results show that the FBC resonates with all stakeholders, generating valuable insights to increase F&V intake. Prototypes in all four routes have been developed. Additionally, other regions in the Netherlands have adopted the FBC approach. Overall, the FBC is an approach that transforms ideas into actionable measures and shows potential to be adapted to promote various healthy eating behaviors among school students.

Abstract Objective This study evaluated the effect of an after-school group-based medium-intensity multicomponent behavioural intervention programme for children aged 8–12 years classified as overweight, obese or at risk for overweight on body mass index standard deviation score (BMI SDS). In accordance with standardized protocols body weight and height were measured in 195 participants (88 boys, 107 girls) at baseline and at the end of the programme. A total of 166 children derived from a school-based monitoring system served as control group. Multivariate regression analyses examined the effect of the intervention and the independent factors associated with better outcomes in the intervention group. Results Analysis of covariance showed a significant intervention effect on BMI SDS in favour of the intervention group (b-coefficient − 0.13 ± 0.03; p

Abstract Introduction Previous longitudinal studies indicate that physical activity (PA) significantly declines from primary-to secondary school, and report both changes in individual and environmental determinants of PA. In order to understand this transition and to prevent this negative trend, it is important to gather contextually rich data on possible mechanisms that drive this decline. Therefore, the aim of this study was to investigate changes of PA patterns in transition between primary and secondary school, and to add domain-specific insights of how, where, and when these changes occur. Methods In total, 175 children participated in a 7-day accelerometer- and Global Positioning System (GPS) protocol at their last year of primary and their first year of secondary school. GPS data-points were overlaid with Geographical Information Systems (GIS) data using ArcGIS 10.1 software. Based on the GPS locations of individual data-points, we identified child’s PA at home, school, local sports grounds, shopping centers, and other locations. Also, trips in active and passive transport were identified according to previously validated GPS speed-algorithms. Longitudinal multi-level linear mixed models were fitted adjusting for age, gender, meteorological circumstances, and the nested structure of days within children and children within schools. Outcome measures were minutes spent in light PA and moderate-to-vigorous PA, specified for the time-segments before school, during school, after school and weekend days. Results Total PA significantly declined from primary to secondary school. Although transport-related PA increased before- and during school, decreases were found for especially afterschool time spent at sports grounds and transport-related PA during weekends. Conclusions This is the first study that demonstrated longitudinal changes of context- and domain-specific PA patterns in transition between primary and secondary school, based on device-assessed PA. Given the importance of this transition-period for the development of long-term PA patterns, results from this study warrant the development of evidence-based PA programs in this transition period, while acknowledging the integrative role of schools, parents, and afterschool sports providers. More specifically, the results underline the need to increase children’s PA levels in primary schools, promote afterschool PA at secondary schools, and to prevent the drop-out in sports participation at secondary schools.

Objective To evaluate the cost-effectiveness of double-layer compared with single-layer uterine closure after a first caesarean section (CS) from a societal and healthcare perspective.Design Economic evaluation alongside a multicentre, double-blind, randomised controlled trial.Setting 32 hospitals in the Netherlands, 2016–2018.Participants 2292 women ≥18 years undergoing a first CS were randomly assigned (1:1). Exclusion criteria were: inability for counselling, previous uterine surgery, known menstrual disorder, placenta increta or percreta, pregnant with three or more fetuses. 1144 women were assigned to single-layer and 1148 to double-layer closure. We included 1620 women with a menstrual cycle in the main analysis.Interventions Single-layer unlocked uterine closure and double-layer unlocked uterine closure with the second layer imbricating the first.Main outcome measures Spotting days, quality-adjusted life-years (QALYs), and societal costs at 9 months of follow-up. Missing data were imputed using multiple imputation.Results No significant differences were found between single-layer versus double-layer closure in mean spotting days (1.44 and 1.39 days; mean difference (md) −0.056, 95% CI −0.374 to 0.263), QALYs (0.663 and 0.658; md −0.005, 95% CI −0.015 to 0.005), total healthcare costs (€744 and €727; md €−17, 95% CI −273 to 143), and total societal costs (€5689 and €5927; md €238, 95% CI −624 to 1108). The probability of the intervention being cost-effective at willingness-to-pay of €0, €10 000 and €20 000/QALY gained was 0.30, 0.27 and 0.25, respectively, (societal perspective), and 0.55, 0.41 and 0.32, respectively, (healthcare perspective).Conclusion Double-layer uterine closure is not cost-effective compared with single-layer uterine closure from both perspectives. If this is confirmed by our long-term reproductive follow-up, we suggest to adjust uterine closure technique guidelines.Trial registration number NTR5480/NL5380.

Augmented Play Spaces (APS) are (semi-) public environments where playful interaction is facilitated by enriching the existing environment with interactive technology. APS can potentially facilitate social interaction and physical activity in (semi-)public environments. In controlled settings APS show promising effects. However, people’s willingness to engage with APS in situ, depends on many factors that do not occur in aforementioned controlled settings (where participation is obvious). To be able to achieve and demonstrate the positive effects of APS when implemented in (semi-)public environments, it is important to gain more insight in how to motivate people to engage with them and better understand when and how those decisions can be influenced by certain (design) factors. The Participant Journey Map (PJM) was developed following multiple iterations. First, based on related work, and insights gained from previously developed and implemented APS, a concept of the PJM was developed. Next, to validate and refine the PJM, interviews with 6 experts with extensive experience with developing and implementing APS were conducted. The first part of these interviews focused on influential (design) factors for engaging people into APS. In the second part, experts were asked to provide feedback on the first concept of the PJM. Based on the insights from the expert interviews, the PJM was adjusted and refined. The Participant Journey Map consists of four layers: Phases, States, Transitions and Influential Factors. There are two overarching phases: ‘Onboarding’ and ‘Participation’ and 6 states a (potential) participant goes through when engaging with an APS: ‘Transit,’ ‘Awareness,’ ‘Interest,’ ‘Intention,’ ‘Participation,’ ‘Finishing.’ Transitions indicate movements between states. Influential factors are the factors that influence these transitions. The PJM supports directions for further research and the design and implementation of APS. It contributes to previous work by providing a detailed overview of a participant journey and the factors that influence motivation to engage with APS. Notable additions are the detailed overview of influential factors, the introduction of the states ‘Awareness,’ ‘Intention’ and ‘Finishing’ and the non-linear approach. This will support taking into account these often overlooked, key moments in future APS research and design projects. Additionally, suggestions for future research into the design of APS are given.

IntroductionPhysical activity (PA) is important for healthy ageing. Better insight into objectively measured PA levels in older adults is needed, since most previous studies employed self-report measures for PA assessment, which are associated with overestimation of PA.AimThis study aimed to provide insight in objectively measured indoor and outdoor PA of older adults, and in PA differences by frailty levels.MethodsData were collected among non-frail (N = 74) and frail (N = 10) subjects, aged 65 to 89 years. PA, measured for seven days with accelerometers and GPS-devices, was categorized into three levels of intensity (sedentary, light, and moderate-to-vigorous PA).ResultsOlder adults spent most time in sedentary and light PA. Subjects spent 84.7%, 15.1% and 0.2% per day in sedentary, light and moderate-to-vigorous PA respectively. On average, older adults spent 9.8 (SD 23.7) minutes per week in moderate-to-vigorous activity, and 747.0 (SD 389.6) minutes per week in light activity. None of the subjects met the WHO recommendations of 150 weekly minutes of moderate-to-vigorous PA. Age-, sex- and health status-adjusted results revealed no differences in PA between non-frail and frail older adults. Subjects spent significantly more sedentary time at home, than not at home. Non-frail subjects spent significantly more time not at home during moderate-to-vigorous activities, than at home.ConclusionsObjective assessment of PA in older adults revealed that most PA was of light intensity, and time spent in moderate-to-vigorous PA was very low. None of the older adults met the World Health Organization recommendations for PA. These levels of MVPA are much lower than generally reported based on self-reported PA. Future studies should employ objective methods, and age specific thresholds for healthy PA levels in older adults are needed. These results emphasize the need for effective strategies for healthy PA levels for the growing proportion of older adults.

BackgroundDirect-acting antivirals (DAAs) are highly effective in achieving sustained virologic response among those with chronic hepatitis C virus (HCV) infection. Quality of life (QOL) benefits for an HCV-infected population with high numbers of people who inject drugs and people living with HIV (PLHIV) in Eastern Europe have not been explored. We estimated such benefits for Ukraine.MethodsUsing data from a demonstration study of 12-week DAA conducted in Kyiv, we compared self-reported QOL as captured with the MOS-SF20 at study entry and 12 weeks after treatment completion (week 24). We calculated domain scores for health perception, physical, role and social functioning, mental health and pain to at entry and week 24, stratified by HIV status.ResultsAmong the 857 patients included in the final analysis, health perception was the domain that showed the largest change, with an improvement of 85.7% between entry and week 24. The improvement was larger among those who were HIV negative (104.4%) than among those living with HIV (69.9%). Other domains that showed significant and meaningful improvements were physical functioning, which improved from 80.5 (95% CI 78.9-82.1) at study entry to 89.4 (88.1-90.7) at 24 weeks, role functioning (64.5 [62.3-66.8] to 86.5 [84.9-88.2]), social functioning (74.2 [72.1-76.2] to 84.8 [83.2-86.5]) and bodily pain (70.1 [68.2-72.0] to 89.8 [88.5-91.1]). Across all domains, QOL improvements among PLHIV were more modest than among HIV-negative participants.ConclusionQOL improved substantially across all domains between study entry and week 24. Changes over the study period were smaller among PLHIV.

Background: Physical activity (PA) is decreasing among children, while sedentary behavior (SB) is increasing. Schoolyards seem suitable settings to influence children's PA behavior. This study investigated the associations between schoolyard characteristics and moderate-to-vigorous physical activity (MVPA) and SB of children aged 8-11 years at schoolyards. Methods: Twenty primary schools in the Netherlands were involved. A total of 257 children wore an accelerometer and global positioning system (GPS) device for 5 consecutive days to objectively assess their PA levels and presence at the schoolyard, respectively. Accelerometer and GPS data were merged using the personal activity and location measurement system. Multilevel linear regression analyses were used to study correlates of MVPA and SB at schoolyards. Results: On average, children spent 54 minutes a day at the schoolyard, 9 minutes of which were spent in MVPA and 20 minutes in SB. Boys engaged in MVPA longer than girls at the schoolyard. Fixed equipment, such as high bars and soccer goals, teacher-initiated activities, and the presence of a ball games policy were correlates of more MVPA and less SB. Conclusion: Well-designed schoolyards, including PA-enhancing fixed equipment, a supportive PA climate created by teachers, and supportive schoolyard policies may contribute to increased PA and decreased SB during school recess among school-aged children.

BackgroundAIDS Clinical Trials Group (ACTG) A5199 compared the neurological and neuropsychological (NP) effects of 3 antiretroviral regimens in participants infected with human immunodeficiency virus type 1 (HIV-1) in resource-limited settings.MethodsParticipants from Brazil, India, Malawi, Peru, South Africa, Thailand, and Zimbabwe were randomized to 3 antiretroviral treatment arms: A (lamivudine-zidovudine plus efavirenz, n = 289), B (atazanavir, emtricitabine, and didanosine-EC, n = 293), and C (emtricitabine-tenofovir-disoproxil fumarate plus efavirenz, n = 278) as part of the ACTG PEARLS study (A5175). Standardized neurological and neuropsychological (NP) screening examinations (grooved pegboard, timed gait, semantic verbal fluency, and finger tapping) were administered every 24 weeks from February 2006 to May 2010. Associations with neurological and neuropsychological function were estimated from linear and logistic regression models using generalized estimating equations.ResultsThe median weeks on study was 168 (Q1 = 96, Q3 = 192) for the 860 participants. NP test scores improved (P < .05) with the exception of semantic verbal fluency. No differences in neurological and neuropsychological functioning between treatment regimens were detected (P > .10). Significant country effects were noted on all NP tests and neurological outcomes (P < .01).ConclusionsThe study detected no significant differences in neuropsychological and neurological outcomes between randomized ART regimens. Significant improvement occurred in neurocognitive and neurological functioning over time after initiation of ARTs. The etiology of these improvements is likely multifactorial, reflecting reduced central nervous system HIV infection, better general health, and practice effects. This study suggests that treatment with either of the World Health Organization -recommended first-line antiretroviral regimens in resource-limited settings will improve neuropsychological functioning and reduce neurological dysfunction.Clinical trials registrationNCT00096824.

The rising rate of cesarean deliveries has led to an increased incidence of long long-term complications, including niche formation in the uterine scar. Niche development is associated with various gynecologic complaints and complications in subsequent pregnancies, such as uterine rupture and placenta accreta spectrum disorders. Although uterine closure technique is considered a potential risk factor for niche development, consensus on the optimal technique remains elusive. We aimed to evaluate the effect of single-layer vs double-layer closure of the uterine incision on live birth rate at a 3-year follow-up with secondary objectives focusing on gynecologic, fertility, and obstetrical outcomes at the same follow-up. A multicenter, double-blind, randomized controlled trial was performed at 32 hospitals in the Netherlands. Women ≥18 years old undergoing a first cesarean delivery were randomly assigned (1:1) to receive either single-layer or double-layer closure of the uterine incision. The primary outcome of the long-term follow-up was the live birth rate; with secondary outcomes, including pregnancy rate, the need for fertility treatment, mode of delivery, and obstetrical and gynecologic complications. This trial is registered on the International Clinical Trials Registry Platform www.who.int (NTR5480; trial finished). Between 2016 and 2018, the 2Close study randomly assigned 2292 women, with 830 of 1144 and 818 of 1148 responding to the 3-year questionnaire in the single-layer and double-layer closure. No differences were observed in live birth rates; also there were no differences in pregnancy rate, need for fertility treatments, mode of delivery, or uterine ruptures in subsequent pregnancies. High rates of gynecologic symptoms, including spotting (30%–32%), dysmenorrhea (47%–49%), and sexual dysfunction (Female Sexual Function Index score, 23) are reported in both groups. The study did not demonstrate the superiority of double-layer closure over single-layer closure in terms of reproductive outcomes after a first cesarean delivery. This challenges the current recommendation favoring double-layer closure, and we propose that surgeons can choose their preferred technique. Furthermore, the high risk of gynecologic symptoms after a cesarean delivery should be discussed with patients. [ABSTRACT FROM AUTHOR]