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BACKGROUND: Levels of physical activity and variation in physical activity and sedentary time by place and person in European children and adolescents are largely unknown. The objective of the study was to assess the variations in objectively measured physical activity and sedentary time in children and adolescents across Europe. METHODS: Six databases were systematically searched to identify pan-European and national data sets on physical activity and sedentary time assessed by the same accelerometer in children (2 to 9.9¿years) and adolescents (=10 to 18¿years). We harmonized individual-level data by reprocessing hip-worn raw accelerometer data files from 30 different studies conducted between 1997 and 2014, representing 47, 497 individuals (2-18¿years) from 18 different European countries. RESULTS: Overall, a maximum of 29% (95% CI: 25, 33) of children and 29% (95% CI: 25, 32) of adolescents were categorized as sufficiently physically active. We observed substantial country- and region-specific differences in physical activity and sedentary time, with lower physical activity levels and prevalence estimates in Southern European countries. Boys were more active and less sedentary in all age-categories. The onset of age-related lowering or leveling-off of physical activity and increase in sedentary time seems to become apparent at around 6 to 7¿years of age. CONCLUSIONS: Two third of European children and adolescents are not sufficiently active. Our findings suggest substantial gender-, country- and region-specific differences in physical activity. These results should encourage policymakers, governments, and local and national stakeholders to take action to facilitate an increase in the physical activity levels of young people across Europe.

BACKGROUND: Cardiovascular disease (CVD) is a leading cause of death worldwide. With atherosclerosis as underlying cause for many CVD events, prevention or reduction of subclinical atherosclerotic plaque burden (SAPB) can have substantial public health and economic benefits. OBJECTIVE: To present the protocol of a randomized controlled trial (RCT) investigating the (cost)effectiveness of a comprehensive 3-year worksite-based lifestyle intervention program aimed at improving dietary, physical activity, and sedentary behaviours in participants having a high level of SAPB or low level of SAPB compared to standard care. TRIAL DESIGN: Two parallel RCTs nested within the ´Progression of Early Subclinical Atherosclerosis´ (PESA) cohort will be conducted. One RCT (n= 350) will focus on a sample of employees drawn from the cohort with high imaging-defined SAPB and a second RCT (n=650) on a sample with low imaging-defined SAPB. In both RCTs, the participants (aged 40-60) will be randomized into either a group receiving a 3year lifestyle intervention or receiving standard care. The lifestyle intervention primarily aims to improve dietary, physical activity, sedentary behaviours. The intervention consists of three elements: (A) 12 personalized lifestyle counseling sessions over a 30-month period, (B) a wrist worn physical activity tracker, and (C) a sit-stand workstation. Data will be collected at baseline and at 1, 2 and 3-year follow up. Primary outcome measure is a compilation score of blood pressure, physical activity, sedentary time, body weight, diet and smoking (BEWAT). Physical activity and sedentary time will be assessed objectively with the activPAL inclinometer. Questionnaires are used to assess: diet, smoking, sleep habits, depression, perceived stress, job strain, social support, vitality, relaxation, quality of life, health care consumption and intervention processes. Physical measurements include anthropometrics, noninvasive imaging to assess SAPB (using 2D ultrasound of carotids, abdominal aorta and iliofemoral arteries, 3D ultrasound of carotid and femoral arteries and coronary artery calcification by computed tomography), and blood biomarkers. A process evaluation and a cost-effectiveness evaluation will be conducted. DISCUSSION: This study will provide insights into the (cost-) effectiveness of a 3-year worksite lifestyle intervention on CVD risk factors, compared to standard care in participants with high-imaging defined SAPB or low-imaging defined SAPB.

Purpose: Time spent sedentary is associated with poor health. Self-monitoring of walking, using pedometers for objectively measured real-time feedback, is highly effective at increasing physical activity. There is no similar device to self-monitor time spent sitting. The aim of this study was: a) to evaluate the acceptability and usability of a prototype of the novel pocket worn SitFIT (TM) as a self-monitoring device for reducing sedentary behaviour and increasing physical activity; b) to assess whether feedback on sitting time or standing time was likely to be most effective. Methods: A convenience sample of forty sedentary men (30-65 years) was randomised into one of two intervention groups. Over a period of 4 weeks, one group received a SitFIT (TM) prototype providing feedback on steps and time spent sedentary (lying/sitting); the other group received a SitFIT (TM) prototype providing feedback on steps and time spent upright (standing/walking). Incremental goals for sedentary/upright time and steps were provided in conjunction with information how to achieve the goals. Change in physical activity and sedentary behaviour was assessed using activPAL (TM) monitors at baseline and 4 week follow up, at which point all participants returned their SitFIT (TM). Semi-structured interviews were conducted with participants after 4 and 8 weeks. The interviews were recorded digitally, transcribed and then analysed thematically. Results: On average, participants in both groups reduced their sedentary time by 32±98 minutes/day (F=4.11, p=0.05) and increased their standing time by 23±60 minutes/day (F=5.87, p=0.02). Step count was increased by 260±2473 steps/day (non-significant). There were no between-group differences. Overall, the SitFIT (TM) was reported as acceptable and usable and seen as helpful to reduce time spent sitting. Participants provided suggestions for improving the SitFIT (TM) design, some of which were incorporated into the next version of the SitFIT (TM). Conclusions: The SitFIT (TM) has potential to be used as a self-monitoring device in interventions aiming to reduce sedentary behaviour. The effectiveness of the SitFIT (TM) for changing sedentary behaviour remains to be determined in a fully powered trial.

promotiedatum: 9-12-2013 � prom-id: 9598

Intensive care units regularly have patients in whom a curative treatment plan is changed to palliative treatment. This does not only concern the medical and technical aspects, but also medical-ethical problems and questions relating to communication and organization. All these play a part in making a correct assessment. It is logical that nurses play an important part in this process as they have the most contact with the patient and his/her family. The optimalization of collaboration between doctors and nurses by means of the mutual exchange of information unique to each different discipline as well as acknowledging one another's talents and skills, forms the basis of good communication and organization concerning end-of-life decisions. It is useful to formalize this collaboration by means of multidisciplinary discussions

Objective. To determine the effects of radiotherapy and other medical interventions on cognitive functioning in patients with a low-grade glioma (LGG). Design. Cross-sectional study. Method. A total of 195 LGG patients, of whom 104 had received radiotherapy 1-22 years previously, were compared to 100 patients with a low-grade haematological malignancy and 195 healthy controls. The analysis was aimed at differentiating between the effects of the tumour (disease duration, lateralisation) and treatment effects (neurosurgery, radiotherapy, use of anticonvulsants) on cognitive function and the relative risk of cognitive disability. Results. LGG patients had lower performance levels in all cognitive domains than haematological patients and performed even worse when they were compared to healthy controls. Radiotherapy was associated with poorer cognitive functioning; however, cognitive disability was found only in patients receiving fractional doses exceeding 2 Gy. The use of anticonvulsants was strongly associated with disorders in the area of attention and planning functions. Conclusion. In this study, the tumour itself was the most damaging factor with respect to cognitive function and radiotherapy was associated with cognitive disability only if elevated fractional doses were used. Epilepsy or the use of anticonvulsants was also associated with diminished cognitive functioning.

Objective: To examine psychological functioning and self-management behaviours of Dutch adult patients with insulin-requiring diabetes mellitus suffering from extreme fear of self-injecting (FSI) and/or fear of self-testing (FST). Methods: A cross-sectional survey was performed in a sample of insulin-treated diabetes patients (n = 1275; 51.1% male; age 49.7 ± 15.8 years; 58.0% Type 1 diabetes), assessing FSI and FST. Patients completed the questionnaires concerning trait/state anxiety, depression, fear of hypoglycemia, diabetes-related distress, diabetes self-care activities, and general well-being. Comparisons were made on these measures between patients with extremely high scores on FSI and/or FST (≥ 95th percentile) and the other patients. Patients with extreme scores on FSI and/or FST were invited to take part in a second survey to assess the prevalence of major depression, common fears/phobias, and psychoneuroticism. Results: People with extreme FSI/FST scores, as compared to the other patients, reported higher levels of trait/state anxiety and depression. This group also reported more fear of hypoglycaemia and diabetes-related distress, had lower levels of general well-being, and reported less frequent self-monitoring of blood glucose. The second survey showed 11.1% of patients with extreme FSI/FST reporting scores indicating major depression. Prevalence of scores greater than or equal to the high scores on phobias (38.0-63.3%) and psychoneuroticism (27.8%) were consistently higher than norm group prevalences. Discussion: Extreme levels of FSI and/or FST are associated with high diabetes-related distress, poor general well-being, and psychological comorbidity, as well as poorer adherence to the diabetes treatment regimen. It is concluded that patients with extreme FSI/FST are often burdened with more than this specific phobia.