Physical activity and quality of life among head&neck cancer survivors

In a study just published on-line in the journal Supportive Care in Cancer, we again found that patient-reported levels of physical activity (PA) were associated with health-related quality of life (HRQoL); this time among head and neck cancer (HNC) survivors, a group of cancer survivors that is under-studied in this respect. This was a cross-sectional study including 116 HNC survivors. Most PA among these HNC survivors consisted of household activities.
In general, it has been found -for example in a recent individual patient data meta analysis- that PA is beneficial for cancer survivors' QoL and physical functioning, but most studies have been conducted fo the most prevalent cancers, such as women with breast cancer.

Views of policy makers and professionals on implementation and maintenance of diet & PA interventions

The uptake, implementation, and maintenance of effective interventions promoting physical activity (PA) and a healthy diet and the implementation of policies targeting these behaviors are processes not well understood. In an exploratory study just published in BMC Public Health with Saskia Muelmann from the Leibniz Institute for Prevention Research and Epidemiology (BIPS) aimed to gain a better understanding of what health promotion professionals and policy makers think are important factors that facilitate adoption, implementation, and maintenance of comprehensive interventions and policies promoting healthy eating and PA in Belgium, Germany, Ireland, Norway, and Poland.
Six interventions and six policies were explored by means of semi-structured interviews with stakeholders from various sectors to elicit information on factors impacting adoption, implementation, and maintenance of these interventions and policies.
Active involvement of relevant stakeholders in all phases of intervention/policy development and good communication between coordinating organizations were described as important factors contributing to successful adoption and implementatio
n of both interventions and policies. Additional facilitating factors included sufficient training of staff and tailoring of materials to match needs of various target groups. The respondents indicated that maintenance of implemented interventions/policies depended on whether they were embedded in existing or newly created organizational structures in different settings and whether continued funding was secured.
Despite considerable heterogeneity of interventions and health policies in the five countries, stakeholders across these countries identified very similar factors facilitating adoption, implementation, and maintenance of these interventions and policies. This study was part of the Determinants of Diet and Physical Activity (DEDIPAC) knowledge hub, the first joint action of the Joint Programming Initiative 'A Healthy Diet for a Healthy Life'.

Determinants of diet and physical activity: a summary of findings

The establishment of the Determinants of Diet and Physical Activity (DEDIPAC) Knowledge Hub, 2013–2016, was the first action taken by the ‘Healthy Diet for a Healthy Life’ European Joint Programming Initiative (HDHL). DEDIPAC aimed to provide better insight into the determinants of diet, physical activity and sedentary behavior across the life course, i.e. insight into the causes of the causes of important, non-communicable diseases across Europe and beyond. DEDIPAC was launched in late 2013, and delivered its final report in December 2016. In a paper just published in International Journal of Behavioral Nutrition and Physical Activity -the same journal in which we presented the DEDIPAC plans a few year earlier-, we give an overview of what was achieved in terms of furthering measurement and monitoring, providing overviews of the state-of-the-art in the field, and building toolboxes for further research and practice. Additionally, we propose some of the next steps that are now required to move forward in this field, arguing in favor of 1) sustaining the Knowledge Hub and developing it into a European virtual research institute and knowledge centre for determinants of behavioural nutrition and physical activity with close links to other parts of the world; 2) establishing a cohort study of families across all regions of Europe focusing specifically on the individual and contextual determinants of major, non-communicable disease; and 3) furthering DEDIPAC’s work on nutrition, physical activity, and sedentary behavior policy evaluation and benchmarking across Europe by aligning with other international initiatives and by supporting harmonization of pan-European surveillance. This last recommendation is now being followed up by the HDHL Policy Evaluation Network (PEN).

Towards FAIR data sharing in behavioural nutrition and physical activity research

The utilisation of available cross-European data for secondary data analyses on physical activity, sedentary behaviours and their underlying determinants may benefit from the wide variation that exists across Europe in terms of these behaviours and their determinants. Such reuse of existing data for further research requires Findable; Accessible; Interoperable; Reusable (FAIR) data management and stewardship. In a paper just published in BMJ Open -with Dr. Jeroen Lakerveld as first author- we describe the inventory and development of a comprehensive European dataset compendium and the process towards cross-European secondary data analyses of pooled data on physical activity, sedentary behaviour and their potential determinants across the life course.
A five-step methodology was followed by the European Determinants of Diet and Physical Activity (DEDIPAC) Knowledge Hub, covering the (1) identification of relevant datasets across Europe, (2) development of a compendium including details on the design, study population, measures and level of accessibility of data from each study, (3) definition of key topics and approaches for secondary analyses, (4) process of gaining access to datasets and (5) pooling and harmonisation of the data and the development of a data harmonisation platform.
A total of 114 unique datasets were found for inclusion within the DEDIPAC compendium. Of these datasets, 14 were eventually obtained and reused to address 10 exemplar research questions. The DEDIPAC data harmonisation platform proved to be useful for pooling, but in general, harmonisation was often restricted to just a few core (crude) outcome variables and some individual-level sociodemographic correlates of these behaviours.
Obtaining, pooling and harmonising data for secondary data analyses proved to be difficult and sometimes even impossible. Compliance to FAIR data management and stewardship principles currently appears to be limited for research in the field of physical activity and sedentary behaviour. In the paper in BMJ Open we discuss some of the reasons why this might be the case and present recommendations based on our experience.

Lessons learned from process evaluation of an exercise intervention among cancer patients

In a paper just published in European Journal of Cancer Care -with Saskia Persoon as first author, and as part of the Alpe D'HuZes Cancer Rehabilitation research program (A-CaRe)-, we describe the process evaluation of an 18-week supervised exercise programme in 50 patients treated with high-dose chemotherapy followed by autologous stem cell transplantation. The intervention included 30 exercise sessions with six resistance exercises and interval training. We evaluated the context, dose delivered and received, and patients' and physiotherapists' satisfaction with the intervention. Ninety-two per cent of the patients trained within 15 km of their home address, with an average session attendance of 86%. Most patients trained at the prescribed intensity for four of the six resistance exercises, but the dose delivered and received of the two remaining resistance exercises and interval training could not be determined. Both patients and physiotherapists highly appreciated the program (score of 8.3 and 7.9 out of 10 respectively).

Which exercise prescriptions improve quality of life and physical function in patients with cancer?

Certain exercise prescriptions for patients with cancer may improve quality of life (QoL) and self-reported physical function (PF). In a systematic review and meta-analysis of the scientific literature, we investigated the effects of exercise on QoL and PF in patients with cancer and studied differences in effects between different intervention-related and exercise-related characteristics. This investigation has just been published online in the British Journal of Sports Medicine, with Maike Sweegers as first author, and as part of the POLARIS (Predicting OptimaL cAncer RehabIlitation and Supportive care) study
We searched four electronic databases to identify randomised controlled trials investigating exercise effects on QoL and PF in patients with cancer. Subgroup analyses were conducted based on intervention dimensions, including timing, duration and delivery mode, and exercise dimensions, including frequency, intensity, type and time (FITT factors).

Patients in exercise interventions had significantly improved QoL and PF compared with patients in control groups. Especially supervised exercise interventions were effective. No significant differences in intervention effects were found for variations in intervention timing, duration or exercise FITT factors. Unsupervised exercise with higher weekly energy expenditure was more effective than unsupervised exercise with lower energy expenditure.
Our conclusion is that exercise interventions, especially when supervised, have statistically significant and small clinical benefit on self-reported QoL and PF in patients with cancer. Unsupervised exercise intervention effects on PF were larger when prescribed at a higher weekly energy expenditure.

Social disparities in food preparation behaviours

Socio-economic differences in nutrition and eating behaviors are important for socio-economic health disparities, and differences in food preparation practices may partly explain such differences in nutrition and eating behaviors. In a study just published in Nutrition Journal (with Dr. Caroline Méjean as first author) we investigated whether there was an independent association of socio-economic indicators (education, occupation, income) with food preparation behaviors.
A total of 62,373 adults participating in the web-based NutriNet-Santé cohort study were included in the analyses. The study was part of the Determinants of Diet and Physical Activity (DEDIPAC) joint action. Cooking skills, preparation from scratch and kitchen equipment were assessed as well as frequency of meal preparation, enjoyment of cooking and willingness to cook better/more frequently.
Participants with the lowest education, the lowest income group and female manual and office workers spent more time preparing food daily than participants with the highest education, those with the highest income and managerial staff. The lowest educated individuals were more likely to be non-cooks than those with the highest education level, while female manual and office workers and the never-employed were less likely to be non-cooks. Female manual and office workers had lower scores of preparation from scratch and were less likely to want to cook more frequently than managerial staff. Women belonging to the lowest income group had less kitchen equipment and were less likely to enjoy cooking meal daily than those with the highest income.
Lower socio-economic groups, particularly women, spend more time preparing food than high socioeconomic groups, but were less likely to prepare meals from scratch with fresh ingredients and enjoy cooking less.

Objectively measured sedentary time among five ethnic groups in Amsterdam

Sedentary behaviour is increasingly recognised as a health risk behaviour, partly independent of moderate to vigorous physical activity. An increasing number of studies focus on sedentary behaviour, but  studies on sedentary behaviour among ethnic minority groups are scarce. In a a study just published in Plos ONE -with Dr. Anne Loyen as first authors- we compared levels and socio-demographic and lifestyle-related correlates of objectively measured sedentary time in five ethnic groups in Amsterdam, the Netherlands.
Data were collected as part of the HELIUS study, a cohort study conducted in Amsterdam. The sample consisted of adults from a Dutch, Moroccan, African Surinamese, South-Asian Surinamese and Turkish ethnic origin. Data were collected by questionnaire, physical examination, and a combined heart rate and accelerometry monitor (Actiheart). Sedentary time was defined as waking time spent on activities of <1 .5="" a="" href="https://en.wikipedia.org/wiki/Metabolic_equivalent" target="_blank">metabolic equivalents
. All analyses were adjusted for gender and age.Sedentary time ranged from 569 minutes/day (9.5 hours/day) for participants with a Moroccan and Turkish origin to 621 minutes/day (10.3 hours/day) in African Surinamese participants. There were no statistically significant differences in the levels or correlates of sedentary time between the ethnic groups. Meeting the physical activity recommendations (150 minutes/week) was consistently inversely associated with sedentary time across all ethnic groups, while age was positively associated with sedentary time in most groups.

Effects of a high intensity exercise program after stem cell transplantation

In a paper just published in Plos ONE, we report on a single blind, multicenter randomized controlled trial in which we evaluate the effects of a supervised high intensity exercise program on physical fitness and fatigue in patients with multiple myeloma or lymphoma recently treated with autologous stem cell transplantation, with Saskia Persoon as first author.
A hundred and nine patients joined our study and were randomly assigned to the 18-week exercise intervention or a usual care control group. The primary outcomes included physical fitness (VO2peak and Wpeak determined using a cardiopulmonary exercise test; grip strength and the 30s chair stand test) and fatigue (Multidimensional Fatigue Inventory) and were assessed prior to randomization and after the patients in de intervention group had completed their exercise program.
Patients in the exercise intervention group a
ttended 86% of the prescribed exercise sessions. Of the patients in the control group, 47% reported to have attended more than 10 physiotherapy sessions in the same period of time. Such physiotherapy sessions most likely include supervised exercise. Thus, because the intervention group exercised less than planned, and the control group did more, the difference in exercise participation between the two groups was smaller than anticipated before the study was started.
Median improvements in physical fitness ranged between 16 and 25% in the intervention group and between 12 and 19% in the control group. Fatigue decreased in both groups. There were no statistical significant differences between the intervention and control group.

Video analyses to study health information provided by midwives

To quantify to what extent evidence-based health behaviour topics relevant for pregnancy are discussed with clients during midwife-led prenatal booking visits and to assess the association of client characteristics with the extent of information provided, we conducted a study among midwives. This study was recently published in the journal Midwifery, with Dr. Ruth Baron as first author. 173 video recordings of prenatal booking visits with primary care midwives and clients in the Netherlands were analysed.
Thirteen topics regarding toxic substances, nutrition, maternal weight, supplements, and health promoting activities were categorized as either ‘never mentioned’, ‘briefly mentioned’, ‘basically explained’ or ‘extensively explained’. Rates on the extent of information provided were calculated for each topic and relationships between client characteristics and the extent of information provided were assessed.
Our findings showed that women who did not take folic acid supplementation, who smoked, or had a partner who smoked, were more likely to be provided with only basic about these topics. Furthermore, the majority of clients were provided with no information on recommended weight gain (91.9%), fish promotion (90.8%), caffeine limitation (89.6%), vitamin D supplementation (87.3%), physical activity promotion (81.5%) and antenatal class attendance (75.7%) and only brief mention of alcohol (91.3%), smoking (81.5%), folic acid (58.4) and weight at the start of pregnancy (52.0%). The importance of a nutritious diet was generally either never mentioned (38.2%) or briefly mentioned (45.1%). Nulliparous women were typically given more information on most topics than multiparous women.
In conclusion, the majority of women were provided with little or no information about pregnancy-relevant health behaviours examined in this study. Midwives may be able to improve prenatal health promotion by providing more extensive health behaviour information to their clients during booking visits.

Correlates of irregular family meal patterns among children

The importance of family meals to the consumption of healthful food choices has been demonstrated and discussed in recent reviews. However, little information is available on barriers that interfere with regular family meal patterns during childhood. In a paper just published in the journal Food and Nutrition Research, we describe family meal patterns among 11-year-old children across Europe and identify correlates of irregular family breakfast and dinner consumption. We used data from 13,305 children from nine European countries who participated in the Pro Children Study in 2003.
The proportions of children who regularly ate family breakfast and dinner were 62% and 90%, respectively. Children who ate less vegetables were less likely to engage in family breakfasts as well as dinners, irregular family breakfasts was associated with more television viewing, and social differences in family breakfast consumption was observed.

Counselor competence for telephone Motivation Interviewing addressing lifestyle change

In a paper just published in the journal Evaluation and Program Planning we explored counselor competence in telephone Motivation Interviewing (MI) to change lifestyle behaviors in a primary care population with the
Motivational Interviewing Treatment Integrity (MITI) rating system. Counselor behavior was evaluated by trained raters. The MI fidelity was examined by comparing the MI fidelity scores direction, empathy, spirit, % open questions, % complex reflections, reflections-to-questions ratio, % MI-adherent responses with the matching beginner proficiency MITI threshold.
The inter-rater agreements for the MI fidelity summary scores were good (spirit, reflections-to-questions ratio), fair (empathy, % open questions, % MI-adherent responses) or poor (direction, % complex reflection). The MI fidelity scores for direction, empathy, spirit and the percentage of complex reflections exceeded the MITI threshold, but lower scores were found for the percentage of open questions, the reflections-to-questions ratio and the percentage of MI-adherent responses.
In conclusion, evidence that MI was implemented was revealed. However, the inter-rater agreements scores and some fidelity scores leave room for improvement ,indicating that raters and counselors may need more ongoing training and feedback to achieve and maintain adequate competence.

Patterns of objectively measured sedentary time in 10- to 12-year-olds

In a study just published in BMC pediatrics we examined the frequency of sedentary 'bouts' of different durations and the total time spent in sedentary on a weekday, a weekend day, during school hours, during after-school hours and during evenings among 10- to 12-year-old Belgian children. The study was part of the “EuropeaN Energy balance Research to prevent excessive weight Gain among Youth” (ENERGY)-project. We looked at total sitting time as well as different bouts of sitting, because uninterrupted sitting may be more harmful.
Accelerometer data were used to assess sedentary time and sedentary bouts. Differences in total sedentary time, sedentary bouts of 2–5, 5–10, 10–20, 20–30 and ≥30 min and total time accumulated in those bouts were examined on a weekday, a weekend day, during school hours, during after-school hours and in the evening period.
More than 60% of the participants’ waking time was spent sedentary. Children typically engaged in short sedentary bouts of 2–5 and 5–10 min, which was almost 50% of their total daily sedentary time. Although the differences were very small, children engaged in significantly fewer sedentary bouts of nearly all durations during after-school hours compared to during school hours and in the evening period. Children also engaged in significantly fewer sedentary bouts of 5–10, 10–20, and 20–30 min per hour on a weekend day than on a weekday.
Although primary school children spend more than 60% of their waking time sitting, they generally do interrupt their sitting time frequently. Children’s sedentary bouts were slightly longer on weekdays, particularly during school hours and in the evening period.

Who sits too much in Europe? A hierarchy of sociodemographic correlates of sedentary behavior

Too much sitting (extended sedentary time) is recognized as a public health concern in Europe and beyond. People who sit too much too long have lower cardio metabolic health and increased risk of premature death. Identifying population subgroups that sit too much may help to develop targeted interventions to reduce sedentary time. In a paper just published in Preventive Medicine, with Dr. Jeroen Lakerveld as first author (Jeroen is leader of the so-called Upstream Team, a research network focusing on environmental determinants of physical activity, dietary behaviours and chronic disease risk), we explored the relative importance of socio-demographic correlates of sedentary time in adults across Europe. We used data from 26,617 adults from 28 EU member states who participated in the 2013 Special Eurobarometer study on sport and physical activity. Their self-reported sedentary time was dichotomized into sitting less or >7.5h/day. A Chi-squared Automatic Interaction Detection (CHAID) algorithm was used to create a 'tree' that hierarchically partitions the data on the basis of the independent variables (i.e., socio-demographic factors) into homogeneous (sub)groups with regard to sedentary time. This allows for the tentative identification of population segments at risk for too much sitting. Eighteen and a half percent of respondents reported sitting >7.5h/day. Occupation was the primary discriminator. The subgroup most likely to engage in extensive sitting were higher educated, had white-collar jobs, reported no difficulties with paying bills, and used the internet frequently.

Barriers to healthy eating and dietary behaviours in European adults

Dietary behaviours may be influenced by perceptions of barriers to healthy eating. In a study just published in the European Journal of Nutrition, we used data from the Spotlight project, a large cross-European study (N = 5900) to study potential determinants of energy balance behaviours and obesity, to explore associations between various perceived barriers to healthy eating and dietary behaviours among adults from urban regions in five European countries and examined whether associations differed across regions and socio-demographic backgrounds. Gabi Pinho is

first author on this study.
We tested associations between barriers (irregular working hours; giving up preferred foods; busy lifestyle; lack of willpower; price of healthy food; taste preferences of family and friends; lack of healthy options and unappealing foods) and dietary variables using multilevel logistic regression models. We explored whether associations differed by age, sex, education, urban region, weight status, household composition or employment.
Perceived ‘lack of willpower’, ‘time constraints’ and ‘taste preferences’ were barriers most strongly related to dietary behaviours, and the association between various barriers and lower intake of fruit and vegetables was somewhat more pronounced among younger participants and women.

Validation and refinement of prediction models to estimate exercise capacity in cancer survivors

Exercise and physical activity is important for rehabilitation among cancer survivors. In a recent individual patient data meta analysis, we concluded that exercise, and particularly supervised exercise, effectively improves quality of life and physical fitness in patients with cancer with different demographic and clinical characteristics during and following treatment. Although effect sizes were small, there is consistent empirical evidence to support implementation of exercise as part of cancer care.

In order to test the effects of exercise interventions, to tailor exercise interventions, and to monitor progress among cancer survivors and patients with cancer, valid and reliable measures to assess exercise capacity are needed. In a paper just published in Archives of Physical Medicine and Rehabilitation -with Dr. Martijn Stuiver as first author- we tested the validity and clinical usefulness of the Steep Ramp Test for estimating exercise tolerance in cancer survivors, by external validation and extension of previously published prediction models for maximal or peak oxygen consumption (VO2peak; which is regarded as the gold standard measurement of cardiorespiratory fitness) and peak power output (Wpeak). Based on this study we concluded that predictions of VO2peak and Wpeak based on the steep ramp test are adequate at the group level, but insufficiently accurate in individual patients. The multivariable prediction model for Wpeak can be used cautiously to aid endurance exercise prescription.

Differences in Commuting to School and Work across Europe

In a study just published online in Preventive Medicine -with Dr. Saskia te Velde as first author- we explored if how school children and their parents commute to and from school and work across Europe, and if these modes of commuting are related to demographic variables, such as country of residence, sex, parental education, and ethnicity, and to weight status.
This study was part of the ENERGY project; children's weight and height were objectively measured; parents self-reported their weight and height and self-reports of mode of commuting and demographics were obtained.
There were marked differences between countries, especially regarding cycling to school, which was common in The Netherlands and Norway and rare in Greece and Spain. Mode of commuting was not associated with weight status in children, but parents who rode their bike to work were significantly less likely to be overweight or obese. Demographic variables were associated with mode of commuting in children and parents. For example: boys were more likely to cycle to school at least four days per week; girls were more likely to walk; children from lower educated parents were less likely to cycle, and children from ethnic minority groups were more likely to walk.

Social support and physical activity in young women in disadvantaged neighborhoods

People tend to become less physically active in transitioning from adolescence to adulthood. Evidence suggests that social support as well as 'intrapersonal' factors  such as self-efficacy, outcome expectations, enjoyment) are associated with physical activity. The aim of a study just published in PLOS One was to explore whether cross-sectional and longitudinal associations of social support from family and friends with leisure-time physical activity (LTPA) among young women living in disadvantaged areas were mediated by these intrapersonal factors, i.e. to explore if social support may help to increase self-efficacy, enjoyment et cetera, to help to increase LTPA. Firsts authors is Anouk Middelweerd, en this study was in close collaboration with and making use of data available at the Institute for Physical Activity and Nutrition at Deakin University, Australia.
Survey data were collected from 18–30 year-old women living in disadvantaged suburbs of Victoria, Australia as part of the longitudinal READI study.
Results from the cross-sectional analyses suggest that the associations of social support from family and from friends with LTPA are mediated by PA enjoyment, outcome expectations and self-efficacy. However, longitudinal analyses did not confirm these findings.

Validation of the Fitbit One for assessing physical activity

Accelerometer-based wearables can provide the user with real-time feedback through the device's interface and the mobile platforms, and this may help to encourage people to get and remain physically active. However, meaningful feedback can only be provided if such wearables validly measure physical activity levels. Very few studies have focussed on the minute-by-minute validity of wearables, which is essential for high quality real-time feedback. In a study just published online by the Journal Medicine & Science in Exercise & Sports we aimed aims to assess the validity of the Fitbit One compared to what is considered a 'gold standard' for assessing physical activity, i.e. the ActiGraph GT3x+. We looked at validity in measuring steps taken, and time spent in moderate, vigorous, and moderate-vigorous physical activity) among young adults using traditional time intervals (i.e., days) and smaller time intervals (i.e., minutes, hours).
Thirty-four healthy young adults participated and wore the ActiGraph GT3x+ and a Fitbit One for one week. As compared to ActiGraph the Fitbit One systematically overestimated physical activity for all aggregation levels: on average 0.82 steps per minute, 45 steps per hour, and 677 steps per day. Strong and significant associations were found between ActiGraph and Fitbit results for steps taken, and weaker but statistically significant associations were found for minutes spent in moderate, vigorous and moderate-vigorous physical activity for all time intervals.
We conclude that although the Fitbit One overestimates the step activity compared to the ActiGraph, it can be considered a valid device to assess step activity also for real-time minute-by-minute self-monitoring. However, agreement and correlation between ActiGraph and Fitbit One regarding time spent in moderate, vigorous and moderate-vigorous physical activity were lower.

Measurement of availability and accessibility of food among youth

Availability and accessibility of foods are regarded as important determinants of food choice and nutrition behavior, because it makes sense that people -children as well as adults- tend to eat what is easily available and accessible to them. To study the relevance of availability and accessibility, good, i.e. valid and reliable, measures of availability and accessibility are needed. In a paper just published in the International Journal of Behavioral Nutrition & Physical Activity, we present and discuss the results of a systematic review of the psychometric properties of measures of food availability and accessibility among youth. A secondary objective was to assess how availability and accessibility were conceptualized in the included studies.
We reviewed studies studies published between January 2010 and March 2016 that reported on at least one psychometric property of a measure of availability and/or accessibility of food among youth were included.
A total of 20 studies were included. While 16 studies included measures of food availability, three included measures of both availability and accessibility; one study included a measure of accessibility only. Different conceptualizations of availability and accessibility were used across the studies. The measures aimed at assessing availability and/or accessibility in the home environment, the school, stores, childcare/early care and education services and restaurants. Most studies followed systematic steps in the development of the measures. The most common psychometrics tested for these measures were test-retest reliability and criterion validity. The majority of the measures had satisfactory evidence of reliability and/or validity. None of the included studies assessed the responsiveness of the measures.

Screentime and soft drinks

Extensive sedentary time, i.e. (uninterrupted) sitting for too long, and especially sitting in from of TV's or other 'screens' have been associated with unfavorable cardiometabolic health. Apart from sitting too long itself, TV time may be accompanied by snacking and sugary drinks, which may lead to excess calorie intake, unnecessary weight gain, and eventually to overweight and obesity. In a study just published in the journal PLOS One we explored if children who spend more time sitting behind or before 'screens' TV, PC, tablet et cetera, i.e. 'screen-based sedentary behavior' drink more sugar-sweetened soft drinks. The study also assessed if such an association between screen-based sitting time and sugary drinks intakes differed according to level of education of the parents.
Data were collected from 7886 children participating in the EuropeaN Energy balance Research to prevent excessive weight Gain among Youth (ENERGY) survey conducted in eight European countries.
In six of the eight included countries, children who reported to watch more TV also reported to drink more soft drinks, but there was no significant association between computer use and soft drink consumption in six of the eight countries. In Norway and Hungary, the association between TV viewing and soft drinks was stronger for children from lower educated parents.

The DONE framework for determinants of nutrition and eating

The question of which factors drive human eating and nutrition is a key issue in many branches of science, and is of utmost importance to inform health promotion interventions and policies. In a paper just published in PLOS One, we describe the creation, evaluation, and updating of an interdisciplinary, interactive, and evolving “framework 2.0” of Determinants Of Nutrition and Eating (DONE). This endeavor was part of the DEDIPAC (determinants of diet and physical activity) joint action within the Healthy Diet, Healthy Life European joint programming initiative. A similar exercise was done and already published for sedentary behavior (the systems of sedentary behavior (SOS) framework). The DONE framework was created by an interdisciplinary workgroup in a multiphase, multimethod process. Modifiability, relationship strength, and population-level effect of the determinants were rated to identify areas of priority for research and interventions. External experts positively evaluated the usefulness, comprehensiveness, and quality of the DONE framework. An approach to continue updating the framework with the help of experts was piloted. The DONE framework can be freely accessed via the lead university for DONE, i.e. university of Konstanz in Germany,
and used in a highly flexible manner: determinants can be sorted, filtered and visualized for both very specific research questions as well as more general queries. The dynamic nature of the framework allows it to evolve as experts can continually add new determinants and ratings. We anticipate this framework will be useful for research prioritization and intervention development.

Built environment and cycling for transport in Europe

In a cross-sectional study just published in the journal Health & Place with Lieze Mertens from Ghent University as first author, we explored which observed built environmental factors were associated with cycling for transport among adults in five urban regions across Europe. This study was part of the SPOTLIGHT (sustainable prevention of obesity through integrated strategies) project, that The build environment was observed with a virtual neighbourhood audit tool using Google street view, that was specifically developed for this study. We further explored if the association of build
environment characteristics with cycling for transport depended on such factors as age, gender, socio-economic status and country/urban region. The results showed that people living in neighbourhoods with a preponderance of speed limits below 30 km/h, many bicycle lanes, with less traffic calming devices, and more trees; but also with more litter and parked cars on the road were more likely to cycle for transport than people living in areas with lower prevalence of these factors. The results suggest that reducing speed limits for motorized vehicles and the provision of more bicycle lanes may help to facilitate cycling for transport in urban regions across Europe. Hardly any evidence was found that the associations were different between men and women, or according to age or socio-economic status.

Exploring health education with midwives

In a study just published -with Ruth Baron as first author- in the journal Midwifery we explored the experiences, wishes and needs of pregnant women with respect to health education in primary care with midwives. We used qualitative semi-structured interviews, using thematic analysis and constant comparison. Twenty-two pregnant women in midwife-led primary care, varying in socio-demographic characteristics, weeks of pregnancy and region of residence in the Netherlands, were interviewed between April and December 2013.

The women considered midwives to be the designated health caregivers for providing prenatal health education, and generally appreciated the information they had received from their midwives. Some women, however, believed the amount of verbal health information was insufficient; others that there was too much written information. Many women still had questions and expressed uncertainties regarding various health issues, especially regarding weight gain, alcohol, and physical activity. Women felt that important qualities for midwives underlying health education, were making them feel at ease and building a relationship of trust with them.

Health education was highly appreciated by women in general, suggesting that midwives should err on the side of providing too much verbal information, as opposed to too little. A more pro-active approach with information provision may be of value not only to those with a clear desire for more information, but also to those who are unsure of what information they may be missing. As midwives are the principal health care providers throughout pregnancy,they should ideally emphasize their availability for questions between prenatal visits.