Breakfast habits partly mediate differences in overweight according to SES and ethnicity

The purpose of a study just published online in Public Health Nutrition -with Dr. Yannis Manios as first author- was to investigate the associations of parental education, employment, and ethnicity with children's weight status and whether children's breakfast habits mediated differences in overweigh/obesity according to parental education and ethnicity.

As part of the ENERGY study, school-based survey among 10-12-year-old children was conducted in eight European countries. Children's weight and height were measured and breakfast habits and family sociodemographic characteristics were self-reported by 5444 children and their parents. International Obesity Task Force cut-off points were used to categorize children as overweight/obese or normal weight. Mediation analyses were used to test the potential mediating effect of children's breakfast consumption on the associations between family sociodemographic characteristics and children's overweight/obesity.
Children's reported daily breakfast consumption varied from 56 % in Slovenia to 92 % in Spain on weekdays and from 79 % in Greece to 93 % in Norway on weekends. Children of 'native' parents (i.e. parents that were born in the country of questionnaire administration), with both parents employed and with at least one parent having more than 14 years of education were more likely to consume breakfast daily and less likely to be overweight/obese. Mediation analyses revealed that the association of parental nationality and parental educational status with children's overweight/obesity was partially mediated by children's daily breakfast consumption.

Parents and friends both matter for schoolchildren's physical activity and diet

The family, and parents in particular, are considered the most important influencers regarding children's energy-balance related behaviours (EBRBs, i.e. physical activity, sedentary and eating behaviours). When children become older and gain more behavioural autonomy regarding different behaviours, the parental influences may become less important and peer influences may gain importance. In a study just published in the International Journal of Behavioral Nutrition and Physical Activity, we investigated simultaneous and interactive associations of family rules, parent and friend norms and parent and friend modelling with soft drink intake, TV viewing, daily breakfast consumption and sport participation among schoolchildren across Europe. We used the data from the ENERGY cross sectional study. Dr. Saskia te Velde is first author on this paper.
Children reported more unfavourable friend norms and modelling regarding soft drink intake and TV viewing, while they reported more favourable friend and parental norms and modelling for breakfast consumption and physical activity. Perceived friend and parental norms and modelling were significantly positively associated with soft drink intake, breakfast consumption, physical activity and TV time. Across the different behaviours, ten significant interactions between parental and friend influencing variables were found and suggested a weaker association of friend norms and modelling when parental rules were in place.
In conclusion: parental and friends norm and modelling are associated with schoolchildren's energy balance-related behaviours. Having family rules and  favourable parental modelling and norms seems to reduce the potential unfavourable influences of friends on EBRBs.

Increases in BMI, waist circumference and skin folds in Dutch teenagers between 2003 and 2011

In a paper just published in the journal Pediatric Obesity we compared anthropometrics of 12- to 14-year-old Dutch adolescents attending lower levels of education in 2011 with adolescents measured in 2003. Femke van Nassau is first author on this paper. We measured adolescents' body height and weight, skin-fold thickness, and waist circumference in 2003 among 1000 youngsters and in 2011 among 1898.
In boys, prevalence of overweight, waist circumference, triceps, biceps and subscapular skin-folds were significantly higher in 2011. This was also true for girls, except for the subscapular skin-fold. These data confirm that -despite the fact that Dutch youngsters are less likely to be overweight than in many other countries - Dutch adolescents have been getting bigger and fatter.

Determinants of exercise adherence and maintenance among cancer survivors: a systematic review

There is better and better evidence that exercise and physical activity is of utmost importance for health and quality of life for cancer survivors. Special exercise and physical activity-based cancer rehabilitation programs are therefore developed, tested and implemented. For such an exercise intervention to be successful, it is -evidently- important that cancer survivors adhere to the prescribed program. To be able to improve adherence and thus the effects of cancer rehabilitation, insights into the factors that may determine adherence to such programs is important. In a paper just published in the International Journal of Behavioral Nutrition and Physical Activity -with Caroline Kampshoff as first author- we aimed to systematically review determinants of exercise adherence and maintenance in cancer survivors. This review was part of the A-CaRe (Alpe D'Huzes Cancer Rehabilitation) research program Eighteen studies were reviewed in which a range of potential determinants of adherence were studied, but only very few of these potential determinants were supported by the available evidence. We found moderate evidence for a positive association between exercise history and exercise adherence, i.e. that patients who already were physically active before becoming a cancer patient, were more likely to adhere to exercise programs. Inconsistent findings were found for age, gender and education as well as for psychological factors such as stage of change, perceived behavioral control, self-efficacy, extraversion, attitude, intention, fatigue, and quality of life, and physical factors including cardiovascular fitness, body mass index, and baseline physical activity.

Interactive-Technology Health Behavior Promotion Program for Heart Failure Patients

In a paper just published in Journal of Medical Internet Research -Research Protocols- (with Rony Calo as first author), we describe a pilot study to explore the use of interactive technology to promote heart failure (HF) patients’ engagement in physical activity (PA) and adherence to medication. This IT-based interventions, called Motivate4Change, is a program for delivery in the hospital setting, and the development was guided by the Intervention Mapping protocol. The study is a collaboration between researchers from the EMGO Institute for Health & Care Research and Philips Research.

We used observations at a hospital in the United Kingdom and semistructured interviews with hospitalized HF patients and HF nurses following their completion of Motivate4Change. Results demonstrated that patient needs included empathic and contextual content, interactive learning, and support from others, including nurses and family members. The nurse needs included integration in current educational practices and finding opportunities for provision of the program.

Schoolchildren from lower educated parents and minority groups have less positive home environments and believes regarding energy balance behaviours

To explore differences in personal and home environmental factors that are regarded as determinants of energy balance-related behaviours (i.e. physical activity, sedentary and dietary behaviours; EBRBs) according to parental education and ethnic background among 10-12 year old schoolchildren across Europe, the data from the cross sectional study of the ENERGY project were analysed (also see the ENERGY website). The results of these analyses were just published in BMC Public Health.
A school-based survey among 10-12 year olds was conducted in eight countries across Europe. A range of personal and home environment variables relevant for soft drink consumption, daily breakfast, sport participation and TV time was assessed by means of child report. Personal factors included attitude, health beliefs, and preference/liking. Home environment factors included parental subjective norm, modeling, support, practices and home availability. Children were classified based on parental education (i.e., low vs. high) and ethnic background (i.e., native vs. non-native). Data from 6018 children in the eight countries were included in the analyses.
Our analyses analyses showed that the majority of the variables tested -and especially home environment variables- were more favorable among children from higher educated parents and from native ethnicity. None of the personal and home environment factors was found to be more favorable among children from lower educated parents or non-native ethnicity.

hand hygiene promotion contributes to a reduced infection rate among very low-birth weight infants

Hand hygiene in hospital settings is needed to reduce hospital infections. Adequate hand hygiene is seen as the most important intervention to prevent nosocomial infections. Compliance with hand hygiene protocols needs continuous promotion and facilitation. In a paper just published in the American Journal of Infection Control, with Dr. Onno Helder as first author, we describe a study of the effectiveness of sequential hand hygiene promotion among hospital workers in an intensive care unit in a children's hospital.
We conducted an observational study with an interrupted time series analysis of the occurrence of nosocomial bloodstream infections (NBSIs) among very low-birth weight (VLBW) infants. Interventions consisted of an education program, gain-framed (i.e. the positive effects of hand hygiene was communicated) screen saver messages, and an infection prevention week with an introduction on consistent glove use.
Almost 2,000 VLBW infants were studied admitted between 2002 and  2011. The proportion of infants with ≥1 NBSI decreased from 47.6%-21.2%; the number of NBSIs per 1,000 patient days decreased from 16.8-8.9. Pre-
intervention, the number of NBSIs significantly increased, while after the first intervention a significantly declining trend in NBSIs was observed, which stayed at this lower level during the sequential interventions.
We concluded that continuous sequential hand hygiene promotion contributes to a sustained low NBSI rate.