Predicting OptimaL cAncer RehabIlitation and Supportive care (POLARIS)

We just published in the journal Systematic Reviews -with Dr. Laurien Buffart as first author- the rationale and design for meta-analyses of individual patient data of randomized controlled trials that evaluate the effect of physical activity and psychosocial interventions on health-related quality of life in cancer survivors, i.e. the POLARIS study.

Because of better cancer treatments, we have more and more cancer http://www.polaris-study.orgsurvivors. Effective interventions to improve quality of life of these cancer survivors are essential. Numerous randomized controlled trials have evaluated the effects of physical activity or psychosocial interventions on health-related quality of life of cancer survivors, with generally small sample sizes and modest effects. Better targeted interventions may result in larger effects. To realize such targeted interventions, we must determine which interventions that are presently available work for which patients, and what the underlying working mechanisms are. Individual patient data meta-analysis has been described as the 'gold standard' of systematic review methodology. Instead of extracting aggregate data from study reports or from authors, the original research data are sought directly from the investigators. Individual patient data meta-analyses allow for adequate statistical analysis of intervention effects and moderators of such effects. In the paper we just published, we report the rationale and design of the Predicting OptimaL cAncer RehabIlitation and Supportive care (POLARIS) Consortium. The primary aim of POLARIS is 1) to conduct meta-analyses based on individual patient data to evaluate the effect of physical activity and psychosocial interventions on the health-related quality of life of cancer survivors; 2) to identify important demographic, clinical, personal, or intervention-related moderators of the effect; and 3) to build and validate clinical prediction models identifying the most relevant predictors of intervention success.

Who is more likely to smoke during pregnancy in the Netherlands?

Smoking during pregnancy is a risk factor for various adverse birth outcomes. In order to develop and target interventions to reduce smoking during pregnancy, insight is needed into the characteristics associated with pregnant women who smoke. In a study we just published in PLOS ONE with Ruth Baron as first author we looked at associations of thirteen socio-demographic or lifestyle-related characteristics with ‘any smoking’, ‘daily smoking’ and ‘occasional smoking’ during pregnancy. Our study sample was drawn from the DELIVER study, a cohort of 6107 pregnant women in primary care in the Netherlands who were up to 34 weeks pregnant. Characteristics most strongly associated with any smoking were low education, being of Turkish ethnicity and having no partner. Women of Dutch ethnicity were three times more likely to smoke than those from Dutch-speaking Caribbean countries and non-religious women were much more likely to smoke than religious women. Daily smokers were more likely to be associated with other unfavorable lifestyle-related characteristics, such as not taking folic acid, being underweight, and having had an unplanned pregnancy. There is still much potential for health gain with respect to smoking during pregnancy in the Netherlands. Daily and occasional smokers appear to differ in characteristics, and therefore possibly require different interventions.

Prof. Guus van Dongen writes about VUmc and the knowledge based economy

The Randstad region website presents a column by VU University medical center's professor Guus van Dongen, who build a case for a 'knowledge-based economy" and how our medical imaging center serves as an example. Please click here.

Can ethnic differences in children’s body composition be explained by differences in eating, physical activity, sedentary or sleeping?

In earlier research published in the journal Pediatric Obesity, we have found that -across Europe and in other affluent countries- children from non-native ethnicity are in general more likely to be overweight or obese, and to have unhealthy eating , physical activity and sleeping patterns than 'native' children. In further analyses just published in the journal PLOS One, with Juan Miguel Fernández-Alvira as first author, we explored if differences in eating, physical activity, sedentary and/or sleeping behaviors according to ethnic background can explain the ethnic differences in overweight and obesity. We conducted mediation analyses on the data of the ENERGY cross sectional study, a cross-European study among 10-12 year old schoolchildren and their parents across eight countries in Europe. For this study we used only data from the countries where ethnic differences in overweight and obesity were most prominent: Greece and the Netherlands. In these two country the ethnic differences were, however, in the opposite direction. As we published before in PLOS One, in Greece -the country with the highest prevalence of childhood overweight and obesity-, children from ethnic minorities are less likely to be overweight or obese than native Greek children. In the Netherlands -a country with relatively low prevalence of overweight and obesity-, ethnic minority children are more likely to be overweight or obese than native Dutch children. In the now published paper in the same journal, we show ethnic differences in children’s body composition were partially mediated by differences in breakfast skipping in the Netherlands and sugared drinks intake, sports participation and sleep duration in Greece.

Children's physical activity and sedentary time, home and neighborhood environments in urban and rural areas.

The environments children live in, their home as well as their school and neighborhood environments, are likely to influence what they do and do not do. A library of research now suggests that such environments influence children's physical activities and sedentary behaviors. How -via what kind of causal pathways- such influences come about, is, however, certainly not well researched and thus not clear. In a study just published online in the scientific journal Health and Place, first authored by Prof. Jo Salmon, Deakin University, Melbourne, we studied associations of home and neighbourhood READI) study, i.e. a cohort of women (aged 18–45 years) and their children (5–12 years). 613 children and their mothers participated. Urban children had higher screen time (i.e. TV and computer time) than rural children. In rural areas access to physical activity equipment in the home was higher, and mothers set better examples for their children regarding PA, had better knowledge of the neighborhood, a stronger social network, and reported higher safety than urban mothers.  Among urban children, the importance of doing PA together as a family was positively associated with ST. Interventions targeting PA and ST may need to target different factors according to urban/rural location.
environments with children's physical activity (PA), and sedentary time (ST). We also investigated if such associations were different for children living in urban vs. rural locations. Data were from the the Resilience for Eating and Activity Despite Inequality (

Obesity rates among pre-schoolers from low income families are declining in many states in the US

A 'vital signs'  report published by the US Centers of Disease Control and Prevention, published August 9, shows that in 18 out of 43 states or territories in the US obesity rates among 2-4 year olds from low income families, have declined significantly between 2008 and 2011. No change was observed in 20 states, while 3 states showed increased obesity rates. The results are based on measured height and weight from 11.6 million low-income children. In USA today, US experts say that the changes are small, but encouraging, because this is the first time in a generation that trends appear to be moving in the right direction.

Evidence-based physical activity guidelines for cancer survivors

Physical activity during and after cancer treatment has beneficial effects on a number of physical and psychosocial outcomes. In a paper that was just published in the journal Cancer Treatment Reviews, with Dr. Laurien Buffart as first author, we discuss the existing physical activity guidelines for cancer survivors and describe future research directions to optimize prescriptions for physical activity among cancer survivors.

Physical activity guidelines for cancer survivors suggest that physical activity should be an integral and continuous part of care for all cancer survivors. However, the development of these guidelines has been limited by the research conducted. To be able to develop more specific guidelines, future studies should focus on identifying clinical, personal, physical, psychosocial, and intervention moderators explaining ‘for whom’ or ‘under what circumstances’ interventions work. Further, more insight into the working mechanisms of exercise interventions on health outcomes in cancer survivors is needed to improve the efficacy and efficiency of interventions. Finally, existing programs should embrace interests and preferences of patients to facilitate optimal uptake of interventions. In conclusion, current physical activity guidelines for cancer survivors are generic, and research is needed to develop more personalized physical activity guidelines. In an ongoing project called POLARIS (Predicting OptimaL cAncer RehabIlitation and Supportive care) we are using existing data from many countries in individual patient data meta analyses to inform better tailored and targeted recommendations for cancer survivors.