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.