Serum proteomics reveals hemophagocytic lymphohistiocytosis-like phenotype in a subset of patients with multisystem inflammatory syndrome in children.

Children with Multisystem Inflammatory Syndrome in Children (MIS-C) can present with thrombocytopenia, which is a key feature of hemophagocytic lymphohistiocytosis (HLH). We hypothesized that thrombocytopenic MIS-C patients have more features of HLH. Clinical characteristics and routine laboratory parameters were collected from 228 MIS-C patients, of whom 85 (37%) were thrombocytopenic. Thrombocytopenic patients had increased ferritin levels; reduced leukocyte subsets; and elevated levels of ASAT and ALAT. Soluble IL-2RA was higher in thrombocytopenic children than in non-thrombocytopenic children. T-cell activation, TNF-alpha and IFN-gamma signaling markers were inversely correlated with thrombocyte levels, consistent with a more pronounced cytokine storm syndrome. Thrombocytopenia was not associated with severity of MIS-C and no pathogenic variants were identified in HLH-related genes. This suggests that thrombocytopenia in MIS-C is not a feature of a more severe disease phenotype, but the consequence of a distinct hyperinflammatory immunopathological process in a subset of children.

Parents' and Children's Experiences with a Coordinating Professional in Integrated Care for Childhood Overweight and Obesity-A Novel Dutch Approach.

BACKGROUND: In the new integrated program of care for childhood overweight and obesity (ICCO), a Youth Health Care (YHC) nurse has the role of a coordinating professional. After a broad assessment of strengths and weaknesses in the family setting, this coordinating professional makes a plan of action with the child and parents and involves other professionals when needed. The aim of this study was to explore the experiences of parents and children with the coordinating professional in the ICCO. MATERIAL & METHODS: Semi-structured interviews were conducted with eight families. Interview data were analyzed using content analysis. In addition, descriptive data on involved professionals and referrals was collected with an online questionnaire in 38 families. RESULTS: In total, eight families (8 mothers, 2 fathers, four boys and three girls aged 10-12 yrs) were interviewed and 38 children and parents filled in (three consecutive) online questionnaires. FINDINGS: The main themes related to the experiences of parents and children with the CP: parents and children felt supported and understood by the coordinating professional. They appreciated the broad perspective and personal approach. Contacts with the coordinating professional were not always frequent. Major points of improvement concerned the intensity of the follow-up and collaboration. Only few parents experienced collaboration between the coordinating professional and other professionals in the ICCO. CONCLUSIONS: Parents and children appreciated the personal approach of the Youth Health Care nurse as a CP. The role of the coordinating professional, however, appears not fully implemented yet. Strengthening the promising role of the coordinating professional in the ICCO is recommended.

Sedentary behaviour in cardiovascular disease patients: Risk group identification and the impact of cardiac rehabilitation.

BACKGROUND: Sedentary behaviour (SB) is potentially an important target to improve cardiovascular health. This study 1) compared SB between cardiovascular disease (CVD) patients and age-matched controls, 2) identified characteristics associated with high SB levels, and 3) determined the impact of contemporary cardiac rehabilitation (CR) on SB. METHODS: For objective 1, we recruited 131 CVD patients and 117 controls. All participants were asked about their general characteristics and medical history. SB was assessed by an objective accelerometer (activPAL3 micro). For objective 2, 2584 CVD patients were asked to fill in a questionnaire about their general characteristics, lifestyle, medical history and their SB. For objective 3, 131 CVD patients were followed over time and measured, pre-, directly post- and 2 months post-CR. RESULTS: Objective 1. CVD patients spent 10.4 h/day (Q25 9.5; Q75 11.2) sedentary which was higher compared to healthy controls (9.4 h/day [Q25 8.4; Q75 10.29]). Objective 2. CVD patients being male, single or divorced, employed, physically inactive, reporting high alcohol consumption, living in an urban environment, having comorbidities and cardiac anxiety demonstrated a greater odds for large amounts of SB. Objective 3. The CR program significantly reduced sedentary time (-0.4 h/day [95%CI -0.7; -0.1]), which remained lower at 2-months post-CR (-0.3 h/day [95%CI -0.6; -0.03]). CONCLUSIONS: CVD patients had greater amounts of objectively measured sedentary time compared to healthy controls. Sedentarism was associated with personal- and lifestyle characteristics, and comorbidities. Participation in a contemporary CR program slightly reduced sedentary time, but tailored interventions are needed to target SB in CVD patients.

The evaluation of an integrated network approach of preventive care for children with overweight and obesity; study protocol for an implementation and effectiveness study.

BACKGROUND: Children with overweight often do not receive appropriate integrated care. An innovative integrated network approach of preventive care for overweight children aged 4-12 years old has been developed and implemented in four neighbourhoods of 's-Hertogenbosch, The Netherlands. This new approach focusses on self-management of the family and is based on the principles of stepped and matched care. Youth health care (YHC) nurses support the families in their new role as central care providers. The aim of this study is to evaluate the implementation and effectiveness of this network approach. METHODS: The implementation of the new approach (reach, functioning of the central care provider, network functioning and patient satisfaction) is assessed by interviews and checklists with professionals and parents of 4-12 year old overweight or obese children. To evaluate effectiveness, we aim to compare 120 overweight or obese children in 's-Hertogenbosch with 60 overweight or obese children outside 's-Hertogenbosch during one year of YHC involvement. Quality of life, psychosocial problems of the child and parental empowerment are the main outcomes of the effectiveness study. Outcomes are measured with digital questionnaires at inclusion, at three months and one year after inclusion. BMI measurements and referrals are distracted from medical files. DISCUSSION: Integrated care for overweight and obese children is high on the agenda of many municipalities in The Netherlands. The new approach is expected to have beneficial effects for overweight children, their parents and professionals. With the results of this study, we can optimize the support for overweight and obese children and their parents. The first results are expected to be available in 2019. TRIAL REGISTRATION: This study is registered in the Dutch Trial Register on 10 November 2017 (NTR number NTR6813). https://www.trialregister.nl/trial/6596 Word count: 281 (max 350).

Implementation of a guideline for local health policy making by regional health services: exploring determinants of use by a web survey.

BACKGROUND: Previous evaluation showed insufficient use of a national guideline for integrated local health policy by Regional Health Services (RHS) in the Netherlands. The guideline focuses on five health topics and includes five checklists to support integrated municipal health policies. This study explores the determinants of guideline use by regional Dutch health professionals. METHODS: A web survey was send to 304 RHS health professionals. The questionnaire was based on a theory- and research-based framework of determinants of public health innovations. Main outcomes were guideline use and completeness of use, defined as the number of health topics and checklists used. Associations between determinants and (completeness of) guideline use were explored by multivariate regression models. RESULTS: The survey was started by 120 professionals (39%). Finally, results from 73 respondents (24%) were eligible for analyses. All 28 Dutch RHS organizations were represented in the final dataset. About half of the respondents (48%) used the guideline. The average score for completeness of use (potential range 1-10) was 2.37 (sd = 1.78; range 1-7). Knowledge, perceived task responsibility and usability were significantly related to guideline use in univariate analyses. Only usability remained significant in the multivariate model on guideline use. Only self-efficacy accounted for significant proportions of variance in completeness of use. CONCLUSIONS: The results imply that strategies to improve guideline use by RHSs should primarily target perceived usability. Self-efficacy appeared the primary target for improving completeness of guideline use. Methods for targeting these determinants in RHSs are discussed.

Impact of Cross-Sectoral Alcohol Policy on Youth Alcohol Consumption.

OBJECTIVE: Cross-sectoral alcohol policy is recommended to reduce youth alcohol consumption, but little evidence is available on its effectiveness. Therefore, we examined whether regions and municipalities in the Dutch province of Noord-Brabant with stronger cross-sectoral alcohol policy showed larger reductions in alcohol consumption among adolescents aged 12-15. METHOD: Strong regional cross-sectoral alcohol policy was defined as participation in a regional alcohol prevention program. Strong municipal cross-sectoral alcohol policy was operationalized by measures on (a) sector variety: involvement of different policy sectors, and (b) strategy variety: formulation of different policy strategies. Relevant data from policy documents were searched for on the Internet. Data on trends in alcohol consumption were extracted from the 2007 and 2011 cross-sectional Youth Health Monitor that includes a random subset of adolescents aged 12-15 (n = 15,380 in 2007 and n = 15,437 in 2011). We used multilevel regression models. RESULTS: Two of the three regions in which municipalities participated in a regional alcohol prevention program showed a larger reduction in weekly drinking than the region in which municipalities did not participate (-12.2% and -13.4% vs. -8.3%). Municipalities with strong compared to weak sector variety showed a larger increase in adolescents' age at consuming their first alcoholic drink (0.63 vs. 0.42 years). Municipalities with strong strategy variety showed a decrease (-3.8%) in heavy weekly drinking, whereas those with weak variety showed an increase (5.1%). Cross-sectoral alcohol policy did not affect trends in other alcohol outcomes. CONCLUSIONS: Our results suggest that strong cross-sectoral alcohol policy may contribute to reducing some aspects of youth alcohol consumption. Monitoring policy implementation is needed to assess the full impact.

Mechanical Reversibility of Strain-Promoted Azide-Alkyne Cycloaddition Reactions.

Mechanophores, that is, molecules that show a defined response to force, are crucial building blocks of mechanoresponsive materials. The possibility of mechanically induced cycloreversion for a series of triazoles formed via strain-promoted azide-alkyne cycloaddition reactions was investigated by density functional theory calculations, and these triazoles were compared to the 1,4- and 1,5-regioisomers formed in the reaction of an azide with a terminal alkyne. We show that cycloreversion is in principal possible and that the pulling geometry is the most important parameter that determines the probability of cycloreversion. We further compared triazole stability to the mechanical stability of polymers that are frequently used as force transducers in mechanochemical experiments and identified DIBAC (azadibenzylcyclooctyne) as a promising mechanophore for future applications.

Habitual physical activity behavior of patients after primary total hip arthroplasty.

BACKGROUND AND PURPOSE: Despite recognized health benefits of physical activity, little is known about the habitual physical activity behavior of patients after total hip arthroplasty (THA). The purpose of this study was to analyze this behavior and the fulfillment of guidelines for health-enhancing physical activity of these patients compared with a normative population. SUBJECTS AND METHODS: The participants were 273 patients who had undergone a primary THA (minimum of 1 year postoperatively). Comparisons were made between this group and 273 age- and sex-matched individuals from a normative population. Comparisons also were made between participants with THA under 65 years of age and those 65 years of age and older and among participants with THA in different Charnley classes. Level of physical activity was assessed with the Short QUestionnaire to ASsess Health-enhancing physical activity (SQUASH). RESULTS: No significant differences in total amount of physical activity or time spent in different categories of physical activity were found between the THA group and the normative group. Participants with THA spent significantly more minutes in activities of moderate intensity compared with the normative group. Participants with THA who were under 65 years of age were significantly more active than older participants with THA. Charnley class had significant effects on time spent at work, time spent in moderate-intensity activities, and total amount of activity, with the least activity performed by participants in Charnley class C. The guidelines were met by 51.2% of the participants with THA and 48.8% of the normative population. Female participants met the guidelines less frequently than male participants in both the combined groups (odds ratio=0.50, 95% confidence interval=0.35-0.72, P<.001) and the THA group (odds ratio=0.48, 95% confidence interval=0.28-0.80, P=.001). DISCUSSION AND CONCLUSION: The results suggest that patients after THA are at least as physically active as a normative population. Nevertheless, a large percentage of these patients do not meet the guidelines; therefore, they need to be stimulated to become more physically active.

Survival into seventh decade after a potts palliation for tetralogy of Fallot.

In this case report we present a 62-year-old patient with unrepaired tetralogy of Fallot who underwent a Potts shunt for palliation. Survival into late adulthood of patients with unoperated tetralogy of Fallot is rare. This patient is currently in New York Heart Association (NYHA) class II. A Potts shunt is associated with severe complications due to pulmonary vascular disease. To our knowledge, this is the first case report on a patient who survived into late adulthood with minor symptoms due to balanced hemodynamics after a Potts shunt.

Combining risk estimates from observational studies with different exposure cutpoints: a meta-analysis on body mass index and diabetes type 2.

Studies on a dose-response relation often report separate relative risks for several risk classes compared with a referent class. When performing a meta-analysis of such studies, one has to convert these relative risks into an overall relative risk for a continuous effect. Apart from taking the dependence between separate relative risks into account, this implies assigning an exposure level to each risk factor class and allowing for the nonlinearity of the dose-response relation. The authors describe a relatively simple method solving these problems. As an illustration, they applied this method in a meta-analysis of the association between body mass index and diabetes type 2, restricted to results of follow-up studies (n=31). Results were compared with a more ad hoc method of assigning exposure levels and with a method in which the nonlinearity of the dose-response method was not taken into account. Differences with the ad hoc method were larger in studies with fewer categories. Not incorporating the nonlinearity of the dose response leads to an overestimation of the pooled relative risk, but this bias is relatively small.