BackgroundObservational studies in humans have reported a link between schistosome infection and lower adiposity, but this may be explained by socioeconomic and demographic factors, intensity of... Show moreBackgroundObservational studies in humans have reported a link between schistosome infection and lower adiposity, but this may be explained by socioeconomic and demographic factors, intensity of infection, or common co-infections such as HIV. MethodsThis was a cross-sectional study that investigated the relationship between schistosome infection and adiposity in a large, well-described cohort of Tanzanian adults living with and without HIV. Cross-sectional data were collected among adults living in Mwanza, Tanzania who were enrolled in the Chronic Infections, Co-morbidities and Diabetes in Africa (CICADA) cohort study. Schistosome circulating anodic antigen, secreted by both Schistosoma mansoni and haematobium which are endemic to Tanzania, was quantified from stored samples. Schistosome infection diagnosed by serum circulating anodic antigen levels. The primary outcome was fat mass measured by bioimpedance analysis. Secondary outcomes included fat-free mass, waist circumference, mid-upper arm circumference, and body mass index. ResultsThe study enrolled 1,947 adults, of whom 1,923 (98.8%) had serum available for schistosome testing. Of these, 873 (45.4%) had a serum circulating anodic antigen >= 30 pg/mL, indicating schistosome infection. Compared to uninfected individuals, those with schistosome infections had -1.1 kg [95% CI -1.9 to -0.3] lower fat mass after adjusting for age, sex, physical activity, tobacco use, education level, and socioeconomic status. Infected participants also had lower waist circumference, mid-upper arm circumference, and body mass index. Fat-free mass was not different between the two groups. Neither being HIV-infected, nor receiving antiretroviral therapy, modified associations between schistosome infection and adiposity. These associations were also not affected by Schistosoma worm burden. ConclusionsSchistosome infection was associated with lower fat mass and less central adiposity without a difference in muscle mass, irrespective of confounders, HIV status, or the intensity of schistosome infection. Future studies should adjust for socioeconomic and demographic factors that are associated with schistosome infection and adiposity. Identifying mechanistic pathways by which schistosome infection reduces adiposity while preserving muscle mass could yield new strategies for obesity control and cardiovascular disease prevention. Show less
Larsen, J.K.; Karssen, L.T.; Veek, S.M.C. van der 2022
BackgroundSocial distancing has been implemented by many countries to curb the COVID-19 pandemic. Understanding public support for this policy calls for effective and efficient methods of... Show moreBackgroundSocial distancing has been implemented by many countries to curb the COVID-19 pandemic. Understanding public support for this policy calls for effective and efficient methods of monitoring public opinion on social distancing. Twitter analysis has been suggested as a cheaper and faster-responding alternative to traditional survey methods. The current empirical evidence is mixed in terms of the correspondence between the two methods. ObjectiveWe aim to compare the two methods in the context of monitoring the Dutch public's opinion on social distancing. For this comparison, we quantified the temporal and spatial variations in public opinion and their sensitivities to critical events using data from both Dutch Twitter users and respondents from a longitudinal survey. MethodsA longitudinal survey on a representative Dutch sample (n = 1,200) was conducted between July and November 2020 to measure opinions on social distancing weekly. From the same period, near 100,000 Dutch tweets were categorized as supporting or rejecting social distancing based on a model trained with annotated data. Average stances for the 12 Dutch provinces and over the 20 weeks were computed from the two data sources and were compared through visualizations and statistical analyses. ResultsBoth data sources suggested strong support for social distancing, but public opinion was much more varied among tweets than survey responses. Both data sources showed an increase in public support for social distancing over time, and a strong temporal correspondence between them was found for most of the provinces. In addition, the survey but not Twitter data revealed structured differences among the 12 provinces, while the two data sources did not correspond much spatially. Finally, stances estimated from tweets were more sensitive to critical events happened during the study period. ConclusionsOur findings indicate consistencies between Twitter data analysis and survey methods in describing the overall stance on social distancing and temporal trends. The lack of spatial correspondence may imply limitations in the data collections and calls for surveys with larger regional samples. For public health management, Twitter analysis can be used to complement survey methods, especially for capturing public's reactivities to critical events amid the current pandemic. Show less
Anastasaki, M.; Bree, E.M. van; Brakema, E.A.; Tsiligianni, I.; Sifaki-Pistolla, D.; Chatzea, V.E.; ... ; Lionis, C. 2022
BackgroundThe global burden of chronic respiratory diseases (CRDs) disproportionally affects Roma populations. Health interventions addressing CRD among Roma or other vulnerable groups often fail... Show moreBackgroundThe global burden of chronic respiratory diseases (CRDs) disproportionally affects Roma populations. Health interventions addressing CRD among Roma or other vulnerable groups often fail to be effective, as their implementation strategy misaligns with the local context. To design context-driven strategies, we studied CRD-related beliefs, perceptions, and behaviors among a Greek Roma population, focussing on asthma and COPD. MethodsFor this qualitative study in Crete, Greece, we used a Rapid Assessment Process. We conducted interviews and focus groups with purposively selected Roma community members (CMs), key informants (KIs) and healthcare professionals (HPs) serving the population. Data were triangulated using observations of households and clinical consultations. Key themes were identified using Thematic Content Analysis. The Health Belief Model, the Explanatory Model of Illness, and the Theory of Planned Behavior that are complementary is some aspects, guided our methodology with the several variables from them to be integrated to better understand CRD risk preventative behavior. ResultsWe conducted six focus groups, seven interviews and 13 observations among 15 CMs, four KIs, and three HPs. Five themes emerged: (1) Poor CRD-awareness (smoking and household air pollution were perceived as harmful, but almost exclusively associated with acute rather than chronic symptoms); (2) Low perceived susceptibility to CRD (and CMs tended to ignore respiratory symptoms); (3) High risk exposure (smoking was common, and air pollution was perceived inevitable due to financial constraints); (4) Healthcare seeking (healthcare was sought only for persistent, severe symptoms, daily needs were a priority); (5) Perceived barriers/facilitators to care (health illiteracy, perceived discrimination and financial constraints were main barriers; established trust the main facilitator). ConclusionThese five themes highlight that strategies to tackle CRD in the studied Roma setting require a multilevel approach: bridging awareness gaps at the population level, providing resources to enhance the adoption of healthy behaviors, and fighting discrimination at the societal level, whilst establishing trusted relationships at the local level. Similar methodologies to address local context may strengthen the implementation of effective interventions for similarly vulnerable and/or low-resource populations. Show less
Smagge, B.A.; Velde, L.A. van der; Kiefte-de Jong, J.C. 2022
In the Netherlands, the neighbourhood food environment has received little attention in initiatives to combat overweight/obesity. This study maps the food environment around primary schools in The... Show moreIn the Netherlands, the neighbourhood food environment has received little attention in initiatives to combat overweight/obesity. This study maps the food environment around primary schools in The Hague, The Netherlands, and examines associations between neighbourhood disadvantage, the school food environment and childhood overweight using Geographic Information Systems (GIS). Linear regression analyses were performed to test the association between schools' disadvantage scores (proxy for neighbourhood disadvantage) and relative fast-food density within 400 m and 1000 m and fast-food proximity. Univariable and multivariable linear regression analyses were used to test the association between the school food environment and overweight prevalence among children in the respective sub-district in which the schools is found. Multivariable analyses were adjusted for the schools' disadvantage scores. Results show that fast-food outlets were available around most primary schools. Schools in disadvantaged neighbourhoods were closer to and surrounded by a higher number of fast-food restaurants, grillrooms and kebab shops. On the sub-district level, the density of such fast-food outlets was associated with overweight prevalence among children. These findings highlight the importance of national and local policies to improve the food environment, particularly in disadvantaged neighbourhoods. Show less
Azizi, B.; Tilburgs, B.; Hout, H.P.J. van; Heide, I. van der; Verheij, R.A.; Achterberg, W.P.; ... ; Joling, K.J. 2022
Background: Advance care planning (ACP) is a process of communication in which patients and family caregivers discuss preferences for future care with the healthcare team. For persons with dementia... Show moreBackground: Advance care planning (ACP) is a process of communication in which patients and family caregivers discuss preferences for future care with the healthcare team. For persons with dementia, it is crucial to timely engage in ACP. Therefore, we study ACP in dementia using electronic health record data. This study aims to determine how often ACP conversations are recorded, analyze time from dementia diagnosis until the first recorded conversation and time from the first recorded conversation to death, and analyze which factors are associated with the timing of ACP. Methods: Electronic records of 15,493 persons with dementia in Dutch general practice between 2008 and 2016 were linked to national administrative databases. ACP conversations and indicators of health deficits to determine frailty were obtained from electronic records coded with the International Classification of Primary Care. Socio-demographic characteristics were derived from the national population registry managed by Statistics Netherlands. Date of death was derived from the Personal Records Database (2008-2018). Results: ACP was recorded as such as 22 (95% CI, 20-23) first conversations per 1,000 person-years of follow-up. The hazard ratio (HR) for the first conversation increased every year after dementia diagnosis, from 0.01 in the first year to 0.07 in the 7th and 8th year after diagnosis. Median time from a first conversation to death was 2.57 years (95% CI, 2.31-2.82). Migrant status [non-Western vs. Western (HR 0.31, 95% CI, 0.15-0.65)] was significantly associated with a longer time from dementia diagnosis to the first conversation. Being pre-frail (HR 2.06, 95% CI, 1.58-2.69) or frail (HR 1.40, 95% CI, 1.13-1.73) vs. non-frail was significantly associated with a shorter time from dementia diagnosis to the first ACP conversation. Conclusion: ACP conversations in Dutch general practice were rare for persons with dementia, or was rarely recorded as such. In particular among persons with a non-Western migration background and those who are non-frail, it started long after diagnosis. We advise further research into public health and practical strategies to engage persons with dementia with a non-Western migration background and non-frail persons early in the disease trajectory in ACP. Show less
Crone, M.R.; Slagboom, M.N.; Overmars, A.; Starken, L.; Sande, M.C.E. van de; Wesdorp, N.; Reis, R. 2021
Prevention programs often are directed at either parents or children separately, thereby ignoring the intergenerational aspect of health and well-being. Engaging the family is likely to improve... Show morePrevention programs often are directed at either parents or children separately, thereby ignoring the intergenerational aspect of health and well-being. Engaging the family is likely to improve both the uptake and long-term impact of health behavior change. We integrated an intergenerational approach into a frequently used shared assessment tool for children's care needs. The current study's aim was 2-fold: to monitor this family-engagement tool's effects on both children and their parents' health behaviors and well-being, and to examine the different dynamics of health behavioral change within a family.Method: We followed 12 children ages 10-14 years and their parents for 12 weeks using an explanatory mixed-methods design comprising interviews, questionnaires, and an n-of-1 study. During home visits at the beginning and end of the study, we interviewed children and their parents about their expectations and experiences, and measured their height and weight. Furthermore, we collected secondary data, such as notes from phone and email conversations with parents, as well as evaluation forms from professionals. In the n-of-1 study, families were prompted three times a week to describe their day and report on their vegetable intake, minutes of exercise, health behavior goals, and psychosomatic well-being. The interviews, notes, and evaluation forms were analyzed using qualitative content analyses. For the n-of-1 study, we performed multi-level time-series analyses across all families to assess changes in outcomes after consulting the family-engagement tool. Using regression analyses with autocorrelation correction, we examined changes within individual families.Results: Five child-mother dyads and three child-mother-father triads provided sufficient pre- and post-data. The mean minutes of children's physical activity significantly increased, and mothers felt more energetic, but other outcomes did not change. In consultations related to overweight, the family-engagement tool often was used without setting specific or family goals.Conclusions: The family-engagement approach elicited positive effects on some families' health and well-being. For multifaceted health problems, such as obesity, family-engagement approaches should focus on setting specific goals and strategies in different life domains, and for different family members. Show less
Koposov, R.; Isaksson, J.; Vermeiren, R.; Schwab-Stone, M.; Stickley, A.; Ruchkin, V. 2021
Background: Many children and adolescents experience violent events which can be associated with negative consequences for their development, mental health, school, and social functioning. However,... Show moreBackground: Many children and adolescents experience violent events which can be associated with negative consequences for their development, mental health, school, and social functioning. However, findings between settings and on the role of gender have been inconsistent. This study aimed to investigate cross-country and gender differences in the relationship between community violence exposure (CVE) and school functioning in a sample of youths from three countries. Methods: A self-report survey was conducted among school students (12-17 years old) in Belgium (Antwerp, N = 4,743), Russia (Arkhangelsk, N = 2,823), and the US (New Haven, N = 4,101). Students were recruited from within classes that were randomly selected from within schools that had themselves been randomly selected (excepting New Haven, where all students were included). CVE was assessed with the Screening Survey of Exposure to Community Violence. School functioning was assessed with four measures: the Perceived Teacher Support scale, Negative Classroom Environment scale, and Academic Motivation and Perception of Safety at School scales. Multivariate Analyses of Covariance were performed to assess differences in the levels of school-related problem behaviors in boys and girls, who reported different degrees of CVE. Results: Participants in all three countries reported a relatively high prevalence of violence exposure (36.2% in Belgium, 39.3% in Russia and 45.2% in the US who witnessed violence), with a higher proportion of girls than boys witnessing violent events (varied from 37.4 to 51.6% between the countries), whereas boys reported more episodes of victimization by violence than girls (varied from 32.3 to 49.9% between the countries). Youths who experienced increased CVE (from no exposure to witnessing to victimization) reported an increase in all school functioning problems in all of the countries and this association was not gender-specific. Conclusions: Our findings suggest that regardless of differences in the level of CVE by country and gender, violence exposure is negatively associated with school functioning across countries. Nonetheless, even though reactions to community violence among adolescents may be expressed in a similar fashion, cross-country differences in social support systems should also be taken into account in order to provide culturally sensitive treatment modalities. Show less
Background and Objectives: Early identification of child mental health problems (MHPs) is important to provide adequate, timely treatment. Dutch preventive youth healthcare monitors all aspects of... Show moreBackground and Objectives: Early identification of child mental health problems (MHPs) is important to provide adequate, timely treatment. Dutch preventive youth healthcare monitors all aspects of a child's healthy development. We explored the usefulness of their electronic health records (EHRs) in scientific research and aimed to develop prediction models for child MHPs.Methods: Population-based cohort study with anonymously extracted electronic healthcare data from preventive youth healthcare centers in the Leiden area, the Netherlands, from the period 2005-2015. Data was analyzed with respect to its continuity, percentage of cases and completeness. Logistic regression analyses were conducted to develop prediction models for the risk of a first recorded concern for MHPs in the next scheduled visit at age 3/4, 5/6, 10/11, and 13/14 years.Results: We included 26,492 children. The continuity of the data was low and the number of concerns for MHPs varied greatly. A large number of determinants had missing data for over 80% of the children. The discriminatory performance of the prediction models were poor.Conclusions: This is the first study exploring the usefulness of EHRs from Dutch preventive youth healthcare in research, especially in predicting child MHPs. We found the usefulness of the data to be limited and the performance of the developed prediction models was poor. When data quality can be improved, e.g., by facilitating accurate recording, or by data enrichment from other available sources, the analysis of EHRs might be helpful for better identification of child MHPs. Show less
