Publications by authors named "Sijmen A Reijneveld"

376 Publications

Using photos of basic facial expressions as a new approach to measuring implicit attitudes.

PLoS One 2021 13;16(5):e0250922. Epub 2021 May 13.

Department of Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

Background: Measuring implicit attitudes is difficult due to social desirability (SD). A new method, the Emotion Based Approach (EBA), can solve this by using emotions from a display of faces as response categories. We applied this on an EBA Spirituality tool (EBA-SPT) and an Actual Situation tool (EBA-AST). Our aim was to assess the structure, reliability and validity of the tools and to compare two EBA assessment approaches, i.e., an explicit one (only assessing final replies to items) and an implicit one (assessing also the selection process).

Methods: We obtained data on a sample of Czech adults (n = 522, age 30.3±12.58; 27.0% men) via an online survey; cortisol was assessed in 46 participants. We assessed the structure and psychometric properties (internal consistency and test-retest reliability; convergent, discriminant, and criterion validity) of the EBA, and examined the differences between explicit vs. implicit EBA approaches.

Results: We found an acceptable-good internal consistency reliability of the EBA tools, acceptable discriminant validity between them and low (neutral expression) to good (joy) test-retest reliability for concrete emotions assessed by the tools. An implicit EBA approach showed stronger correlations between emotions and weaker convergent validity, but higher criterion validity, than an explicit approach and standard questionnaires.

Conclusion: Compared to standard questionnaires, EBA is a more reliable approach for measuring attitudes, with an implicit approach that reflects the selection process yielding the best results.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0250922PLOS
May 2021

An Individual Participant Data Meta-analysis: Behavioral Treatments for Children and Adolescents With Attention-Deficit/Hyperactivity Disorder.

J Am Acad Child Adolesc Psychiatry 2021 Apr 28. Epub 2021 Apr 28.

University of Washington, Seattle.

Objective: Behavioral interventions are well established treatments for children with attention-deficit/hyperactivity disorder (ADHD). However, insight into moderators of treatment outcome is limited.

Method: We conducted an individual participant data meta-analysis [IPDMA], including data of randomized controlled behavioral intervention trials for individuals with ADHD<18 years. Outcomes were symptoms of ADHD, oppositional defiant disorder (ODD), and conduct disorder (CD) and impairment. Moderators investigated were symptoms and impairment severity, medication use, age, IQ, sex, socioeconomic status, and single parenthood.

Results: For raters most proximal to treatment, small to medium sized effects of behavioral interventions were found for symptoms of ADHD, inattention, hyperactivity/impulsivity (HI), ODD and CD, and impairment. Blinded outcomes were only available for small preschool subsamples and limited measures. CD symptoms and/or diagnosis moderated outcome on ADHD, HI, ODD, and CD symptoms. Single parenthood moderated ODD outcome, ADHD severity moderated impairment outcome. Higher baseline CD or ADHD symptoms, a CD diagnosis, and single parenthood were related to worsening of symptoms in the untreated, but not in the treated group, indicating a protective rather than an ameliorative effect of behavioral interventions for these children.

Conclusion: Behavioral treatments are effective for reducing ADHD symptoms, behavioral problems, and impairment as reported by raters most proximal to treatment. Those with severe CD or ADHD symptoms, a CD diagnosis, or single parents, should be prioritized for treatment, as they may evidence worsening of symptoms in the absence of intervention.
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http://dx.doi.org/10.1016/j.jaac.2021.02.024DOI Listing
April 2021

Depressive Symptom Trajectories and Early Adult Education and Employment: Comparing Longitudinal Cohorts in Canada and the United States.

Int J Environ Res Public Health 2021 Apr 17;18(8). Epub 2021 Apr 17.

School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC V6T 1Z9, Canada.

Adolescent depressive symptoms are risk factors for lower education and unemployment in early adulthood. This study examines how the course of symptoms from ages 16-25 influences early adult education and employment in Canada and the USA. Using data from the National Longitudinal Survey of Children and Youth ( = 2348) and the National Longitudinal Survey of Youth 79 Child/Young Adult ( = 3961), four trajectories (low-stable; increasing; decreasing; and increasing then decreasing, i.e., mid-peak) were linked to five outcomes (working with a post-secondary degree; a high school degree; no degree; in school; and NEET, i.e., not in employment, education, or training). In both countries, increasing, decreasing, and mid-peak trajectories were associated with higher odds of working with low educational credentials, and/or NEET relative to low-stable trajectories. In Canada, however, all trajectories had a higher predicted probability of either being in school or working with a post-secondary degree than the other outcomes; in the USA, all trajectory groups were most likely to be working with a high school degree. Higher depressive symptom levels at various points between adolescent and adulthood are associated with working with low education and NEET in Canada and the USA, but Canadians are more likely to have better education and employment outcomes.
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http://dx.doi.org/10.3390/ijerph18084279DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8073553PMC
April 2021

Stability of Executive Functioning of Moderately-Late Preterm and Full-Term Born Children at Ages 11 and 19: The TRAILS Cohort Study.

Int J Environ Res Public Health 2021 Apr 14;18(8). Epub 2021 Apr 14.

Department of Health Sciences, University Medical Center Groningen, University of Groningen, 9700RB Groningen, The Netherlands.

Moderately-late preterm-born children (MLPs, 32-36 weeks gestational age, GA) have poorer executive functioning (EF) at primary school age than full-term children (FTs). Evidence is lacking on their EF in adolescence, but for early preterm-born children, this has been shown to be much poorer. We, therefore, compared EF of MLPs and FTs at ages 11 and 19 and assessed development between these ages. We obtained data from TRAILS, a community-based prospective cohort study in the northern Netherlands, on 98 MLPs and 1832 FTs. We assessed EF by the Amsterdam Neuropsychological Tasks (ANT) at ages 11 and 19 years and computed gender-specific z-scores on reaction time and accuracy. We compared baseline speed, pattern search, working memory, sustained attention, inhibition, and attentional flexibility of MLPs and FTs crude, and adjusted for small-for-GA status, socioeconomic status, and estimated intelligence. MLPs and FTs performed similarly on all EF components at ages 11 and 19, except for the speed, but not the accuracy measure of attentional flexibility. This was slightly poorer for MLPs than FTs at age 19 (adjusted B 0.25; 95% confidence interval: 0.00 to 0.50; = 0.047), but not at age 11 (adjusted B -0.02; -0.19 to 0.22; = 0.87). Differences in EF between MLPs and FTs did not change significantly from age 11 to 19. MLPs had comparable EF on most components as FTs, with only attentional flexibility at age 19 developing slightly poorer for MLPs than for FTs. These findings suggest the effects of MLP birth on long-term EF to be small.
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http://dx.doi.org/10.3390/ijerph18084161DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8071027PMC
April 2021

Multi-domain cognitive impairments at school age in very preterm-born children compared to term-born peers.

BMC Pediatr 2021 Apr 13;21(1):169. Epub 2021 Apr 13.

Division of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.

Background: Preterm infants are at risk for functional impairments in motor, cognitive, and behavioral development that may persist into childhood. The aim of this study was to determine the co-occurrence of cognitive impairments in multiple cognitive domains at school age in very preterm born children compared to term-born children.

Methods: Comparative study including 60 very preterm-born children (gestational age ≤ 32 weeks) and 120 term-born controls. At school age, we assessed intelligence with the WISC-III, and visuomotor integration with the NEPSY-II, verbal memory with the AVLT, attention with the TEA-ch, and executive functioning with the BRIEF. We investigated co-occurrence of various abnormal (<5th percentile) and suspect-abnormal (<15th percentile, including both suspect and abnormal) cognitive functions.

Results: At mean age 8.8 years, 15% of preterm children had abnormal outcomes in multiple cognitive functions (≥2), versus 3% of the controls (odds ratio, OR 4.65, 95%-confidence interval, CI 1.33-16.35). For multiple suspect-abnormal cognitive outcomes, rates were 55% versus 25% (OR 3.02, 95%-CI 1.49-6.12). We found no pattern of co-occurrence of cognitive impairments among preterm children that deviated from term-born controls. However, low performance IQ was more frequently accompanied by additional cognitive impairments in preterms than in controls (OR 5.43, 95%-CI 1.75-16.81).

Conclusions: A majority of preterm children showed co-occurrence of impairments in multiple cognitive domains, but with no specific pattern of impairments. The occurrence of multi-domain cognitive impairments is higher in preterms but this seems to reflect a general increase, not one with a pattern specific for preterm-born children.
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http://dx.doi.org/10.1186/s12887-021-02641-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8042721PMC
April 2021

Predictors of persistent and changing developmental problems of preterm children.

Early Hum Dev 2021 May 17;156:105350. Epub 2021 Mar 17.

Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.

Background: Accurate prediction of persistent and emerging developmental problems in preterm-born children may lead to targeted interventions.

Aims: To determine whether specific perinatal and social factors were associated with persistent, emerging, and resolving developmental problems of early-preterm (EPs) and moderately-and-late-preterm children (MLPs) from before to after school entry.

Study Design: Observational longitudinal cohort study, part of the LOLLIPOP cohort-study.

Subjects: 341 EPs and 565 MLPs.

Outcome Measures: Developmental problems using the Ages and Stages Questionnaire at ages 4 and 5. We collected data on perinatal and social factors from medical records. Using logistic regression analyses we assessed associations between 48 factors and persistent, emerging, and resolving problems.

Results: Of EPs, 8.7% had persistent and 5.1% emerging problems; this was 4.3% and 1.9% for MLPs, respectively. Predictors for persistent problems included chronic mental illness of the mother, odds ratio (95% confidence interval) 8.01 (1.85-34.60), male sex 4.96 (2.28-10.82), being born small-for-gestational age (SGA) 2.39 (1.15-4.99), and multiparity 3.56 (1.87-6.76). Predictors for emerging problems included MLP birth with prolonged premature rupture of membranes (PPROM) 5.01 (1.38-18.14). Including all predictors in a single prediction model, the explained variance (Nagelkerke R) was 21.9%, whereas this was 3.0% with only EP/MLP birth as predictor.

Conclusions: Only few perinatal and social factors had associations with persistent and emerging developmental problems for both EPs and MLPs. For children with specific neonatal conditions such as SGA, and PPROM in MLPs, problems may persist. Insight in risk factors largely improved the prediction of developmental problems among preterm children.
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http://dx.doi.org/10.1016/j.earlhumdev.2021.105350DOI Listing
May 2021

Low Health Literacy is Associated with the Onset of CKD during the Life Course.

J Am Soc Nephrol 2021 Mar 25. Epub 2021 Mar 25.

Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, The Netherlands.

Background: Health literacy, the ability to deal with information related to one's health, is a predictor of health outcomes in CKD. However, research has not explored whether low health literacy predicts the onset of CKD.

Methods: We used data from participants of Lifelines, a prospective population-based cohort study of individuals living in The Netherlands, to assess the share of individuals with low health literacy by eGFR category, whether low health literacy is associated with CKD onset in the general population and in the subgroup of older adults, and whether established CKD risk factors mediate this association.

Results: In the total sample of 93,885 adults (mean follow-up 3.9 years), low health literacy was more likely among individuals in worse eGFR categories, increasing from 26.4% in eGFR category 1 to 50.0% in category 5 (=0.02). Low health literacy, compared with adequate health literacy, was associated with the onset of CKD in the total sample (3.0% versus 2.1%) and in the subgroup of older adults (13.4% versus 11.3%), with odds ratios (ORs) of 1.44 (95% confidence interval (95% CI), 1.31 to 1.59) and 1.21 (95% CI, 1.04 to 1.41), respectively. After adjustment for sex, age, education, and income, health literacy was associated with CKD onset only in older adults (OR, 1.25; 95% CI, 1.04 to 1.50). This association was mediated by hypertension and high body mass index (BMI) in the crude model, but only by BMI after adjustment (with BMI explaining 18.8% of the association).

Conclusions: Low health literacy is a risk factor for CKD onset among older adults, which suggests that CKD prevention might benefit from strategies to address low health literacy.
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http://dx.doi.org/10.1681/ASN.2020081155DOI Listing
March 2021

Lifelines COVID-19 cohort: investigating COVID-19 infection and its health and societal impacts in a Dutch population-based cohort.

BMJ Open 2021 03 17;11(3):e044474. Epub 2021 Mar 17.

Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

Purpose: The Lifelines COVID-19 cohort was set up to assess the psychological and societal impacts of the COVID-19 pandemic and investigate potential risk factors for COVID-19 within the Lifelines prospective population cohort.

Participants: Participants were recruited from the 140 000 eligible participants of Lifelines and the Lifelines NEXT birth cohort, who are all residents of the three northern provinces of the Netherlands. Participants filled out detailed questionnaires about their physical and mental health and experiences on a weekly basis starting in late March 2020, and the cohort consists of everyone who filled in at least one questionnaire in the first 8 weeks of the project. FINDINGS TO DATE: >71 000 unique participants responded to the questionnaires at least once during the first 8 weeks, with >22 000 participants responding to seven questionnaires. Compiled questionnaire results are continuously updated and shared with the public through the Corona Barometer website. Early results included a clear signal that younger people living alone were experiencing greater levels of loneliness due to lockdown, and subsequent results showed the easing of anxiety as lockdown was eased in June 2020.

Future Plans: Questionnaires were sent on a (bi)weekly basis starting in March 2020 and on a monthly basis starting July 2020, with plans for new questionnaire rounds to continue through 2020 and early 2021. Questionnaire frequency can be increased again for subsequent waves of infections. Cohort data will be used to address how the COVID-19 pandemic developed in the northern provinces of the Netherlands, which environmental and genetic risk factors predict disease susceptibility and severity and the psychological and societal impacts of the crisis. Cohort data are linked to the extensive health, lifestyle and sociodemographic data held for these participants by Lifelines, a 30-year project that started in 2006, and to data about participants held in national databases.
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http://dx.doi.org/10.1136/bmjopen-2020-044474DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7977080PMC
March 2021

Postpartum depression and anxiety: a community-based study on risk factors before, during and after pregnancy.

J Affect Disord 2021 05 4;286:158-165. Epub 2021 Mar 4.

Department of Health Sciences, University Medical Center Groningen, University of Groningen, the Netherlands.

Background: Depression and anxiety occur frequently postpartum, calling for early detection and treatment. Evidence on risk factors may support early detection, but is inconclusive. Our aim was to identify risk factors for postpartum depression and anxiety, before, during and after pregnancy.

Methods: We used data from 1406 mothers of the intervention arm of the Post-Up study. Risk factors were collected at 3 weeks and 12 months postpartum. Depression and anxiety symptoms were measured in the first month postpartum by the Edinburgh Postnatal Depression Scale (EPDS) and 6-item State-Trait Anxiety Inventory (STAI-6), respectively. We used stepwise logistic regression to identify relevant risk factors.

Results: Of the mothers, 8.0% had EPDS-scores ≥9 and 14.7% STAI-6-scores ≥42. Factors associated with higher risk of depression were: foreign language spoken at home, history of depression, low maternal self-efficacy and poor current health of the mother. No initiation of breastfeeding was associated with lower risk of depression, no breastfeeding at 3 weeks postpartum increased the risk. Factors associated with higher risk of anxiety were: higher educational level, history of depression, preterm birth, negative experience of delivery and first week postpartum, excessive infant crying, low maternal self-efficacy, low partner support and poor current maternal health.

Limitations: Use of a self-report instrument, potential bias by postpartum mood status, and no inclusion of emerging depression cases after one month postpartum.

Conclusions: The shared and separate risk factors for postpartum depression and anxiety may help professionals in identifying mothers at increased risk and provide opportunities for preventive interventions and treatment.
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http://dx.doi.org/10.1016/j.jad.2021.02.062DOI Listing
May 2021

Attainment of smiling and walking in infancy associates with developmental delays at school entry in moderately-late preterm children: a community-based cohort study.

BMC Pediatr 2021 Feb 17;21(1):84. Epub 2021 Feb 17.

Department of Health Sciences, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.

Background: Moderately-late preterm (MLP) children (gestational age [GA] 32-36 weeks) are followed-up within community services, which often use developmental milestones as indicators of delay. We aimed to examine associations of parental report of smiling-age and walking-age with developmental delay upon school entry for MLP and full-term children.

Methods: This study regards a community-based cohort study, including 1241 children. Parent-reported smiling-age (n = 514) and walking-age (n = 1210) were recorded in preventive child healthcare. To determine developmental delay at school entry (at age 4) we used the Ages and Stages Questionnaire (ASQ) total and domain scores. We assessed the association of smiling-age and walking-age with dichotomized ASQ-scores, using logistic regression analyses.

Results: For MLP children, each week later corrected smiling-age was associated with a relative increased likelihood of delays of 31, 43, 36 and 35% in the personal-social, problem-solving, gross motor and general developmental functioning, respectively. Each month later corrected walking-age was associated with a relative increased likelihood of delays of 10, 15 and 13% in the personal-social, gross motor and general developmental functioning, respectively. All corrected smiling-ages and walking-ages were within normal full-term ranges. For full-term children, we only found that later walking-age was associated with delays in the personal-social and gross motor domains.

Conclusions: Smiling-age and walking-age are associated with developmental delay in several domains for MLP and full-term children. Professionals could use these milestones to identify children that may benefit from closer monitoring of their development.

Trial Registration: Clinical Trial Registry name and registration number: controlled-trials.com , ISRCTN80622320 .
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http://dx.doi.org/10.1186/s12887-021-02548-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7888138PMC
February 2021

Organization and activities of school health services among EU countries.

Eur J Public Health 2021 Feb 14. Epub 2021 Feb 14.

Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

Background: School health services (SHS) can be defined as health services provided to enrol pupils by health professionals and/or allied professions. The aim of this study was to explore the current state of the governance, organization and workforce of SHS and their provision of preventive activities in European countries.

Methods: Observational study. Data were collected as part of the Horizon 2020-funded project 'Models of Child Health Appraised'. Only 1 expert from each of the 30 included European countries answered a closed-items questionnaire during the years 2017 and 2018.

Results: All countries (except Spain and the Czech Republic, which do not have formal SHS) provided school-based individual screening and health-enhancing measures. The majority performed height, weight, vision and hearing checks; some integrated other assessments of limited evidence-based effectiveness. Most countries also delivered health education and promotion activities in areas, such as sexual health, substance use and healthy nutrition. Almost all countries seemed to suffer from a shortage of school health professionals; moreover, many of these professionals had no specific training in the area of school health and prevention.

Conclusions: Many EU countries need better administrative and legal support. They should promote evidence-based screening procedures and should hire and train more school health professionals. Overall, they need to adapt to the evolving health priorities of pupils, adopt a more holistic paradigm and extend their activities beyond traditional screening or vaccination procedures.
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http://dx.doi.org/10.1093/eurpub/ckaa200DOI Listing
February 2021

Adolescents' mental health problems increase after parental divorce, not before, and persist until adulthood: a longitudinal TRAILS study.

Eur Child Adolesc Psychiatry 2021 Feb 10. Epub 2021 Feb 10.

Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, PO Box 196, 9700 AD, Groningen, The Netherlands.

Parental divorce is one of the most stressful life events for youth and is often associated with (long-lasting) emotional and behavioral problems (EBP). However, not much is known about the timing of the emergence of these EBP in adolescents relative to the moment of parental divorce, and its longitudinal effects. We therefore assessed this timing of EBP in adolescents of divorce and its longitudinal effects. We used the first four waves of the TRacking Adolescent's Individual Lives Survey (TRAILS) cohort, which included 2230 10-12 years olds at baseline. EBP were measured through the Youth Self-Report (YSR), as internalizing and externalizing problems. We applied multilevel analysis to assess the effect of divorce on EBP. The levels of both internalizing and externalizing problems were significantly higher in the period after parental divorce (β = 0.03, and 0.03, respectively; p < 0.05), but not in the period before divorce, with a persistent and increasing effect over the follow-up periods compared to adolescents not experiencing divorce. Adolescents tend to develop more EBP in the period after parental divorce, not before. These effects are long-lasting and underline the need for better care for children with divorcing parents.
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http://dx.doi.org/10.1007/s00787-020-01715-0DOI Listing
February 2021

Regional splanchnic oxygen saturation for preterm infants in the first week after birth: reference values.

Pediatr Res 2021 Jan 27. Epub 2021 Jan 27.

Division of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

Background: Near-infrared spectroscopy is used in the assessment of regional splanchnic oxygen saturation (rSO), but solid reference values are scarce. We aimed to establish reference values of rSO for preterm infants during the first week after birth, both crude and modeled based on predictors.

Methods: We included infants with gestational age (GA) <32 weeks and/or birth weight <1200 g. We excluded infants who developed necrotizing enterocolitis or sepsis or who died. In the first week after birth, we determined a daily 2-h mean of rSO to assess its associations with sex, GA, postnatal age (PNA), small-for-gestational age (SGA) status, patent ductus arteriosus, hemoglobin, nutrition, and head circumference at birth and translated those into a prediction model.

Results: We included 220 infants. On day 1, the mean ± SD rSO value was 48.2% ± 16.6. The nadir of rSO was on day 4 (38.7% ± 16.6 smoothed line) to 5 (37.4%±17.3, actual data), after which rSO increased to 44.2% ± 16.6 on day 7. The final model of the reference values of rSO included the following coefficients: rSO = 3.2 - 7.0 × PNA + 0.8 × PNA - 4.0 × SGA + 1.8 × GA.

Conclusions: We established reference values of rSO for preterm infants during the first week after birth. GA, PNA, and SGA affect these values and need to be taken into account.

Impact: Regional splanchnic oxygen saturation is lower in infants with a lower gestational age and in small-for-gestational age infants. Regional splanchnic oxygen saturation decreases with a higher postnatal age until day 4 after birth and then increases until day 7 after birth. Gestational age, postnatal age, and small-for-gestational age status affect regional splanchnic oxygen saturation and need to be taken into account when interpreting regional splanchnic oxygen saturations using NIRS. Reference values for infant regional splanchnic oxygen saturation can be computed with a formula based on these variables, as provided by this study.
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http://dx.doi.org/10.1038/s41390-020-01323-3DOI Listing
January 2021

Alternative pediatric metabolic syndrome definitions impact prevalence estimates and socioeconomic gradients.

Pediatr Res 2021 Jan 14. Epub 2021 Jan 14.

Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

Background: There is no consensus regarding the definition of pediatric metabolic syndrome (MetS). This study assessed the impact of alternative definitions on the prevalence, children identified, and association with socioeconomic status (SES).

Methods: Data were from the prospective multigenerational Dutch Lifelines Cohort Study. At baseline, 9754 children participated, and 5085 (52.1%) with average follow-up of 3.0 (SD = 0.75) years were included in the longitudinal analyses; median ages were 12 (IQR = 10-14) and 14 years (IQR = 12-15), respectively. We computed MetS prevalence according to five published definitions and measured the observed proportion of positive agreement. We used logistic regression to assess the SES-MetS association, adjusted for age and sex. Longitudinal models were also adjusted for baseline MetS.

Results: MetS prevalence and positive agreement varied between definitions, from 0.7 to 3.0% and from 0.34 (95% CI: 0.28; 0.41) to 0.66 (95% CI: 0.58; 0.75) at baseline, respectively. We consistently found a socioeconomic gradient; in the longitudinal analyses, each additional year of parental education reduced the odds of having MetS by 8% (95% CI: 1%; 14%) to 19% (95% CI: 7%; 30%).

Conclusions: Alternative MetS definitions had differing prevalence estimates and agreed on 50% of the average number of cases. Additionally, regardless of the definition, low SES was a risk factor for MetS.

Impact: Little is known about the impact of using different definitions of pediatric metabolic syndrome on study results. Our study showed that the choice of pediatric metabolic syndrome definition produces very different prevalence estimates. We also showed that the choice of definition influences the socioeconomic gradient. However, low socioeconomic status was consistently a risk factor for having pediatric metabolic syndrome. In conclusion, studies using different definitions of metabolic syndrome could be reasonably compared when investigating the association with socioeconomic status but not always validly when comparing prevalence studies.
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http://dx.doi.org/10.1038/s41390-020-01331-3DOI Listing
January 2021

How to tackle health literacy problems in chronic kidney disease patients? A systematic review to identify promising intervention targets and strategies.

Nephrol Dial Transplant 2020 Dec 22. Epub 2020 Dec 22.

Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen,The Netherlands.

Background: Limited health literacy (LHL) is associated with multiple adverse health outcomes in chronic kidney disease (CKD). Interventions are needed to improve this situation, but evidence on intervention targets and strategies is lacking. This systematic review aims to identify potential targets and strategies by summarizing the evidence on: (i) patient- and system-level factors potentially mediating the relation between LHL and health outcomes; and (ii) the effectiveness of health literacy interventions customized to CKD patients.

Methods: We performed a systematic review of peer-reviewed research articles in Medline, Embase and Web of Science, 2009-19. We assessed the quality of the studies and conducted a best-evidence synthesis.

Results: We identified 860 publications and included 48 studies. Most studies were of low quality (n = 26) and focused on dialysis and transplantation (n = 38). We found strong evidence for an association of LHL with smoking and having a suboptimal transplantation process. Evidence was weak for associations between LHL and a variety of factors related to self-care management (n = 25), utilization of care (n = 23), patient-provider interaction (n = 8) and social context (n = 5). Six interventions were aimed at improving knowledge, decision-making and health behaviours, but evidence for their effectiveness was weak.

Conclusions: Study heterogeneity, low quality and focus on kidney failure largely impede the identification of intervention targets and strategies for LHL. More and higher quality studies in earlier CKD stages are needed to unravel how LHL leads to worse health outcomes, and to identify targets and strategies to prevent disease deterioration. Healthcare organizations need to develop and evaluate efforts to support LHL patients.
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http://dx.doi.org/10.1093/ndt/gfaa273DOI Listing
December 2020

Sleep characteristics across the lifespan in 1.1 million people from the Netherlands, United Kingdom and United States: a systematic review and meta-analysis.

Nat Hum Behav 2021 01 16;5(1):113-122. Epub 2020 Nov 16.

Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, the Netherlands.

We aimed to obtain reliable reference charts for sleep duration, estimate the prevalence of sleep complaints across the lifespan and identify risk indicators of poor sleep. Studies were identified through systematic literature search in Embase, Medline and Web of Science (9 August 2019) and through personal contacts. Eligible studies had to be published between 2000 and 2017 with data on sleep assessed with questionnaires including ≥100 participants from the general population. We assembled individual participant data from 200,358 people (aged 1-100 years, 55% female) from 36 studies from the Netherlands, 471,759 people (40-69 years, 55.5% female) from the United Kingdom and 409,617 people (≥18 years, 55.8% female) from the United States. One in four people slept less than age-specific recommendations, but only 5.8% slept outside of the 'acceptable' sleep duration. Among teenagers, 51.5% reported total sleep times (TST) of less than the recommended 8-10 h and 18% report daytime sleepiness. In adults (≥18 years), poor sleep quality (13.3%) and insomnia symptoms (9.6-19.4%) were more prevalent than short sleep duration (6.5% with TST < 6 h). Insomnia symptoms were most frequent in people spending ≥9 h in bed, whereas poor sleep quality was more frequent in those spending <6 h in bed. TST was similar across countries, but insomnia symptoms were 1.5-2.9 times higher in the United States. Women (≥41 years) reported sleeping shorter times or slightly less efficiently than men, whereas with actigraphy they were estimated to sleep longer and more efficiently than man. This study provides age- and sex-specific population reference charts for sleep duration and efficiency which can help guide personalized advice on sleep length and preventive practices.
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http://dx.doi.org/10.1038/s41562-020-00965-xDOI Listing
January 2021

Development of a Prediction Model to Identify Children at Risk of Future Developmental Delay at Age 4 in a Population-Based Setting.

Int J Environ Res Public Health 2020 11 11;17(22). Epub 2020 Nov 11.

Department of Health Sciences, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713GZ Groningen, The Netherlands.

Our aim was to develop a prediction model for infants from the general population, with easily obtainable predictors, that accurately predicts risk of future developmental delay at age 4 and then assess its performance. Longitudinal cohort data were used ( = 1983), including full-term and preterm children. Development at age 4 was assessed using the Ages and Stages Questionnaire. Candidate predictors included perinatal and parental factors as well as growth and developmental milestones during the first two years. We applied multiple logistic regression with backwards selection and internal validation, and we assessed calibration and discriminative performance (i.e., area under the curve (AUC)). The model was evaluated in terms of sensitivity and specificity at several cut-off values. The final model included sex, maternal educational level, pre-existing maternal obesity, several milestones (smiling, speaking 2-3 word sentences, standing) and weight for height z score at age 1. The fit was good, and the discriminative performance was high (AUC: 0.837). Sensitivity and specificity were 73% and 80% at a cut-off probability of 10%. Our model is promising for use as a prediction tool in community-based settings. It could aid to identify infants in early life (age 2) with increased risk of future developmental problems at age 4 that may benefit from early interventions.
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http://dx.doi.org/10.3390/ijerph17228341DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7698029PMC
November 2020

Variance constraints strongly influenced model performance in growth mixture modeling: a simulation and empirical study.

BMC Med Res Methodol 2020 11 12;20(1):276. Epub 2020 Nov 12.

Department of Health Sciences, Community and Occupational Medicine Groningen, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

Background: Growth Mixture Modeling (GMM) is commonly used to group individuals on their development over time, but convergence issues and impossible values are common. This can result in unreliable model estimates. Constraining variance parameters across classes or over time can solve these issues, but can also seriously bias estimates if variances differ. We aimed to determine which variance parameters can best be constrained in Growth Mixture Modeling.

Methods: To identify the variance constraints that lead to the best performance for different sample sizes, we conducted a simulation study and next verified our results with the TRacking Adolescent Individuals' Lives Survey (TRAILS) cohort.

Results: If variance parameters differed across classes and over time, fitting a model without constraints led to the best results. No constrained model consistently performed well. However, the model that constrained the random effect variance and residual variances across classes consistently performed very poorly. For a small sample size (N = 100) all models showed issues. In TRAILS, the same model showed substantially different results from the other models and performed poorly in terms of model fit.

Conclusions: If possible, a Growth Mixture Model should be fit without any constraints on variance parameters. If not, we recommend to try different variance specifications and to not solely rely on the default model, which constrains random effect variances and residual variances across classes. The variance structure must always be reported Researchers should carefully follow the GRoLTS-Checklist when analyzing and reporting trajectory analyses.
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http://dx.doi.org/10.1186/s12874-020-01154-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7659099PMC
November 2020

Feasibility of Live-Performed Music Therapy for Extremely and Very Preterm Infants in a Tertiary NICU.

Front Pediatr 2020 16;8:581372. Epub 2020 Oct 16.

Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.

We aimed to investigate the feasibility of live-performed music therapy for extremely and very preterm infants admitted to the neonatal intensive care unit (NICU), and their parents, starting the 1st-2nd week after birth. They may benefit from live-performed music therapy as comforting non-pharmacological intervention. We included infants born before 30 weeks' gestation in a single center NICU study. Live-performed music therapy was provided three times per week, tailored to the infant's medical condition. Parents were actively involved. Feasibility was determined as a combination of participation, drop-out, overstimulation (based on COMFORT-Neo scores), and evaluations of the intervention by parents and nurses (using a questionnaire on perceived effects on the parent, their infant and the NICU sound environment). We included 18 infants (90% participation rate), with a gestational age of median 27 weeks (IQR 26-28 weeks), 61% males. One infant (5.6%) dropped-out. Differences of COMFORT-Neo scores during and after sessions compared with before sessions were non-significant; overstimulation by music therapy did not occur. Parents reported high satisfaction (highest score possible of 7) with the interventions and reported improvements in both infant and their own respiratory rates. Nurses also reported high satisfaction with the intervention and perceived a quieter NICU sound environment during and after sessions. Live-performed music therapy for extremely and very preterm infants is feasible and well-tolerated, and is experienced as an added value to developmental care. Future studies should assess both short-term and long-term effects, to determine whether this intervention should be part of routine care at the NICU and whether it is most beneficial to start shortly after birth.
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http://dx.doi.org/10.3389/fped.2020.581372DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7596259PMC
October 2020

Does Depression and Anxiety Mediate the Relation between Limited Health Literacy and Diet Non-Adherence?

Int J Environ Res Public Health 2020 10 28;17(21). Epub 2020 Oct 28.

Department of Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands.

Limited health literacy (HL), depression and anxiety are common in dialyzed patients and affect health outcomes and self-management. We explored whether depression and anxiety mediate the association of HL with diet non-adherence (DN-A) in dialyzed patients. We performed a cross-sectional study in 20 dialysis clinics in Slovakia ( = 452; mean age: 63.6 years; males: 60.7%). Hierarchical cluster analysis was performed to create three HL groups. Logistic regression adjusted for age, gender and education was used to explore whether depression and anxiety mediate the association of HL with DN-A. Patients in the moderate HL group were more likely to be non-adherent to diet (OR (Odds Ratio)/95% CI: 2.19/1.21-3.99) than patients in the high HL group. Patients in the low HL and moderate HL group more likely reported depression or anxiety. Patients reporting depression (OR/95% CI: 1.94/1.26-2.98) or anxiety (OR/95% CI: 1.81/1.22-2.69) were more likely to be non-adherent with diet. Adjustment for depression reduced the association between moderate HL and DN-A by 19.5%. Adjustment for anxiety reduced the association between moderate HL and DN-A by 11.8%. Anxiety and depression partly mediated the association of HL with DN-A. More attention should be paid to treating patients' psychological distress to ensure adequate adherence with recommended diet.
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http://dx.doi.org/10.3390/ijerph17217913DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7663113PMC
October 2020

The combined self- and parent-rated SDQ score profile predicts care use and psychiatric diagnoses.

Eur Child Adolesc Psychiatry 2020 Oct 30. Epub 2020 Oct 30.

Heymans Institute for Psychological Research, University of Groningen, Groningen, The Netherlands.

The Strengths and Difficulties Questionnaire (SDQ) is widely used, based on evidence of its value for screening. This evidence primarily regards the single informant total difficulties scale and separate difficulties subscales. We assessed to what degree adolescents' SDQ profiles that combined all self- and parent-rated subscales were associated with use of care and psychiatric diagnoses, and examined the added value thereof over using only a single informant and the total scale. Cluster analysis was used to identify common SDQ profiles based on self- and parent-reports among adolescents aged 12-17 in mental healthcare (n = 4282), social care (n = 124), and the general population (n = 1293). We investigated associations of the profiles with 'care use' and 'DSM-IV diagnoses', depending on gender. We identified six common SDQ profiles: five profiles with varying types and severities of reported difficulties, pertaining to 95% of adolescents in care, and one without difficulties, pertaining to 55% of adolescents not in care. The types of reported difficulties in the profiles matched DSM-IV diagnoses for 88% of the diagnosed adolescents. The SDQ profiles were found to be more useful for predicting care use and diagnoses than SDQ scores reported by the adolescent as single informant and the total difficulties scale. The latter indicated the presence of problems among 42-63% of the adolescents in care, missing a substantial number of adolescents with reported emotional difficulties and borderline problem severity. These findings advocate the use of combined self- and parent-rated SDQ score profiles for screening.
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http://dx.doi.org/10.1007/s00787-020-01667-5DOI Listing
October 2020

Test-Retest Reliability of a Questionnaire on Motives for Physical Activity among Adolescents.

Int J Environ Res Public Health 2020 10 17;17(20). Epub 2020 Oct 17.

Department of Community & Occupational Medicine, University Medical Center Groningen, University of Groningen, A. Deusinglaan 1, 9713 AV Groningen, The Netherlands.

The aim of this study was to investigate the test-retest reliability of the motives for undertaking physical activity (PA) items from the Health Behavior in School-Aged Children (HBSC) study questionnaire among Slovak and Czech adolescents and to determine whether this reliability differs by gender, age group and country. We obtained data from 580 students aged 11 and 15 years old (51.2% boys) who participated in a test and retest study with a four-week interval in 2013 via the Health Behavior in School-Aged Children cross-sectional study in the Czech Republic and Slovakia. We estimated the test-retest reliability of all 13 dichotomized motives by using Intraclass Correlation Coefficients (ICC) and Cohen's Kappa statistics, for continuous and dichotomized motives, respectively. Test-retest reliability showed moderate agreement for nine motives (ICC from 0.41 to 0.60) and fair agreement for four motives (ICC from 0.33 to 0.40). Kappa statistics were similarly moderate to large (0.33 to 0.61), except for three motives with small or trivial correlations. The motives "To improve my health" and "To enjoy the feeling of using my body" had consistently low Kappas and correlations. Overall, the results of this study suggest that most questions on motives for PA on the HBSC questionnaire have acceptable test-retest characteristics for use among adolescents.
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http://dx.doi.org/10.3390/ijerph17207551DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7589029PMC
October 2020

Novel loci for childhood body mass index and shared heritability with adult cardiometabolic traits.

PLoS Genet 2020 10 12;16(10):e1008718. Epub 2020 Oct 12.

Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.

The genetic background of childhood body mass index (BMI), and the extent to which the well-known associations of childhood BMI with adult diseases are explained by shared genetic factors, are largely unknown. We performed a genome-wide association study meta-analysis of BMI in 61,111 children aged between 2 and 10 years. Twenty-five independent loci reached genome-wide significance in the combined discovery and replication analyses. Two of these, located near NEDD4L and SLC45A3, have not previously been reported in relation to either childhood or adult BMI. Positive genetic correlations of childhood BMI with birth weight and adult BMI, waist-to-hip ratio, diastolic blood pressure and type 2 diabetes were detected (Rg ranging from 0.11 to 0.76, P-values <0.002). A negative genetic correlation of childhood BMI with age at menarche was observed. Our results suggest that the biological processes underlying childhood BMI largely, but not completely, overlap with those underlying adult BMI. The well-known observational associations of BMI in childhood with cardio-metabolic diseases in adulthood may reflect partial genetic overlap, but in light of previous evidence, it is also likely that they are explained through phenotypic continuity of BMI from childhood into adulthood.
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http://dx.doi.org/10.1371/journal.pgen.1008718DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7581004PMC
October 2020

Adolescent Enrollment in Psychosocial Care: Do Parents Make a Difference?

Int J Environ Res Public Health 2020 09 27;17(19). Epub 2020 Sep 27.

Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, 9713 AV Groningen, The Netherlands.

Care for adolescents with emotional and behavioral problems (EBP) is frequently unequally distributed. Parents may play a role in the access to this care. Therefore, the aim was to explore the association between parental characteristics and their adolescent's enrollment in psychosocial care. We used data from the Care4Youth cohort study. Our sample consisted of 446 adolescents (mean age 13.22 years, 48% boys) and 382 parents (mean age 42.95 years, 14% males). EBP combined with enrollment created four groups: 1, no EBP/no care; 2, no EBP/care; 3, EBP/no care; 4, EBP/care. We assessed differences in parental characteristics among the groups. Group 2 had a significantly lower socioeconomic position ( < 0.01), more psychological distress ( < 0.001), poorer supervision ( < 0.001) and lower family social support ( < 0.05) than Group 1. Group 4 had a significantly lower socioeconomic position ( < 0.01) and poorer supervision ( < 0.001) than Group 1. Group 3 had significantly poorer supervision ( < 0.001) than Group 4. The poor supervision in Group 3 requires attention, as these adolescents receive no care. The quality of parental supervision should be addressed generally, e.g., by providing better parenting support and more parental training.
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http://dx.doi.org/10.3390/ijerph17197066DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7579495PMC
September 2020

MicroRNA molecules as predictive biomarkers of adaptive responses to strength training and physical inactivity in haemodialysis patients.

Sci Rep 2020 09 24;10(1):15597. Epub 2020 Sep 24.

Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, 9700 RB, The Netherlands.

The miRNA-206 and miRNA-23a play an important role in muscle tissue hypertrophy, regeneration and atrophy. Both of these miRNAs have been highlighted as promising adaptation predictors; however, the available evidence on associations is inconclusive. Therefore, our aim was to assess the expression levels of these two miRNAs as predictors of change in muscle function during strength training and physical inactivity among dialysed patients. For this purpose, 46 haemodialysis patients were monitored for 12-weeks of either intradialytic strength training (EXG, n = 20) or physical inactivity during dialysis (CON, n = 26). In both groups of patients, we assessed the baseline expression levels of miRNA-23a and miRNA-206 and the isometric force generated during hip flexion (HF) contraction before and after the 12-week period. Among the EXG group, the expression of miRNA-206 predicted the change in HF (R = 0.63, p = 0.0005) much more strongly than the expression of miRNA-23a (R = 0.21, p = 0.027). Interestingly, baseline miRNA-23a (R = 0.30, p = 0.006) predicted the change in HF much more than miRNA-206 (p = ns) among the CON group. Our study indicates that the baseline expression of miRNA-206 could predict the response to strength training, while miRNA-23a could serve as a potential predictive marker of functional changes during physical inactivity in dialysis patients.
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http://dx.doi.org/10.1038/s41598-020-72542-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7519115PMC
September 2020

Teacher and classmate support may keep adolescents satisfied with school and education. Does gender matter?

Int J Public Health 2020 Nov 16;65(8):1423-1429. Epub 2020 Sep 16.

Department of Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, A. Deusinglaan 1, 9713 AV, Groningen, The Netherlands.

Objectives: To examine the associations of teacher and classmate support with school satisfaction in adolescents, and whether gender modifies these associations.

Methods: Data were used from the cross-sectional Health Behaviour in School-aged Children study collected in 2018 among Slovak 15-year-old adolescents (N = 931; 50.6% boys). School satisfaction was measured by school engagement and attitudes towards education leading to three groups of adolescents: satisfied, inconsistent and indifferent. We used multinomial logistic regression to examine the associations of teacher and classmate support with school satisfaction and its modification by gender.

Results: Adolescents who experienced support from teachers and classmates were less likely to feel indifferent (OR/95% CI: 0.77/0.70-0.85; and 0.76/0.67-0.85, respectively) or inconsistent (OR/95% CI: 0.84/0.77-0.92; and 0.73/0.65-0.81, respectively) than to feel satisfied than adolescents who did not experience such support. Adolescents who experienced support from teachers were less prone to feel indifferent than to feel inconsistent (OR/95% CI: 0.92/0.87-0.97). Gender did not modify the associations of social support with school satisfaction.

Conclusion: Teacher and classmate support keep adolescents satisfied with school and education and might increase their chances for a healthy development.
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http://dx.doi.org/10.1007/s00038-020-01477-1DOI Listing
November 2020

The Effects of Urbanization on the Infant Gut Microbiota and Health Outcomes.

Front Pediatr 2020 29;8:408. Epub 2020 Jul 29.

Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.

Humans and their gut microbiota have co-evolved over thousands of years, resulting in the establishment of a complex host-microbiota ecosystem. Early life environmental factors, such as delivery mode, nutrition, and medication use, have been shown to substantially affect both host-microbiota interactions and health outcomes. However, the effects of urbanization (characterized by the spectrum of rural and urban populations) on these early life events have been overlooked. A deeper understanding of the relationship between urbanization and microbiota development will allow for the identification of novel biological and social approaches that can be implemented to prevent and treat disease and promote maternal and infant/child health. The aim of this narrative review is to summarize how factors associated with urbanization differentially impact delivery mode, nutrition, and medication use, and how these changes subsequently affect the gut microbiota and health outcomes of infants. This narrative review also describes the important evidence gaps associated with these relationships and recommends actions that can be taken to improve the health of mothers and infants worldwide.
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http://dx.doi.org/10.3389/fped.2020.00408DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7438894PMC
July 2020

School is (not) calling: the associations of gender, family affluence, disruptions in the social context and learning difficulties with school satisfaction among adolescents in Slovakia.

Int J Public Health 2020 Nov 7;65(8):1413-1421. Epub 2020 Sep 7.

Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

Objectives: Education is an important tool to reduce health inequalities. Several factors influence the educational trajectory of children, with school satisfaction being one of them. The aim was to explore how learning difficulties, a disrupted social context and family affluence relate to school satisfaction.

Methods: We used data from the 2018 Slovak cross-sectional Health Behaviour in School-aged Children-study (age 15 years; N = 913; 50.3% boys). School satisfaction was categorized as liking school and caring about education (satisfied), disliking school but caring about education or vice versa (inconsistent), and disliking school and not caring about education (indifferent). We explored the association of learning difficulties, disrupted social context and family affluence with school satisfaction using multinomial logistic regression.

Results: Boys, and children having learning difficulties, or disruption in the social context and living in low affluence family were significantly less likely to be satisfied at school.

Conclusions: The key is to create a stimulating and encouraging environment at school, where children successfully learn functional literacy and feel well. The more satisfaction pupils get from school, the more likely is a favourable educational trajectory for them.
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http://dx.doi.org/10.1007/s00038-020-01474-4DOI Listing
November 2020

Vitamin Status and Diet in Elderly with Low and High Socioeconomic Status: The Lifelines-MINUTHE Study.

Nutrients 2020 Aug 31;12(9). Epub 2020 Aug 31.

Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands.

Socioeconomic health inequalities are an important global public health problem. However, it is not well known to what extent socioeconomic inequalities culminate in impaired vitamin status and whether this is mediated by diet. We, therefore, aimed to assess vitamin status in a population already at increased risk of micronutrient deficiency, i.e., elderly with high and low socioeconomic status (SES), and to investigate whether potential differences therein were mediated by diet quality. Vitamin status in 1605 individuals (60-75 years) from the Lifelines- Micronutrients and Health inequalities in Elderly (MINUTHE) Study was assessed by measuring folic acid and the vitamins B6, B12, D, A, E, and K. Multinomial logistic and linear regression analyses were applied to test the associations between SES and vitamin status. Mediation analysis was used to explore the interrelationship between SES, diet quality, and vitamin status. Low SES was associated with poorer status of vitamin B6, vitamin B12, and, notably, folic acid. Moreover, multivitamin deficiencies were more prevalent in the low SES group. Diet quality was found to mediate the associations of SES with folic acid (for 39.1%), vitamin B6 (for 37.1%), and vitamin B12 (for 37.2%). We conclude that low SES is a risk factor for a spectrum of vitamin deficiencies. Diet quality can partially explain the socioeconomic differences in vitamin status, suggesting that policymakers can mitigate socioeconomic inequality in nutritional status through improving diet quality.
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http://dx.doi.org/10.3390/nu12092659DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7551314PMC
August 2020

Adolescents exposed to discrimination: are they more prone to excessive internet use?

BMC Pediatr 2020 08 25;20(1):402. Epub 2020 Aug 25.

Graduate School Kosice Institute for Society and Health, Faculty of Medicine, P. J. Safarik University, Kosice, Slovakia.

Background: The Internet may serve as a suitable environment for discriminated adolescents as they may consider the online space as the place where they have possibility to build social ties they are missing in their offline life or manage their self-presentation. Therefore, our aim was to explore the association between different types of discrimination by peers (because of gender, physical appearance, culture/skin color/language, unfavorable family situation) and excessive Internet use (EIU), and whether gender moderates this association.

Methods: We used data from a representative sample of 6,462 Slovak adolescents (mean age: 13.00, 49.6% boys) from the HBSC study conducted in 2018. Data were collected through online self-reported questionnaires. We assessed the association between various types of discrimination by peers and EIU using linear regression, and the role of gender as potential moderator.

Results: Discrimination because of physical appearance was most prevalent (18.0%). Adolescents exposed to discrimination by peers reported higher levels of EIU. We found an interaction of gender on the association of discrimination because unfavorable family situation with EIU. Boys who experienced this type of discrimination were at higher risk of EIU compared to girls.

Conclusion: Discriminated adolescents are more likely to use the Internet excessively, with some associations being stronger for boys than for girls. Prevention strategies focused on raising adolescent awareness of the risks and benefits of the Internet should target discriminated adolescents, especially boys, as they seem to be the vulnerable group.
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http://dx.doi.org/10.1186/s12887-020-02241-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7448512PMC
August 2020